|
RUXOLITINIB 25 MG TABLET [153890]
|
Facility
|
OP
|
$363.80
|
|
|
Service Code
|
NDC 5088102560
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$72.76 |
| Max. Negotiated Rate |
$309.23 |
| Rate for Payer: Adventist Health Commercial |
$72.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$238.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$309.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$200.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$272.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$233.45
|
| Rate for Payer: Cash Price |
$163.71
|
| Rate for Payer: Cigna of CA HMO |
$254.66
|
| Rate for Payer: Cigna of CA PPO |
$254.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$309.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$309.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$309.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$254.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$145.52
|
| Rate for Payer: EPIC Health Plan Senior |
$145.52
|
| Rate for Payer: Galaxy Health WC |
$309.23
|
| Rate for Payer: Global Benefits Group Commercial |
$218.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$231.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$132.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$214.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$254.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$254.66
|
| Rate for Payer: Multiplan Commercial |
$291.04
|
| Rate for Payer: Networks By Design Commercial |
$236.47
|
| Rate for Payer: Prime Health Services Commercial |
$309.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$218.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$218.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$181.90
|
| Rate for Payer: United Healthcare All Other HMO |
$181.90
|
| Rate for Payer: United Healthcare HMO Rider |
$181.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$181.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$309.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$309.23
|
| Rate for Payer: Vantage Medical Group Senior |
$309.23
|
|
|
RUXOLITINIB 5 MG TABLET [153886]
|
Facility
|
OP
|
$363.80
|
|
|
Service Code
|
NDC 5088100560
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$72.76 |
| Max. Negotiated Rate |
$309.23 |
| Rate for Payer: Adventist Health Commercial |
$72.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$238.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$309.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$200.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$272.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$233.45
|
| Rate for Payer: Cash Price |
$163.71
|
| Rate for Payer: Cigna of CA HMO |
$254.66
|
| Rate for Payer: Cigna of CA PPO |
$254.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$309.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$309.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$309.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$254.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$145.52
|
| Rate for Payer: EPIC Health Plan Senior |
$145.52
|
| Rate for Payer: Galaxy Health WC |
$309.23
|
| Rate for Payer: Global Benefits Group Commercial |
$218.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$231.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$132.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$214.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$254.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$254.66
|
| Rate for Payer: Multiplan Commercial |
$291.04
|
| Rate for Payer: Networks By Design Commercial |
$236.47
|
| Rate for Payer: Prime Health Services Commercial |
$309.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$218.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$218.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$181.90
|
| Rate for Payer: United Healthcare All Other HMO |
$181.90
|
| Rate for Payer: United Healthcare HMO Rider |
$181.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$181.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$309.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$309.23
|
| Rate for Payer: Vantage Medical Group Senior |
$309.23
|
|
|
RUXOLITINIB 5 MG TABLET [153886]
|
Facility
|
IP
|
$363.80
|
|
|
Service Code
|
NDC 5088100560
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$72.76 |
| Max. Negotiated Rate |
$309.23 |
| Rate for Payer: Adventist Health Commercial |
$72.76
|
| Rate for Payer: Blue Shield of California Commercial |
$184.45
|
| Rate for Payer: Blue Shield of California Commercial |
$279.76
|
| Rate for Payer: Cash Price |
$163.71
|
| Rate for Payer: Cigna of CA HMO |
$254.66
|
| Rate for Payer: Cigna of CA PPO |
$254.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$254.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$145.52
|
| Rate for Payer: EPIC Health Plan Senior |
$145.52
|
| Rate for Payer: Galaxy Health WC |
$309.23
|
| Rate for Payer: Global Benefits Group Commercial |
$218.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$231.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$214.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.31
|
| Rate for Payer: Multiplan Commercial |
$291.04
|
| Rate for Payer: Networks By Design Commercial |
$236.47
|
| Rate for Payer: Prime Health Services Commercial |
$309.23
|
|
|
SACITUZUMAB GOVITECAN-HZIY 180 MG INTRAVENOUS SOLUTION [227764]
|
Facility
|
OP
|
$3,137.72
|
|
|
Service Code
|
HCPCS J9317
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.64 |
| Max. Negotiated Rate |
$2,667.06 |
| Rate for Payer: Adventist Health Commercial |
$627.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$70.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.37
|
| Rate for Payer: Blue Shield of California Commercial |
$41.07
|
| Rate for Payer: Cash Price |
$1,411.97
|
| Rate for Payer: Cash Price |
$1,411.97
|
| Rate for Payer: Cigna of CA HMO |
$2,196.40
|
| Rate for Payer: Cigna of CA PPO |
$2,196.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$47.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,196.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.11
|
| Rate for Payer: EPIC Health Plan Senior |
$41.40
|
| Rate for Payer: Galaxy Health WC |
$2,667.06
|
| Rate for Payer: Global Benefits Group Commercial |
$1,882.63
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,992.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$70.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$753.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.44
|
| Rate for Payer: Multiplan Commercial |
$2,510.18
|
| Rate for Payer: Networks By Design Commercial |
$1,568.86
|
| Rate for Payer: Prime Health Services Commercial |
$2,667.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,882.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,882.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,177.59
|
| Rate for Payer: United Healthcare All Other HMO |
$1,146.21
|
| Rate for Payer: United Healthcare HMO Rider |
$1,121.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,027.60
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$47.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.40
|
| Rate for Payer: Vantage Medical Group Senior |
$41.40
|
|
|
SACITUZUMAB GOVITECAN-HZIY 180 MG INTRAVENOUS SOLUTION [227764]
|
Facility
|
IP
|
$3,137.72
|
|
|
Service Code
|
HCPCS J9317
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$627.54 |
| Max. Negotiated Rate |
$2,667.06 |
| Rate for Payer: Adventist Health Commercial |
$627.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1,590.82
|
| Rate for Payer: Blue Shield of California Commercial |
$2,412.91
|
| Rate for Payer: Cash Price |
$1,411.97
|
| Rate for Payer: Cigna of CA HMO |
$2,196.40
|
| Rate for Payer: Cigna of CA PPO |
$2,196.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,196.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,255.09
|
| Rate for Payer: EPIC Health Plan Senior |
$1,255.09
|
| Rate for Payer: Galaxy Health WC |
$2,667.06
|
| Rate for Payer: Global Benefits Group Commercial |
$1,882.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,992.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,851.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$753.05
|
| Rate for Payer: Multiplan Commercial |
$2,510.18
|
| Rate for Payer: Networks By Design Commercial |
$1,568.86
|
| Rate for Payer: Prime Health Services Commercial |
$2,667.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,177.59
|
| Rate for Payer: United Healthcare All Other HMO |
$1,146.21
|
| Rate for Payer: United Healthcare HMO Rider |
$1,121.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,027.60
|
|
|
SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET [210397]
|
Facility
|
IP
|
$1.04
|
|
|
Service Code
|
NDC 3334257009
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.88 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California Commercial |
$0.53
|
| Rate for Payer: Blue Shield of California Commercial |
$0.80
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Cigna of CA HMO |
$0.73
|
| Rate for Payer: Cigna of CA PPO |
$0.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: EPIC Health Plan Senior |
$0.42
|
| Rate for Payer: Galaxy Health WC |
$0.88
|
| Rate for Payer: Global Benefits Group Commercial |
$0.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: Networks By Design Commercial |
$0.68
|
| Rate for Payer: Prime Health Services Commercial |
$0.88
|
|
|
SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET [210397]
|
Facility
|
OP
|
$14.53
|
|
|
Service Code
|
NDC 0078065920
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$12.35 |
| Rate for Payer: Adventist Health Commercial |
$2.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.32
|
| Rate for Payer: Cash Price |
$6.54
|
| Rate for Payer: Cigna of CA HMO |
$10.17
|
| Rate for Payer: Cigna of CA PPO |
$10.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.81
|
| Rate for Payer: EPIC Health Plan Senior |
$5.81
|
| Rate for Payer: Galaxy Health WC |
$12.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.17
|
| Rate for Payer: Multiplan Commercial |
$11.62
|
| Rate for Payer: Networks By Design Commercial |
$9.44
|
| Rate for Payer: Prime Health Services Commercial |
$12.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.26
|
| Rate for Payer: United Healthcare All Other HMO |
$7.26
|
| Rate for Payer: United Healthcare HMO Rider |
$7.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.35
|
| Rate for Payer: Vantage Medical Group Senior |
$12.35
|
|
|
SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET [210397]
|
Facility
|
IP
|
$14.53
|
|
|
Service Code
|
NDC 0078065920
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$12.35 |
| Rate for Payer: Adventist Health Commercial |
$2.91
|
| Rate for Payer: Blue Shield of California Commercial |
$11.17
|
| Rate for Payer: Blue Shield of California Commercial |
$7.37
|
| Rate for Payer: Cash Price |
$6.54
|
| Rate for Payer: Cigna of CA HMO |
$10.17
|
| Rate for Payer: Cigna of CA PPO |
$10.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.81
|
| Rate for Payer: EPIC Health Plan Senior |
$5.81
|
| Rate for Payer: Galaxy Health WC |
$12.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.49
|
| Rate for Payer: Multiplan Commercial |
$11.62
|
| Rate for Payer: Networks By Design Commercial |
$9.44
|
| Rate for Payer: Prime Health Services Commercial |
$12.35
|
|
|
SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET [210397]
|
Facility
|
IP
|
$1.64
|
|
|
Service Code
|
NDC 6233255660
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.39 |
| Rate for Payer: Adventist Health Commercial |
$0.33
|
| Rate for Payer: Blue Shield of California Commercial |
$0.83
|
| Rate for Payer: Blue Shield of California Commercial |
$1.26
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Cigna of CA HMO |
$1.15
|
| Rate for Payer: Cigna of CA PPO |
$1.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.66
|
| Rate for Payer: EPIC Health Plan Senior |
$0.66
|
| Rate for Payer: Galaxy Health WC |
$1.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$1.31
|
| Rate for Payer: Networks By Design Commercial |
$1.07
|
| Rate for Payer: Prime Health Services Commercial |
$1.39
|
|
|
SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET [210397]
|
Facility
|
OP
|
$1.64
|
|
|
Service Code
|
NDC 6233255660
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.39 |
| Rate for Payer: Adventist Health Commercial |
$0.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.05
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Cigna of CA HMO |
$1.15
|
| Rate for Payer: Cigna of CA PPO |
$1.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.66
|
| Rate for Payer: EPIC Health Plan Senior |
$0.66
|
| Rate for Payer: Galaxy Health WC |
$1.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.15
|
| Rate for Payer: Multiplan Commercial |
$1.31
|
| Rate for Payer: Networks By Design Commercial |
$1.07
|
| Rate for Payer: Prime Health Services Commercial |
$1.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.82
|
| Rate for Payer: United Healthcare All Other HMO |
$0.82
|
| Rate for Payer: United Healthcare HMO Rider |
$0.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1.39
|
|
|
SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET [210397]
|
Facility
|
OP
|
$1.04
|
|
|
Service Code
|
NDC 3334257009
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.88 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.67
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Cigna of CA HMO |
$0.73
|
| Rate for Payer: Cigna of CA PPO |
$0.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: EPIC Health Plan Senior |
$0.42
|
| Rate for Payer: Galaxy Health WC |
$0.88
|
| Rate for Payer: Global Benefits Group Commercial |
$0.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.73
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: Networks By Design Commercial |
$0.68
|
| Rate for Payer: Prime Health Services Commercial |
$0.88
|
| 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
|
|
|
SACUBITRIL 49 MG-VALSARTAN 51 MG TABLET [210398]
|
Facility
|
IP
|
$14.53
|
|
|
Service Code
|
NDC 0078077767
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$12.35 |
| Rate for Payer: Adventist Health Commercial |
$2.91
|
| Rate for Payer: Blue Shield of California Commercial |
$11.17
|
| Rate for Payer: Blue Shield of California Commercial |
$7.37
|
| Rate for Payer: Cash Price |
$6.54
|
| Rate for Payer: Cigna of CA HMO |
$10.17
|
| Rate for Payer: Cigna of CA PPO |
$10.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.81
|
| Rate for Payer: EPIC Health Plan Senior |
$5.81
|
| Rate for Payer: Galaxy Health WC |
$12.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.49
|
| Rate for Payer: Multiplan Commercial |
$11.62
|
| Rate for Payer: Networks By Design Commercial |
$9.44
|
| Rate for Payer: Prime Health Services Commercial |
$12.35
|
|
|
SACUBITRIL 49 MG-VALSARTAN 51 MG TABLET [210398]
|
Facility
|
IP
|
$14.53
|
|
|
Service Code
|
NDC 0078077720
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$12.35 |
| Rate for Payer: Adventist Health Commercial |
$2.91
|
| Rate for Payer: Blue Shield of California Commercial |
$11.17
|
| Rate for Payer: Blue Shield of California Commercial |
$7.37
|
| Rate for Payer: Cash Price |
$6.54
|
| Rate for Payer: Cigna of CA HMO |
$10.17
|
| Rate for Payer: Cigna of CA PPO |
$10.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.81
|
| Rate for Payer: EPIC Health Plan Senior |
$5.81
|
| Rate for Payer: Galaxy Health WC |
$12.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.49
|
| Rate for Payer: Multiplan Commercial |
$11.62
|
| Rate for Payer: Networks By Design Commercial |
$9.44
|
| Rate for Payer: Prime Health Services Commercial |
$12.35
|
|
|
SACUBITRIL 49 MG-VALSARTAN 51 MG TABLET [210398]
|
Facility
|
OP
|
$1.24
|
|
|
Service Code
|
NDC 3334257109
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Adventist Health Commercial |
$0.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.80
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: Cigna of CA HMO |
$0.87
|
| Rate for Payer: Cigna of CA PPO |
$0.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
| Rate for Payer: EPIC Health Plan Senior |
$0.50
|
| Rate for Payer: Galaxy Health WC |
$1.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.87
|
| Rate for Payer: Multiplan Commercial |
$0.99
|
| Rate for Payer: Networks By Design Commercial |
$0.81
|
| Rate for Payer: Prime Health Services Commercial |
$1.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.62
|
| Rate for Payer: United Healthcare All Other HMO |
$0.62
|
| Rate for Payer: United Healthcare HMO Rider |
$0.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1.05
|
|
|
SACUBITRIL 49 MG-VALSARTAN 51 MG TABLET [210398]
|
Facility
|
OP
|
$14.53
|
|
|
Service Code
|
NDC 0078077767
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$12.35 |
| Rate for Payer: Adventist Health Commercial |
$2.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.32
|
| Rate for Payer: Cash Price |
$6.54
|
| Rate for Payer: Cigna of CA HMO |
$10.17
|
| Rate for Payer: Cigna of CA PPO |
$10.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.81
|
| Rate for Payer: EPIC Health Plan Senior |
$5.81
|
| Rate for Payer: Galaxy Health WC |
$12.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.17
|
| Rate for Payer: Multiplan Commercial |
$11.62
|
| Rate for Payer: Networks By Design Commercial |
$9.44
|
| Rate for Payer: Prime Health Services Commercial |
$12.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.26
|
| Rate for Payer: United Healthcare All Other HMO |
$7.26
|
| Rate for Payer: United Healthcare HMO Rider |
$7.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.35
|
| Rate for Payer: Vantage Medical Group Senior |
$12.35
|
|
|
SACUBITRIL 49 MG-VALSARTAN 51 MG TABLET [210398]
|
Facility
|
OP
|
$14.53
|
|
|
Service Code
|
NDC 0078077720
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$12.35 |
| Rate for Payer: Adventist Health Commercial |
$2.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.32
|
| Rate for Payer: Cash Price |
$6.54
|
| Rate for Payer: Cigna of CA HMO |
$10.17
|
| Rate for Payer: Cigna of CA PPO |
$10.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.81
|
| Rate for Payer: EPIC Health Plan Senior |
$5.81
|
| Rate for Payer: Galaxy Health WC |
$12.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.17
|
| Rate for Payer: Multiplan Commercial |
$11.62
|
| Rate for Payer: Networks By Design Commercial |
$9.44
|
| Rate for Payer: Prime Health Services Commercial |
$12.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.26
|
| Rate for Payer: United Healthcare All Other HMO |
$7.26
|
| Rate for Payer: United Healthcare HMO Rider |
$7.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.35
|
| Rate for Payer: Vantage Medical Group Senior |
$12.35
|
|
|
SACUBITRIL 49 MG-VALSARTAN 51 MG TABLET [210398]
|
Facility
|
IP
|
$1.64
|
|
|
Service Code
|
NDC 6233255760
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.39 |
| Rate for Payer: Adventist Health Commercial |
$0.33
|
| Rate for Payer: Blue Shield of California Commercial |
$0.83
|
| Rate for Payer: Blue Shield of California Commercial |
$1.26
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Cigna of CA HMO |
$1.15
|
| Rate for Payer: Cigna of CA PPO |
$1.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.66
|
| Rate for Payer: EPIC Health Plan Senior |
$0.66
|
| Rate for Payer: Galaxy Health WC |
$1.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$1.31
|
| Rate for Payer: Networks By Design Commercial |
$1.07
|
| Rate for Payer: Prime Health Services Commercial |
$1.39
|
|
|
SACUBITRIL 49 MG-VALSARTAN 51 MG TABLET [210398]
|
Facility
|
IP
|
$1.24
|
|
|
Service Code
|
NDC 3334257109
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Adventist Health Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California Commercial |
$0.63
|
| Rate for Payer: Blue Shield of California Commercial |
$0.95
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: Cigna of CA HMO |
$0.87
|
| Rate for Payer: Cigna of CA PPO |
$0.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
| Rate for Payer: EPIC Health Plan Senior |
$0.50
|
| Rate for Payer: Galaxy Health WC |
$1.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$0.99
|
| Rate for Payer: Networks By Design Commercial |
$0.81
|
| Rate for Payer: Prime Health Services Commercial |
$1.05
|
|
|
SACUBITRIL 49 MG-VALSARTAN 51 MG TABLET [210398]
|
Facility
|
OP
|
$1.64
|
|
|
Service Code
|
NDC 6233255760
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.39 |
| Rate for Payer: Adventist Health Commercial |
$0.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.05
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Cigna of CA HMO |
$1.15
|
| Rate for Payer: Cigna of CA PPO |
$1.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.66
|
| Rate for Payer: EPIC Health Plan Senior |
$0.66
|
| Rate for Payer: Galaxy Health WC |
$1.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.15
|
| Rate for Payer: Multiplan Commercial |
$1.31
|
| Rate for Payer: Networks By Design Commercial |
$1.07
|
| Rate for Payer: Prime Health Services Commercial |
$1.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.82
|
| Rate for Payer: United Healthcare All Other HMO |
$0.82
|
| Rate for Payer: United Healthcare HMO Rider |
$0.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1.39
|
|
|
SACUBITRIL 97 MG-VALSARTAN 103 MG TABLET [210399]
|
Facility
|
OP
|
$14.53
|
|
|
Service Code
|
NDC 0078069620
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$12.35 |
| Rate for Payer: Adventist Health Commercial |
$2.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.32
|
| Rate for Payer: Cash Price |
$6.54
|
| Rate for Payer: Cigna of CA HMO |
$10.17
|
| Rate for Payer: Cigna of CA PPO |
$10.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.81
|
| Rate for Payer: EPIC Health Plan Senior |
$5.81
|
| Rate for Payer: Galaxy Health WC |
$12.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.17
|
| Rate for Payer: Multiplan Commercial |
$11.62
|
| Rate for Payer: Networks By Design Commercial |
$9.44
|
| Rate for Payer: Prime Health Services Commercial |
$12.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.26
|
| Rate for Payer: United Healthcare All Other HMO |
$7.26
|
| Rate for Payer: United Healthcare HMO Rider |
$7.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.35
|
| Rate for Payer: Vantage Medical Group Senior |
$12.35
|
|
|
SACUBITRIL 97 MG-VALSARTAN 103 MG TABLET [210399]
|
Facility
|
IP
|
$14.53
|
|
|
Service Code
|
NDC 0078069620
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$12.35 |
| Rate for Payer: Adventist Health Commercial |
$2.91
|
| Rate for Payer: Blue Shield of California Commercial |
$11.17
|
| Rate for Payer: Blue Shield of California Commercial |
$7.37
|
| Rate for Payer: Cash Price |
$6.54
|
| Rate for Payer: Cigna of CA HMO |
$10.17
|
| Rate for Payer: Cigna of CA PPO |
$10.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.81
|
| Rate for Payer: EPIC Health Plan Senior |
$5.81
|
| Rate for Payer: Galaxy Health WC |
$12.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.49
|
| Rate for Payer: Multiplan Commercial |
$11.62
|
| Rate for Payer: Networks By Design Commercial |
$9.44
|
| Rate for Payer: Prime Health Services Commercial |
$12.35
|
|
|
SACUBITRIL 97 MG-VALSARTAN 103 MG TABLET [210399]
|
Facility
|
IP
|
$1.99
|
|
|
Service Code
|
NDC 6923827331
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.69 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1.53
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO |
$1.39
|
| Rate for Payer: Cigna of CA PPO |
$1.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Senior |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.69
|
| Rate for Payer: Global Benefits Group Commercial |
$1.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.59
|
| Rate for Payer: Networks By Design Commercial |
$1.29
|
| Rate for Payer: Prime Health Services Commercial |
$1.69
|
|
|
SACUBITRIL 97 MG-VALSARTAN 103 MG TABLET [210399]
|
Facility
|
OP
|
$1.64
|
|
|
Service Code
|
NDC 7037703313
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.39 |
| Rate for Payer: Adventist Health Commercial |
$0.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.05
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Cigna of CA HMO |
$1.15
|
| Rate for Payer: Cigna of CA PPO |
$1.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.66
|
| Rate for Payer: EPIC Health Plan Senior |
$0.66
|
| Rate for Payer: Galaxy Health WC |
$1.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.15
|
| Rate for Payer: Multiplan Commercial |
$1.31
|
| Rate for Payer: Networks By Design Commercial |
$1.07
|
| Rate for Payer: Prime Health Services Commercial |
$1.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.82
|
| Rate for Payer: United Healthcare All Other HMO |
$0.82
|
| Rate for Payer: United Healthcare HMO Rider |
$0.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1.39
|
|
|
SACUBITRIL 97 MG-VALSARTAN 103 MG TABLET [210399]
|
Facility
|
OP
|
$1.99
|
|
|
Service Code
|
NDC 6923827331
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.69 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.28
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO |
$1.39
|
| Rate for Payer: Cigna of CA PPO |
$1.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Senior |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.69
|
| Rate for Payer: Global Benefits Group Commercial |
$1.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.39
|
| Rate for Payer: Multiplan Commercial |
$1.59
|
| Rate for Payer: Networks By Design Commercial |
$1.29
|
| Rate for Payer: Prime Health Services Commercial |
$1.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1.69
|
|
|
SACUBITRIL 97 MG-VALSARTAN 103 MG TABLET [210399]
|
Facility
|
IP
|
$1.64
|
|
|
Service Code
|
NDC 7037703313
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.39 |
| Rate for Payer: Adventist Health Commercial |
$0.33
|
| Rate for Payer: Blue Shield of California Commercial |
$0.83
|
| Rate for Payer: Blue Shield of California Commercial |
$1.26
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Cigna of CA HMO |
$1.15
|
| Rate for Payer: Cigna of CA PPO |
$1.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.66
|
| Rate for Payer: EPIC Health Plan Senior |
$0.66
|
| Rate for Payer: Galaxy Health WC |
$1.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$1.31
|
| Rate for Payer: Networks By Design Commercial |
$1.07
|
| Rate for Payer: Prime Health Services Commercial |
$1.39
|
|
