|
VIT E-GLYCERIN-DIMETHICONE LOTION [115875]
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 0299391808
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
VITRECTOMY, MECHANICAL, PARS PLANA APPROACH;
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 67036
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$409.82 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,316.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,974.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,847.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,316.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$8,144.17
|
| Rate for Payer: Blue Shield of California Commercial |
$6,228.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,974.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,847.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,316.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,771.85
|
| Rate for Payer: EPIC Health Plan Senior |
$5,847.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8,718.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$409.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,316.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$452.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,442.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7,123.80
|
| Rate for Payer: Multiplan WC |
$8,144.17
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5,316.27
|
| Rate for Payer: Preferred Health Network WC |
$8,310.38
|
| Rate for Payer: Prime Health Services Medicare |
$5,635.25
|
| Rate for Payer: Prime Health Services WC |
$8,061.07
|
| Rate for Payer: Riverside University Health System MISP |
$5,847.90
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$5,316.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,974.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,847.90
|
| Rate for Payer: Vantage Medical Group Senior |
$5,316.27
|
|
|
VITRECTOMY, MECHANICAL, PARS PLANA APPROACH; WITH ENDOLASER PANRETINAL PHOTOCOAGULATION
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 67040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$297.77 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,316.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,974.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,847.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,316.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$8,144.17
|
| Rate for Payer: Blue Shield of California Commercial |
$9,831.25
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,974.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,847.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,316.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,771.85
|
| Rate for Payer: EPIC Health Plan Senior |
$5,847.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8,718.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$297.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,316.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$328.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,442.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7,123.80
|
| Rate for Payer: Multiplan WC |
$8,144.17
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5,316.27
|
| Rate for Payer: Preferred Health Network WC |
$8,310.38
|
| Rate for Payer: Prime Health Services Medicare |
$5,635.25
|
| Rate for Payer: Prime Health Services WC |
$8,061.07
|
| Rate for Payer: Riverside University Health System MISP |
$5,847.90
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$5,316.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,974.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,847.90
|
| Rate for Payer: Vantage Medical Group Senior |
$5,316.27
|
|
|
VITRECTOMY, MECHANICAL, PARS PLANA APPROACH; WITH FOCAL ENDOLASER PHOTOCOAGULATION
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 67039
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,177.21 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,316.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,974.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,847.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,316.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$8,144.17
|
| Rate for Payer: Blue Shield of California Commercial |
$9,831.25
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,974.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,847.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,316.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,771.85
|
| Rate for Payer: EPIC Health Plan Senior |
$5,847.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8,718.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,177.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,316.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,405.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,442.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7,123.80
|
| Rate for Payer: Multiplan WC |
$8,144.17
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5,316.27
|
| Rate for Payer: Preferred Health Network WC |
$8,310.38
|
| Rate for Payer: Prime Health Services Medicare |
$5,635.25
|
| Rate for Payer: Prime Health Services WC |
$8,061.07
|
| Rate for Payer: Riverside University Health System MISP |
$5,847.90
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$5,316.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,974.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,847.90
|
| Rate for Payer: Vantage Medical Group Senior |
$5,316.27
|
|
|
VITRECTOMY, MECHANICAL, PARS PLANA APPROACH; WITH REMOVAL OF INTERNAL LIMITING MEMBRANE OF RETINA (EG, FOR REPAIR OF MACULAR HOLE, DIABETIC MACULAR EDEMA), INCLUDES, IF PERFORMED, INTRAOCULAR TAMPONADE (IE, AIR, GAS OR SILICONE OIL)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 67042
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$324.01 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Adventist Health Medi-Cal |
$5,316.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,974.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,847.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,316.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$8,144.17
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,974.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,847.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,316.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,771.85
|
| Rate for Payer: EPIC Health Plan Senior |
$5,847.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8,718.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$324.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,316.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$357.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,442.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7,123.80
|
| Rate for Payer: Multiplan WC |
$8,144.17
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5,316.27
|
| Rate for Payer: Preferred Health Network WC |
$8,310.38
|
| Rate for Payer: Prime Health Services Medicare |
$5,635.25
|
| Rate for Payer: Prime Health Services WC |
$8,061.07
|
| Rate for Payer: Riverside University Health System MISP |
$5,847.90
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$5,316.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,974.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,847.90
|
| Rate for Payer: Vantage Medical Group Senior |
$5,316.27
|
|
|
VITRECTOMY, MECHANICAL, PARS PLANA APPROACH; WITH REMOVAL OF PRERETINAL CELLULAR MEMBRANE (EG, MACULAR PUCKER)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 67041
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,415.84 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,316.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,974.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,847.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,316.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$8,144.17
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,974.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,847.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,316.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,771.85
|
| Rate for Payer: EPIC Health Plan Senior |
$5,847.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8,718.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,415.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,316.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,564.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,442.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7,123.80
|
| Rate for Payer: Multiplan WC |
$8,144.17
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5,316.27
|
| Rate for Payer: Preferred Health Network WC |
$8,310.38
|
| Rate for Payer: Prime Health Services Medicare |
$5,635.25
|
| Rate for Payer: Prime Health Services WC |
$8,061.07
|
| Rate for Payer: Riverside University Health System MISP |
$5,847.90
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$5,316.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,974.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,847.90
|
| Rate for Payer: Vantage Medical Group Senior |
$5,316.27
|
|
|
VORICONAZOLE 200 MG/5 ML (40 MG/ML) ORAL SUSPENSION [38103]
|
Facility
|
IP
|
$12.83
|
|
|
Service Code
|
NDC 6516291322
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$11.55 |
| Rate for Payer: Adventist Health Commercial |
$2.57
|
| Rate for Payer: Blue Shield of California Commercial |
$10.29
|
| Rate for Payer: Blue Shield of California EPN |
$6.47
|
| Rate for Payer: Cash Price |
$5.77
|
| Rate for Payer: Central Health Plan Commercial |
$10.26
|
| Rate for Payer: Cigna of CA HMO |
$8.98
|
| Rate for Payer: Cigna of CA PPO |
$8.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.13
|
| Rate for Payer: EPIC Health Plan Senior |
$5.13
|
| Rate for Payer: Galaxy Health WC |
$10.91
|
| Rate for Payer: Global Benefits Group Commercial |
$7.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.57
|
| Rate for Payer: Multiplan Commercial |
$9.62
|
| Rate for Payer: Networks By Design Commercial |
$8.34
|
| Rate for Payer: Prime Health Services Commercial |
$10.91
|
|
|
VORICONAZOLE 200 MG/5 ML (40 MG/ML) ORAL SUSPENSION [38103]
|
Facility
|
OP
|
$9.82
|
|
|
Service Code
|
NDC 0049316044
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$8.84 |
| Rate for Payer: Adventist Health Commercial |
$1.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.71
|
| Rate for Payer: Blue Shield of California Commercial |
$6.23
|
| Rate for Payer: Blue Shield of California EPN |
$3.92
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: Central Health Plan Commercial |
$7.86
|
| Rate for Payer: Cigna of CA HMO |
$6.87
|
| Rate for Payer: Cigna of CA PPO |
$6.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3.93
|
| Rate for Payer: Galaxy Health WC |
$8.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.87
|
| Rate for Payer: Multiplan Commercial |
$7.37
|
| Rate for Payer: Networks By Design Commercial |
$6.38
|
| Rate for Payer: Prime Health Services Commercial |
$8.35
|
| Rate for Payer: Riverside University Health System MISP |
$3.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.91
|
| Rate for Payer: United Healthcare All Other HMO |
$4.91
|
| Rate for Payer: United Healthcare HMO Rider |
$4.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.35
|
| Rate for Payer: Vantage Medical Group Senior |
$8.35
|
|
|
VORICONAZOLE 200 MG/5 ML (40 MG/ML) ORAL SUSPENSION [38103]
|
Facility
|
OP
|
$12.83
|
|
|
Service Code
|
NDC 6516291322
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$11.55 |
| Rate for Payer: Adventist Health Commercial |
$2.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.46
|
| Rate for Payer: Blue Shield of California Commercial |
$8.13
|
| Rate for Payer: Blue Shield of California EPN |
$5.12
|
| Rate for Payer: Cash Price |
$5.77
|
| Rate for Payer: Central Health Plan Commercial |
$10.26
|
| Rate for Payer: Cigna of CA HMO |
$8.98
|
| Rate for Payer: Cigna of CA PPO |
$8.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.13
|
| Rate for Payer: EPIC Health Plan Senior |
$5.13
|
| Rate for Payer: Galaxy Health WC |
$10.91
|
| Rate for Payer: Global Benefits Group Commercial |
$7.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.98
|
| Rate for Payer: Multiplan Commercial |
$9.62
|
| Rate for Payer: Networks By Design Commercial |
$8.34
|
| Rate for Payer: Prime Health Services Commercial |
$10.91
|
| Rate for Payer: Riverside University Health System MISP |
$5.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.42
|
| Rate for Payer: United Healthcare All Other HMO |
$6.42
|
| Rate for Payer: United Healthcare HMO Rider |
$6.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.91
|
| Rate for Payer: Vantage Medical Group Senior |
$10.91
|
|
|
VORICONAZOLE 200 MG/5 ML (40 MG/ML) ORAL SUSPENSION [38103]
|
Facility
|
IP
|
$9.82
|
|
|
Service Code
|
NDC 0049316044
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$8.84 |
| Rate for Payer: Adventist Health Commercial |
$1.96
|
| Rate for Payer: Blue Shield of California Commercial |
$7.88
|
| Rate for Payer: Blue Shield of California EPN |
$4.95
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: Central Health Plan Commercial |
$7.86
|
| Rate for Payer: Cigna of CA HMO |
$6.87
|
| Rate for Payer: Cigna of CA PPO |
$6.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3.93
|
| Rate for Payer: Galaxy Health WC |
$8.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.96
|
| Rate for Payer: Multiplan Commercial |
$7.37
|
| Rate for Payer: Networks By Design Commercial |
$6.38
|
| Rate for Payer: Prime Health Services Commercial |
$8.35
|
|
|
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 |
$65.12 |
| Rate for Payer: Adventist Health Commercial |
$14.47
|
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Adventist Health Commercial |
$17.58
|
| Rate for Payer: Blue Shield of California Commercial |
$38.50
|
| Rate for Payer: Blue Shield of California Commercial |
$70.49
|
| Rate for Payer: Blue Shield of California Commercial |
$58.03
|
| Rate for Payer: Blue Shield of California Commercial |
$33.68
|
| Rate for Payer: Blue Shield of California Commercial |
$57.74
|
| Rate for Payer: Blue Shield of California EPN |
$36.47
|
| Rate for Payer: Blue Shield of California EPN |
$24.19
|
| Rate for Payer: Blue Shield of California EPN |
$44.30
|
| Rate for Payer: Blue Shield of California EPN |
$36.29
|
| Rate for Payer: Blue Shield of California EPN |
$21.17
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$32.56
|
| Rate for Payer: Cash Price |
$39.55
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Central Health Plan Commercial |
$70.31
|
| Rate for Payer: Central Health Plan Commercial |
$38.40
|
| Rate for Payer: Central Health Plan Commercial |
$33.60
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: Central Health Plan Commercial |
$57.89
|
| Rate for Payer: Cigna of CA HMO |
$61.52
|
| 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 |
$50.65
|
| Rate for Payer: Cigna of CA PPO |
$33.60
|
| Rate for Payer: Cigna of CA PPO |
$29.40
|
| Rate for Payer: Cigna of CA PPO |
$61.52
|
| Rate for Payer: Cigna of CA PPO |
$50.65
|
| Rate for Payer: Cigna of CA PPO |
$50.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$50.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$50.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.80
|
| 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 |
$28.80
|
| Rate for Payer: EPIC Health Plan Senior |
$28.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16.80
|
| Rate for Payer: EPIC Health Plan Senior |
$19.20
|
| Rate for Payer: EPIC Health Plan Senior |
$35.16
|
| Rate for Payer: EPIC Health Plan Senior |
$28.94
|
| Rate for Payer: Galaxy Health WC |
$61.51
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Galaxy Health WC |
$74.71
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.73
|
| Rate for Payer: Global Benefits Group Commercial |
$43.42
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$65.12
|
| 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 Commercial/Self Funded |
$45.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.81
|
| 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 |
$8.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.47
|
| Rate for Payer: Multiplan Commercial |
$65.92
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$54.27
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| 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 |
$36.18
|
| Rate for Payer: Networks By Design Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$36.00
|
| 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 |
$61.20
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Prime Health Services Commercial |
$61.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.99
|
| 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 |
$27.16
|
| Rate for Payer: United Healthcare All Other HMO |
$26.30
|
| 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 |
$26.43
|
| Rate for Payer: United Healthcare All Other HMO |
$32.11
|
| 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 |
$17.16
|
| Rate for Payer: United Healthcare HMO Rider |
$25.86
|
| 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 |
$15.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.58
|
|
|
VORICONAZOLE 200 MG INTRAVENOUS POWDER FOR SOLUTION [33010]
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS J3465
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Adventist Health Commercial |
$14.47
|
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Adventist Health Commercial |
$17.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.34
|
| 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 |
$39.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$54.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.50
|
| 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: Anthem Blue Cross of CA Exchange |
$9.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.37
|
| Rate for Payer: Blue Shield of California Commercial |
$3.94
|
| Rate for Payer: Blue Shield of California Commercial |
$3.94
|
| Rate for Payer: Blue Shield of California Commercial |
$3.94
|
| Rate for Payer: Blue Shield of California Commercial |
$3.94
|
| Rate for Payer: Blue Shield of California Commercial |
$3.94
|
| Rate for Payer: Blue Shield of California EPN |
$3.58
|
| Rate for Payer: Blue Shield of California EPN |
$3.58
|
| Rate for Payer: Blue Shield of California EPN |
$3.58
|
| Rate for Payer: Blue Shield of California EPN |
$3.58
|
| Rate for Payer: Blue Shield of California EPN |
$3.58
|
| 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 |
$39.55
|
| Rate for Payer: Cash Price |
$32.56
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$32.56
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$39.55
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: Central Health Plan Commercial |
$33.60
|
| Rate for Payer: Central Health Plan Commercial |
$57.89
|
| Rate for Payer: Central Health Plan Commercial |
$38.40
|
| Rate for Payer: Central Health Plan Commercial |
$70.31
|
| 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 HMO |
$50.65
|
| Rate for Payer: Cigna of CA HMO |
$50.40
|
| 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 |
$50.40
|
| Rate for Payer: Cigna of CA PPO |
$50.65
|
| Rate for Payer: Cigna of CA PPO |
$29.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$61.51
|
| 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 |
$74.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$61.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$61.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$74.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$61.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$50.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$50.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.80
|
| 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 |
$28.80
|
| Rate for Payer: EPIC Health Plan Senior |
$28.80
|
| Rate for Payer: EPIC Health Plan Senior |
$19.20
|
| 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: Galaxy Health WC |
$61.20
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Galaxy Health WC |
$61.51
|
| Rate for Payer: Galaxy Health WC |
$74.71
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Global Benefits Group Commercial |
$43.42
|
| Rate for Payer: Global Benefits Group Commercial |
$52.73
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$65.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.80
|
| 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 |
$45.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.67
|
| 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 |
$55.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.14
|
| 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 Medi-Cal |
$15.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$61.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$50.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$50.65
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$65.92
|
| Rate for Payer: Multiplan Commercial |
$54.27
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: Networks By Design Commercial |
$21.00
|
| Rate for Payer: Networks By Design Commercial |
$36.18
|
| Rate for Payer: Networks By Design Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$43.95
|
| Rate for Payer: Networks By Design Commercial |
$36.00
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Prime Health Services Commercial |
$61.51
|
| Rate for Payer: Prime Health Services Commercial |
$74.71
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: Riverside University Health System MISP |
$35.16
|
| Rate for Payer: Riverside University Health System MISP |
$28.80
|
| Rate for Payer: Riverside University Health System MISP |
$16.80
|
| Rate for Payer: Riverside University Health System MISP |
$28.94
|
| Rate for Payer: Riverside University Health System MISP |
$19.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.80
|
| 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: TriValley Medical Group Commercial/Senior |
$28.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.01
|
| Rate for Payer: United Healthcare All Other HMO |
$17.53
|
| 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 |
$26.30
|
| Rate for Payer: United Healthcare All Other HMO |
$32.11
|
| Rate for Payer: United Healthcare HMO Rider |
$25.73
|
| Rate for Payer: United Healthcare HMO Rider |
$25.86
|
| 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 Select/Navigate/Core |
$23.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.71
|
| Rate for Payer: Vantage Medical Group Senior |
$61.51
|
| 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 |
$74.71
|
| Rate for Payer: Vantage Medical Group Senior |
$35.70
|
|
|
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 |
$8.10 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.47
|
| 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 Exchange |
$4.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.24
|
| Rate for Payer: Blue Shield of California Commercial |
$5.71
|
| Rate for Payer: Blue Shield of California EPN |
$3.59
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Central Health Plan Commercial |
$7.20
|
| 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: Health Management Network EPO/PPO |
$8.10
|
| 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 |
$1.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$6.75
|
| Rate for Payer: Networks By Design Commercial |
$5.85
|
| Rate for Payer: Prime Health Services Commercial |
$7.65
|
| Rate for Payer: Riverside University Health System MISP |
$3.60
|
| 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 |
$19.29 |
| Rate for Payer: Adventist Health Commercial |
$4.29
|
| Rate for Payer: Blue Shield of California Commercial |
$17.19
|
| Rate for Payer: Blue Shield of California EPN |
$10.80
|
| Rate for Payer: Cash Price |
$9.64
|
| Rate for Payer: Central Health Plan Commercial |
$17.14
|
| 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: Health Management Network EPO/PPO |
$19.29
|
| 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 |
$4.29
|
| Rate for Payer: Multiplan Commercial |
$16.07
|
| 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 |
$8.10 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.47
|
| 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 Exchange |
$4.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.24
|
| Rate for Payer: Blue Shield of California Commercial |
$5.71
|
| Rate for Payer: Blue Shield of California EPN |
$3.59
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Central Health Plan Commercial |
$7.20
|
| 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: Health Management Network EPO/PPO |
$8.10
|
| 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 |
$1.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$6.75
|
| Rate for Payer: Networks By Design Commercial |
$5.85
|
| Rate for Payer: Prime Health Services Commercial |
$7.65
|
| Rate for Payer: Riverside University Health System MISP |
$3.60
|
| 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
|
$9.00
|
|
|
Service Code
|
NDC 4354737803
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7.22
|
| Rate for Payer: Blue Shield of California EPN |
$4.54
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Central Health Plan Commercial |
$7.20
|
| 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: Health Management Network EPO/PPO |
$8.10
|
| 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 |
$1.80
|
| Rate for Payer: Multiplan Commercial |
$6.75
|
| 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 6846257330
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7.22
|
| Rate for Payer: Blue Shield of California EPN |
$4.54
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Central Health Plan Commercial |
$7.20
|
| 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: Health Management Network EPO/PPO |
$8.10
|
| 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 |
$1.80
|
| Rate for Payer: Multiplan Commercial |
$6.75
|
| 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 |
$8.10 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.47
|
| 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 Exchange |
$4.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.24
|
| Rate for Payer: Blue Shield of California Commercial |
$5.71
|
| Rate for Payer: Blue Shield of California EPN |
$3.59
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Central Health Plan Commercial |
$7.20
|
| 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: Health Management Network EPO/PPO |
$8.10
|
| 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 |
$1.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$6.75
|
| Rate for Payer: Networks By Design Commercial |
$5.85
|
| Rate for Payer: Prime Health Services Commercial |
$7.65
|
| Rate for Payer: Riverside University Health System MISP |
$3.60
|
| 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
|
$9.00
|
|
|
Service Code
|
NDC 6586289230
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7.22
|
| Rate for Payer: Blue Shield of California EPN |
$4.54
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Central Health Plan Commercial |
$7.20
|
| 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: Health Management Network EPO/PPO |
$8.10
|
| 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 |
$1.80
|
| Rate for Payer: Multiplan Commercial |
$6.75
|
| 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
|
$21.43
|
|
|
Service Code
|
NDC 5026880312
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$19.29 |
| Rate for Payer: Adventist Health Commercial |
$4.29
|
| Rate for Payer: Blue Shield of California Commercial |
$17.19
|
| Rate for Payer: Blue Shield of California EPN |
$10.80
|
| Rate for Payer: Cash Price |
$9.64
|
| Rate for Payer: Central Health Plan Commercial |
$17.14
|
| 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: Health Management Network EPO/PPO |
$19.29
|
| 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 |
$4.29
|
| Rate for Payer: Multiplan Commercial |
$16.07
|
| 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
|
$21.43
|
|
|
Service Code
|
NDC 5026880311
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$19.29 |
| Rate for Payer: Adventist Health Commercial |
$4.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.01
|
| 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 Exchange |
$10.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.47
|
| Rate for Payer: Blue Shield of California Commercial |
$13.59
|
| Rate for Payer: Blue Shield of California EPN |
$8.55
|
| Rate for Payer: Cash Price |
$9.64
|
| Rate for Payer: Central Health Plan Commercial |
$17.14
|
| 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: Health Management Network EPO/PPO |
$19.29
|
| 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 |
$4.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$16.07
|
| Rate for Payer: Networks By Design Commercial |
$13.93
|
| Rate for Payer: Prime Health Services Commercial |
$18.22
|
| Rate for Payer: Riverside University Health System MISP |
$8.57
|
| 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
|
OP
|
$21.43
|
|
|
Service Code
|
NDC 5026880312
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$19.29 |
| Rate for Payer: Adventist Health Commercial |
$4.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.01
|
| 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 Exchange |
$10.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.47
|
| Rate for Payer: Blue Shield of California Commercial |
$13.59
|
| Rate for Payer: Blue Shield of California EPN |
$8.55
|
| Rate for Payer: Cash Price |
$9.64
|
| Rate for Payer: Central Health Plan Commercial |
$17.14
|
| 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: Health Management Network EPO/PPO |
$19.29
|
| 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 |
$4.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$16.07
|
| Rate for Payer: Networks By Design Commercial |
$13.93
|
| Rate for Payer: Prime Health Services Commercial |
$18.22
|
| Rate for Payer: Riverside University Health System MISP |
$8.57
|
| 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 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 |
$2.34 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California Commercial |
$2.09
|
| Rate for Payer: Blue Shield of California EPN |
$1.31
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Central Health Plan Commercial |
$2.08
|
| 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: Health Management Network EPO/PPO |
$2.34
|
| 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 |
$0.52
|
| Rate for Payer: Multiplan Commercial |
$1.95
|
| 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 4354737703
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.58
|
| 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 Exchange |
$1.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.51
|
| Rate for Payer: Blue Shield of California Commercial |
$1.65
|
| Rate for Payer: Blue Shield of California EPN |
$1.04
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Central Health Plan Commercial |
$2.08
|
| 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: Health Management Network EPO/PPO |
$2.34
|
| 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 |
$0.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.82
|
| Rate for Payer: Multiplan Commercial |
$1.95
|
| Rate for Payer: Networks By Design Commercial |
$1.69
|
| Rate for Payer: Prime Health Services Commercial |
$2.21
|
| Rate for Payer: Riverside University Health System MISP |
$1.04
|
| 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
|
OP
|
$2.60
|
|
|
Service Code
|
NDC 6846257230
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.58
|
| 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 Exchange |
$1.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.51
|
| Rate for Payer: Blue Shield of California Commercial |
$1.65
|
| Rate for Payer: Blue Shield of California EPN |
$1.04
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Central Health Plan Commercial |
$2.08
|
| 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: Health Management Network EPO/PPO |
$2.34
|
| 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 |
$0.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.82
|
| Rate for Payer: Multiplan Commercial |
$1.95
|
| Rate for Payer: Networks By Design Commercial |
$1.69
|
| Rate for Payer: Prime Health Services Commercial |
$2.21
|
| Rate for Payer: Riverside University Health System MISP |
$1.04
|
| 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
|
|
