|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
|
IP
|
$8.81
|
|
|
Service Code
|
NDC 0409-1632-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$7.49 |
| Rate for Payer: Adventist Health Commercial |
$1.76
|
| Rate for Payer: Blue Shield of California Commercial |
$6.50
|
| Rate for Payer: Blue Shield of California EPN |
$4.28
|
| Rate for Payer: Cash Price |
$4.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.52
|
| Rate for Payer: EPIC Health Plan Senior |
$3.52
|
| Rate for Payer: Galaxy Health WC |
$7.49
|
| Rate for Payer: Global Benefits Group Commercial |
$5.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.11
|
| Rate for Payer: Multiplan Commercial |
$7.05
|
| Rate for Payer: Networks By Design Commercial |
$5.73
|
| Rate for Payer: Prime Health Services Commercial |
$7.49
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
|
IP
|
$5.28
|
|
|
Service Code
|
NDC 55150-235-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$4.49 |
| Rate for Payer: Adventist Health Commercial |
$1.06
|
| Rate for Payer: Blue Shield of California Commercial |
$3.90
|
| Rate for Payer: Blue Shield of California EPN |
$2.57
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.11
|
| Rate for Payer: EPIC Health Plan Senior |
$2.11
|
| Rate for Payer: Galaxy Health WC |
$4.49
|
| Rate for Payer: Global Benefits Group Commercial |
$3.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: Multiplan Commercial |
$4.22
|
| Rate for Payer: Networks By Design Commercial |
$3.43
|
| Rate for Payer: Prime Health Services Commercial |
$4.49
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
|
OP
|
$5.28
|
|
|
Service Code
|
NDC 55150-235-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$4.49 |
| Rate for Payer: Adventist Health Commercial |
$1.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.24
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: Cigna of CA HMO |
$3.38
|
| Rate for Payer: Cigna of CA PPO |
$3.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.11
|
| Rate for Payer: EPIC Health Plan Senior |
$2.11
|
| Rate for Payer: Galaxy Health WC |
$4.49
|
| Rate for Payer: Global Benefits Group Commercial |
$3.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.70
|
| Rate for Payer: Multiplan Commercial |
$4.22
|
| Rate for Payer: Networks By Design Commercial |
$3.43
|
| Rate for Payer: Prime Health Services Commercial |
$4.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.64
|
| Rate for Payer: United Healthcare All Other HMO |
$2.64
|
| Rate for Payer: United Healthcare HMO Rider |
$2.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4.49
|
|
|
VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]
|
Facility
|
OP
|
$14.46
|
|
|
Service Code
|
NDC 63323-782-23
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$12.29 |
| Rate for Payer: Adventist Health Commercial |
$2.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.88
|
| Rate for Payer: Cash Price |
$7.95
|
| Rate for Payer: Cigna of CA HMO |
$9.25
|
| Rate for Payer: Cigna of CA PPO |
$10.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.78
|
| Rate for Payer: EPIC Health Plan Senior |
$5.78
|
| Rate for Payer: Galaxy Health WC |
$12.29
|
| Rate for Payer: Global Benefits Group Commercial |
$8.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.12
|
| Rate for Payer: Multiplan Commercial |
$11.57
|
| Rate for Payer: Networks By Design Commercial |
$9.40
|
| Rate for Payer: Prime Health Services Commercial |
$12.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.23
|
| Rate for Payer: United Healthcare All Other HMO |
$7.23
|
| Rate for Payer: United Healthcare HMO Rider |
$7.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.29
|
| Rate for Payer: Vantage Medical Group Senior |
$12.29
|
|
|
VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]
|
Facility
|
OP
|
$13.68
|
|
|
Service Code
|
NDC 67457-475-20
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$11.63 |
| Rate for Payer: Adventist Health Commercial |
$2.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.40
|
| Rate for Payer: Cash Price |
$7.52
|
| Rate for Payer: Cigna of CA HMO |
$8.76
|
| Rate for Payer: Cigna of CA PPO |
$10.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.47
|
| Rate for Payer: EPIC Health Plan Senior |
$5.47
|
| Rate for Payer: Galaxy Health WC |
$11.63
|
| Rate for Payer: Global Benefits Group Commercial |
$8.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.58
|
| Rate for Payer: Multiplan Commercial |
$10.94
|
| Rate for Payer: Networks By Design Commercial |
$8.89
|
| Rate for Payer: Prime Health Services Commercial |
$11.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.84
|
| Rate for Payer: United Healthcare All Other HMO |
$6.84
|
| Rate for Payer: United Healthcare HMO Rider |
$6.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.63
|
| Rate for Payer: Vantage Medical Group Senior |
$11.63
|
|
|
VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]
|
Facility
|
IP
|
$13.68
|
|
|
Service Code
|
NDC 67457-475-20
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$11.63 |
| Rate for Payer: Adventist Health Commercial |
$2.74
|
| Rate for Payer: Blue Shield of California Commercial |
$10.10
|
| Rate for Payer: Blue Shield of California EPN |
$6.65
|
| Rate for Payer: Cash Price |
$7.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.47
|
| Rate for Payer: EPIC Health Plan Senior |
$5.47
|
| Rate for Payer: Galaxy Health WC |
$11.63
|
| Rate for Payer: Global Benefits Group Commercial |
$8.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.28
|
| Rate for Payer: Multiplan Commercial |
$10.94
|
| Rate for Payer: Networks By Design Commercial |
$8.89
|
| Rate for Payer: Prime Health Services Commercial |
$11.63
|
|
|
VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]
|
Facility
|
OP
|
$13.68
|
|
|
Service Code
|
NDC 67457-475-00
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$11.63 |
| Rate for Payer: Adventist Health Commercial |
$2.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.40
|
| Rate for Payer: Cash Price |
$7.52
|
| Rate for Payer: Cigna of CA HMO |
$8.76
|
| Rate for Payer: Cigna of CA PPO |
$10.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.47
|
| Rate for Payer: EPIC Health Plan Senior |
$5.47
|
| Rate for Payer: Galaxy Health WC |
$11.63
|
| Rate for Payer: Global Benefits Group Commercial |
$8.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.58
|
| Rate for Payer: Multiplan Commercial |
$10.94
|
| Rate for Payer: Networks By Design Commercial |
$8.89
|
| Rate for Payer: Prime Health Services Commercial |
$11.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.84
|
| Rate for Payer: United Healthcare All Other HMO |
$6.84
|
| Rate for Payer: United Healthcare HMO Rider |
$6.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.63
|
| Rate for Payer: Vantage Medical Group Senior |
$11.63
|
|
|
VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]
|
Facility
|
OP
|
$10.80
|
|
|
Service Code
|
NDC 55150-236-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: Adventist Health Commercial |
$2.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.63
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cigna of CA HMO |
$6.91
|
| Rate for Payer: Cigna of CA PPO |
$7.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.32
|
| Rate for Payer: EPIC Health Plan Senior |
$4.32
|
| Rate for Payer: Galaxy Health WC |
$9.18
|
| Rate for Payer: Global Benefits Group Commercial |
$6.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.56
|
| Rate for Payer: Multiplan Commercial |
$8.64
|
| Rate for Payer: Networks By Design Commercial |
$7.02
|
| Rate for Payer: Prime Health Services Commercial |
$9.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.40
|
| Rate for Payer: United Healthcare All Other HMO |
$5.40
|
| Rate for Payer: United Healthcare HMO Rider |
$5.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.18
|
| Rate for Payer: Vantage Medical Group Senior |
$9.18
|
|
|
VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]
|
Facility
|
IP
|
$13.68
|
|
|
Service Code
|
NDC 67457-475-00
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$11.63 |
| Rate for Payer: Adventist Health Commercial |
$2.74
|
| Rate for Payer: Blue Shield of California Commercial |
$10.10
|
| Rate for Payer: Blue Shield of California EPN |
$6.65
|
| Rate for Payer: Cash Price |
$7.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.47
|
| Rate for Payer: EPIC Health Plan Senior |
$5.47
|
| Rate for Payer: Galaxy Health WC |
$11.63
|
| Rate for Payer: Global Benefits Group Commercial |
$8.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.28
|
| Rate for Payer: Multiplan Commercial |
$10.94
|
| Rate for Payer: Networks By Design Commercial |
$8.89
|
| Rate for Payer: Prime Health Services Commercial |
$11.63
|
|
|
VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]
|
Facility
|
IP
|
$14.46
|
|
|
Service Code
|
NDC 63323-782-23
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$12.29 |
| Rate for Payer: Adventist Health Commercial |
$2.89
|
| Rate for Payer: Blue Shield of California Commercial |
$10.67
|
| Rate for Payer: Blue Shield of California EPN |
$7.03
|
| Rate for Payer: Cash Price |
$7.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.78
|
| Rate for Payer: EPIC Health Plan Senior |
$5.78
|
| Rate for Payer: Galaxy Health WC |
$12.29
|
| Rate for Payer: Global Benefits Group Commercial |
$8.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.47
|
| Rate for Payer: Multiplan Commercial |
$11.57
|
| Rate for Payer: Networks By Design Commercial |
$9.40
|
| Rate for Payer: Prime Health Services Commercial |
$12.29
|
|
|
VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]
|
Facility
|
OP
|
$14.46
|
|
|
Service Code
|
NDC 63323-782-20
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$12.29 |
| Rate for Payer: Adventist Health Commercial |
$2.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.88
|
| Rate for Payer: Cash Price |
$7.95
|
| Rate for Payer: Cigna of CA HMO |
$9.25
|
| Rate for Payer: Cigna of CA PPO |
$10.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.78
|
| Rate for Payer: EPIC Health Plan Senior |
$5.78
|
| Rate for Payer: Galaxy Health WC |
$12.29
|
| Rate for Payer: Global Benefits Group Commercial |
$8.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.12
|
| Rate for Payer: Multiplan Commercial |
$11.57
|
| Rate for Payer: Networks By Design Commercial |
$9.40
|
| Rate for Payer: Prime Health Services Commercial |
$12.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.23
|
| Rate for Payer: United Healthcare All Other HMO |
$7.23
|
| Rate for Payer: United Healthcare HMO Rider |
$7.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.29
|
| Rate for Payer: Vantage Medical Group Senior |
$12.29
|
|
|
VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]
|
Facility
|
IP
|
$14.46
|
|
|
Service Code
|
NDC 63323-782-20
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$12.29 |
| Rate for Payer: Adventist Health Commercial |
$2.89
|
| Rate for Payer: Blue Shield of California Commercial |
$10.67
|
| Rate for Payer: Blue Shield of California EPN |
$7.03
|
| Rate for Payer: Cash Price |
$7.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.78
|
| Rate for Payer: EPIC Health Plan Senior |
$5.78
|
| Rate for Payer: Galaxy Health WC |
$12.29
|
| Rate for Payer: Global Benefits Group Commercial |
$8.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.47
|
| Rate for Payer: Multiplan Commercial |
$11.57
|
| Rate for Payer: Networks By Design Commercial |
$9.40
|
| Rate for Payer: Prime Health Services Commercial |
$12.29
|
|
|
VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]
|
Facility
|
OP
|
$10.80
|
|
|
Service Code
|
NDC 55150-236-20
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: Adventist Health Commercial |
$2.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.63
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cigna of CA HMO |
$6.91
|
| Rate for Payer: Cigna of CA PPO |
$7.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.32
|
| Rate for Payer: EPIC Health Plan Senior |
$4.32
|
| Rate for Payer: Galaxy Health WC |
$9.18
|
| Rate for Payer: Global Benefits Group Commercial |
$6.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.56
|
| Rate for Payer: Multiplan Commercial |
$8.64
|
| Rate for Payer: Networks By Design Commercial |
$7.02
|
| Rate for Payer: Prime Health Services Commercial |
$9.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.40
|
| Rate for Payer: United Healthcare All Other HMO |
$5.40
|
| Rate for Payer: United Healthcare HMO Rider |
$5.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.18
|
| Rate for Payer: Vantage Medical Group Senior |
$9.18
|
|
|
VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]
|
Facility
|
IP
|
$10.80
|
|
|
Service Code
|
NDC 55150-236-20
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: Adventist Health Commercial |
$2.16
|
| Rate for Payer: Blue Shield of California Commercial |
$7.97
|
| Rate for Payer: Blue Shield of California EPN |
$5.25
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.32
|
| Rate for Payer: EPIC Health Plan Senior |
$4.32
|
| Rate for Payer: Galaxy Health WC |
$9.18
|
| Rate for Payer: Global Benefits Group Commercial |
$6.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.59
|
| Rate for Payer: Multiplan Commercial |
$8.64
|
| Rate for Payer: Networks By Design Commercial |
$7.02
|
| Rate for Payer: Prime Health Services Commercial |
$9.18
|
|
|
VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]
|
Facility
|
IP
|
$10.80
|
|
|
Service Code
|
NDC 55150-236-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: Adventist Health Commercial |
$2.16
|
| Rate for Payer: Blue Shield of California Commercial |
$7.97
|
| Rate for Payer: Blue Shield of California EPN |
$5.25
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.32
|
| Rate for Payer: EPIC Health Plan Senior |
$4.32
|
| Rate for Payer: Galaxy Health WC |
$9.18
|
| Rate for Payer: Global Benefits Group Commercial |
$6.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.59
|
| Rate for Payer: Multiplan Commercial |
$8.64
|
| Rate for Payer: Networks By Design Commercial |
$7.02
|
| Rate for Payer: Prime Health Services Commercial |
$9.18
|
|
|
VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
NDC 47335-932-44
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$17.34 |
| Rate for Payer: Adventist Health Commercial |
$4.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.53
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Cigna of CA HMO |
$13.06
|
| Rate for Payer: Cigna of CA PPO |
$15.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.16
|
| Rate for Payer: EPIC Health Plan Senior |
$8.16
|
| Rate for Payer: Galaxy Health WC |
$17.34
|
| Rate for Payer: Global Benefits Group Commercial |
$12.24
|
| 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 Medicare Advantage |
$12.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.28
|
| Rate for Payer: Multiplan Commercial |
$16.32
|
| Rate for Payer: Networks By Design Commercial |
$13.26
|
| Rate for Payer: Prime Health Services Commercial |
$17.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.20
|
| Rate for Payer: United Healthcare All Other HMO |
$10.20
|
| Rate for Payer: United Healthcare HMO Rider |
$10.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.34
|
| Rate for Payer: Vantage Medical Group Senior |
$17.34
|
|
|
VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
NDC 47335-932-44
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$17.34 |
| Rate for Payer: Adventist Health Commercial |
$4.08
|
| Rate for Payer: Blue Shield of California Commercial |
$15.06
|
| Rate for Payer: Blue Shield of California EPN |
$9.91
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.16
|
| Rate for Payer: EPIC Health Plan Senior |
$8.16
|
| Rate for Payer: Galaxy Health WC |
$17.34
|
| Rate for Payer: Global Benefits Group Commercial |
$12.24
|
| 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 Medicare Advantage |
$12.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.90
|
| Rate for Payer: Multiplan Commercial |
$16.32
|
| Rate for Payer: Networks By Design Commercial |
$13.26
|
| Rate for Payer: Prime Health Services Commercial |
$17.34
|
|
|
VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
NDC 47335-932-40
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$17.34 |
| Rate for Payer: Adventist Health Commercial |
$4.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.53
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Cigna of CA HMO |
$13.06
|
| Rate for Payer: Cigna of CA PPO |
$15.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.16
|
| Rate for Payer: EPIC Health Plan Senior |
$8.16
|
| Rate for Payer: Galaxy Health WC |
$17.34
|
| Rate for Payer: Global Benefits Group Commercial |
$12.24
|
| 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 Medicare Advantage |
$12.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.28
|
| Rate for Payer: Multiplan Commercial |
$16.32
|
| Rate for Payer: Networks By Design Commercial |
$13.26
|
| Rate for Payer: Prime Health Services Commercial |
$17.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.20
|
| Rate for Payer: United Healthcare All Other HMO |
$10.20
|
| Rate for Payer: United Healthcare HMO Rider |
$10.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.34
|
| Rate for Payer: Vantage Medical Group Senior |
$17.34
|
|
|
VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
NDC 47335-932-40
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$17.34 |
| Rate for Payer: Adventist Health Commercial |
$4.08
|
| Rate for Payer: Blue Shield of California Commercial |
$15.06
|
| Rate for Payer: Blue Shield of California EPN |
$9.91
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.16
|
| Rate for Payer: EPIC Health Plan Senior |
$8.16
|
| Rate for Payer: Galaxy Health WC |
$17.34
|
| Rate for Payer: Global Benefits Group Commercial |
$12.24
|
| 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 Medicare Advantage |
$12.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.90
|
| Rate for Payer: Multiplan Commercial |
$16.32
|
| Rate for Payer: Networks By Design Commercial |
$13.26
|
| Rate for Payer: Prime Health Services Commercial |
$17.34
|
|
|
VENETOCLAX 100 MG TABLET [214191]
|
Facility
|
OP
|
$156.21
|
|
|
Service Code
|
NDC 0074-0576-22
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$31.24 |
| Max. Negotiated Rate |
$132.78 |
| Rate for Payer: Adventist Health Commercial |
$31.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$102.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$132.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$85.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95.93
|
| Rate for Payer: Cash Price |
$85.91
|
| Rate for Payer: Cigna of CA HMO |
$109.35
|
| Rate for Payer: Cigna of CA PPO |
$109.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$132.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$132.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.48
|
| Rate for Payer: EPIC Health Plan Senior |
$62.48
|
| Rate for Payer: Galaxy Health WC |
$132.78
|
| Rate for Payer: Global Benefits Group Commercial |
$93.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$96.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$109.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$109.35
|
| Rate for Payer: Multiplan Commercial |
$124.97
|
| Rate for Payer: Networks By Design Commercial |
$101.54
|
| Rate for Payer: Prime Health Services Commercial |
$132.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.11
|
| Rate for Payer: United Healthcare All Other HMO |
$78.11
|
| Rate for Payer: United Healthcare HMO Rider |
$78.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$78.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$132.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$132.78
|
| Rate for Payer: Vantage Medical Group Senior |
$132.78
|
|
|
VENETOCLAX 100 MG TABLET [214191]
|
Facility
|
IP
|
$156.21
|
|
|
Service Code
|
NDC 0074-0576-22
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$31.24 |
| Max. Negotiated Rate |
$132.78 |
| Rate for Payer: Adventist Health Commercial |
$31.24
|
| Rate for Payer: Blue Shield of California Commercial |
$115.28
|
| Rate for Payer: Blue Shield of California EPN |
$75.92
|
| Rate for Payer: Cash Price |
$85.91
|
| Rate for Payer: Cigna of CA HMO |
$109.35
|
| Rate for Payer: Cigna of CA PPO |
$109.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.48
|
| Rate for Payer: EPIC Health Plan Senior |
$62.48
|
| Rate for Payer: Galaxy Health WC |
$132.78
|
| Rate for Payer: Global Benefits Group Commercial |
$93.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$96.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.49
|
| Rate for Payer: Multiplan Commercial |
$124.97
|
| Rate for Payer: Networks By Design Commercial |
$101.54
|
| Rate for Payer: Prime Health Services Commercial |
$132.78
|
|
|
VENLAFAXINE 100 MG TABLET [12205]
|
Facility
|
IP
|
$0.46
|
|
|
Service Code
|
NDC 68382-101-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Cash Price |
$0.25
|
| 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: EPIC Health Plan Senior |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.30
|
| Rate for Payer: Prime Health Services Commercial |
$0.39
|
|
|
VENLAFAXINE 100 MG TABLET [12205]
|
Facility
|
OP
|
$0.46
|
|
|
Service Code
|
NDC 68382-101-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.28
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Cigna of CA HMO |
$0.32
|
| Rate for Payer: Cigna of CA PPO |
$0.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Senior |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.30
|
| Rate for Payer: Prime Health Services Commercial |
$0.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.23
|
| Rate for Payer: United Healthcare All Other HMO |
$0.23
|
| Rate for Payer: United Healthcare HMO Rider |
$0.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.39
|
| Rate for Payer: Vantage Medical Group Senior |
$0.39
|
|
|
VENLAFAXINE 25 MG TABLET [12203]
|
Facility
|
OP
|
$1.26
|
|
|
Service Code
|
NDC 68084-896-25
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.07 |
| Rate for Payer: Adventist Health Commercial |
$0.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.77
|
| Rate for Payer: Cash Price |
$0.69
|
| Rate for Payer: Cigna of CA HMO |
$0.88
|
| Rate for Payer: Cigna of CA PPO |
$0.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
| Rate for Payer: EPIC Health Plan Senior |
$0.50
|
| Rate for Payer: Galaxy Health WC |
$1.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.88
|
| Rate for Payer: Multiplan Commercial |
$1.01
|
| Rate for Payer: Networks By Design Commercial |
$0.82
|
| Rate for Payer: Prime Health Services Commercial |
$1.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.63
|
| Rate for Payer: United Healthcare All Other HMO |
$0.63
|
| Rate for Payer: United Healthcare HMO Rider |
$0.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.07
|
| Rate for Payer: Vantage Medical Group Senior |
$1.07
|
|
|
VENLAFAXINE 25 MG TABLET [12203]
|
Facility
|
IP
|
$1.26
|
|
|
Service Code
|
NDC 68084-896-95
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.07 |
| Rate for Payer: Adventist Health Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California Commercial |
$0.93
|
| Rate for Payer: Blue Shield of California EPN |
$0.61
|
| Rate for Payer: Cash Price |
$0.69
|
| Rate for Payer: Cigna of CA HMO |
$0.88
|
| Rate for Payer: Cigna of CA PPO |
$0.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
| Rate for Payer: EPIC Health Plan Senior |
$0.50
|
| Rate for Payer: Galaxy Health WC |
$1.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$1.01
|
| Rate for Payer: Networks By Design Commercial |
$0.82
|
| Rate for Payer: Prime Health Services Commercial |
$1.07
|
|
