|
VASOPRESSIN SPEC DIL 2 UNITS/ML [4081064]
|
Facility
|
OP
|
$1.09
|
|
|
Service Code
|
NDC 9994081064
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.63
|
| Rate for Payer: Blue Shield of California Commercial |
$0.69
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Central Health Plan Commercial |
$0.87
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.93
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
| Rate for Payer: Networks By Design Commercial |
$0.71
|
| Rate for Payer: Prime Health Services Commercial |
$0.93
|
| Rate for Payer: Riverside University Health System MISP |
$0.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.55
|
| Rate for Payer: United Healthcare All Other HMO |
$0.55
|
| Rate for Payer: United Healthcare HMO Rider |
$0.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.93
|
| Rate for Payer: Vantage Medical Group Senior |
$0.93
|
|
|
VASOPRESSIN SPEC DIL 2 UNITS/ML [4081064]
|
Facility
|
IP
|
$1.09
|
|
|
Service Code
|
NDC 9994081064
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$0.55
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Central Health Plan Commercial |
$0.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.93
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
| Rate for Payer: Networks By Design Commercial |
$0.71
|
| Rate for Payer: Prime Health Services Commercial |
$0.93
|
|
|
VECURONIUM 10 MG IV BOLUS - CODE [4080584]
|
Facility
|
IP
|
$6.84
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$6.16 |
| Rate for Payer: Adventist Health Commercial |
$1.37
|
| Rate for Payer: Adventist Health Commercial |
$2.04
|
| Rate for Payer: Blue Shield of California Commercial |
$5.49
|
| Rate for Payer: Blue Shield of California Commercial |
$8.18
|
| Rate for Payer: Blue Shield of California EPN |
$5.14
|
| Rate for Payer: Blue Shield of California EPN |
$3.45
|
| Rate for Payer: Cash Price |
$3.08
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: Central Health Plan Commercial |
$5.47
|
| Rate for Payer: Central Health Plan Commercial |
$8.16
|
| Rate for Payer: Cigna of CA HMO |
$7.14
|
| Rate for Payer: Cigna of CA HMO |
$4.79
|
| Rate for Payer: Cigna of CA PPO |
$7.14
|
| Rate for Payer: Cigna of CA PPO |
$4.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.74
|
| Rate for Payer: EPIC Health Plan Senior |
$4.08
|
| Rate for Payer: EPIC Health Plan Senior |
$2.74
|
| Rate for Payer: Galaxy Health WC |
$5.81
|
| Rate for Payer: Galaxy Health WC |
$8.67
|
| Rate for Payer: Global Benefits Group Commercial |
$6.12
|
| Rate for Payer: Global Benefits Group Commercial |
$4.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.04
|
| Rate for Payer: Multiplan Commercial |
$7.65
|
| Rate for Payer: Multiplan Commercial |
$5.13
|
| Rate for Payer: Networks By Design Commercial |
$5.10
|
| Rate for Payer: Networks By Design Commercial |
$3.42
|
| Rate for Payer: Prime Health Services Commercial |
$5.81
|
| Rate for Payer: Prime Health Services Commercial |
$8.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.57
|
| Rate for Payer: United Healthcare All Other HMO |
$2.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3.73
|
| Rate for Payer: United Healthcare HMO Rider |
$3.65
|
| Rate for Payer: United Healthcare HMO Rider |
$2.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.24
|
|
|
VECURONIUM 10 MG IV BOLUS - CODE [4080584]
|
Facility
|
OP
|
$6.84
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$6.16 |
| Rate for Payer: Adventist Health Commercial |
$1.37
|
| Rate for Payer: Adventist Health Commercial |
$2.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.13
|
| Rate for Payer: Blue Shield of California Commercial |
$4.34
|
| Rate for Payer: Blue Shield of California Commercial |
$6.47
|
| Rate for Payer: Blue Shield of California EPN |
$2.73
|
| Rate for Payer: Blue Shield of California EPN |
$4.07
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: Cash Price |
$3.08
|
| Rate for Payer: Central Health Plan Commercial |
$8.16
|
| Rate for Payer: Central Health Plan Commercial |
$5.47
|
| Rate for Payer: Cigna of CA HMO |
$4.79
|
| Rate for Payer: Cigna of CA HMO |
$7.14
|
| Rate for Payer: Cigna of CA PPO |
$7.14
|
| Rate for Payer: Cigna of CA PPO |
$4.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.74
|
| Rate for Payer: EPIC Health Plan Senior |
$2.74
|
| Rate for Payer: EPIC Health Plan Senior |
$4.08
|
| Rate for Payer: Galaxy Health WC |
$8.67
|
| Rate for Payer: Galaxy Health WC |
$5.81
|
| Rate for Payer: Global Benefits Group Commercial |
$6.12
|
| Rate for Payer: Global Benefits Group Commercial |
$4.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.14
|
| Rate for Payer: Multiplan Commercial |
$7.65
|
| Rate for Payer: Multiplan Commercial |
$5.13
|
| Rate for Payer: Networks By Design Commercial |
$3.42
|
| Rate for Payer: Networks By Design Commercial |
$5.10
|
| Rate for Payer: Prime Health Services Commercial |
$5.81
|
| Rate for Payer: Prime Health Services Commercial |
$8.67
|
| Rate for Payer: Riverside University Health System MISP |
$2.74
|
| Rate for Payer: Riverside University Health System MISP |
$4.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.57
|
| Rate for Payer: United Healthcare All Other HMO |
$3.73
|
| Rate for Payer: United Healthcare All Other HMO |
$2.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3.65
|
| Rate for Payer: United Healthcare HMO Rider |
$2.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.81
|
| Rate for Payer: Vantage Medical Group Senior |
$8.67
|
| Rate for Payer: Vantage Medical Group Senior |
$5.81
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
|
OP
|
$5.28
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Adventist Health Commercial |
$1.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.21
|
| 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: Blue Shield of California Commercial |
$3.35
|
| Rate for Payer: Blue Shield of California EPN |
$2.11
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Central Health Plan Commercial |
$4.22
|
| Rate for Payer: Cigna of CA HMO |
$3.70
|
| Rate for Payer: Cigna of CA PPO |
$3.70
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.70
|
| 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: Health Management Network EPO/PPO |
$4.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.70
|
| Rate for Payer: Multiplan Commercial |
$3.96
|
| Rate for Payer: Networks By Design Commercial |
$2.64
|
| Rate for Payer: Prime Health Services Commercial |
$4.49
|
| Rate for Payer: Riverside University Health System MISP |
$2.11
|
| 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 |
$1.98
|
| Rate for Payer: United Healthcare All Other HMO |
$1.93
|
| Rate for Payer: United Healthcare HMO Rider |
$1.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.73
|
| 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 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
|
IP
|
$5.28
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Adventist Health Commercial |
$1.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4.23
|
| Rate for Payer: Blue Shield of California EPN |
$2.66
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Central Health Plan Commercial |
$4.22
|
| Rate for Payer: Cigna of CA HMO |
$3.70
|
| Rate for Payer: Cigna of CA PPO |
$3.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.70
|
| 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: Health Management Network EPO/PPO |
$4.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Multiplan Commercial |
$3.96
|
| Rate for Payer: Networks By Design Commercial |
$2.64
|
| Rate for Payer: Prime Health Services Commercial |
$4.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.98
|
| Rate for Payer: United Healthcare All Other HMO |
$1.93
|
| Rate for Payer: United Healthcare HMO Rider |
$1.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.73
|
|
|
VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]
|
Facility
|
IP
|
$13.68
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$12.31 |
| Rate for Payer: Adventist Health Commercial |
$2.74
|
| Rate for Payer: Adventist Health Commercial |
$4.08
|
| Rate for Payer: Adventist Health Commercial |
$2.89
|
| Rate for Payer: Adventist Health Commercial |
$2.16
|
| Rate for Payer: Blue Shield of California Commercial |
$10.97
|
| Rate for Payer: Blue Shield of California Commercial |
$8.66
|
| Rate for Payer: Blue Shield of California Commercial |
$16.36
|
| Rate for Payer: Blue Shield of California Commercial |
$11.60
|
| Rate for Payer: Blue Shield of California EPN |
$6.89
|
| Rate for Payer: Blue Shield of California EPN |
$5.44
|
| Rate for Payer: Blue Shield of California EPN |
$7.29
|
| Rate for Payer: Blue Shield of California EPN |
$10.28
|
| Rate for Payer: Cash Price |
$9.18
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Cash Price |
$6.51
|
| Rate for Payer: Cash Price |
$6.16
|
| Rate for Payer: Central Health Plan Commercial |
$16.32
|
| Rate for Payer: Central Health Plan Commercial |
$10.94
|
| Rate for Payer: Central Health Plan Commercial |
$8.64
|
| Rate for Payer: Central Health Plan Commercial |
$11.57
|
| Rate for Payer: Cigna of CA HMO |
$9.58
|
| Rate for Payer: Cigna of CA HMO |
$10.12
|
| Rate for Payer: Cigna of CA HMO |
$14.28
|
| Rate for Payer: Cigna of CA HMO |
$7.56
|
| Rate for Payer: Cigna of CA PPO |
$7.56
|
| Rate for Payer: Cigna of CA PPO |
$9.58
|
| Rate for Payer: Cigna of CA PPO |
$10.12
|
| Rate for Payer: Cigna of CA PPO |
$14.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.32
|
| Rate for Payer: EPIC Health Plan Senior |
$5.47
|
| Rate for Payer: EPIC Health Plan Senior |
$5.78
|
| Rate for Payer: EPIC Health Plan Senior |
$8.16
|
| Rate for Payer: EPIC Health Plan Senior |
$4.32
|
| Rate for Payer: Galaxy Health WC |
$12.29
|
| Rate for Payer: Galaxy Health WC |
$9.18
|
| Rate for Payer: Galaxy Health WC |
$11.63
|
| Rate for Payer: Galaxy Health WC |
$17.34
|
| Rate for Payer: Global Benefits Group Commercial |
$12.24
|
| Rate for Payer: Global Benefits Group Commercial |
$8.21
|
| Rate for Payer: Global Benefits Group Commercial |
$8.68
|
| Rate for Payer: Global Benefits Group Commercial |
$6.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.89
|
| Rate for Payer: Multiplan Commercial |
$15.30
|
| Rate for Payer: Multiplan Commercial |
$10.26
|
| Rate for Payer: Multiplan Commercial |
$8.10
|
| Rate for Payer: Multiplan Commercial |
$10.85
|
| Rate for Payer: Networks By Design Commercial |
$10.20
|
| Rate for Payer: Networks By Design Commercial |
$5.40
|
| Rate for Payer: Networks By Design Commercial |
$7.23
|
| Rate for Payer: Networks By Design Commercial |
$6.84
|
| Rate for Payer: Prime Health Services Commercial |
$12.29
|
| Rate for Payer: Prime Health Services Commercial |
$11.63
|
| Rate for Payer: Prime Health Services Commercial |
$9.18
|
| Rate for Payer: Prime Health Services Commercial |
$17.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.13
|
| Rate for Payer: United Healthcare All Other HMO |
$5.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3.95
|
| Rate for Payer: United Healthcare All Other HMO |
$7.45
|
| Rate for Payer: United Healthcare All Other HMO |
$5.28
|
| Rate for Payer: United Healthcare HMO Rider |
$3.86
|
| Rate for Payer: United Healthcare HMO Rider |
$5.17
|
| Rate for Payer: United Healthcare HMO Rider |
$7.29
|
| Rate for Payer: United Healthcare HMO Rider |
$4.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.74
|
|
|
VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]
|
Facility
|
OP
|
$10.80
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$9.72 |
| Rate for Payer: Adventist Health Commercial |
$2.16
|
| Rate for Payer: Adventist Health Commercial |
$4.08
|
| Rate for Payer: Adventist Health Commercial |
$2.89
|
| Rate for Payer: Adventist Health Commercial |
$2.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.85
|
| Rate for Payer: Blue Shield of California Commercial |
$9.17
|
| Rate for Payer: Blue Shield of California Commercial |
$6.85
|
| Rate for Payer: Blue Shield of California Commercial |
$12.93
|
| Rate for Payer: Blue Shield of California Commercial |
$8.67
|
| Rate for Payer: Blue Shield of California EPN |
$4.31
|
| Rate for Payer: Blue Shield of California EPN |
$5.77
|
| Rate for Payer: Blue Shield of California EPN |
$8.14
|
| Rate for Payer: Blue Shield of California EPN |
$5.46
|
| Rate for Payer: Cash Price |
$9.18
|
| Rate for Payer: Cash Price |
$6.51
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Cash Price |
$6.16
|
| Rate for Payer: Central Health Plan Commercial |
$11.57
|
| Rate for Payer: Central Health Plan Commercial |
$10.94
|
| Rate for Payer: Central Health Plan Commercial |
$8.64
|
| Rate for Payer: Central Health Plan Commercial |
$16.32
|
| Rate for Payer: Cigna of CA HMO |
$10.12
|
| Rate for Payer: Cigna of CA HMO |
$9.58
|
| Rate for Payer: Cigna of CA HMO |
$7.56
|
| Rate for Payer: Cigna of CA HMO |
$14.28
|
| Rate for Payer: Cigna of CA PPO |
$14.28
|
| Rate for Payer: Cigna of CA PPO |
$9.58
|
| Rate for Payer: Cigna of CA PPO |
$7.56
|
| Rate for Payer: Cigna of CA PPO |
$10.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.47
|
| Rate for Payer: EPIC Health Plan Senior |
$5.78
|
| Rate for Payer: EPIC Health Plan Senior |
$5.47
|
| Rate for Payer: EPIC Health Plan Senior |
$4.32
|
| Rate for Payer: EPIC Health Plan Senior |
$8.16
|
| Rate for Payer: Galaxy Health WC |
$9.18
|
| Rate for Payer: Galaxy Health WC |
$12.29
|
| Rate for Payer: Galaxy Health WC |
$17.34
|
| Rate for Payer: Galaxy Health WC |
$11.63
|
| Rate for Payer: Global Benefits Group Commercial |
$12.24
|
| Rate for Payer: Global Benefits Group Commercial |
$8.21
|
| Rate for Payer: Global Benefits Group Commercial |
$6.48
|
| Rate for Payer: Global Benefits Group Commercial |
$8.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.56
|
| Rate for Payer: Multiplan Commercial |
$10.26
|
| Rate for Payer: Multiplan Commercial |
$15.30
|
| Rate for Payer: Multiplan Commercial |
$10.85
|
| Rate for Payer: Multiplan Commercial |
$8.10
|
| Rate for Payer: Networks By Design Commercial |
$5.40
|
| Rate for Payer: Networks By Design Commercial |
$10.20
|
| Rate for Payer: Networks By Design Commercial |
$7.23
|
| Rate for Payer: Networks By Design Commercial |
$6.84
|
| Rate for Payer: Prime Health Services Commercial |
$12.29
|
| Rate for Payer: Prime Health Services Commercial |
$9.18
|
| Rate for Payer: Prime Health Services Commercial |
$11.63
|
| Rate for Payer: Prime Health Services Commercial |
$17.34
|
| Rate for Payer: Riverside University Health System MISP |
$8.16
|
| Rate for Payer: Riverside University Health System MISP |
$5.78
|
| Rate for Payer: Riverside University Health System MISP |
$4.32
|
| Rate for Payer: Riverside University Health System MISP |
$5.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.43
|
| Rate for Payer: United Healthcare All Other HMO |
$7.45
|
| Rate for Payer: United Healthcare All Other HMO |
$5.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5.28
|
| Rate for Payer: United Healthcare All Other HMO |
$3.95
|
| Rate for Payer: United Healthcare HMO Rider |
$5.17
|
| Rate for Payer: United Healthcare HMO Rider |
$7.29
|
| Rate for Payer: United Healthcare HMO Rider |
$4.89
|
| Rate for Payer: United Healthcare HMO Rider |
$3.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.63
|
| Rate for Payer: Vantage Medical Group Senior |
$9.18
|
| Rate for Payer: Vantage Medical Group Senior |
$17.34
|
| Rate for Payer: Vantage Medical Group Senior |
$12.29
|
| Rate for Payer: Vantage Medical Group Senior |
$11.63
|
|
|
VEDOLIZUMAB 300 MG INTRAVENOUS SOLUTION [205964]
|
Facility
|
IP
|
$12,130.44
|
|
|
Service Code
|
HCPCS J3380
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,426.09 |
| Max. Negotiated Rate |
$10,917.40 |
| Rate for Payer: Adventist Health Commercial |
$2,426.09
|
| Rate for Payer: Blue Shield of California Commercial |
$9,728.61
|
| Rate for Payer: Blue Shield of California EPN |
$6,113.74
|
| Rate for Payer: Cash Price |
$5,458.70
|
| Rate for Payer: Central Health Plan Commercial |
$9,704.35
|
| Rate for Payer: Cigna of CA HMO |
$8,491.31
|
| Rate for Payer: Cigna of CA PPO |
$8,491.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,491.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,852.18
|
| Rate for Payer: EPIC Health Plan Senior |
$4,852.18
|
| Rate for Payer: Galaxy Health WC |
$10,310.87
|
| Rate for Payer: Global Benefits Group Commercial |
$7,278.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,917.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,702.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,156.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,426.09
|
| Rate for Payer: Multiplan Commercial |
$9,097.83
|
| Rate for Payer: Networks By Design Commercial |
$6,065.22
|
| Rate for Payer: Prime Health Services Commercial |
$10,310.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,552.55
|
| Rate for Payer: United Healthcare All Other HMO |
$4,431.25
|
| Rate for Payer: United Healthcare HMO Rider |
$4,335.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,972.72
|
|
|
VEDOLIZUMAB 300 MG INTRAVENOUS SOLUTION [205964]
|
Facility
|
OP
|
$12,130.44
|
|
|
Service Code
|
HCPCS J3380
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.62 |
| Max. Negotiated Rate |
$10,917.40 |
| Rate for Payer: Adventist Health Commercial |
$2,426.09
|
| Rate for Payer: Adventist Health Medi-Cal |
$21.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.70
|
| Rate for Payer: Blue Shield of California Commercial |
$38.14
|
| Rate for Payer: Blue Shield of California EPN |
$34.67
|
| Rate for Payer: Cash Price |
$5,458.70
|
| Rate for Payer: Cash Price |
$5,458.70
|
| Rate for Payer: Central Health Plan Commercial |
$9,704.35
|
| Rate for Payer: Cigna of CA HMO |
$8,491.31
|
| Rate for Payer: Cigna of CA PPO |
$8,491.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,491.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.67
|
| Rate for Payer: EPIC Health Plan Senior |
$23.78
|
| Rate for Payer: Galaxy Health WC |
$10,310.87
|
| Rate for Payer: Global Benefits Group Commercial |
$7,278.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,917.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$35.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,702.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,426.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28.97
|
| Rate for Payer: Multiplan Commercial |
$9,097.83
|
| Rate for Payer: Networks By Design Commercial |
$6,065.22
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$21.62
|
| Rate for Payer: Prime Health Services Commercial |
$10,310.87
|
| Rate for Payer: Prime Health Services Medicare |
$22.92
|
| Rate for Payer: Riverside University Health System MISP |
$23.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,278.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,278.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,552.55
|
| Rate for Payer: United Healthcare All Other HMO |
$4,431.25
|
| Rate for Payer: United Healthcare HMO Rider |
$4,335.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,972.72
|
| Rate for Payer: Upland Medical Group Pediatric |
$21.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.78
|
| Rate for Payer: Vantage Medical Group Senior |
$23.78
|
|
|
VEIN LIGATION AND STRIPPING
|
Facility
|
IP
|
$80,467.71
|
|
|
Service Code
|
MSDRG 263
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$80,467.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$80,467.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$51,978.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72,772.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$71,064.53
|
| Rate for Payer: EPIC Health Plan Senior |
$47,376.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$43,069.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$60,297.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57,713.01
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$43,069.41
|
| Rate for Payer: Prime Health Services Medicare |
$45,653.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
VENETOCLAX 100 MG TABLET [214191]
|
Facility
|
IP
|
$160.89
|
|
|
Service Code
|
NDC 0074057622
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$32.18 |
| Max. Negotiated Rate |
$144.80 |
| Rate for Payer: Adventist Health Commercial |
$32.18
|
| Rate for Payer: Blue Shield of California Commercial |
$129.03
|
| Rate for Payer: Blue Shield of California EPN |
$81.09
|
| Rate for Payer: Cash Price |
$72.40
|
| Rate for Payer: Central Health Plan Commercial |
$128.71
|
| Rate for Payer: Cigna of CA HMO |
$112.62
|
| Rate for Payer: Cigna of CA PPO |
$112.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$112.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.36
|
| Rate for Payer: EPIC Health Plan Senior |
$64.36
|
| Rate for Payer: Galaxy Health WC |
$136.76
|
| Rate for Payer: Global Benefits Group Commercial |
$96.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$144.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$102.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$94.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.18
|
| Rate for Payer: Multiplan Commercial |
$120.67
|
| Rate for Payer: Networks By Design Commercial |
$104.58
|
| Rate for Payer: Prime Health Services Commercial |
$136.76
|
|
|
VENETOCLAX 100 MG TABLET [214191]
|
Facility
|
OP
|
$160.89
|
|
|
Service Code
|
NDC 0074057622
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$32.18 |
| Max. Negotiated Rate |
$144.80 |
| Rate for Payer: Adventist Health Commercial |
$32.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$136.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$120.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$77.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.59
|
| Rate for Payer: Blue Shield of California Commercial |
$102.00
|
| Rate for Payer: Blue Shield of California EPN |
$64.20
|
| Rate for Payer: Cash Price |
$72.40
|
| Rate for Payer: Central Health Plan Commercial |
$128.71
|
| Rate for Payer: Cigna of CA HMO |
$112.62
|
| Rate for Payer: Cigna of CA PPO |
$112.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$136.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$136.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$112.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.36
|
| Rate for Payer: EPIC Health Plan Senior |
$64.36
|
| Rate for Payer: Galaxy Health WC |
$136.76
|
| Rate for Payer: Global Benefits Group Commercial |
$96.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$144.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$102.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$94.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$112.62
|
| Rate for Payer: Multiplan Commercial |
$120.67
|
| Rate for Payer: Networks By Design Commercial |
$104.58
|
| Rate for Payer: Prime Health Services Commercial |
$136.76
|
| Rate for Payer: Riverside University Health System MISP |
$64.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$96.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$96.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$80.44
|
| Rate for Payer: United Healthcare All Other HMO |
$80.44
|
| Rate for Payer: United Healthcare HMO Rider |
$80.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$80.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$136.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.76
|
| Rate for Payer: Vantage Medical Group Senior |
$136.76
|
|
|
VENLAFAXINE 100 MG TABLET [12205]
|
Facility
|
IP
|
$0.46
|
|
|
Service Code
|
NDC 6838210101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Central Health Plan Commercial |
$0.37
|
| Rate for Payer: Cigna of CA HMO |
$0.32
|
| Rate for Payer: Cigna of CA PPO |
$0.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Health Management Network EPO/PPO |
$0.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| 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 6838210101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.28
|
| 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 Exchange |
$0.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.27
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Central Health Plan Commercial |
$0.37
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Health Management Network EPO/PPO |
$0.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: Networks By Design Commercial |
$0.30
|
| Rate for Payer: Prime Health Services Commercial |
$0.39
|
| Rate for Payer: Riverside University Health System MISP |
$0.18
|
| 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
|
IP
|
$1.44
|
|
|
Service Code
|
NDC 6808489625
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$1.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.73
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Central Health Plan Commercial |
$1.15
|
| Rate for Payer: Cigna of CA HMO |
$1.01
|
| Rate for Payer: Cigna of CA PPO |
$1.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Senior |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$1.08
|
| Rate for Payer: Networks By Design Commercial |
$0.94
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
|
|
VENLAFAXINE 25 MG TABLET [12203]
|
Facility
|
IP
|
$1.44
|
|
|
Service Code
|
NDC 6808489695
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$1.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.73
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Central Health Plan Commercial |
$1.15
|
| Rate for Payer: Cigna of CA HMO |
$1.01
|
| Rate for Payer: Cigna of CA PPO |
$1.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Senior |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$1.08
|
| Rate for Payer: Networks By Design Commercial |
$0.94
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
|
|
VENLAFAXINE 25 MG TABLET [12203]
|
Facility
|
OP
|
$1.44
|
|
|
Service Code
|
NDC 6808489625
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.84
|
| Rate for Payer: Blue Shield of California Commercial |
$0.91
|
| Rate for Payer: Blue Shield of California EPN |
$0.57
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Central Health Plan Commercial |
$1.15
|
| Rate for Payer: Cigna of CA HMO |
$1.01
|
| Rate for Payer: Cigna of CA PPO |
$1.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Senior |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.01
|
| Rate for Payer: Multiplan Commercial |
$1.08
|
| Rate for Payer: Networks By Design Commercial |
$0.94
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
| Rate for Payer: Riverside University Health System MISP |
$0.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.72
|
| Rate for Payer: United Healthcare All Other HMO |
$0.72
|
| Rate for Payer: United Healthcare HMO Rider |
$0.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.22
|
| Rate for Payer: Vantage Medical Group Senior |
$1.22
|
|
|
VENLAFAXINE 25 MG TABLET [12203]
|
Facility
|
OP
|
$1.44
|
|
|
Service Code
|
NDC 6808489695
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.84
|
| Rate for Payer: Blue Shield of California Commercial |
$0.91
|
| Rate for Payer: Blue Shield of California EPN |
$0.57
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Central Health Plan Commercial |
$1.15
|
| Rate for Payer: Cigna of CA HMO |
$1.01
|
| Rate for Payer: Cigna of CA PPO |
$1.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Senior |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.01
|
| Rate for Payer: Multiplan Commercial |
$1.08
|
| Rate for Payer: Networks By Design Commercial |
$0.94
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
| Rate for Payer: Riverside University Health System MISP |
$0.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.72
|
| Rate for Payer: United Healthcare All Other HMO |
$0.72
|
| Rate for Payer: United Healthcare HMO Rider |
$0.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.22
|
| Rate for Payer: Vantage Medical Group Senior |
$1.22
|
|
|
VENLAFAXINE 37.5 MG TABLET [12207]
|
Facility
|
OP
|
$1.03
|
|
|
Service Code
|
NDC 6808484401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.60
|
| Rate for Payer: Blue Shield of California Commercial |
$0.65
|
| Rate for Payer: Blue Shield of California EPN |
$0.41
|
| Rate for Payer: Cash Price |
$0.46
|
| Rate for Payer: Central Health Plan Commercial |
$0.82
|
| Rate for Payer: Cigna of CA HMO |
$0.72
|
| Rate for Payer: Cigna of CA PPO |
$0.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.41
|
| Rate for Payer: EPIC Health Plan Senior |
$0.41
|
| Rate for Payer: Galaxy Health WC |
$0.88
|
| Rate for Payer: Global Benefits Group Commercial |
$0.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$0.77
|
| Rate for Payer: Networks By Design Commercial |
$0.67
|
| Rate for Payer: Prime Health Services Commercial |
$0.88
|
| Rate for Payer: Riverside University Health System MISP |
$0.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.52
|
| Rate for Payer: United Healthcare All Other HMO |
$0.52
|
| Rate for Payer: United Healthcare HMO Rider |
$0.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.88
|
| Rate for Payer: Vantage Medical Group Senior |
$0.88
|
|
|
VENLAFAXINE 37.5 MG TABLET [12207]
|
Facility
|
IP
|
$0.40
|
|
|
Service Code
|
NDC 5766439388
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Central Health Plan Commercial |
$0.32
|
| Rate for Payer: Cigna of CA HMO |
$0.28
|
| Rate for Payer: Cigna of CA PPO |
$0.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Senior |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.30
|
| Rate for Payer: Networks By Design Commercial |
$0.26
|
| Rate for Payer: Prime Health Services Commercial |
$0.34
|
|
|
VENLAFAXINE 37.5 MG TABLET [12207]
|
Facility
|
IP
|
$1.03
|
|
|
Service Code
|
NDC 6808484411
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California Commercial |
$0.83
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Cash Price |
$0.46
|
| Rate for Payer: Central Health Plan Commercial |
$0.82
|
| Rate for Payer: Cigna of CA HMO |
$0.72
|
| Rate for Payer: Cigna of CA PPO |
$0.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.41
|
| Rate for Payer: EPIC Health Plan Senior |
$0.41
|
| Rate for Payer: Galaxy Health WC |
$0.88
|
| Rate for Payer: Global Benefits Group Commercial |
$0.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.77
|
| Rate for Payer: Networks By Design Commercial |
$0.67
|
| Rate for Payer: Prime Health Services Commercial |
$0.88
|
|
|
VENLAFAXINE 37.5 MG TABLET [12207]
|
Facility
|
OP
|
$0.40
|
|
|
Service Code
|
NDC 5766439388
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.23
|
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Central Health Plan Commercial |
$0.32
|
| Rate for Payer: Cigna of CA HMO |
$0.28
|
| Rate for Payer: Cigna of CA PPO |
$0.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Senior |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$0.30
|
| Rate for Payer: Networks By Design Commercial |
$0.26
|
| Rate for Payer: Prime Health Services Commercial |
$0.34
|
| Rate for Payer: Riverside University Health System MISP |
$0.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.20
|
| Rate for Payer: United Healthcare All Other HMO |
$0.20
|
| Rate for Payer: United Healthcare HMO Rider |
$0.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Vantage Medical Group Senior |
$0.34
|
|
|
VENLAFAXINE 37.5 MG TABLET [12207]
|
Facility
|
IP
|
$1.03
|
|
|
Service Code
|
NDC 6808484401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California Commercial |
$0.83
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Cash Price |
$0.46
|
| Rate for Payer: Central Health Plan Commercial |
$0.82
|
| Rate for Payer: Cigna of CA HMO |
$0.72
|
| Rate for Payer: Cigna of CA PPO |
$0.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.41
|
| Rate for Payer: EPIC Health Plan Senior |
$0.41
|
| Rate for Payer: Galaxy Health WC |
$0.88
|
| Rate for Payer: Global Benefits Group Commercial |
$0.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.77
|
| Rate for Payer: Networks By Design Commercial |
$0.67
|
| Rate for Payer: Prime Health Services Commercial |
$0.88
|
|
|
VENLAFAXINE 37.5 MG TABLET [12207]
|
Facility
|
OP
|
$1.03
|
|
|
Service Code
|
NDC 6808484411
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.60
|
| Rate for Payer: Blue Shield of California Commercial |
$0.65
|
| Rate for Payer: Blue Shield of California EPN |
$0.41
|
| Rate for Payer: Cash Price |
$0.46
|
| Rate for Payer: Central Health Plan Commercial |
$0.82
|
| Rate for Payer: Cigna of CA HMO |
$0.72
|
| Rate for Payer: Cigna of CA PPO |
$0.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.41
|
| Rate for Payer: EPIC Health Plan Senior |
$0.41
|
| Rate for Payer: Galaxy Health WC |
$0.88
|
| Rate for Payer: Global Benefits Group Commercial |
$0.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$0.77
|
| Rate for Payer: Networks By Design Commercial |
$0.67
|
| Rate for Payer: Prime Health Services Commercial |
$0.88
|
| Rate for Payer: Riverside University Health System MISP |
$0.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.52
|
| Rate for Payer: United Healthcare All Other HMO |
$0.52
|
| Rate for Payer: United Healthcare HMO Rider |
$0.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.88
|
| Rate for Payer: Vantage Medical Group Senior |
$0.88
|
|
