|
VORICONAZOLE 200 MG/5 ML (40 MG/ML) ORAL SUSPENSION [38103]
|
Facility
|
OP
|
$12.83
|
|
|
Service Code
|
NDC 6516291322
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$10.91 |
| Rate for Payer: Adventist Health Commercial |
$2.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.42
|
| Rate for Payer: Blue Shield of California Commercial |
$7.83
|
| Rate for Payer: Blue Shield of California EPN |
$6.26
|
| Rate for Payer: Cash Price |
$5.77
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.94
|
| Rate for Payer: Heritage Provider Network Senior |
$7.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.98
|
| Rate for Payer: Multiplan Commercial |
$9.62
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.13
|
| Rate for Payer: TriValley Medical Group Senior |
$5.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.91
|
| Rate for Payer: Vantage Medical Group Senior |
$10.91
|
|
|
VORICONAZOLE 200 MG INTRAVENOUS POWDER FOR SOLUTION [33010]
|
Facility
|
OP
|
$72.36
|
|
|
Service Code
|
HCPCS J3465
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$61.51 |
| Rate for Payer: Adventist Health Commercial |
$14.47
|
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Adventist Health Commercial |
$17.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$44.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$44.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$54.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$54.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.16
|
| Rate for Payer: Blue Shield of California Commercial |
$3.04
|
| Rate for Payer: Blue Shield of California Commercial |
$3.04
|
| Rate for Payer: Blue Shield of California Commercial |
$3.04
|
| Rate for Payer: Blue Shield of California Commercial |
$3.04
|
| Rate for Payer: Blue Shield of California Commercial |
$3.04
|
| Rate for Payer: Blue Shield of California EPN |
$3.04
|
| Rate for Payer: Blue Shield of California EPN |
$3.04
|
| Rate for Payer: Blue Shield of California EPN |
$3.04
|
| Rate for Payer: Blue Shield of California EPN |
$3.04
|
| Rate for Payer: Blue Shield of California EPN |
$3.04
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.56
|
| Rate for Payer: Cash Price |
$39.55
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$39.55
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$32.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$33.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$33.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.80
|
| 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 |
$74.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$61.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$61.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$61.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$74.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$61.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.50
|
| Rate for Payer: Heritage Provider Network Senior |
$33.50
|
| Rate for Payer: Heritage Provider Network Senior |
$33.34
|
| Rate for Payer: Heritage Provider Network Senior |
$40.69
|
| Rate for Payer: Heritage Provider Network Senior |
$22.22
|
| Rate for Payer: Heritage Provider Network Senior |
$19.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$20.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$22.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$34.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$41.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$34.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$50.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$50.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$61.52
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: Multiplan Commercial |
$54.27
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$65.92
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$19.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$28.94
|
| Rate for Payer: TriValley Medical Group Commercial |
$28.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.16
|
| Rate for Payer: TriValley Medical Group Senior |
$16.80
|
| Rate for Payer: TriValley Medical Group Senior |
$19.20
|
| Rate for Payer: TriValley Medical Group Senior |
$28.94
|
| Rate for Payer: TriValley Medical Group Senior |
$28.80
|
| Rate for Payer: TriValley Medical Group Senior |
$35.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.70
|
| Rate for Payer: Vantage Medical Group Senior |
$74.71
|
| Rate for Payer: Vantage Medical Group Senior |
$35.70
|
| Rate for Payer: Vantage Medical Group Senior |
$61.51
|
| Rate for Payer: Vantage Medical Group Senior |
$40.80
|
| Rate for Payer: Vantage Medical Group Senior |
$61.20
|
|
|
VORICONAZOLE 200 MG INTRAVENOUS POWDER FOR SOLUTION [33010]
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
HCPCS J3465
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Adventist Health Commercial |
$17.58
|
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Adventist Health Commercial |
$14.47
|
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.37
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$32.56
|
| Rate for Payer: Cash Price |
$39.55
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$33.29
|
| Rate for Payer: Cigna of CA HMO/PPO |
$33.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.22
|
| Rate for Payer: Heritage Provider Network Senior |
$33.34
|
| Rate for Payer: Heritage Provider Network Senior |
$19.45
|
| Rate for Payer: Heritage Provider Network Senior |
$22.22
|
| Rate for Payer: Heritage Provider Network Senior |
$33.50
|
| Rate for Payer: Heritage Provider Network Senior |
$40.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: Multiplan Commercial |
$54.27
|
| Rate for Payer: Multiplan Commercial |
$65.92
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.10
|
|
|
VORICONAZOLE 200 MG TABLET [33009]
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
NDC 4354737803
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$6.75 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.80
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.09
|
| Rate for Payer: Heritage Provider Network Senior |
$6.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$6.75
|
|
|
VORICONAZOLE 200 MG TABLET [33009]
|
Facility
|
IP
|
$21.43
|
|
|
Service Code
|
NDC 5026880312
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.88 |
| Max. Negotiated Rate |
$16.07 |
| Rate for Payer: Adventist Health Commercial |
$4.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.80
|
| Rate for Payer: Cash Price |
$9.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.51
|
| Rate for Payer: Heritage Provider Network Senior |
$14.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.36
|
| Rate for Payer: Multiplan Commercial |
$16.07
|
|
|
VORICONAZOLE 200 MG TABLET [33009]
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
NDC 6846257330
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.56
|
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.50
|
| Rate for Payer: Blue Shield of California Commercial |
$5.49
|
| Rate for Payer: Blue Shield of California EPN |
$4.39
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.57
|
| Rate for Payer: Heritage Provider Network Senior |
$5.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$6.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.60
|
| Rate for Payer: TriValley Medical Group Senior |
$3.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.65
|
| Rate for Payer: Vantage Medical Group Senior |
$7.65
|
|
|
VORICONAZOLE 200 MG TABLET [33009]
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
NDC 6846257330
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$6.75 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.80
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.09
|
| Rate for Payer: Heritage Provider Network Senior |
$6.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$6.75
|
|
|
VORICONAZOLE 200 MG TABLET [33009]
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
NDC 6586289230
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.50
|
| Rate for Payer: Blue Shield of California Commercial |
$5.49
|
| Rate for Payer: Blue Shield of California EPN |
$4.39
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.57
|
| Rate for Payer: Heritage Provider Network Senior |
$5.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$6.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.60
|
| Rate for Payer: TriValley Medical Group Senior |
$3.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.65
|
| Rate for Payer: Vantage Medical Group Senior |
$7.65
|
|
|
VORICONAZOLE 200 MG TABLET [33009]
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
NDC 6586289230
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$6.75 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.80
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.09
|
| Rate for Payer: Heritage Provider Network Senior |
$6.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$6.75
|
|
|
VORICONAZOLE 200 MG TABLET [33009]
|
Facility
|
OP
|
$21.43
|
|
|
Service Code
|
NDC 5026880312
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.88 |
| Max. Negotiated Rate |
$18.22 |
| Rate for Payer: Adventist Health Commercial |
$4.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.72
|
| Rate for Payer: Blue Shield of California Commercial |
$13.07
|
| Rate for Payer: Blue Shield of California EPN |
$10.46
|
| Rate for Payer: Cash Price |
$9.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.27
|
| Rate for Payer: Heritage Provider Network Senior |
$13.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$16.07
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.57
|
| Rate for Payer: TriValley Medical Group Senior |
$8.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.22
|
| Rate for Payer: Vantage Medical Group Senior |
$18.22
|
|
|
VORICONAZOLE 200 MG TABLET [33009]
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
NDC 4354737803
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.50
|
| Rate for Payer: Blue Shield of California Commercial |
$5.49
|
| Rate for Payer: Blue Shield of California EPN |
$4.39
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.57
|
| Rate for Payer: Heritage Provider Network Senior |
$5.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$6.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.60
|
| Rate for Payer: TriValley Medical Group Senior |
$3.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.65
|
| Rate for Payer: Vantage Medical Group Senior |
$7.65
|
|
|
VORICONAZOLE 200 MG TABLET [33009]
|
Facility
|
IP
|
$21.43
|
|
|
Service Code
|
NDC 5026880311
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.88 |
| Max. Negotiated Rate |
$16.07 |
| Rate for Payer: Adventist Health Commercial |
$4.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.80
|
| Rate for Payer: Cash Price |
$9.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.51
|
| Rate for Payer: Heritage Provider Network Senior |
$14.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.36
|
| Rate for Payer: Multiplan Commercial |
$16.07
|
|
|
VORICONAZOLE 200 MG TABLET [33009]
|
Facility
|
OP
|
$21.43
|
|
|
Service Code
|
NDC 5026880311
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.88 |
| Max. Negotiated Rate |
$18.22 |
| Rate for Payer: Adventist Health Commercial |
$4.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.72
|
| Rate for Payer: Blue Shield of California Commercial |
$13.07
|
| Rate for Payer: Blue Shield of California EPN |
$10.46
|
| Rate for Payer: Cash Price |
$9.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.27
|
| Rate for Payer: Heritage Provider Network Senior |
$13.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$16.07
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.57
|
| Rate for Payer: TriValley Medical Group Senior |
$8.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.22
|
| Rate for Payer: Vantage Medical Group Senior |
$18.22
|
|
|
VORICONAZOLE 50 MG TABLET [33008]
|
Facility
|
IP
|
$2.60
|
|
|
Service Code
|
NDC 6846257230
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.67
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.76
|
| Rate for Payer: Heritage Provider Network Senior |
$1.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.65
|
| Rate for Payer: Multiplan Commercial |
$1.95
|
|
|
VORICONAZOLE 50 MG TABLET [33008]
|
Facility
|
OP
|
$2.60
|
|
|
Service Code
|
NDC 6846257230
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$2.21 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1.59
|
| Rate for Payer: Blue Shield of California EPN |
$1.27
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.61
|
| Rate for Payer: Heritage Provider Network Senior |
$1.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.82
|
| Rate for Payer: Multiplan Commercial |
$1.95
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.04
|
| Rate for Payer: TriValley Medical Group Senior |
$1.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.21
|
| Rate for Payer: Vantage Medical Group Senior |
$2.21
|
|
|
VORICONAZOLE 50 MG TABLET [33008]
|
Facility
|
OP
|
$1.60
|
|
|
Service Code
|
NDC 2724106203
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.36 |
| Rate for Payer: Adventist Health Commercial |
$0.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.80
|
| Rate for Payer: Blue Shield of California Commercial |
$0.98
|
| Rate for Payer: Blue Shield of California EPN |
$0.78
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.99
|
| Rate for Payer: Heritage Provider Network Senior |
$0.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.12
|
| Rate for Payer: Multiplan Commercial |
$1.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.64
|
| Rate for Payer: TriValley Medical Group Senior |
$0.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.36
|
| Rate for Payer: Vantage Medical Group Senior |
$1.36
|
|
|
VORICONAZOLE 50 MG TABLET [33008]
|
Facility
|
IP
|
$2.60
|
|
|
Service Code
|
NDC 4354737703
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.67
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.76
|
| Rate for Payer: Heritage Provider Network Senior |
$1.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.65
|
| Rate for Payer: Multiplan Commercial |
$1.95
|
|
|
VORICONAZOLE 50 MG TABLET [33008]
|
Facility
|
OP
|
$2.60
|
|
|
Service Code
|
NDC 4354737703
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$2.21 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1.59
|
| Rate for Payer: Blue Shield of California EPN |
$1.27
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.61
|
| Rate for Payer: Heritage Provider Network Senior |
$1.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.82
|
| Rate for Payer: Multiplan Commercial |
$1.95
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.04
|
| Rate for Payer: TriValley Medical Group Senior |
$1.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.21
|
| Rate for Payer: Vantage Medical Group Senior |
$2.21
|
|
|
VORICONAZOLE 50 MG TABLET [33008]
|
Facility
|
IP
|
$1.60
|
|
|
Service Code
|
NDC 2724106203
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.20 |
| Rate for Payer: Adventist Health Commercial |
$0.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.03
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.08
|
| Rate for Payer: Heritage Provider Network Senior |
$1.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.20
|
|
|
VORINOSTAT 100 MG CAPSULE [77539]
|
Facility
|
IP
|
$150.10
|
|
|
Service Code
|
NDC 0006056840
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$27.17 |
| Max. Negotiated Rate |
$112.58 |
| Rate for Payer: Adventist Health Commercial |
$30.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.66
|
| Rate for Payer: Cash Price |
$67.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.62
|
| Rate for Payer: Heritage Provider Network Senior |
$101.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.52
|
| Rate for Payer: Multiplan Commercial |
$112.58
|
|
|
VORINOSTAT 100 MG CAPSULE [77539]
|
Facility
|
OP
|
$150.10
|
|
|
Service Code
|
NDC 0006056840
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$27.17 |
| Max. Negotiated Rate |
$127.58 |
| Rate for Payer: Adventist Health Commercial |
$30.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$92.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$127.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$82.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$112.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.08
|
| Rate for Payer: Blue Shield of California Commercial |
$91.56
|
| Rate for Payer: Blue Shield of California EPN |
$73.25
|
| Rate for Payer: Cash Price |
$67.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$97.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$127.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$127.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.91
|
| Rate for Payer: Heritage Provider Network Senior |
$92.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$71.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$105.07
|
| Rate for Payer: Multiplan Commercial |
$112.58
|
| Rate for Payer: TriValley Medical Group Commercial |
$60.04
|
| Rate for Payer: TriValley Medical Group Senior |
$60.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$75.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$75.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$127.58
|
| 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 9994080357
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.93 |
| Max. Negotiated Rate |
$41.95 |
| Rate for Payer: Adventist Health Commercial |
$9.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.68
|
| Rate for Payer: Blue Shield of California Commercial |
$30.10
|
| Rate for Payer: Blue Shield of California EPN |
$24.08
|
| Rate for Payer: Cash Price |
$22.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.55
|
| Rate for Payer: Heritage Provider Network Senior |
$30.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$23.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34.55
|
| Rate for Payer: Multiplan Commercial |
$37.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$19.74
|
| Rate for Payer: TriValley Medical Group Senior |
$19.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$24.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.95
|
| 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 9994080357
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.93 |
| Max. Negotiated Rate |
$37.01 |
| Rate for Payer: Adventist Health Commercial |
$9.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31.78
|
| Rate for Payer: Cash Price |
$22.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.41
|
| Rate for Payer: Heritage Provider Network Senior |
$33.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.34
|
| Rate for Payer: Multiplan Commercial |
$37.01
|
|
|
VULVECTOMY SIMPLE; PARTIAL
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 56620
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,163.48 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,163.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,136.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,579.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,163.48
|
| Rate for Payer: Heritage Provider Network Senior |
$5,121.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,910.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,788.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,579.06
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,579.83
|
| Rate for Payer: TriValley Medical Group Senior |
$4,579.83
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.48
|
|
|
WARFARIN 0.5 MG PARTIAL TABLET [4081492]
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
NDC 9994081492
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.13
|
| 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: Cigna of CA HMO/PPO |
$0.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Senior |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Vantage Medical Group Senior |
$0.22
|
|
