|
VORICONAZOLE 200 MG INTRAVENOUS SOLUTION [33010]
|
Facility
OP
|
$72.00
|
|
|
Service Code
|
CPT J3465
|
| Hospital Charge Code |
1753462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$35.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$152.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$61.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$23.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$98.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$39.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$39.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$23.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$98.96
|
| 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 |
$9.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.97
|
| Rate for Payer: BCBS Transplant Transplant |
$43.20
|
| Rate for Payer: BCBS Transplant Transplant |
$25.20
|
| Rate for Payer: BCBS Transplant Transplant |
$107.96
|
| Rate for Payer: Blue Shield of California Commercial |
$3.96
|
| Rate for Payer: Blue Shield of California Commercial |
$3.96
|
| Rate for Payer: Blue Shield of California Commercial |
$3.96
|
| Rate for Payer: Blue Shield of California EPN |
$3.60
|
| Rate for Payer: Blue Shield of California EPN |
$3.60
|
| Rate for Payer: Blue Shield of California EPN |
$3.60
|
| Rate for Payer: Cash Price |
$80.97
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$80.97
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Central Health Plan Commercial |
$33.60
|
| Rate for Payer: Central Health Plan Commercial |
$143.94
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$50.40
|
| Rate for Payer: Cigna of CA HMO |
$29.40
|
| Rate for Payer: Cigna of CA HMO |
$125.95
|
| Rate for Payer: Cigna of CA PPO |
$50.40
|
| Rate for Payer: Cigna of CA PPO |
$125.95
|
| Rate for Payer: Cigna of CA PPO |
$29.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$152.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$28.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$71.97
|
| Rate for Payer: Galaxy Health WC |
$152.94
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Global Benefits Group Commercial |
$107.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$161.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$31.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$134.95
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$54.00
|
| Rate for Payer: IEHP medi-cal |
$0.70
|
| Rate for Payer: IEHP medi-cal |
$0.70
|
| Rate for Payer: IEHP medi-cal |
$0.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.99
|
| 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: Multiplan Commercial |
$31.50
|
| Rate for Payer: Multiplan Commercial |
$134.95
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: Networks By Design Commercial |
$21.00
|
| Rate for Payer: Networks By Design Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$89.96
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: Prime Health Services Commercial |
$152.94
|
| Rate for Payer: Riverside University Health MISP |
$16.80
|
| Rate for Payer: Riverside University Health MISP |
$71.97
|
| Rate for Payer: Riverside University Health MISP |
$28.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$107.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$107.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$89.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.00
|
| Rate for Payer: United Healthcare All Other HMO |
$36.00
|
| Rate for Payer: United Healthcare All Other HMO |
$89.96
|
| Rate for Payer: United Healthcare All Other HMO |
$21.00
|
| Rate for Payer: United Healthcare HMO Rider |
$36.00
|
| Rate for Payer: United Healthcare HMO Rider |
$21.00
|
| Rate for Payer: United Healthcare HMO Rider |
$89.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$152.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61.20
|
| Rate for Payer: Vantage Medical Group Senior |
$35.70
|
| Rate for Payer: Vantage Medical Group Senior |
$152.94
|
| Rate for Payer: Vantage Medical Group Senior |
$61.20
|
|
|
VORICONAZOLE 200 MG INTRAVENOUS SOLUTION [33010]
|
Facility
IP
|
$72.00
|
|
|
Service Code
|
CPT J3465
|
| Hospital Charge Code |
1753462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Blue Shield of California Commercial |
$54.00
|
| Rate for Payer: Blue Shield of California Commercial |
$134.95
|
| Rate for Payer: Blue Shield of California Commercial |
$31.50
|
| Rate for Payer: Blue Shield of California EPN |
$38.45
|
| Rate for Payer: Blue Shield of California EPN |
$96.08
|
| Rate for Payer: Blue Shield of California EPN |
$22.43
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$80.97
|
| Rate for Payer: Central Health Plan Commercial |
$33.60
|
| Rate for Payer: Central Health Plan Commercial |
$143.94
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$125.95
|
| Rate for Payer: Cigna of CA HMO |
$29.40
|
| Rate for Payer: Cigna of CA HMO |
$50.40
|
| Rate for Payer: Cigna of CA PPO |
$29.40
|
| Rate for Payer: Cigna of CA PPO |
$50.40
|
| Rate for Payer: Cigna of CA PPO |
$125.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$71.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$28.80
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Galaxy Health WC |
$152.94
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| 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 |
$107.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$161.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: Multiplan Commercial |
$134.95
|
| Rate for Payer: Networks By Design Commercial |
$21.00
|
| Rate for Payer: Networks By Design Commercial |
$89.96
|
| Rate for Payer: Networks By Design Commercial |
$36.00
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Prime Health Services Commercial |
$152.94
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
|
|
VORICONAZOLE 200 MG TABLET [33009]
|
Facility
IP
|
$4.47
|
|
|
Service Code
|
NDC 0049-3180-30
|
| Hospital Charge Code |
1711820
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Blue Shield of California Commercial |
$3.35
|
| Rate for Payer: Blue Shield of California EPN |
$2.39
|
| Rate for Payer: Cash Price |
$2.01
|
| Rate for Payer: Central Health Plan Commercial |
$3.58
|
| Rate for Payer: Cigna of CA HMO |
$3.13
|
| Rate for Payer: Cigna of CA PPO |
$3.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.79
|
| Rate for Payer: Galaxy Health WC |
$3.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.89
|
| Rate for Payer: Multiplan Commercial |
$3.35
|
| Rate for Payer: Networks By Design Commercial |
$2.91
|
| Rate for Payer: Prime Health Services Commercial |
$3.80
|
|
|
VORICONAZOLE 200 MG TABLET [33009]
|
Facility
OP
|
$9.00
|
|
|
Service Code
|
NDC 68462-573-30
|
| Hospital Charge Code |
1711820
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.32
|
| Rate for Payer: BCBS Transplant Transplant |
$5.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5.66
|
| Rate for Payer: Blue Shield of California EPN |
$4.40
|
| 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: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$6.75
|
| Rate for Payer: IEHP medi-cal |
$3.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.00
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.40
|
| Rate for Payer: Riverside University Health 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 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 68462-573-30
|
| Hospital Charge Code |
1711820
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Blue Shield of California Commercial |
$6.75
|
| Rate for Payer: Blue Shield of California EPN |
$4.81
|
| 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: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$6.00
|
| 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
|
$4.47
|
|
|
Service Code
|
NDC 0049-3180-30
|
| Hospital Charge Code |
1711820
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.46
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.64
|
| Rate for Payer: BCBS Transplant Transplant |
$2.68
|
| Rate for Payer: Blue Shield of California Commercial |
$2.81
|
| Rate for Payer: Blue Shield of California EPN |
$2.19
|
| Rate for Payer: Cash Price |
$2.01
|
| Rate for Payer: Central Health Plan Commercial |
$3.58
|
| Rate for Payer: Cigna of CA HMO |
$3.13
|
| Rate for Payer: Cigna of CA PPO |
$3.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.79
|
| Rate for Payer: Galaxy Health WC |
$3.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.35
|
| Rate for Payer: IEHP medi-cal |
$1.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.89
|
| Rate for Payer: Multiplan Commercial |
$3.35
|
| Rate for Payer: Networks By Design Commercial |
$2.91
|
| Rate for Payer: Prime Health Services Commercial |
$3.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.68
|
| Rate for Payer: Riverside University Health MISP |
$1.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.24
|
| Rate for Payer: United Healthcare All Other HMO |
$2.24
|
| Rate for Payer: United Healthcare HMO Rider |
$2.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3.80
|
|
|
VORICONAZOLE 200 MG TABLET [33009]
|
Facility
OP
|
$9.00
|
|
|
Service Code
|
NDC 65862-892-30
|
| Hospital Charge Code |
1711820
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.32
|
| Rate for Payer: BCBS Transplant Transplant |
$5.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5.66
|
| Rate for Payer: Blue Shield of California EPN |
$4.40
|
| 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: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$6.75
|
| Rate for Payer: IEHP medi-cal |
$3.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.00
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.40
|
| Rate for Payer: Riverside University Health 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 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 65862-892-30
|
| Hospital Charge Code |
1711820
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Blue Shield of California Commercial |
$6.75
|
| Rate for Payer: Blue Shield of California EPN |
$4.81
|
| 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: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$6.00
|
| 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 50 MG TABLET [33008]
|
Facility
OP
|
$2.60
|
|
|
Service Code
|
NDC 68462-572-30
|
| Hospital Charge Code |
1711819
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.54
|
| Rate for Payer: BCBS Transplant Transplant |
$1.56
|
| Rate for Payer: Blue Shield of California Commercial |
$1.64
|
| Rate for Payer: Blue Shield of California EPN |
$1.27
|
| 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: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$1.95
|
| Rate for Payer: IEHP medi-cal |
$0.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.73
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.56
|
| Rate for Payer: Riverside University Health 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 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 27241-062-03
|
| Hospital Charge Code |
1711819
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.54
|
| Rate for Payer: BCBS Transplant Transplant |
$1.56
|
| Rate for Payer: Blue Shield of California Commercial |
$1.64
|
| Rate for Payer: Blue Shield of California EPN |
$1.27
|
| 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: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$1.95
|
| Rate for Payer: IEHP medi-cal |
$0.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.73
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.56
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$2.21
|
| Rate for Payer: Vantage Medical Group Senior |
$2.21
|
|
|
VORICONAZOLE 50 MG TABLET [33008]
|
Facility
IP
|
$2.60
|
|
|
Service Code
|
NDC 68462-572-30
|
| Hospital Charge Code |
1711819
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: Blue Shield of California Commercial |
$1.95
|
| Rate for Payer: Blue Shield of California EPN |
$1.39
|
| 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: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$1.73
|
| 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
IP
|
$2.60
|
|
|
Service Code
|
NDC 27241-062-03
|
| Hospital Charge Code |
1711819
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: Blue Shield of California Commercial |
$1.95
|
| Rate for Payer: Blue Shield of California EPN |
$1.39
|
| 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: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$1.73
|
| 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
|
|
|
VORINOSTAT 100 MG CAPSULE [77539]
|
Facility
IP
|
$150.10
|
|
|
Service Code
|
NDC 0006-0568-40
|
| Hospital Charge Code |
1711910
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$30.02 |
| Max. Negotiated Rate |
$135.09 |
| Rate for Payer: Blue Shield of California Commercial |
$112.58
|
| Rate for Payer: Blue Shield of California EPN |
$80.15
|
| Rate for Payer: Cash Price |
$67.55
|
| Rate for Payer: Central Health Plan Commercial |
$120.08
|
| Rate for Payer: Cigna of CA HMO |
$105.07
|
| Rate for Payer: Cigna of CA PPO |
$105.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.04
|
| Rate for Payer: Galaxy Health WC |
$127.58
|
| Rate for Payer: Global Benefits Group Commercial |
$90.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.02
|
| Rate for Payer: Multiplan Commercial |
$112.58
|
| Rate for Payer: Networks By Design Commercial |
$97.56
|
| Rate for Payer: Prime Health Services Commercial |
$127.58
|
|
|
VORINOSTAT 100 MG CAPSULE [77539]
|
Facility
OP
|
$150.10
|
|
|
Service Code
|
NDC 0006-0568-40
|
| Hospital Charge Code |
1711910
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$30.02 |
| Max. Negotiated Rate |
$135.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$91.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$127.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$82.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$82.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$72.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.68
|
| Rate for Payer: BCBS Transplant Transplant |
$90.06
|
| Rate for Payer: Blue Shield of California Commercial |
$94.41
|
| Rate for Payer: Blue Shield of California EPN |
$73.40
|
| Rate for Payer: Cash Price |
$67.55
|
| Rate for Payer: Central Health Plan Commercial |
$120.08
|
| Rate for Payer: Cigna of CA HMO |
$105.07
|
| Rate for Payer: Cigna of CA PPO |
$105.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$60.04
|
| Rate for Payer: Galaxy Health WC |
$127.58
|
| Rate for Payer: Global Benefits Group Commercial |
$90.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.09
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$112.58
|
| Rate for Payer: IEHP medi-cal |
$52.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.02
|
| Rate for Payer: Multiplan Commercial |
$112.58
|
| Rate for Payer: Networks By Design Commercial |
$97.56
|
| Rate for Payer: Prime Health Services Commercial |
$127.58
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$90.06
|
| Rate for Payer: Riverside University Health MISP |
$60.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.05
|
| Rate for Payer: United Healthcare All Other HMO |
$75.05
|
| Rate for Payer: United Healthcare HMO Rider |
$75.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$127.58
|
| Rate for Payer: Vantage Medical Group Senior |
$127.58
|
|
|
VORINOSTAT ORAL SUSPENSION COMPOUND 50 MG/ML [4080357]
|
Facility
OP
|
$49.35
|
|
|
Service Code
|
NDC 9994-0803-57
|
| Hospital Charge Code |
1715205
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.87 |
| Max. Negotiated Rate |
$44.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$29.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$41.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$27.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$27.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.16
|
| Rate for Payer: BCBS Transplant Transplant |
$29.61
|
| Rate for Payer: Blue Shield of California Commercial |
$31.04
|
| Rate for Payer: Blue Shield of California EPN |
$24.13
|
| Rate for Payer: Cash Price |
$22.21
|
| Rate for Payer: Central Health Plan Commercial |
$39.48
|
| Rate for Payer: Cigna of CA HMO |
$34.54
|
| Rate for Payer: Cigna of CA PPO |
$34.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$19.74
|
| Rate for Payer: Galaxy Health WC |
$41.95
|
| Rate for Payer: Global Benefits Group Commercial |
$29.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.42
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$37.01
|
| Rate for Payer: IEHP medi-cal |
$17.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.87
|
| Rate for Payer: Multiplan Commercial |
$37.01
|
| Rate for Payer: Networks By Design Commercial |
$32.08
|
| Rate for Payer: Prime Health Services Commercial |
$41.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$29.61
|
| Rate for Payer: Riverside University Health MISP |
$19.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.68
|
| Rate for Payer: United Healthcare All Other HMO |
$24.68
|
| Rate for Payer: United Healthcare HMO Rider |
$24.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.95
|
| Rate for Payer: Vantage Medical Group Senior |
$41.95
|
|
|
VORINOSTAT ORAL SUSPENSION COMPOUND 50 MG/ML [4080357]
|
Facility
IP
|
$49.35
|
|
|
Service Code
|
NDC 9994-0803-57
|
| Hospital Charge Code |
1715205
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.87 |
| Max. Negotiated Rate |
$44.42 |
| Rate for Payer: Blue Shield of California Commercial |
$37.01
|
| Rate for Payer: Blue Shield of California EPN |
$26.35
|
| Rate for Payer: Cash Price |
$22.21
|
| Rate for Payer: Central Health Plan Commercial |
$39.48
|
| Rate for Payer: Cigna of CA HMO |
$34.54
|
| Rate for Payer: Cigna of CA PPO |
$34.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.74
|
| Rate for Payer: Galaxy Health WC |
$41.95
|
| Rate for Payer: Global Benefits Group Commercial |
$29.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.87
|
| Rate for Payer: Multiplan Commercial |
$37.01
|
| Rate for Payer: Networks By Design Commercial |
$32.08
|
| Rate for Payer: Prime Health Services Commercial |
$41.95
|
|
|
VOXELOTOR 500 MG TABLET [226660]
|
Facility
OP
|
$152.38
|
|
|
Service Code
|
NDC 72786-101-01
|
| Hospital Charge Code |
ERX226660
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.48 |
| Max. Negotiated Rate |
$137.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$92.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$129.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$83.81
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$83.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$73.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.03
|
| Rate for Payer: BCBS Transplant Transplant |
$91.43
|
| Rate for Payer: Blue Shield of California Commercial |
$95.85
|
| Rate for Payer: Blue Shield of California EPN |
$74.51
|
| Rate for Payer: Cash Price |
$68.57
|
| Rate for Payer: Cash Price |
$68.57
|
| Rate for Payer: Central Health Plan Commercial |
$121.90
|
| Rate for Payer: Cigna of CA HMO |
$106.67
|
| Rate for Payer: Cigna of CA PPO |
$106.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$129.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$60.95
|
| Rate for Payer: Galaxy Health WC |
$129.52
|
| Rate for Payer: Global Benefits Group Commercial |
$91.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$137.14
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$114.28
|
| Rate for Payer: IEHP medi-cal |
$53.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.48
|
| Rate for Payer: Multiplan Commercial |
$114.28
|
| Rate for Payer: Networks By Design Commercial |
$76.19
|
| Rate for Payer: Prime Health Services Commercial |
$129.52
|
| Rate for Payer: Riverside University Health MISP |
$60.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.19
|
| Rate for Payer: United Healthcare All Other HMO |
$76.19
|
| Rate for Payer: United Healthcare HMO Rider |
$76.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.52
|
| Rate for Payer: Vantage Medical Group Senior |
$129.52
|
|
|
VOXELOTOR 500 MG TABLET [226660]
|
Facility
IP
|
$152.38
|
|
|
Service Code
|
NDC 72786-101-01
|
| Hospital Charge Code |
ERX226660
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.48 |
| Max. Negotiated Rate |
$137.14 |
| Rate for Payer: Blue Shield of California Commercial |
$114.28
|
| Rate for Payer: Blue Shield of California EPN |
$81.37
|
| Rate for Payer: Cash Price |
$68.57
|
| Rate for Payer: Central Health Plan Commercial |
$121.90
|
| Rate for Payer: Cigna of CA HMO |
$106.67
|
| Rate for Payer: Cigna of CA PPO |
$106.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$60.95
|
| Rate for Payer: Galaxy Health WC |
$129.52
|
| Rate for Payer: Global Benefits Group Commercial |
$91.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$137.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.48
|
| Rate for Payer: Multiplan Commercial |
$114.28
|
| Rate for Payer: Networks By Design Commercial |
$76.19
|
| Rate for Payer: Prime Health Services Commercial |
$129.52
|
|
|
Vulvectomy simple; partial
|
Facility
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 56620
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,906.18 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,906.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| 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: 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 |
$3,906.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,273.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,906.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,406.14
|
| Rate for Payer: IEHP medi-cal |
$6,445.20
|
| Rate for Payer: IEHP Medicare Advantage |
$3,906.18
|
| Rate for Payer: Innovage PACE Commercial |
$5,859.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,234.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,234.28
|
| Rate for Payer: Prime Health Services Medicare |
$4,140.55
|
| Rate for Payer: Riverside University Health MISP |
$4,296.80
|
| 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 |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
WARFARIN 0.5 MG PARTIAL TABLET [4081492]
|
Facility
IP
|
$0.26
|
|
|
Service Code
|
NDC 9994-0814-92
|
| Hospital Charge Code |
NDC4081492
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Central Health Plan Commercial |
$0.21
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.17
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
|
|
WARFARIN 0.5 MG PARTIAL TABLET [4081492]
|
Facility
OP
|
$0.26
|
|
|
Service Code
|
NDC 9994-0814-92
|
| Hospital Charge Code |
NDC4081492
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: BCBS Transplant Transplant |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Central Health Plan Commercial |
$0.21
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.23
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.20
|
| Rate for Payer: IEHP medi-cal |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.17
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: Riverside University Health MISP |
$0.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Vantage Medical Group Senior |
$0.22
|
|
|
WARFARIN 10 MG TABLET [8748]
|
Facility
OP
|
$0.73
|
|
|
Service Code
|
NDC 0832-1219-89
|
| Hospital Charge Code |
1710799
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.43
|
| Rate for Payer: BCBS Transplant Transplant |
$0.44
|
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Central Health Plan Commercial |
$0.58
|
| Rate for Payer: Cigna of CA HMO |
$0.51
|
| Rate for Payer: Cigna of CA PPO |
$0.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.62
|
| Rate for Payer: Global Benefits Group Commercial |
$0.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.66
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.55
|
| Rate for Payer: IEHP medi-cal |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.55
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.62
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.44
|
| Rate for Payer: Riverside University Health MISP |
$0.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.37
|
| Rate for Payer: United Healthcare All Other HMO |
$0.37
|
| Rate for Payer: United Healthcare HMO Rider |
$0.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.62
|
| Rate for Payer: Vantage Medical Group Senior |
$0.62
|
|
|
WARFARIN 10 MG TABLET [8748]
|
Facility
OP
|
$0.73
|
|
|
Service Code
|
NDC 0832-1219-01
|
| Hospital Charge Code |
1710799
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.43
|
| Rate for Payer: BCBS Transplant Transplant |
$0.44
|
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Central Health Plan Commercial |
$0.58
|
| Rate for Payer: Cigna of CA HMO |
$0.51
|
| Rate for Payer: Cigna of CA PPO |
$0.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.62
|
| Rate for Payer: Global Benefits Group Commercial |
$0.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.66
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.55
|
| Rate for Payer: IEHP medi-cal |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.55
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.62
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.44
|
| Rate for Payer: Riverside University Health MISP |
$0.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.37
|
| Rate for Payer: United Healthcare All Other HMO |
$0.37
|
| Rate for Payer: United Healthcare HMO Rider |
$0.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.62
|
| Rate for Payer: Vantage Medical Group Senior |
$0.62
|
|
|
WARFARIN 10 MG TABLET [8748]
|
Facility
IP
|
$0.73
|
|
|
Service Code
|
NDC 0832-1219-89
|
| Hospital Charge Code |
1710799
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Blue Shield of California Commercial |
$0.55
|
| Rate for Payer: Blue Shield of California EPN |
$0.39
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Central Health Plan Commercial |
$0.58
|
| Rate for Payer: Cigna of CA HMO |
$0.51
|
| Rate for Payer: Cigna of CA PPO |
$0.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.62
|
| Rate for Payer: Global Benefits Group Commercial |
$0.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.55
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.62
|
|
|
WARFARIN 10 MG TABLET [8748]
|
Facility
IP
|
$0.44
|
|
|
Service Code
|
NDC 0093-1720-01
|
| Hospital Charge Code |
1710799
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: Blue Shield of California Commercial |
$0.33
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Central Health Plan Commercial |
$0.35
|
| Rate for Payer: Cigna of CA HMO |
$0.31
|
| Rate for Payer: Cigna of CA PPO |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.33
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
|
