|
VERAPAMIL ORAL SUSPENSION COMPOUND 50 MG/ML [4080356]
|
Facility
OP
|
$0.36
|
|
|
Service Code
|
NDC 9994-0803-56
|
| Hospital Charge Code |
1715022
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.27
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
| Rate for Payer: Dignity Health Senior |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Senior |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
|
VERAPAMIL ORAL SUSPENSION COMPOUND 50 MG/ML [4080356]
|
Facility
IP
|
$0.36
|
|
|
Service Code
|
NDC 9994-0803-56
|
| Hospital Charge Code |
1715022
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.25
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.24
|
| Rate for Payer: Heritage Provider Network Senior |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
|
|
VERTEBRAL AND INTERVERTEBRAL SPINAL PROCEDURES INCLUDING DISC PROCEDURES
|
Facility
IP
|
$13,213.22
|
|
|
Service Code
|
APR-DRG 3102
|
| Min. Negotiated Rate |
$13,213.22 |
| Max. Negotiated Rate |
$13,213.22 |
| Rate for Payer: IEHP Medi-Cal |
$13,213.22
|
|
|
VERTEBRAL AND INTERVERTEBRAL SPINAL PROCEDURES INCLUDING DISC PROCEDURES
|
Facility
IP
|
$9,800.72
|
|
|
Service Code
|
APR-DRG 3101
|
| Min. Negotiated Rate |
$9,800.72 |
| Max. Negotiated Rate |
$9,800.72 |
| Rate for Payer: IEHP Medi-Cal |
$9,800.72
|
|
|
VERTEBRAL AND INTERVERTEBRAL SPINAL PROCEDURES INCLUDING DISC PROCEDURES
|
Facility
IP
|
$18,491.13
|
|
|
Service Code
|
APR-DRG 3103
|
| Min. Negotiated Rate |
$18,491.13 |
| Max. Negotiated Rate |
$18,491.13 |
| Rate for Payer: IEHP Medi-Cal |
$18,491.13
|
|
|
VERTEBRAL AND INTERVERTEBRAL SPINAL PROCEDURES INCLUDING DISC PROCEDURES
|
Facility
IP
|
$31,804.83
|
|
|
Service Code
|
APR-DRG 3104
|
| Min. Negotiated Rate |
$31,804.83 |
| Max. Negotiated Rate |
$31,804.83 |
| Rate for Payer: IEHP Medi-Cal |
$31,804.83
|
|
|
Vertebral corpectomy (vertebral body resection), partial or complete, anterior approach with decompression of spinal cord and/or nerve root(s); cervical, each additional segment (List separately in addition to code for primary procedure)
|
Facility
OP
|
$5,505.00
|
|
|
Service Code
|
CPT 63082
|
| Min. Negotiated Rate |
$422.81 |
| Max. Negotiated Rate |
$5,505.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$548.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: IEHP Medi-Cal |
$422.81
|
|
|
Vertebral corpectomy (vertebral body resection), partial or complete, anterior approach with decompression of spinal cord and/or nerve root(s); cervical, single segment
|
Facility
OP
|
$8,576.00
|
|
|
Service Code
|
CPT 63081
|
| Min. Negotiated Rate |
$420.50 |
| Max. Negotiated Rate |
$8,576.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,583.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,576.00
|
| Rate for Payer: IEHP Medi-Cal |
$420.50
|
|
|
VERTIGO AND OTHER LABYRINTH DISORDERS
|
Facility
IP
|
$11,725.84
|
|
|
Service Code
|
APR-DRG 1114
|
| Min. Negotiated Rate |
$11,725.84 |
| Max. Negotiated Rate |
$11,725.84 |
| Rate for Payer: IEHP Medi-Cal |
$11,725.84
|
|
|
VERTIGO AND OTHER LABYRINTH DISORDERS
|
Facility
IP
|
$4,821.27
|
|
|
Service Code
|
APR-DRG 1111
|
| Min. Negotiated Rate |
$4,821.27 |
| Max. Negotiated Rate |
$4,821.27 |
| Rate for Payer: IEHP Medi-Cal |
$4,821.27
|
|
|
VERTIGO AND OTHER LABYRINTH DISORDERS
|
Facility
IP
|
$6,687.69
|
|
|
Service Code
|
APR-DRG 1113
|
| Min. Negotiated Rate |
$6,687.69 |
| Max. Negotiated Rate |
$6,687.69 |
| Rate for Payer: IEHP Medi-Cal |
$6,687.69
|
|
|
VERTIGO AND OTHER LABYRINTH DISORDERS
|
Facility
IP
|
$5,538.59
|
|
|
Service Code
|
APR-DRG 1112
|
| Min. Negotiated Rate |
$5,538.59 |
| Max. Negotiated Rate |
$5,538.59 |
| Rate for Payer: IEHP Medi-Cal |
$5,538.59
|
|
|
Vestibuloplasty; complex (including ridge extension, muscle repositioning)
|
Facility
OP
|
$13,902.11
|
|
|
Service Code
|
CPT 40845
|
| Min. Negotiated Rate |
$308.40 |
| Max. Negotiated Rate |
$13,902.11 |
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,048.59
|
| Rate for Payer: Dignity Health Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,316.90
|
| Rate for Payer: Humana Medicare |
$7,316.90
|
| Rate for Payer: IEHP Medi-Cal |
$308.40
|
| Rate for Payer: IEHP Medicare Advantage |
$7,316.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,902.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,633.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,219.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,219.29
|
| Rate for Payer: TriValley Medical Group Commercial |
$8,048.59
|
| Rate for Payer: TriValley Medical Group Senior |
$7,316.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
Vestibuloplasty; posterior, unilateral
|
Facility
OP
|
$13,902.11
|
|
|
Service Code
|
CPT 40842
|
| Min. Negotiated Rate |
$768.38 |
| Max. Negotiated Rate |
$13,902.11 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,048.59
|
| Rate for Payer: Dignity Health Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,316.90
|
| Rate for Payer: Humana Medicare |
$7,316.90
|
| Rate for Payer: IEHP Medi-Cal |
$768.38
|
| Rate for Payer: IEHP Medicare Advantage |
$7,316.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,902.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,633.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,219.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,219.29
|
| Rate for Payer: TriValley Medical Group Commercial |
$8,048.59
|
| Rate for Payer: TriValley Medical Group Senior |
$7,316.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
VILAZODONE 20 MG TABLET [109403]
|
Facility
OP
|
$6.13
|
|
|
Service Code
|
NDC 60505-4773-3
|
| Hospital Charge Code |
1712642
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$5.21 |
| Rate for Payer: Adventist Health Commercial |
$1.23
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3.81
|
| Rate for Payer: Blue Shield of California EPN |
$3.60
|
| Rate for Payer: Cash Price |
$2.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.21
|
| Rate for Payer: Dignity Health Senior |
$5.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.79
|
| Rate for Payer: Heritage Provider Network Senior |
$3.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.53
|
| Rate for Payer: Multiplan Commercial |
$4.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.21
|
| Rate for Payer: Vantage Medical Group Senior |
$5.21
|
|
|
VILAZODONE 20 MG TABLET [109403]
|
Facility
IP
|
$6.13
|
|
|
Service Code
|
NDC 60505-4773-3
|
| Hospital Charge Code |
1712642
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Adventist Health Commercial |
$1.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.21
|
| Rate for Payer: Cash Price |
$2.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.15
|
| Rate for Payer: Heritage Provider Network Senior |
$4.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.53
|
| Rate for Payer: Multiplan Commercial |
$4.60
|
|
|
VINBLASTINE 1 MG/ML INTRAVENOUS SOLUTION [8594]
|
Facility
IP
|
$5.66
|
|
|
Service Code
|
CPT J9360
|
| Hospital Charge Code |
NDG8594
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$4.24 |
| Rate for Payer: Adventist Health Commercial |
$1.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.89
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.83
|
| Rate for Payer: Heritage Provider Network Senior |
$3.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.42
|
| Rate for Payer: Multiplan Commercial |
$4.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.89
|
|
|
VINBLASTINE 1 MG/ML INTRAVENOUS SOLUTION [8594]
|
Facility
OP
|
$5.66
|
|
|
Service Code
|
CPT J9360
|
| Hospital Charge Code |
NDG8594
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$13.54 |
| Rate for Payer: Adventist Health Commercial |
$1.13
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.81
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.59
|
| Rate for Payer: Blue Shield of California Commercial |
$4.81
|
| Rate for Payer: Blue Shield of California EPN |
$4.81
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.81
|
| Rate for Payer: Dignity Health Senior |
$4.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.62
|
| Rate for Payer: Heritage Provider Network Senior |
$2.62
|
| Rate for Payer: IEHP Medi-Cal |
$13.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.42
|
| Rate for Payer: Multiplan Commercial |
$4.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.81
|
| Rate for Payer: Vantage Medical Group Senior |
$4.81
|
|
|
VINCRISTINE 1 MG/ML INTRAVENOUS SOLUTION [8597]
|
Facility
OP
|
$19.37
|
|
|
Service Code
|
NDC 61703-309-06
|
| Hospital Charge Code |
1755769
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$16.46 |
| Rate for Payer: Adventist Health Commercial |
$3.87
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.53
|
| Rate for Payer: Blue Shield of California Commercial |
$12.03
|
| Rate for Payer: Blue Shield of California EPN |
$11.37
|
| Rate for Payer: Cash Price |
$8.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.46
|
| Rate for Payer: Dignity Health Senior |
$16.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.97
|
| Rate for Payer: Heritage Provider Network Senior |
$8.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.84
|
| Rate for Payer: Multiplan Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.46
|
| Rate for Payer: Vantage Medical Group Senior |
$16.46
|
|
|
VINCRISTINE 1 MG/ML INTRAVENOUS SOLUTION [8597]
|
Facility
IP
|
$19.37
|
|
|
Service Code
|
NDC 61703-309-06
|
| Hospital Charge Code |
1755769
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$14.53 |
| Rate for Payer: Adventist Health Commercial |
$3.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.31
|
| Rate for Payer: Cash Price |
$8.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.11
|
| Rate for Payer: Heritage Provider Network Senior |
$13.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.84
|
| Rate for Payer: Multiplan Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.47
|
|
|
VINCRISTINE 2 MG/2 ML INTRAVENOUS SOLUTION [120009]
|
Facility
OP
|
$8.39
|
|
|
Service Code
|
CPT J9370
|
| Hospital Charge Code |
1755094
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$71.47 |
| Rate for Payer: Adventist Health Commercial |
$1.68
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.47
|
| Rate for Payer: Blue Shield of California Commercial |
$5.75
|
| Rate for Payer: Blue Shield of California EPN |
$5.75
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: Dignity Health Senior |
$7.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.88
|
| Rate for Payer: Heritage Provider Network Senior |
$3.88
|
| Rate for Payer: IEHP Medi-Cal |
$19.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$6.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Senior |
$7.13
|
|
|
VINCRISTINE 2 MG/2 ML INTRAVENOUS SOLUTION [120009]
|
Facility
IP
|
$8.39
|
|
|
Service Code
|
CPT J9370
|
| Hospital Charge Code |
1755094
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$6.29 |
| Rate for Payer: Adventist Health Commercial |
$1.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.76
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.68
|
| Rate for Payer: Heritage Provider Network Senior |
$5.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$6.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.80
|
|
|
VINCRISTINE SULFATE LIPOSOMAL 5 MG/31 ML(0.16 MG/ML)(FINAL CONC)IV KIT [201456]
|
Facility
OP
|
$20,636.03
|
|
|
Service Code
|
NDC 72893-008-03
|
| Hospital Charge Code |
ERX201456
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,735.12 |
| Max. Negotiated Rate |
$17,540.63 |
| Rate for Payer: Adventist Health Commercial |
$4,127.21
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11,029.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,176.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17,540.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11,349.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15,477.02
|
| Rate for Payer: Blue Shield of California Commercial |
$12,814.97
|
| Rate for Payer: Blue Shield of California EPN |
$12,113.35
|
| Rate for Payer: Cash Price |
$9,286.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,492.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17,540.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$17,540.63
|
| Rate for Payer: Dignity Health Senior |
$17,540.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,207.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,554.48
|
| Rate for Payer: Heritage Provider Network Senior |
$9,554.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9,946.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,735.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,159.01
|
| Rate for Payer: Multiplan Commercial |
$15,477.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,523.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,894.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,540.63
|
| Rate for Payer: Vantage Medical Group Senior |
$17,540.63
|
|
|
VINCRISTINE SULFATE LIPOSOMAL 5 MG/31 ML(0.16 MG/ML)(FINAL CONC)IV KIT [201456]
|
Facility
IP
|
$20,636.03
|
|
|
Service Code
|
NDC 72893-008-03
|
| Hospital Charge Code |
ERX201456
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,735.12 |
| Max. Negotiated Rate |
$15,477.02 |
| Rate for Payer: Adventist Health Commercial |
$4,127.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,176.95
|
| Rate for Payer: Cash Price |
$9,286.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,492.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,143.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,970.59
|
| Rate for Payer: Heritage Provider Network Senior |
$13,970.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,735.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,159.01
|
| Rate for Payer: Multiplan Commercial |
$15,477.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,523.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,894.50
|
|
|
VINORELBINE 10 MG/ML INTRAVENOUS SOLUTION [14203]
|
Facility
OP
|
$30.00
|
|
|
Service Code
|
CPT J9390
|
| Hospital Charge Code |
NDG14203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$203.76 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.76
|
| Rate for Payer: Blue Shield of California Commercial |
$17.34
|
| Rate for Payer: Blue Shield of California EPN |
$17.34
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.50
|
| Rate for Payer: Dignity Health Senior |
$25.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.89
|
| Rate for Payer: Heritage Provider Network Senior |
$13.89
|
| Rate for Payer: IEHP Medi-Cal |
$18.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.50
|
| Rate for Payer: Vantage Medical Group Senior |
$25.50
|
|
