|
VALACYCLOVIR 500 MG TABLET [13133]
|
Facility
OP
|
$0.98
|
|
|
Service Code
|
NDC 31722-704-30
|
| Hospital Charge Code |
1710891
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.54
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.58
|
| Rate for Payer: BCBS Transplant Transplant |
$0.59
|
| Rate for Payer: Blue Shield of California Commercial |
$0.62
|
| Rate for Payer: Blue Shield of California EPN |
$0.48
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Central Health Plan Commercial |
$0.78
|
| Rate for Payer: Cigna of CA HMO |
$0.69
|
| Rate for Payer: Cigna of CA PPO |
$0.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.39
|
| Rate for Payer: Galaxy Health WC |
$0.83
|
| Rate for Payer: Global Benefits Group Commercial |
$0.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.88
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.74
|
| Rate for Payer: IEHP medi-cal |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.74
|
| Rate for Payer: Networks By Design Commercial |
$0.64
|
| Rate for Payer: Prime Health Services Commercial |
$0.83
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.59
|
| Rate for Payer: Riverside University Health MISP |
$0.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.49
|
| Rate for Payer: United Healthcare All Other HMO |
$0.49
|
| Rate for Payer: United Healthcare HMO Rider |
$0.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.83
|
| Rate for Payer: Vantage Medical Group Senior |
$0.83
|
|
|
VALACYCLOVIR 500 MG TABLET [13133]
|
Facility
IP
|
$0.98
|
|
|
Service Code
|
NDC 31722-704-90
|
| Hospital Charge Code |
1710891
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.74
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Central Health Plan Commercial |
$0.78
|
| Rate for Payer: Cigna of CA HMO |
$0.69
|
| Rate for Payer: Cigna of CA PPO |
$0.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.39
|
| Rate for Payer: Galaxy Health WC |
$0.83
|
| Rate for Payer: Global Benefits Group Commercial |
$0.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.74
|
| Rate for Payer: Networks By Design Commercial |
$0.64
|
| Rate for Payer: Prime Health Services Commercial |
$0.83
|
|
|
VALACYCLOVIR 500 MG TABLET [13133]
|
Facility
OP
|
$0.47
|
|
|
Service Code
|
NDC 0378-4275-77
|
| Hospital Charge Code |
1710891
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.28
|
| Rate for Payer: BCBS Transplant Transplant |
$0.28
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Central Health Plan Commercial |
$0.38
|
| Rate for Payer: Cigna of CA HMO |
$0.33
|
| Rate for Payer: Cigna of CA PPO |
$0.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$0.40
|
| Rate for Payer: Global Benefits Group Commercial |
$0.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.42
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.35
|
| Rate for Payer: IEHP medi-cal |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: Networks By Design Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.28
|
| Rate for Payer: Riverside University Health MISP |
$0.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO |
$0.24
|
| Rate for Payer: United Healthcare HMO Rider |
$0.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: Vantage Medical Group Senior |
$0.40
|
|
|
VALACYCLOVIR 500 MG TABLET [13133]
|
Facility
IP
|
$0.48
|
|
|
Service Code
|
NDC 0378-4275-93
|
| Hospital Charge Code |
1710891
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.38
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$0.41
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.36
|
| Rate for Payer: Networks By Design Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.41
|
|
|
VALACYCLOVIR ORAL SUSPENSION COMPOUND 50 MG/ML [4080355]
|
Facility
IP
|
$0.72
|
|
|
Service Code
|
NDC 9994-0803-55
|
| Hospital Charge Code |
1715245
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.54
|
| Rate for Payer: Blue Shield of California EPN |
$0.38
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Central Health Plan Commercial |
$0.58
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.61
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.61
|
|
|
VALACYCLOVIR ORAL SUSPENSION COMPOUND 50 MG/ML [4080355]
|
Facility
OP
|
$0.72
|
|
|
Service Code
|
NDC 9994-0803-55
|
| Hospital Charge Code |
1715245
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.61
|
| 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 |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Central Health Plan Commercial |
$0.58
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.61
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.65
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.54
|
| Rate for Payer: IEHP medi-cal |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.61
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.43
|
| Rate for Payer: Riverside University Health MISP |
$0.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.36
|
| Rate for Payer: United Healthcare All Other HMO |
$0.36
|
| Rate for Payer: United Healthcare HMO Rider |
$0.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.61
|
| Rate for Payer: Vantage Medical Group Senior |
$0.61
|
|
|
VALGANCICLOVIR 450 MG TABLET [30148]
|
Facility
IP
|
$20.19
|
|
|
Service Code
|
NDC 0603-6330-20
|
| Hospital Charge Code |
1712248
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$15.14
|
| Rate for Payer: Blue Shield of California EPN |
$10.78
|
| Rate for Payer: Cash Price |
$9.09
|
| Rate for Payer: Cash Price |
$9.09
|
| Rate for Payer: Central Health Plan Commercial |
$16.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.08
|
| Rate for Payer: Galaxy Health WC |
$17.16
|
| Rate for Payer: Global Benefits Group Commercial |
$12.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.04
|
| Rate for Payer: Multiplan Commercial |
$15.14
|
| Rate for Payer: Networks By Design Commercial |
$13.12
|
| Rate for Payer: Prime Health Services Commercial |
$17.16
|
|
|
VALGANCICLOVIR 450 MG TABLET [30148]
|
Facility
OP
|
$4.76
|
|
|
Service Code
|
NDC 65862-753-60
|
| Hospital Charge Code |
1712248
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.81
|
| Rate for Payer: BCBS Transplant Transplant |
$2.86
|
| Rate for Payer: Blue Shield of California Commercial |
$2.99
|
| Rate for Payer: Blue Shield of California EPN |
$2.33
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Central Health Plan Commercial |
$3.81
|
| Rate for Payer: Cigna of CA HMO |
$3.05
|
| Rate for Payer: Cigna of CA PPO |
$3.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.90
|
| Rate for Payer: Galaxy Health WC |
$4.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.28
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.57
|
| Rate for Payer: IEHP medi-cal |
$1.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Multiplan Commercial |
$3.57
|
| Rate for Payer: Networks By Design Commercial |
$3.09
|
| Rate for Payer: Prime Health Services Commercial |
$4.05
|
| Rate for Payer: Riverside University Health MISP |
$1.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.38
|
| Rate for Payer: United Healthcare All Other HMO |
$2.38
|
| Rate for Payer: United Healthcare HMO Rider |
$2.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.05
|
| Rate for Payer: Vantage Medical Group Senior |
$4.05
|
|
|
VALGANCICLOVIR 450 MG TABLET [30148]
|
Facility
OP
|
$5.00
|
|
|
Service Code
|
NDC 27241-158-60
|
| Hospital Charge Code |
1712248
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.95
|
| Rate for Payer: BCBS Transplant Transplant |
$3.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3.14
|
| Rate for Payer: Blue Shield of California EPN |
$2.44
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Central Health Plan Commercial |
$4.00
|
| Rate for Payer: Cigna of CA HMO |
$3.20
|
| Rate for Payer: Cigna of CA PPO |
$3.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.00
|
| Rate for Payer: Galaxy Health WC |
$4.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.75
|
| Rate for Payer: IEHP medi-cal |
$1.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.00
|
| Rate for Payer: Multiplan Commercial |
$3.75
|
| Rate for Payer: Networks By Design Commercial |
$3.25
|
| Rate for Payer: Prime Health Services Commercial |
$4.25
|
| Rate for Payer: Riverside University Health MISP |
$2.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.25
|
| Rate for Payer: Vantage Medical Group Senior |
$4.25
|
|
|
VALGANCICLOVIR 450 MG TABLET [30148]
|
Facility
IP
|
$51.00
|
|
|
Service Code
|
NDC 68084-965-25
|
| Hospital Charge Code |
1712248
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$38.25
|
| Rate for Payer: Blue Shield of California EPN |
$27.23
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Central Health Plan Commercial |
$40.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.40
|
| Rate for Payer: Galaxy Health WC |
$43.35
|
| Rate for Payer: Global Benefits Group Commercial |
$30.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.20
|
| Rate for Payer: Multiplan Commercial |
$38.25
|
| Rate for Payer: Networks By Design Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Commercial |
$43.35
|
|
|
VALGANCICLOVIR 450 MG TABLET [30148]
|
Facility
OP
|
$4.76
|
|
|
Service Code
|
NDC 69097-277-03
|
| Hospital Charge Code |
1712248
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.81
|
| Rate for Payer: BCBS Transplant Transplant |
$2.86
|
| Rate for Payer: Blue Shield of California Commercial |
$2.99
|
| Rate for Payer: Blue Shield of California EPN |
$2.33
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Central Health Plan Commercial |
$3.81
|
| Rate for Payer: Cigna of CA HMO |
$3.05
|
| Rate for Payer: Cigna of CA PPO |
$3.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.90
|
| Rate for Payer: Galaxy Health WC |
$4.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.28
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.57
|
| Rate for Payer: IEHP medi-cal |
$1.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Multiplan Commercial |
$3.57
|
| Rate for Payer: Networks By Design Commercial |
$3.09
|
| Rate for Payer: Prime Health Services Commercial |
$4.05
|
| Rate for Payer: Riverside University Health MISP |
$1.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.38
|
| Rate for Payer: United Healthcare All Other HMO |
$2.38
|
| Rate for Payer: United Healthcare HMO Rider |
$2.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.05
|
| Rate for Payer: Vantage Medical Group Senior |
$4.05
|
|
|
VALGANCICLOVIR 450 MG TABLET [30148]
|
Facility
OP
|
$28.11
|
|
|
Service Code
|
NDC 55111-762-60
|
| Hospital Charge Code |
1712248
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.62 |
| Max. Negotiated Rate |
$25.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$23.89
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.46
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.61
|
| Rate for Payer: BCBS Transplant Transplant |
$16.87
|
| Rate for Payer: Blue Shield of California Commercial |
$17.68
|
| Rate for Payer: Blue Shield of California EPN |
$13.75
|
| Rate for Payer: Cash Price |
$12.65
|
| Rate for Payer: Cash Price |
$12.65
|
| Rate for Payer: Central Health Plan Commercial |
$22.49
|
| Rate for Payer: Cigna of CA HMO |
$17.99
|
| Rate for Payer: Cigna of CA PPO |
$20.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.24
|
| Rate for Payer: Galaxy Health WC |
$23.89
|
| Rate for Payer: Global Benefits Group Commercial |
$16.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$21.08
|
| Rate for Payer: IEHP medi-cal |
$9.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.62
|
| Rate for Payer: Multiplan Commercial |
$21.08
|
| Rate for Payer: Networks By Design Commercial |
$18.27
|
| Rate for Payer: Prime Health Services Commercial |
$23.89
|
| Rate for Payer: Riverside University Health MISP |
$11.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.06
|
| Rate for Payer: United Healthcare All Other HMO |
$14.06
|
| Rate for Payer: United Healthcare HMO Rider |
$14.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.89
|
| Rate for Payer: Vantage Medical Group Senior |
$23.89
|
|
|
VALGANCICLOVIR 450 MG TABLET [30148]
|
Facility
IP
|
$5.00
|
|
|
Service Code
|
NDC 27241-158-60
|
| Hospital Charge Code |
1712248
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$3.75
|
| Rate for Payer: Blue Shield of California EPN |
$2.67
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Central Health Plan Commercial |
$4.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.00
|
| Rate for Payer: Galaxy Health WC |
$4.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.00
|
| Rate for Payer: Multiplan Commercial |
$3.75
|
| Rate for Payer: Networks By Design Commercial |
$3.25
|
| Rate for Payer: Prime Health Services Commercial |
$4.25
|
|
|
VALGANCICLOVIR 450 MG TABLET [30148]
|
Facility
OP
|
$51.00
|
|
|
Service Code
|
NDC 68084-965-95
|
| Hospital Charge Code |
1712248
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$43.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$28.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$28.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.13
|
| Rate for Payer: BCBS Transplant Transplant |
$30.60
|
| Rate for Payer: Blue Shield of California Commercial |
$32.08
|
| Rate for Payer: Blue Shield of California EPN |
$24.94
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Central Health Plan Commercial |
$40.80
|
| Rate for Payer: Cigna of CA HMO |
$32.64
|
| Rate for Payer: Cigna of CA PPO |
$37.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.40
|
| Rate for Payer: Galaxy Health WC |
$43.35
|
| Rate for Payer: Global Benefits Group Commercial |
$30.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$38.25
|
| Rate for Payer: IEHP medi-cal |
$17.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.20
|
| Rate for Payer: Multiplan Commercial |
$38.25
|
| Rate for Payer: Networks By Design Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Commercial |
$43.35
|
| Rate for Payer: Riverside University Health MISP |
$20.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.50
|
| Rate for Payer: United Healthcare All Other HMO |
$25.50
|
| Rate for Payer: United Healthcare HMO Rider |
$25.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.35
|
| Rate for Payer: Vantage Medical Group Senior |
$43.35
|
|
|
VALGANCICLOVIR 450 MG TABLET [30148]
|
Facility
IP
|
$6.00
|
|
|
Service Code
|
NDC 31722-832-60
|
| Hospital Charge Code |
1712248
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$4.50
|
| Rate for Payer: Blue Shield of California EPN |
$3.20
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Central Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
|
|
VALGANCICLOVIR 450 MG TABLET [30148]
|
Facility
OP
|
$106.08
|
|
|
Service Code
|
NDC 0004-0038-22
|
| Hospital Charge Code |
1712248
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.22 |
| Max. Negotiated Rate |
$95.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$64.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$90.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$58.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$58.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$51.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.67
|
| Rate for Payer: BCBS Transplant Transplant |
$63.65
|
| Rate for Payer: Blue Shield of California Commercial |
$66.72
|
| Rate for Payer: Blue Shield of California EPN |
$51.87
|
| Rate for Payer: Cash Price |
$47.74
|
| Rate for Payer: Cash Price |
$47.74
|
| Rate for Payer: Central Health Plan Commercial |
$84.86
|
| Rate for Payer: Cigna of CA HMO |
$67.89
|
| Rate for Payer: Cigna of CA PPO |
$78.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$42.43
|
| Rate for Payer: Galaxy Health WC |
$90.17
|
| Rate for Payer: Global Benefits Group Commercial |
$63.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.47
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$79.56
|
| Rate for Payer: IEHP medi-cal |
$37.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.22
|
| Rate for Payer: Multiplan Commercial |
$79.56
|
| Rate for Payer: Networks By Design Commercial |
$68.95
|
| Rate for Payer: Prime Health Services Commercial |
$90.17
|
| Rate for Payer: Riverside University Health MISP |
$42.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.04
|
| Rate for Payer: United Healthcare All Other HMO |
$53.04
|
| Rate for Payer: United Healthcare HMO Rider |
$53.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.17
|
| Rate for Payer: Vantage Medical Group Senior |
$90.17
|
|
|
VALGANCICLOVIR 450 MG TABLET [30148]
|
Facility
IP
|
$106.08
|
|
|
Service Code
|
NDC 0004-0038-22
|
| Hospital Charge Code |
1712248
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.22 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$79.56
|
| Rate for Payer: Blue Shield of California EPN |
$56.65
|
| Rate for Payer: Cash Price |
$47.74
|
| Rate for Payer: Cash Price |
$47.74
|
| Rate for Payer: Central Health Plan Commercial |
$84.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.43
|
| Rate for Payer: Galaxy Health WC |
$90.17
|
| Rate for Payer: Global Benefits Group Commercial |
$63.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.22
|
| Rate for Payer: Multiplan Commercial |
$79.56
|
| Rate for Payer: Networks By Design Commercial |
$68.95
|
| Rate for Payer: Prime Health Services Commercial |
$90.17
|
|
|
VALGANCICLOVIR 450 MG TABLET [30148]
|
Facility
OP
|
$20.19
|
|
|
Service Code
|
NDC 0603-6330-20
|
| Hospital Charge Code |
1712248
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$18.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.93
|
| Rate for Payer: BCBS Transplant Transplant |
$12.11
|
| Rate for Payer: Blue Shield of California Commercial |
$12.70
|
| Rate for Payer: Blue Shield of California EPN |
$9.87
|
| Rate for Payer: Cash Price |
$9.09
|
| Rate for Payer: Cash Price |
$9.09
|
| Rate for Payer: Central Health Plan Commercial |
$16.15
|
| Rate for Payer: Cigna of CA HMO |
$12.92
|
| Rate for Payer: Cigna of CA PPO |
$14.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.08
|
| Rate for Payer: Galaxy Health WC |
$17.16
|
| Rate for Payer: Global Benefits Group Commercial |
$12.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.17
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15.14
|
| Rate for Payer: IEHP medi-cal |
$7.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.04
|
| Rate for Payer: Multiplan Commercial |
$15.14
|
| Rate for Payer: Networks By Design Commercial |
$13.12
|
| Rate for Payer: Prime Health Services Commercial |
$17.16
|
| Rate for Payer: Riverside University Health MISP |
$8.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.10
|
| Rate for Payer: United Healthcare All Other HMO |
$10.10
|
| Rate for Payer: United Healthcare HMO Rider |
$10.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.16
|
| Rate for Payer: Vantage Medical Group Senior |
$17.16
|
|
|
VALGANCICLOVIR 450 MG TABLET [30148]
|
Facility
IP
|
$4.76
|
|
|
Service Code
|
NDC 69097-277-03
|
| Hospital Charge Code |
1712248
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$3.57
|
| Rate for Payer: Blue Shield of California EPN |
$2.54
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Central Health Plan Commercial |
$3.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.90
|
| Rate for Payer: Galaxy Health WC |
$4.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Multiplan Commercial |
$3.57
|
| Rate for Payer: Networks By Design Commercial |
$3.09
|
| Rate for Payer: Prime Health Services Commercial |
$4.05
|
|
|
VALGANCICLOVIR 450 MG TABLET [30148]
|
Facility
IP
|
$51.00
|
|
|
Service Code
|
NDC 68084-965-95
|
| Hospital Charge Code |
1712248
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$38.25
|
| Rate for Payer: Blue Shield of California EPN |
$27.23
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Central Health Plan Commercial |
$40.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.40
|
| Rate for Payer: Galaxy Health WC |
$43.35
|
| Rate for Payer: Global Benefits Group Commercial |
$30.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.20
|
| Rate for Payer: Multiplan Commercial |
$38.25
|
| Rate for Payer: Networks By Design Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Commercial |
$43.35
|
|
|
VALGANCICLOVIR 450 MG TABLET [30148]
|
Facility
OP
|
$6.00
|
|
|
Service Code
|
NDC 31722-832-60
|
| Hospital Charge Code |
1712248
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.54
|
| Rate for Payer: BCBS Transplant Transplant |
$3.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3.77
|
| Rate for Payer: Blue Shield of California EPN |
$2.93
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Central Health Plan Commercial |
$4.80
|
| Rate for Payer: Cigna of CA HMO |
$3.84
|
| Rate for Payer: Cigna of CA PPO |
$4.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.50
|
| Rate for Payer: IEHP medi-cal |
$2.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: Riverside University Health MISP |
$2.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$5.10
|
|
|
VALGANCICLOVIR 450 MG TABLET [30148]
|
Facility
IP
|
$28.11
|
|
|
Service Code
|
NDC 55111-762-60
|
| Hospital Charge Code |
1712248
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.62 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$21.08
|
| Rate for Payer: Blue Shield of California EPN |
$15.01
|
| Rate for Payer: Cash Price |
$12.65
|
| Rate for Payer: Cash Price |
$12.65
|
| Rate for Payer: Central Health Plan Commercial |
$22.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.24
|
| Rate for Payer: Galaxy Health WC |
$23.89
|
| Rate for Payer: Global Benefits Group Commercial |
$16.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.62
|
| Rate for Payer: Multiplan Commercial |
$21.08
|
| Rate for Payer: Networks By Design Commercial |
$18.27
|
| Rate for Payer: Prime Health Services Commercial |
$23.89
|
|
|
VALGANCICLOVIR 450 MG TABLET [30148]
|
Facility
OP
|
$51.00
|
|
|
Service Code
|
NDC 68084-965-25
|
| Hospital Charge Code |
1712248
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$43.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$28.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$28.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.13
|
| Rate for Payer: BCBS Transplant Transplant |
$30.60
|
| Rate for Payer: Blue Shield of California Commercial |
$32.08
|
| Rate for Payer: Blue Shield of California EPN |
$24.94
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Central Health Plan Commercial |
$40.80
|
| Rate for Payer: Cigna of CA HMO |
$32.64
|
| Rate for Payer: Cigna of CA PPO |
$37.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.40
|
| Rate for Payer: Galaxy Health WC |
$43.35
|
| Rate for Payer: Global Benefits Group Commercial |
$30.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$38.25
|
| Rate for Payer: IEHP medi-cal |
$17.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.20
|
| Rate for Payer: Multiplan Commercial |
$38.25
|
| Rate for Payer: Networks By Design Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Commercial |
$43.35
|
| Rate for Payer: Riverside University Health MISP |
$20.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.50
|
| Rate for Payer: United Healthcare All Other HMO |
$25.50
|
| Rate for Payer: United Healthcare HMO Rider |
$25.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.35
|
| Rate for Payer: Vantage Medical Group Senior |
$43.35
|
|
|
VALGANCICLOVIR 450 MG TABLET [30148]
|
Facility
IP
|
$4.76
|
|
|
Service Code
|
NDC 65862-753-60
|
| Hospital Charge Code |
1712248
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$3.57
|
| Rate for Payer: Blue Shield of California EPN |
$2.54
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Central Health Plan Commercial |
$3.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.90
|
| Rate for Payer: Galaxy Health WC |
$4.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Multiplan Commercial |
$3.57
|
| Rate for Payer: Networks By Design Commercial |
$3.09
|
| Rate for Payer: Prime Health Services Commercial |
$4.05
|
|
|
VALGANCICLOVIR 50 MG/ML ORAL SOLUTION [99443]
|
Facility
IP
|
$10.91
|
|
|
Service Code
|
NDC 70010-051-40
|
| Hospital Charge Code |
1715257
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$8.18
|
| Rate for Payer: Blue Shield of California EPN |
$5.83
|
| Rate for Payer: Cash Price |
$4.91
|
| Rate for Payer: Cash Price |
$4.91
|
| Rate for Payer: Central Health Plan Commercial |
$8.73
|
| Rate for Payer: Cigna of CA HMO |
$7.64
|
| Rate for Payer: Cigna of CA PPO |
$7.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.36
|
| Rate for Payer: Galaxy Health WC |
$9.27
|
| Rate for Payer: Global Benefits Group Commercial |
$6.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.18
|
| Rate for Payer: Multiplan Commercial |
$8.18
|
| Rate for Payer: Networks By Design Commercial |
$7.09
|
| Rate for Payer: Prime Health Services Commercial |
$9.27
|
|
