|
VALACYCLOVIR 500 MG TABLET [13133]
|
Facility
|
OP
|
$0.98
|
|
|
Service Code
|
NDC 63304-904-90
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.83 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.74
|
| Rate for Payer: Blue Shield of California Commercial |
$0.60
|
| Rate for Payer: Blue Shield of California EPN |
$0.48
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.83
|
| Rate for Payer: Dignity Health Senior |
$0.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.61
|
| Rate for Payer: Heritage Provider Network Senior |
$0.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$0.74
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.39
|
| Rate for Payer: TriValley Medical Group Senior |
$0.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.83
|
| 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
|
$3.84
|
|
|
Service Code
|
NDC 68084-215-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$2.88 |
| Rate for Payer: Adventist Health Commercial |
$0.77
|
| Rate for Payer: Cash Price |
$2.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.60
|
| Rate for Payer: Heritage Provider Network Senior |
$2.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
|
|
VALACYCLOVIR 500 MG TABLET [13133]
|
Facility
|
OP
|
$3.84
|
|
|
Service Code
|
NDC 68084-215-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$3.26 |
| Rate for Payer: Adventist Health Commercial |
$0.77
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2.34
|
| Rate for Payer: Blue Shield of California EPN |
$1.87
|
| Rate for Payer: Cash Price |
$2.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.26
|
| Rate for Payer: Dignity Health Senior |
$3.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.38
|
| Rate for Payer: Heritage Provider Network Senior |
$2.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.69
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.54
|
| Rate for Payer: TriValley Medical Group Senior |
$1.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.26
|
| Rate for Payer: Vantage Medical Group Senior |
$3.26
|
|
|
VALACYCLOVIR 500 MG TABLET [13133]
|
Facility
|
IP
|
$3.71
|
|
|
Service Code
|
NDC 68084-215-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$2.78 |
| Rate for Payer: Adventist Health Commercial |
$0.74
|
| Rate for Payer: Cash Price |
$2.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.51
|
| Rate for Payer: Heritage Provider Network Senior |
$2.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.93
|
| Rate for Payer: Multiplan Commercial |
$2.78
|
|
|
VALACYCLOVIR 500 MG TABLET [13133]
|
Facility
|
IP
|
$0.98
|
|
|
Service Code
|
NDC 31722-704-90
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.74 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.66
|
| Rate for Payer: Heritage Provider Network Senior |
$0.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.74
|
|
|
VALACYCLOVIR 500 MG TABLET [13133]
|
Facility
|
OP
|
$3.71
|
|
|
Service Code
|
NDC 68084-215-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$3.15 |
| Rate for Payer: Adventist Health Commercial |
$0.74
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.78
|
| Rate for Payer: Blue Shield of California Commercial |
$2.26
|
| Rate for Payer: Blue Shield of California EPN |
$1.81
|
| Rate for Payer: Cash Price |
$2.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.15
|
| Rate for Payer: Dignity Health Senior |
$3.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.30
|
| Rate for Payer: Heritage Provider Network Senior |
$2.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.60
|
| Rate for Payer: Multiplan Commercial |
$2.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.48
|
| Rate for Payer: TriValley Medical Group Senior |
$1.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.15
|
| Rate for Payer: Vantage Medical Group Senior |
$3.15
|
|
|
VALACYCLOVIR 500 MG TABLET [13133]
|
Facility
|
OP
|
$0.98
|
|
|
Service Code
|
NDC 31722-704-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.83 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.74
|
| Rate for Payer: Blue Shield of California Commercial |
$0.60
|
| Rate for Payer: Blue Shield of California EPN |
$0.48
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.83
|
| Rate for Payer: Dignity Health Senior |
$0.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.61
|
| Rate for Payer: Heritage Provider Network Senior |
$0.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$0.74
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.39
|
| Rate for Payer: TriValley Medical Group Senior |
$0.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.83
|
| 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 31722-704-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.74 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.66
|
| Rate for Payer: Heritage Provider Network Senior |
$0.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.74
|
|
|
VALACYCLOVIR 500 MG TABLET [13133]
|
Facility
|
OP
|
$0.48
|
|
|
Service Code
|
NDC 0378-4275-93
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.41
|
| Rate for Payer: Dignity Health Senior |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.30
|
| Rate for Payer: Heritage Provider Network Senior |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$0.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.19
|
| Rate for Payer: TriValley Medical Group Senior |
$0.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Vantage Medical Group Senior |
$0.41
|
|
|
VALACYCLOVIR 500 MG TABLET [13133]
|
Facility
|
IP
|
$0.48
|
|
|
Service Code
|
NDC 0378-4275-93
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.32
|
| Rate for Payer: Heritage Provider Network Senior |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.36
|
|
|
VALACYCLOVIR 500 MG TABLET [13133]
|
Facility
|
OP
|
$0.47
|
|
|
Service Code
|
NDC 0378-4275-77
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.35
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.40
|
| Rate for Payer: Dignity Health Senior |
$0.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.29
|
| Rate for Payer: Heritage Provider Network Senior |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.33
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.19
|
| Rate for Payer: TriValley Medical Group Senior |
$0.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.40
|
| 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
|
$2.10
|
|
|
Service Code
|
NDC 50268-788-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Adventist Health Commercial |
$0.42
|
| Rate for Payer: Cash Price |
$1.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.42
|
| Rate for Payer: Heritage Provider Network Senior |
$1.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: Multiplan Commercial |
$1.57
|
|
|
VALACYCLOVIR 500 MG TABLET [13133]
|
Facility
|
OP
|
$0.98
|
|
|
Service Code
|
NDC 31722-704-90
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.83 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.74
|
| Rate for Payer: Blue Shield of California Commercial |
$0.60
|
| Rate for Payer: Blue Shield of California EPN |
$0.48
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.83
|
| Rate for Payer: Dignity Health Senior |
$0.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.61
|
| Rate for Payer: Heritage Provider Network Senior |
$0.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$0.74
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.39
|
| Rate for Payer: TriValley Medical Group Senior |
$0.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.83
|
| Rate for Payer: Vantage Medical Group Senior |
$0.83
|
|
|
VALACYCLOVIR ORAL SUSPENSION COMPOUND 50 MG/ML [4080355]
|
Facility
|
IP
|
$0.72
|
|
|
Service Code
|
NDC 9994-0803-55
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.49
|
| Rate for Payer: Heritage Provider Network Senior |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
|
|
VALACYCLOVIR ORAL SUSPENSION COMPOUND 50 MG/ML [4080355]
|
Facility
|
OP
|
$0.72
|
|
|
Service Code
|
NDC 9994-0803-55
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.54
|
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.61
|
| Rate for Payer: Dignity Health Senior |
$0.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.45
|
| Rate for Payer: Heritage Provider Network Senior |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Senior |
$0.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.61
|
| 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
|
OP
|
$19.13
|
|
|
Service Code
|
NDC 68084-965-95
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$16.26 |
| Rate for Payer: Adventist Health Commercial |
$3.83
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.35
|
| Rate for Payer: Blue Shield of California Commercial |
$11.67
|
| Rate for Payer: Blue Shield of California EPN |
$9.34
|
| Rate for Payer: Cash Price |
$10.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.26
|
| Rate for Payer: Dignity Health Senior |
$16.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.84
|
| Rate for Payer: Heritage Provider Network Senior |
$11.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.39
|
| Rate for Payer: Multiplan Commercial |
$14.35
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.65
|
| Rate for Payer: TriValley Medical Group Senior |
$7.65
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.26
|
| Rate for Payer: Vantage Medical Group Senior |
$16.26
|
|
|
VALGANCICLOVIR 450 MG TABLET [30148]
|
Facility
|
IP
|
$106.08
|
|
|
Service Code
|
NDC 0004-0038-22
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$79.56 |
| Rate for Payer: Adventist Health Commercial |
$21.22
|
| Rate for Payer: Cash Price |
$58.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.82
|
| Rate for Payer: Heritage Provider Network Senior |
$71.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.52
|
| Rate for Payer: Multiplan Commercial |
$79.56
|
|
|
VALGANCICLOVIR 450 MG TABLET [30148]
|
Facility
|
OP
|
$106.08
|
|
|
Service Code
|
NDC 0004-0038-22
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$90.17 |
| Rate for Payer: Adventist Health Commercial |
$21.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$56.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$79.56
|
| Rate for Payer: Blue Shield of California Commercial |
$64.71
|
| Rate for Payer: Blue Shield of California EPN |
$51.77
|
| Rate for Payer: Cash Price |
$58.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$68.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.17
|
| Rate for Payer: Dignity Health Senior |
$90.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.66
|
| Rate for Payer: Heritage Provider Network Senior |
$65.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$50.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74.26
|
| Rate for Payer: Multiplan Commercial |
$79.56
|
| Rate for Payer: TriValley Medical Group Commercial |
$42.43
|
| Rate for Payer: TriValley Medical Group Senior |
$42.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$53.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$53.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.17
|
| 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
|
$5.00
|
|
|
Service Code
|
NDC 27241-158-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Adventist Health Commercial |
$1.00
|
| Rate for Payer: Cash Price |
$2.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.38
|
| Rate for Payer: Heritage Provider Network Senior |
$3.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.25
|
| Rate for Payer: Multiplan Commercial |
$3.75
|
|
|
VALGANCICLOVIR 450 MG TABLET [30148]
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
NDC 27241-158-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Adventist Health Commercial |
$1.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.75
|
| Rate for Payer: Blue Shield of California Commercial |
$3.05
|
| Rate for Payer: Blue Shield of California EPN |
$2.44
|
| Rate for Payer: Cash Price |
$2.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.25
|
| Rate for Payer: Dignity Health Senior |
$4.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.10
|
| Rate for Payer: Heritage Provider Network Senior |
$3.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.50
|
| Rate for Payer: Multiplan Commercial |
$3.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.00
|
| Rate for Payer: TriValley Medical Group Senior |
$2.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.25
|
| 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
|
$5.00
|
|
|
Service Code
|
NDC 31722-832-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Adventist Health Commercial |
$1.00
|
| Rate for Payer: Cash Price |
$2.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.38
|
| Rate for Payer: Heritage Provider Network Senior |
$3.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.25
|
| Rate for Payer: Multiplan Commercial |
$3.75
|
|
|
VALGANCICLOVIR 450 MG TABLET [30148]
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
NDC 31722-832-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Adventist Health Commercial |
$1.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.75
|
| Rate for Payer: Blue Shield of California Commercial |
$3.05
|
| Rate for Payer: Blue Shield of California EPN |
$2.44
|
| Rate for Payer: Cash Price |
$2.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.25
|
| Rate for Payer: Dignity Health Senior |
$4.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.10
|
| Rate for Payer: Heritage Provider Network Senior |
$3.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.50
|
| Rate for Payer: Multiplan Commercial |
$3.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.00
|
| Rate for Payer: TriValley Medical Group Senior |
$2.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.25
|
| 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
|
$28.11
|
|
|
Service Code
|
NDC 55111-762-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.09 |
| Max. Negotiated Rate |
$21.08 |
| Rate for Payer: Adventist Health Commercial |
$5.62
|
| Rate for Payer: Cash Price |
$15.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.03
|
| Rate for Payer: Heritage Provider Network Senior |
$19.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.03
|
| Rate for Payer: Multiplan Commercial |
$21.08
|
|
|
VALGANCICLOVIR 450 MG TABLET [30148]
|
Facility
|
OP
|
$28.11
|
|
|
Service Code
|
NDC 55111-762-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.09 |
| Max. Negotiated Rate |
$23.89 |
| Rate for Payer: Adventist Health Commercial |
$5.62
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.08
|
| Rate for Payer: Blue Shield of California Commercial |
$17.15
|
| Rate for Payer: Blue Shield of California EPN |
$13.72
|
| Rate for Payer: Cash Price |
$15.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.89
|
| Rate for Payer: Dignity Health Senior |
$23.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.40
|
| Rate for Payer: Heritage Provider Network Senior |
$17.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.68
|
| Rate for Payer: Multiplan Commercial |
$21.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.24
|
| Rate for Payer: TriValley Medical Group Senior |
$11.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.89
|
| 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
|
$4.76
|
|
|
Service Code
|
NDC 65862-753-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Adventist Health Commercial |
$0.95
|
| Rate for Payer: Cash Price |
$2.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.22
|
| Rate for Payer: Heritage Provider Network Senior |
$3.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.19
|
| Rate for Payer: Multiplan Commercial |
$3.57
|
|
