|
VORICONAZOLE 200 MG INTRAVENOUS POWDER FOR SOLUTION [33010]
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
HCPCS J3465
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Adventist Health Commercial |
$14.47
|
| Rate for Payer: Adventist Health Commercial |
$17.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$54.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$54.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.76
|
| Rate for Payer: Blue Shield of California Commercial |
$3.58
|
| Rate for Payer: Blue Shield of California Commercial |
$3.58
|
| Rate for Payer: Blue Shield of California Commercial |
$3.58
|
| Rate for Payer: Blue Shield of California Commercial |
$3.58
|
| Rate for Payer: Blue Shield of California Commercial |
$3.58
|
| Rate for Payer: Cash Price |
$39.55
|
| Rate for Payer: Cash Price |
$32.56
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.56
|
| Rate for Payer: Cash Price |
$39.55
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna of CA HMO |
$50.65
|
| Rate for Payer: Cigna of CA HMO |
$33.60
|
| Rate for Payer: Cigna of CA HMO |
$50.40
|
| Rate for Payer: Cigna of CA HMO |
$29.40
|
| Rate for Payer: Cigna of CA HMO |
$61.52
|
| Rate for Payer: Cigna of CA PPO |
$50.40
|
| Rate for Payer: Cigna of CA PPO |
$50.65
|
| Rate for Payer: Cigna of CA PPO |
$33.60
|
| Rate for Payer: Cigna of CA PPO |
$61.52
|
| Rate for Payer: Cigna of CA PPO |
$29.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$61.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$61.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$61.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$74.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$61.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$50.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$50.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Senior |
$28.80
|
| Rate for Payer: EPIC Health Plan Senior |
$35.16
|
| Rate for Payer: EPIC Health Plan Senior |
$28.94
|
| Rate for Payer: EPIC Health Plan Senior |
$16.80
|
| Rate for Payer: EPIC Health Plan Senior |
$19.20
|
| Rate for Payer: Galaxy Health WC |
$61.51
|
| Rate for Payer: Galaxy Health WC |
$74.71
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Global Benefits Group Commercial |
$52.73
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$61.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$50.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$50.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$61.52
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: Multiplan Commercial |
$70.31
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$57.89
|
| Rate for Payer: Networks By Design Commercial |
$21.00
|
| Rate for Payer: Networks By Design Commercial |
$43.95
|
| Rate for Payer: Networks By Design Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$36.18
|
| Rate for Payer: Prime Health Services Commercial |
$61.51
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: Prime Health Services Commercial |
$74.71
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.99
|
| Rate for Payer: United Healthcare All Other HMO |
$32.11
|
| Rate for Payer: United Healthcare All Other HMO |
$26.43
|
| Rate for Payer: United Healthcare All Other HMO |
$15.34
|
| Rate for Payer: United Healthcare All Other HMO |
$17.53
|
| Rate for Payer: United Healthcare All Other HMO |
$26.30
|
| Rate for Payer: United Healthcare HMO Rider |
$17.16
|
| Rate for Payer: United Healthcare HMO Rider |
$31.41
|
| Rate for Payer: United Healthcare HMO Rider |
$15.01
|
| Rate for Payer: United Healthcare HMO Rider |
$25.73
|
| Rate for Payer: United Healthcare HMO Rider |
$25.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61.20
|
| Rate for Payer: Vantage Medical Group Senior |
$74.71
|
| Rate for Payer: Vantage Medical Group Senior |
$35.70
|
| Rate for Payer: Vantage Medical Group Senior |
$40.80
|
| Rate for Payer: Vantage Medical Group Senior |
$61.20
|
| Rate for Payer: Vantage Medical Group Senior |
$61.51
|
|
|
VORICONAZOLE 200 MG INTRAVENOUS POWDER FOR SOLUTION [33010]
|
Facility
|
IP
|
$72.36
|
|
|
Service Code
|
HCPCS J3465
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.47 |
| Max. Negotiated Rate |
$61.51 |
| Rate for Payer: Adventist Health Commercial |
$17.58
|
| Rate for Payer: Adventist Health Commercial |
$14.47
|
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Blue Shield of California Commercial |
$36.91
|
| Rate for Payer: Blue Shield of California Commercial |
$24.34
|
| Rate for Payer: Blue Shield of California Commercial |
$32.30
|
| Rate for Payer: Blue Shield of California Commercial |
$36.50
|
| Rate for Payer: Blue Shield of California Commercial |
$44.56
|
| Rate for Payer: Blue Shield of California Commercial |
$67.59
|
| Rate for Payer: Blue Shield of California Commercial |
$55.37
|
| Rate for Payer: Blue Shield of California Commercial |
$55.64
|
| Rate for Payer: Blue Shield of California Commercial |
$21.29
|
| Rate for Payer: Blue Shield of California Commercial |
$36.69
|
| Rate for Payer: Cash Price |
$39.55
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$32.56
|
| Rate for Payer: Cigna of CA HMO |
$50.65
|
| Rate for Payer: Cigna of CA HMO |
$50.40
|
| Rate for Payer: Cigna of CA HMO |
$29.40
|
| Rate for Payer: Cigna of CA HMO |
$33.60
|
| Rate for Payer: Cigna of CA HMO |
$61.52
|
| Rate for Payer: Cigna of CA PPO |
$50.65
|
| Rate for Payer: Cigna of CA PPO |
$50.40
|
| Rate for Payer: Cigna of CA PPO |
$29.40
|
| Rate for Payer: Cigna of CA PPO |
$33.60
|
| Rate for Payer: Cigna of CA PPO |
$61.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$50.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$50.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16.80
|
| Rate for Payer: EPIC Health Plan Senior |
$28.94
|
| Rate for Payer: EPIC Health Plan Senior |
$35.16
|
| Rate for Payer: EPIC Health Plan Senior |
$28.80
|
| Rate for Payer: EPIC Health Plan Senior |
$19.20
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Galaxy Health WC |
$74.71
|
| Rate for Payer: Galaxy Health WC |
$61.51
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Global Benefits Group Commercial |
$52.73
|
| Rate for Payer: Global Benefits Group Commercial |
$43.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: Multiplan Commercial |
$57.89
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: Multiplan Commercial |
$70.31
|
| Rate for Payer: Networks By Design Commercial |
$43.95
|
| Rate for Payer: Networks By Design Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$36.18
|
| Rate for Payer: Networks By Design Commercial |
$21.00
|
| Rate for Payer: Prime Health Services Commercial |
$74.71
|
| Rate for Payer: Prime Health Services Commercial |
$61.51
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.02
|
| Rate for Payer: United Healthcare All Other HMO |
$32.11
|
| Rate for Payer: United Healthcare All Other HMO |
$26.43
|
| Rate for Payer: United Healthcare All Other HMO |
$17.53
|
| Rate for Payer: United Healthcare All Other HMO |
$15.34
|
| Rate for Payer: United Healthcare All Other HMO |
$26.30
|
| Rate for Payer: United Healthcare HMO Rider |
$15.01
|
| Rate for Payer: United Healthcare HMO Rider |
$25.73
|
| Rate for Payer: United Healthcare HMO Rider |
$31.41
|
| Rate for Payer: United Healthcare HMO Rider |
$25.86
|
| Rate for Payer: United Healthcare HMO Rider |
$17.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.76
|
|
|
VORICONAZOLE 200 MG TABLET [33009]
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
NDC 4354737803
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.78
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cigna of CA HMO |
$6.30
|
| Rate for Payer: Cigna of CA PPO |
$6.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3.60
|
| Rate for Payer: Galaxy Health WC |
$7.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: Networks By Design Commercial |
$5.85
|
| Rate for Payer: Prime Health Services Commercial |
$7.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.65
|
| Rate for Payer: Vantage Medical Group Senior |
$7.65
|
|
|
VORICONAZOLE 200 MG TABLET [33009]
|
Facility
|
OP
|
$21.43
|
|
|
Service Code
|
NDC 5026880312
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$18.22 |
| Rate for Payer: Adventist Health Commercial |
$4.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.75
|
| Rate for Payer: Cash Price |
$9.64
|
| Rate for Payer: Cigna of CA HMO |
$15.00
|
| Rate for Payer: Cigna of CA PPO |
$15.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.57
|
| Rate for Payer: EPIC Health Plan Senior |
$8.57
|
| Rate for Payer: Galaxy Health WC |
$18.22
|
| Rate for Payer: Global Benefits Group Commercial |
$12.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$17.14
|
| Rate for Payer: Networks By Design Commercial |
$13.93
|
| Rate for Payer: Prime Health Services Commercial |
$18.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.71
|
| Rate for Payer: United Healthcare All Other HMO |
$10.71
|
| Rate for Payer: United Healthcare HMO Rider |
$10.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.22
|
| Rate for Payer: Vantage Medical Group Senior |
$18.22
|
|
|
VORICONAZOLE 200 MG TABLET [33009]
|
Facility
|
IP
|
$21.43
|
|
|
Service Code
|
NDC 5026880312
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$18.22 |
| Rate for Payer: Adventist Health Commercial |
$4.29
|
| Rate for Payer: Blue Shield of California Commercial |
$10.87
|
| Rate for Payer: Blue Shield of California Commercial |
$16.48
|
| Rate for Payer: Cash Price |
$9.64
|
| Rate for Payer: Cigna of CA HMO |
$15.00
|
| Rate for Payer: Cigna of CA PPO |
$15.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.57
|
| Rate for Payer: EPIC Health Plan Senior |
$8.57
|
| Rate for Payer: Galaxy Health WC |
$18.22
|
| Rate for Payer: Global Benefits Group Commercial |
$12.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.14
|
| Rate for Payer: Multiplan Commercial |
$17.14
|
| Rate for Payer: Networks By Design Commercial |
$13.93
|
| Rate for Payer: Prime Health Services Commercial |
$18.22
|
|
|
VORICONAZOLE 200 MG TABLET [33009]
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
NDC 6586289230
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.78
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cigna of CA HMO |
$6.30
|
| Rate for Payer: Cigna of CA PPO |
$6.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3.60
|
| Rate for Payer: Galaxy Health WC |
$7.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: Networks By Design Commercial |
$5.85
|
| Rate for Payer: Prime Health Services Commercial |
$7.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.65
|
| Rate for Payer: Vantage Medical Group Senior |
$7.65
|
|
|
VORICONAZOLE 200 MG TABLET [33009]
|
Facility
|
IP
|
$21.43
|
|
|
Service Code
|
NDC 5026880311
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$18.22 |
| Rate for Payer: Adventist Health Commercial |
$4.29
|
| Rate for Payer: Blue Shield of California Commercial |
$10.87
|
| Rate for Payer: Blue Shield of California Commercial |
$16.48
|
| Rate for Payer: Cash Price |
$9.64
|
| Rate for Payer: Cigna of CA HMO |
$15.00
|
| Rate for Payer: Cigna of CA PPO |
$15.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.57
|
| Rate for Payer: EPIC Health Plan Senior |
$8.57
|
| Rate for Payer: Galaxy Health WC |
$18.22
|
| Rate for Payer: Global Benefits Group Commercial |
$12.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.14
|
| Rate for Payer: Multiplan Commercial |
$17.14
|
| Rate for Payer: Networks By Design Commercial |
$13.93
|
| Rate for Payer: Prime Health Services Commercial |
$18.22
|
|
|
VORICONAZOLE 200 MG TABLET [33009]
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
NDC 4354737803
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4.56
|
| Rate for Payer: Blue Shield of California Commercial |
$6.92
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cigna of CA HMO |
$6.30
|
| Rate for Payer: Cigna of CA PPO |
$6.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3.60
|
| Rate for Payer: Galaxy Health WC |
$7.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: Networks By Design Commercial |
$5.85
|
| Rate for Payer: Prime Health Services Commercial |
$7.65
|
|
|
VORICONAZOLE 200 MG TABLET [33009]
|
Facility
|
OP
|
$21.43
|
|
|
Service Code
|
NDC 5026880311
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$18.22 |
| Rate for Payer: Adventist Health Commercial |
$4.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.75
|
| Rate for Payer: Cash Price |
$9.64
|
| Rate for Payer: Cigna of CA HMO |
$15.00
|
| Rate for Payer: Cigna of CA PPO |
$15.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.57
|
| Rate for Payer: EPIC Health Plan Senior |
$8.57
|
| Rate for Payer: Galaxy Health WC |
$18.22
|
| Rate for Payer: Global Benefits Group Commercial |
$12.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$17.14
|
| Rate for Payer: Networks By Design Commercial |
$13.93
|
| Rate for Payer: Prime Health Services Commercial |
$18.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.71
|
| Rate for Payer: United Healthcare All Other HMO |
$10.71
|
| Rate for Payer: United Healthcare HMO Rider |
$10.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.22
|
| Rate for Payer: Vantage Medical Group Senior |
$18.22
|
|
|
VORICONAZOLE 200 MG TABLET [33009]
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
NDC 6846257330
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4.56
|
| Rate for Payer: Blue Shield of California Commercial |
$6.92
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cigna of CA HMO |
$6.30
|
| Rate for Payer: Cigna of CA PPO |
$6.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3.60
|
| Rate for Payer: Galaxy Health WC |
$7.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: Networks By Design Commercial |
$5.85
|
| Rate for Payer: Prime Health Services Commercial |
$7.65
|
|
|
VORICONAZOLE 200 MG TABLET [33009]
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
NDC 6586289230
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4.56
|
| Rate for Payer: Blue Shield of California Commercial |
$6.92
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cigna of CA HMO |
$6.30
|
| Rate for Payer: Cigna of CA PPO |
$6.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3.60
|
| Rate for Payer: Galaxy Health WC |
$7.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: Networks By Design Commercial |
$5.85
|
| Rate for Payer: Prime Health Services Commercial |
$7.65
|
|
|
VORICONAZOLE 200 MG TABLET [33009]
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
NDC 6846257330
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.78
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cigna of CA HMO |
$6.30
|
| Rate for Payer: Cigna of CA PPO |
$6.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3.60
|
| Rate for Payer: Galaxy Health WC |
$7.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: Networks By Design Commercial |
$5.85
|
| Rate for Payer: Prime Health Services Commercial |
$7.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.65
|
| Rate for Payer: Vantage Medical Group Senior |
$7.65
|
|
|
VORICONAZOLE 50 MG TABLET [33008]
|
Facility
|
OP
|
$2.60
|
|
|
Service Code
|
NDC 4354737703
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.21 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.67
|
| 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 Medi-Cal |
$2.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: EPIC Health Plan Senior |
$1.04
|
| Rate for Payer: Galaxy Health WC |
$2.21
|
| Rate for Payer: Global Benefits Group Commercial |
$1.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.82
|
| 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: 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
|
|
|
VORICONAZOLE 50 MG TABLET [33008]
|
Facility
|
IP
|
$1.60
|
|
|
Service Code
|
NDC 2724106203
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.36 |
| Rate for Payer: Adventist Health Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California Commercial |
$0.81
|
| Rate for Payer: Blue Shield of California Commercial |
$1.23
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Cigna of CA HMO |
$1.12
|
| Rate for Payer: Cigna of CA PPO |
$1.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: EPIC Health Plan Senior |
$0.64
|
| Rate for Payer: Galaxy Health WC |
$1.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$1.28
|
| Rate for Payer: Networks By Design Commercial |
$1.04
|
| Rate for Payer: Prime Health Services Commercial |
$1.36
|
|
|
VORICONAZOLE 50 MG TABLET [33008]
|
Facility
|
OP
|
$1.60
|
|
|
Service Code
|
NDC 2724106203
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.36 |
| Rate for Payer: Adventist Health Commercial |
$0.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.03
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Cigna of CA HMO |
$1.12
|
| Rate for Payer: Cigna of CA PPO |
$1.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: EPIC Health Plan Senior |
$0.64
|
| Rate for Payer: Galaxy Health WC |
$1.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.12
|
| Rate for Payer: Multiplan Commercial |
$1.28
|
| Rate for Payer: Networks By Design Commercial |
$1.04
|
| Rate for Payer: Prime Health Services Commercial |
$1.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.80
|
| Rate for Payer: United Healthcare All Other HMO |
$0.80
|
| Rate for Payer: United Healthcare HMO Rider |
$0.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.36
|
| Rate for Payer: Vantage Medical Group Senior |
$1.36
|
|
|
VORICONAZOLE 50 MG TABLET [33008]
|
Facility
|
IP
|
$2.60
|
|
|
Service Code
|
NDC 4354737703
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.21 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1.32
|
| Rate for Payer: Blue Shield of California Commercial |
$2.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: EPIC Health Plan Senior |
$1.04
|
| Rate for Payer: Galaxy Health WC |
$2.21
|
| Rate for Payer: Global Benefits Group Commercial |
$1.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.53
|
| 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 6846257230
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.21 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.67
|
| 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 Medi-Cal |
$2.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: EPIC Health Plan Senior |
$1.04
|
| Rate for Payer: Galaxy Health WC |
$2.21
|
| Rate for Payer: Global Benefits Group Commercial |
$1.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.82
|
| 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: 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
|
|
|
VORICONAZOLE 50 MG TABLET [33008]
|
Facility
|
IP
|
$2.60
|
|
|
Service Code
|
NDC 6846257230
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.21 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1.32
|
| Rate for Payer: Blue Shield of California Commercial |
$2.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: EPIC Health Plan Senior |
$1.04
|
| Rate for Payer: Galaxy Health WC |
$2.21
|
| Rate for Payer: Global Benefits Group Commercial |
$1.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.53
|
| 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
|
|
|
VORINOSTAT 100 MG CAPSULE [77539]
|
Facility
|
OP
|
$150.10
|
|
|
Service Code
|
NDC 0006056840
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$30.02 |
| Max. Negotiated Rate |
$127.58 |
| Rate for Payer: Adventist Health Commercial |
$30.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$98.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$127.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$82.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$112.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.32
|
| Rate for Payer: Cash Price |
$67.54
|
| 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 Medi-Cal |
$127.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$127.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.04
|
| Rate for Payer: EPIC Health Plan Senior |
$60.04
|
| Rate for Payer: Galaxy Health WC |
$127.58
|
| Rate for Payer: Global Benefits Group Commercial |
$90.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$105.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$105.07
|
| 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: 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 100 MG CAPSULE [77539]
|
Facility
|
IP
|
$150.10
|
|
|
Service Code
|
NDC 0006056840
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$30.02 |
| Max. Negotiated Rate |
$127.58 |
| Rate for Payer: Adventist Health Commercial |
$30.02
|
| Rate for Payer: Blue Shield of California Commercial |
$115.43
|
| Rate for Payer: Blue Shield of California Commercial |
$76.10
|
| Rate for Payer: Cash Price |
$67.54
|
| Rate for Payer: Cigna of CA HMO |
$105.07
|
| Rate for Payer: Cigna of CA PPO |
$105.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.04
|
| Rate for Payer: EPIC Health Plan Senior |
$60.04
|
| Rate for Payer: Galaxy Health WC |
$127.58
|
| Rate for Payer: Global Benefits Group Commercial |
$90.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88.56
|
| 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 ORAL SUSPENSION COMPOUND 50 MG/ML [4080357]
|
Facility
|
OP
|
$49.35
|
|
|
Service Code
|
NDC 9994080357
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.87 |
| Max. Negotiated Rate |
$41.95 |
| Rate for Payer: Adventist Health Commercial |
$9.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.67
|
| Rate for Payer: Cash Price |
$22.21
|
| Rate for Payer: Cigna of CA HMO |
$34.55
|
| Rate for Payer: Cigna of CA PPO |
$34.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.74
|
| Rate for Payer: EPIC Health Plan Senior |
$19.74
|
| Rate for Payer: Galaxy Health WC |
$41.95
|
| Rate for Payer: Global Benefits Group Commercial |
$29.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.55
|
| 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: 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 9994080357
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.87 |
| Max. Negotiated Rate |
$41.95 |
| Rate for Payer: Adventist Health Commercial |
$9.87
|
| Rate for Payer: Blue Shield of California Commercial |
$25.02
|
| Rate for Payer: Blue Shield of California Commercial |
$37.95
|
| Rate for Payer: Cash Price |
$22.21
|
| Rate for Payer: Cigna of CA HMO |
$34.55
|
| Rate for Payer: Cigna of CA PPO |
$34.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.74
|
| Rate for Payer: EPIC Health Plan Senior |
$19.74
|
| Rate for Payer: Galaxy Health WC |
$41.95
|
| Rate for Payer: Global Benefits Group Commercial |
$29.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.12
|
| 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
|
|
|
WARFARIN 0.5 MG PARTIAL TABLET [4081492]
|
Facility
|
IP
|
$0.26
|
|
|
Service Code
|
NDC 9994081492
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.15
|
| 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 9994081492
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| 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 Medi-Cal |
$0.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.18
|
| 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: 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
|
$0.73
|
|
|
Service Code
|
NDC 0832121989
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$0.56
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: EPIC Health Plan Senior |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.62
|
| Rate for Payer: Global Benefits Group Commercial |
$0.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.43
|
| 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
|
|
