|
VERTIGO AND OTHER LABYRINTH DISORDERS
|
Facility
IP
|
$6,468.26
|
|
|
Service Code
|
APR-DRG 1111
|
| Min. Negotiated Rate |
$5,427.91 |
| Max. Negotiated Rate |
$6,468.26 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,427.91
|
| Rate for Payer: IEHP medi-cal |
$6,468.26
|
|
|
VERTIGO AND OTHER LABYRINTH DISORDERS
|
Facility
IP
|
$8,972.26
|
|
|
Service Code
|
APR-DRG 1113
|
| Min. Negotiated Rate |
$7,529.17 |
| Max. Negotiated Rate |
$8,972.26 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,529.17
|
| Rate for Payer: IEHP medi-cal |
$8,972.26
|
|
|
Vestibuloplasty; complex (including ridge extension, muscle repositioning)
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 40845
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,755.97 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,316.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,017.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$10,003.24
|
| Rate for Payer: Blue Shield of California Commercial |
$6,621.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,755.97
|
| Rate for Payer: Caremore Medicare Advantage |
$7,316.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,877.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,316.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,999.72
|
| Rate for Payer: IEHP medi-cal |
$12,072.88
|
| Rate for Payer: IEHP Medicare Advantage |
$7,316.90
|
| Rate for Payer: Innovage PACE Commercial |
$10,975.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,316.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,804.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,804.65
|
| Rate for Payer: Multiplan WC |
$10,003.24
|
| Rate for Payer: Preferred Health Network WC |
$10,207.39
|
| Rate for Payer: Prime Health Services Medicare |
$7,755.91
|
| Rate for Payer: Prime Health Services WC |
$9,901.17
|
| Rate for Payer: Riverside University Health MISP |
$8,048.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
Vestibuloplasty; posterior, unilateral
|
Facility
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 40842
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,316.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$10,003.24
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$7,316.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,877.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,316.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,999.72
|
| Rate for Payer: IEHP medi-cal |
$12,072.88
|
| Rate for Payer: IEHP Medicare Advantage |
$7,316.90
|
| Rate for Payer: Innovage PACE Commercial |
$10,975.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,316.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,804.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,804.65
|
| Rate for Payer: Multiplan WC |
$10,003.24
|
| Rate for Payer: Preferred Health Network WC |
$10,207.39
|
| Rate for Payer: Prime Health Services Medicare |
$7,755.91
|
| Rate for Payer: Prime Health Services WC |
$9,901.17
|
| Rate for Payer: Riverside University Health MISP |
$8,048.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
VILAZODONE 20 MG TABLET [109403]
|
Facility
OP
|
$6.13
|
|
|
Service Code
|
NDC 60505-4773-3
|
| Hospital Charge Code |
1712642
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$5.52 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.62
|
| Rate for Payer: BCBS Transplant Transplant |
$3.68
|
| Rate for Payer: Blue Shield of California Commercial |
$3.86
|
| Rate for Payer: Blue Shield of California EPN |
$3.00
|
| Rate for Payer: Cash Price |
$2.76
|
| Rate for Payer: Central Health Plan Commercial |
$4.90
|
| Rate for Payer: Cigna of CA HMO |
$4.29
|
| Rate for Payer: Cigna of CA PPO |
$4.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.45
|
| Rate for Payer: Galaxy Health WC |
$5.21
|
| Rate for Payer: Global Benefits Group Commercial |
$3.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.52
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.60
|
| Rate for Payer: IEHP medi-cal |
$2.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.23
|
| Rate for Payer: Multiplan Commercial |
$4.60
|
| Rate for Payer: Networks By Design Commercial |
$3.98
|
| Rate for Payer: Prime Health Services Commercial |
$5.21
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.68
|
| Rate for Payer: Riverside University Health MISP |
$2.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.06
|
| Rate for Payer: United Healthcare All Other HMO |
$3.06
|
| Rate for Payer: United Healthcare HMO Rider |
$3.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.21
|
| Rate for Payer: Vantage Medical Group Senior |
$5.21
|
|
|
VILAZODONE 20 MG TABLET [109403]
|
Facility
IP
|
$6.13
|
|
|
Service Code
|
NDC 60505-4773-3
|
| Hospital Charge Code |
1712642
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$5.52 |
| Rate for Payer: Blue Shield of California Commercial |
$4.60
|
| Rate for Payer: Blue Shield of California EPN |
$3.27
|
| Rate for Payer: Cash Price |
$2.76
|
| Rate for Payer: Central Health Plan Commercial |
$4.90
|
| Rate for Payer: Cigna of CA HMO |
$4.29
|
| Rate for Payer: Cigna of CA PPO |
$4.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.45
|
| Rate for Payer: Galaxy Health WC |
$5.21
|
| Rate for Payer: Global Benefits Group Commercial |
$3.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.23
|
| Rate for Payer: Multiplan Commercial |
$4.60
|
| Rate for Payer: Networks By Design Commercial |
$3.98
|
| Rate for Payer: Prime Health Services Commercial |
$5.21
|
|
|
VINBLASTINE 1 MG/ML INTRAVENOUS SOLUTION [8594]
|
Facility
IP
|
$5.66
|
|
|
Service Code
|
CPT J9360
|
| Hospital Charge Code |
NDG8594
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$5.09 |
| Rate for Payer: Blue Shield of California Commercial |
$4.24
|
| Rate for Payer: Blue Shield of California EPN |
$3.02
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Central Health Plan Commercial |
$4.53
|
| Rate for Payer: Cigna of CA HMO |
$3.96
|
| Rate for Payer: Cigna of CA PPO |
$3.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.26
|
| Rate for Payer: Galaxy Health WC |
$4.81
|
| Rate for Payer: Global Benefits Group Commercial |
$3.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.13
|
| Rate for Payer: Multiplan Commercial |
$4.24
|
| Rate for Payer: Networks By Design Commercial |
$2.83
|
| Rate for Payer: Prime Health Services Commercial |
$4.81
|
|
|
VINBLASTINE 1 MG/ML INTRAVENOUS SOLUTION [8594]
|
Facility
OP
|
$5.66
|
|
|
Service Code
|
CPT J9360
|
| Hospital Charge Code |
NDG8594
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$26.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$26.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.81
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.71
|
| Rate for Payer: BCBS Transplant Transplant |
$3.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5.69
|
| Rate for Payer: Blue Shield of California EPN |
$5.17
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Central Health Plan Commercial |
$4.53
|
| Rate for Payer: Cigna of CA HMO |
$3.96
|
| Rate for Payer: Cigna of CA PPO |
$3.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.26
|
| Rate for Payer: Galaxy Health WC |
$4.81
|
| Rate for Payer: Global Benefits Group Commercial |
$3.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.09
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.24
|
| Rate for Payer: IEHP medi-cal |
$3.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.13
|
| Rate for Payer: Multiplan Commercial |
$4.24
|
| Rate for Payer: Networks By Design Commercial |
$2.83
|
| Rate for Payer: Prime Health Services Commercial |
$4.81
|
| Rate for Payer: Riverside University Health MISP |
$2.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.83
|
| Rate for Payer: United Healthcare All Other HMO |
$2.83
|
| Rate for Payer: United Healthcare HMO Rider |
$2.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.81
|
| Rate for Payer: Vantage Medical Group Senior |
$4.81
|
|
|
VINCRISTINE 1 MG/ML INTRAVENOUS SOLUTION [8597]
|
Facility
IP
|
$19.37
|
|
|
Service Code
|
NDC 61703-309-06
|
| Hospital Charge Code |
1755769
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.87 |
| Max. Negotiated Rate |
$17.43 |
| Rate for Payer: Blue Shield of California Commercial |
$14.53
|
| Rate for Payer: Blue Shield of California EPN |
$10.34
|
| Rate for Payer: Cash Price |
$8.72
|
| Rate for Payer: Central Health Plan Commercial |
$15.50
|
| Rate for Payer: Cigna of CA HMO |
$13.56
|
| Rate for Payer: Cigna of CA PPO |
$13.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.75
|
| Rate for Payer: Galaxy Health WC |
$16.46
|
| Rate for Payer: Global Benefits Group Commercial |
$11.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.87
|
| Rate for Payer: Multiplan Commercial |
$14.53
|
| Rate for Payer: Networks By Design Commercial |
$9.68
|
| Rate for Payer: Prime Health Services Commercial |
$16.46
|
|
|
VINCRISTINE 1 MG/ML INTRAVENOUS SOLUTION [8597]
|
Facility
OP
|
$19.37
|
|
|
Service Code
|
NDC 61703-309-06
|
| Hospital Charge Code |
1755769
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.87 |
| Max. Negotiated Rate |
$17.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.44
|
| Rate for Payer: BCBS Transplant Transplant |
$11.62
|
| Rate for Payer: Blue Shield of California Commercial |
$12.18
|
| Rate for Payer: Blue Shield of California EPN |
$9.47
|
| Rate for Payer: Cash Price |
$8.72
|
| Rate for Payer: Cash Price |
$8.72
|
| Rate for Payer: Central Health Plan Commercial |
$15.50
|
| Rate for Payer: Cigna of CA HMO |
$13.56
|
| Rate for Payer: Cigna of CA PPO |
$13.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.75
|
| Rate for Payer: Galaxy Health WC |
$16.46
|
| Rate for Payer: Global Benefits Group Commercial |
$11.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.43
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14.53
|
| Rate for Payer: IEHP medi-cal |
$6.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.87
|
| Rate for Payer: Multiplan Commercial |
$14.53
|
| Rate for Payer: Networks By Design Commercial |
$9.68
|
| Rate for Payer: Prime Health Services Commercial |
$16.46
|
| Rate for Payer: Riverside University Health MISP |
$7.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.68
|
| Rate for Payer: United Healthcare All Other HMO |
$9.68
|
| Rate for Payer: United Healthcare HMO Rider |
$9.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.46
|
| Rate for Payer: Vantage Medical Group Senior |
$16.46
|
|
|
VINCRISTINE 2 MG/2 ML INTRAVENOUS SOLUTION [120009]
|
Facility
OP
|
$8.39
|
|
|
Service Code
|
CPT J9370
|
| Hospital Charge Code |
1755094
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$72.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$47.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$66.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.47
|
| Rate for Payer: BCBS Transplant Transplant |
$5.03
|
| Rate for Payer: Blue Shield of California Commercial |
$7.32
|
| Rate for Payer: Blue Shield of California EPN |
$6.66
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Central Health Plan Commercial |
$6.71
|
| Rate for Payer: Cigna of CA HMO |
$5.87
|
| Rate for Payer: Cigna of CA PPO |
$5.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.36
|
| Rate for Payer: Galaxy Health WC |
$7.13
|
| Rate for Payer: Global Benefits Group Commercial |
$5.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.55
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.29
|
| Rate for Payer: IEHP medi-cal |
$8.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.68
|
| Rate for Payer: Multiplan Commercial |
$6.29
|
| Rate for Payer: Networks By Design Commercial |
$4.20
|
| Rate for Payer: Prime Health Services Commercial |
$7.13
|
| Rate for Payer: Riverside University Health MISP |
$3.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Other HMO |
$4.20
|
| Rate for Payer: United Healthcare HMO Rider |
$4.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Senior |
$7.13
|
|
|
VINCRISTINE 2 MG/2 ML INTRAVENOUS SOLUTION [120009]
|
Facility
IP
|
$8.39
|
|
|
Service Code
|
CPT J9370
|
| Hospital Charge Code |
1755094
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$7.55 |
| Rate for Payer: Blue Shield of California Commercial |
$6.29
|
| Rate for Payer: Blue Shield of California EPN |
$4.48
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Central Health Plan Commercial |
$6.71
|
| Rate for Payer: Cigna of CA HMO |
$5.87
|
| Rate for Payer: Cigna of CA PPO |
$5.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.36
|
| Rate for Payer: Galaxy Health WC |
$7.13
|
| Rate for Payer: Global Benefits Group Commercial |
$5.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.68
|
| Rate for Payer: Multiplan Commercial |
$6.29
|
| Rate for Payer: Networks By Design Commercial |
$4.20
|
| Rate for Payer: Prime Health Services Commercial |
$7.13
|
|
|
VINCRISTINE SULFATE LIPOSOMAL 5 MG/31 ML(0.16 MG/ML)(FINAL CONC)IV KIT [201456]
|
Facility
IP
|
$20,636.03
|
|
|
Service Code
|
NDC 72893-008-03
|
| Hospital Charge Code |
ERX201456
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,127.21 |
| Max. Negotiated Rate |
$18,572.43 |
| Rate for Payer: Blue Shield of California Commercial |
$15,477.02
|
| Rate for Payer: Blue Shield of California EPN |
$11,019.64
|
| Rate for Payer: Cash Price |
$9,286.21
|
| Rate for Payer: Central Health Plan Commercial |
$16,508.82
|
| Rate for Payer: Cigna of CA HMO |
$14,445.22
|
| Rate for Payer: Cigna of CA PPO |
$14,445.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,254.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,254.41
|
| Rate for Payer: Galaxy Health WC |
$17,540.63
|
| Rate for Payer: Global Benefits Group Commercial |
$12,381.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,572.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,764.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,127.21
|
| Rate for Payer: Multiplan Commercial |
$15,477.02
|
| Rate for Payer: Networks By Design Commercial |
$10,318.02
|
| Rate for Payer: Prime Health Services Commercial |
$17,540.63
|
|
|
VINCRISTINE SULFATE LIPOSOMAL 5 MG/31 ML(0.16 MG/ML)(FINAL CONC)IV KIT [201456]
|
Facility
OP
|
$20,636.03
|
|
|
Service Code
|
NDC 72893-008-03
|
| Hospital Charge Code |
ERX201456
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,127.21 |
| Max. Negotiated Rate |
$18,572.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,532.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17,540.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11,349.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11,349.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9,991.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,191.77
|
| Rate for Payer: BCBS Transplant Transplant |
$12,381.62
|
| Rate for Payer: Blue Shield of California Commercial |
$12,980.06
|
| Rate for Payer: Blue Shield of California EPN |
$10,091.02
|
| Rate for Payer: Cash Price |
$9,286.21
|
| Rate for Payer: Cash Price |
$9,286.21
|
| Rate for Payer: Central Health Plan Commercial |
$16,508.82
|
| Rate for Payer: Cigna of CA HMO |
$14,445.22
|
| Rate for Payer: Cigna of CA PPO |
$14,445.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17,540.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,254.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,254.41
|
| Rate for Payer: Galaxy Health WC |
$17,540.63
|
| Rate for Payer: Global Benefits Group Commercial |
$12,381.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,572.43
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15,477.02
|
| Rate for Payer: IEHP medi-cal |
$7,222.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,764.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,127.21
|
| Rate for Payer: Multiplan Commercial |
$15,477.02
|
| Rate for Payer: Networks By Design Commercial |
$10,318.02
|
| Rate for Payer: Prime Health Services Commercial |
$17,540.63
|
| Rate for Payer: Riverside University Health MISP |
$8,254.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,381.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12,381.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,318.02
|
| Rate for Payer: United Healthcare All Other HMO |
$10,318.02
|
| Rate for Payer: United Healthcare HMO Rider |
$10,318.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10,318.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,540.63
|
| Rate for Payer: Vantage Medical Group Senior |
$17,540.63
|
|
|
VINORELBINE 10 MG/ML INTRAVENOUS SOLUTION [14203]
|
Facility
OP
|
$30.00
|
|
|
Service Code
|
CPT J9390
|
| Hospital Charge Code |
NDG14203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$206.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$45.96
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$188.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.60
|
| Rate for Payer: BCBS Transplant Transplant |
$18.00
|
| Rate for Payer: Blue Shield of California Commercial |
$22.44
|
| Rate for Payer: Blue Shield of California EPN |
$20.40
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: Cigna of CA HMO |
$21.00
|
| Rate for Payer: Cigna of CA PPO |
$21.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$22.50
|
| Rate for Payer: IEHP medi-cal |
$8.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$15.00
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Riverside University Health MISP |
$12.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15.00
|
| Rate for Payer: United Healthcare HMO Rider |
$15.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.50
|
| Rate for Payer: Vantage Medical Group Senior |
$25.50
|
|
|
VINORELBINE 10 MG/ML INTRAVENOUS SOLUTION [14203]
|
Facility
IP
|
$30.00
|
|
|
Service Code
|
CPT J9390
|
| Hospital Charge Code |
NDG14203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Blue Shield of California Commercial |
$22.50
|
| Rate for Payer: Blue Shield of California EPN |
$16.02
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: Cigna of CA HMO |
$21.00
|
| Rate for Payer: Cigna of CA PPO |
$21.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$15.00
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
|
|
VINORELBINE 50 MG/5 ML INTRAVENOUS SOLUTION [41673]
|
Facility
IP
|
$20.40
|
|
|
Service Code
|
CPT J9390
|
| Hospital Charge Code |
1755671
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Blue Shield of California Commercial |
$15.30
|
| Rate for Payer: Blue Shield of California Commercial |
$16.20
|
| Rate for Payer: Blue Shield of California EPN |
$11.53
|
| Rate for Payer: Blue Shield of California EPN |
$10.89
|
| Rate for Payer: Cash Price |
$9.18
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Central Health Plan Commercial |
$16.32
|
| Rate for Payer: Central Health Plan Commercial |
$17.28
|
| Rate for Payer: Cigna of CA HMO |
$14.28
|
| Rate for Payer: Cigna of CA HMO |
$15.12
|
| Rate for Payer: Cigna of CA PPO |
$15.12
|
| Rate for Payer: Cigna of CA PPO |
$14.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.16
|
| Rate for Payer: Galaxy Health WC |
$18.36
|
| Rate for Payer: Galaxy Health WC |
$17.34
|
| Rate for Payer: Global Benefits Group Commercial |
$12.24
|
| Rate for Payer: Global Benefits Group Commercial |
$12.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: Multiplan Commercial |
$16.20
|
| Rate for Payer: Multiplan Commercial |
$15.30
|
| Rate for Payer: Networks By Design Commercial |
$10.20
|
| Rate for Payer: Networks By Design Commercial |
$10.80
|
| Rate for Payer: Prime Health Services Commercial |
$17.34
|
| Rate for Payer: Prime Health Services Commercial |
$18.36
|
|
|
VINORELBINE 50 MG/5 ML INTRAVENOUS SOLUTION [41673]
|
Facility
OP
|
$21.60
|
|
|
Service Code
|
CPT J9390
|
| Hospital Charge Code |
1755671
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.32 |
| Max. Negotiated Rate |
$206.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$45.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.96
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.88
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$188.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$188.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.60
|
| Rate for Payer: BCBS Transplant Transplant |
$12.24
|
| Rate for Payer: BCBS Transplant Transplant |
$12.96
|
| Rate for Payer: Blue Shield of California Commercial |
$22.44
|
| Rate for Payer: Blue Shield of California Commercial |
$22.44
|
| Rate for Payer: Blue Shield of California EPN |
$20.40
|
| Rate for Payer: Blue Shield of California EPN |
$20.40
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cash Price |
$9.18
|
| Rate for Payer: Cash Price |
$9.18
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Central Health Plan Commercial |
$17.28
|
| Rate for Payer: Central Health Plan Commercial |
$16.32
|
| Rate for Payer: Cigna of CA HMO |
$14.28
|
| Rate for Payer: Cigna of CA HMO |
$15.12
|
| Rate for Payer: Cigna of CA PPO |
$14.28
|
| Rate for Payer: Cigna of CA PPO |
$15.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.64
|
| Rate for Payer: Galaxy Health WC |
$18.36
|
| Rate for Payer: Galaxy Health WC |
$17.34
|
| Rate for Payer: Global Benefits Group Commercial |
$12.96
|
| Rate for Payer: Global Benefits Group Commercial |
$12.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.44
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$16.20
|
| Rate for Payer: IEHP medi-cal |
$8.20
|
| Rate for Payer: IEHP medi-cal |
$8.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: Multiplan Commercial |
$15.30
|
| Rate for Payer: Multiplan Commercial |
$16.20
|
| Rate for Payer: Networks By Design Commercial |
$10.20
|
| Rate for Payer: Networks By Design Commercial |
$10.80
|
| Rate for Payer: Prime Health Services Commercial |
$18.36
|
| Rate for Payer: Prime Health Services Commercial |
$17.34
|
| Rate for Payer: Riverside University Health MISP |
$8.16
|
| Rate for Payer: Riverside University Health MISP |
$8.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.20
|
| Rate for Payer: United Healthcare All Other HMO |
$10.80
|
| Rate for Payer: United Healthcare All Other HMO |
$10.20
|
| Rate for Payer: United Healthcare HMO Rider |
$10.20
|
| Rate for Payer: United Healthcare HMO Rider |
$10.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.36
|
| Rate for Payer: Vantage Medical Group Senior |
$17.34
|
| Rate for Payer: Vantage Medical Group Senior |
$18.36
|
|
|
VIRAL ILLNESS
|
Facility
IP
|
$18,158.10
|
|
|
Service Code
|
APR-DRG 7234
|
| Min. Negotiated Rate |
$15,237.56 |
| Max. Negotiated Rate |
$18,158.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$15,237.56
|
| Rate for Payer: IEHP medi-cal |
$18,158.10
|
|
|
VIRAL ILLNESS
|
Facility
IP
|
$9,192.51
|
|
|
Service Code
|
APR-DRG 7233
|
| Min. Negotiated Rate |
$7,714.00 |
| Max. Negotiated Rate |
$9,192.51 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,714.00
|
| Rate for Payer: IEHP medi-cal |
$9,192.51
|
|
|
VIRAL ILLNESS
|
Facility
IP
|
$6,125.22
|
|
|
Service Code
|
APR-DRG 7232
|
| Min. Negotiated Rate |
$5,140.04 |
| Max. Negotiated Rate |
$6,125.22 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,140.04
|
| Rate for Payer: IEHP medi-cal |
$6,125.22
|
|
|
VIRAL ILLNESS
|
Facility
IP
|
$4,293.93
|
|
|
Service Code
|
APR-DRG 7231
|
| Min. Negotiated Rate |
$3,603.30 |
| Max. Negotiated Rate |
$4,293.93 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,603.30
|
| Rate for Payer: IEHP medi-cal |
$4,293.93
|
|
|
VIRAL MENINGITIS
|
Facility
IP
|
$27,876.51
|
|
|
Service Code
|
APR-DRG 0514
|
| Min. Negotiated Rate |
$23,392.87 |
| Max. Negotiated Rate |
$27,876.51 |
| Rate for Payer: Adventist Health Medi-Cal |
$23,392.87
|
| Rate for Payer: IEHP medi-cal |
$27,876.51
|
|
|
VIRAL MENINGITIS
|
Facility
IP
|
$8,434.35
|
|
|
Service Code
|
APR-DRG 0512
|
| Min. Negotiated Rate |
$7,077.78 |
| Max. Negotiated Rate |
$8,434.35 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,077.78
|
| Rate for Payer: IEHP medi-cal |
$8,434.35
|
|
|
VIRAL MENINGITIS
|
Facility
IP
|
$5,600.67
|
|
|
Service Code
|
APR-DRG 0511
|
| Min. Negotiated Rate |
$4,699.86 |
| Max. Negotiated Rate |
$5,600.67 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,699.86
|
| Rate for Payer: IEHP medi-cal |
$5,600.67
|
|
