|
TADALAFIL 20 MG TABLET (PULMONARY HYPERTENSION) [214774]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 27241-123-02
|
| Hospital Charge Code |
ERX214774
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Blue Shield of California Commercial |
$0.71
|
| Rate for Payer: Blue Shield of California EPN |
$0.51
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
|
|
TADALAFIL 20 MG TABLET (PULMONARY HYPERTENSION) [214774]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 33342-278-09
|
| Hospital Charge Code |
ERX214774
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.60
|
| Rate for Payer: Blue Distinction Transplant |
$0.60
|
| Rate for Payer: Blue Shield of California Commercial |
$0.74
|
| Rate for Payer: Blue Shield of California EPN |
$0.58
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Media |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
TADALAFIL 20 MG TABLET (PULMONARY HYPERTENSION) [214774]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 33342-278-09
|
| Hospital Charge Code |
ERX214774
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Blue Shield of California Commercial |
$0.71
|
| Rate for Payer: Blue Shield of California EPN |
$0.51
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
|
|
TADALAFIL 20 MG TABLET (PULMONARY HYPERTENSION) [214774]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 69097-526-03
|
| Hospital Charge Code |
ERX214774
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Blue Shield of California Commercial |
$0.71
|
| Rate for Payer: Blue Shield of California EPN |
$0.51
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
|
|
TADALAFIL 20 MG TABLET (PULMONARY HYPERTENSION) [214774]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 69097-526-03
|
| Hospital Charge Code |
ERX214774
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.60
|
| Rate for Payer: Blue Distinction Transplant |
$0.60
|
| Rate for Payer: Blue Shield of California Commercial |
$0.74
|
| Rate for Payer: Blue Shield of California EPN |
$0.58
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Media |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
TADALAFIL 20 MG TABLET (PULMONARY HYPERTENSION) [214774]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 27241-123-02
|
| Hospital Charge Code |
ERX214774
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.60
|
| Rate for Payer: Blue Distinction Transplant |
$0.60
|
| Rate for Payer: Blue Shield of California Commercial |
$0.74
|
| Rate for Payer: Blue Shield of California EPN |
$0.58
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Media |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
TADALAFIL 5 MG TABLET [37400]
|
Facility
|
IP
|
$0.36
|
|
|
Service Code
|
NDC 43598-575-30
|
| Hospital Charge Code |
ERX37400
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
|
|
TADALAFIL 5 MG TABLET [37400]
|
Facility
|
OP
|
$0.36
|
|
|
Service Code
|
NDC 43598-575-30
|
| Hospital Charge Code |
ERX37400
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.21
|
| Rate for Payer: Blue Distinction Transplant |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: Dignity Health Media |
$0.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
|
TADALAFIL ORAL SUSPENSION COMPOUND 5 MG/ML [4081077]
|
Facility
|
OP
|
$0.25
|
|
|
Service Code
|
NDC 99994-0810-77
|
| Hospital Charge Code |
NDC4081077
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Blue Distinction Transplant |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.21
|
| Rate for Payer: Dignity Health Media |
$0.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Vantage Medical Group Senior |
$0.21
|
|
|
TADALAFIL ORAL SUSPENSION COMPOUND 5 MG/ML [4081077]
|
Facility
|
IP
|
$0.25
|
|
|
Service Code
|
NDC 99994-0810-77
|
| Hospital Charge Code |
NDC4081077
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
|
|
TAFASITAMAB-CXIX 200 MG INTRAVENOUS SOLUTION [228997]
|
Facility
|
IP
|
$1,570.38
|
|
|
Service Code
|
CPT J9349
|
| Hospital Charge Code |
ERX228997
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$376.89 |
| Max. Negotiated Rate |
$1,334.82 |
| Rate for Payer: Blue Shield of California Commercial |
$1,118.11
|
| Rate for Payer: Blue Shield of California EPN |
$804.03
|
| Rate for Payer: Cash Price |
$706.67
|
| Rate for Payer: Cigna of CA HMO |
$1,099.27
|
| Rate for Payer: Cigna of CA PPO |
$1,099.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$628.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$628.15
|
| Rate for Payer: Galaxy Health WC |
$1,334.82
|
| Rate for Payer: Global Benefits Group Commercial |
$942.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,047.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$598.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$376.89
|
| Rate for Payer: Multiplan Commercial |
$1,256.30
|
| Rate for Payer: Networks By Design Commercial |
$785.19
|
| Rate for Payer: Prime Health Services Commercial |
$1,334.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$592.98
|
| Rate for Payer: United Healthcare All Other HMO |
$579.16
|
| Rate for Payer: United Healthcare HMO Rider |
$566.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$518.23
|
|
|
TAFASITAMAB-CXIX 200 MG INTRAVENOUS SOLUTION [228997]
|
Facility
|
OP
|
$1,570.38
|
|
|
Service Code
|
CPT J9349
|
| Hospital Charge Code |
ERX228997
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$1,334.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$26.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.58
|
| Rate for Payer: Blue Distinction Transplant |
$942.23
|
| Rate for Payer: Blue Shield of California Commercial |
$1,157.37
|
| Rate for Payer: Blue Shield of California EPN |
$917.10
|
| Rate for Payer: Cash Price |
$706.67
|
| Rate for Payer: Cash Price |
$706.67
|
| Rate for Payer: Cigna of CA HMO |
$1,099.27
|
| Rate for Payer: Cigna of CA PPO |
$1,099.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.00
|
| Rate for Payer: Dignity Health Media |
$14.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.35
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.60
|
| Rate for Payer: Galaxy Health WC |
$1,334.82
|
| Rate for Payer: Global Benefits Group Commercial |
$942.23
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,177.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.30
|
| Rate for Payer: Heritage Provider Network Transplant |
$22.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$22.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,047.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$376.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.22
|
| Rate for Payer: Multiplan Commercial |
$1,256.30
|
| Rate for Payer: Networks By Design Commercial |
$785.19
|
| Rate for Payer: Prime Health Services Commercial |
$1,334.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$942.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$942.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$785.19
|
| Rate for Payer: United Healthcare All Other HMO |
$785.19
|
| Rate for Payer: United Healthcare HMO Rider |
$785.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$785.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.96
|
| Rate for Payer: Vantage Medical Group Senior |
$14.96
|
|
|
TALIMOGENE LAHERPAREPVEC 10EXP6 (1 MILLION) PFU/ML SUSP FOR INJECTION [211748]
|
Facility
|
IP
|
$76.04
|
|
|
Service Code
|
CPT J9325
|
| Hospital Charge Code |
NDG211748
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.25 |
| Max. Negotiated Rate |
$64.63 |
| Rate for Payer: Blue Shield of California Commercial |
$54.14
|
| Rate for Payer: Blue Shield of California EPN |
$38.93
|
| Rate for Payer: Cash Price |
$34.22
|
| Rate for Payer: Cigna of CA HMO |
$53.23
|
| Rate for Payer: Cigna of CA PPO |
$53.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$30.42
|
| Rate for Payer: Galaxy Health WC |
$64.63
|
| Rate for Payer: Global Benefits Group Commercial |
$45.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.25
|
| Rate for Payer: Multiplan Commercial |
$60.83
|
| Rate for Payer: Networks By Design Commercial |
$38.02
|
| Rate for Payer: Prime Health Services Commercial |
$64.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.71
|
| Rate for Payer: United Healthcare All Other HMO |
$28.04
|
| Rate for Payer: United Healthcare HMO Rider |
$27.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.09
|
|
|
TALIMOGENE LAHERPAREPVEC 10EXP6 (1 MILLION) PFU/ML SUSP FOR INJECTION [211748]
|
Facility
|
OP
|
$76.04
|
|
|
Service Code
|
CPT J9325
|
| Hospital Charge Code |
NDG211748
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.25 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$131.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$83.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.81
|
| Rate for Payer: Blue Distinction Transplant |
$45.62
|
| Rate for Payer: Blue Shield of California Commercial |
$56.04
|
| Rate for Payer: Blue Shield of California EPN |
$62.16
|
| Rate for Payer: Cash Price |
$34.22
|
| Rate for Payer: Cash Price |
$34.22
|
| Rate for Payer: Cigna of CA HMO |
$53.23
|
| Rate for Payer: Cigna of CA PPO |
$53.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$99.88
|
| Rate for Payer: Dignity Health Media |
$66.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$66.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$66.59
|
| Rate for Payer: Galaxy Health WC |
$64.63
|
| Rate for Payer: Global Benefits Group Commercial |
$45.62
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$57.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$109.20
|
| Rate for Payer: Heritage Provider Network Transplant |
$109.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$107.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$107.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$66.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$66.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$83.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$89.23
|
| Rate for Payer: Multiplan Commercial |
$60.83
|
| Rate for Payer: Networks By Design Commercial |
$38.02
|
| Rate for Payer: Prime Health Services Commercial |
$64.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.02
|
| Rate for Payer: United Healthcare All Other HMO |
$38.02
|
| Rate for Payer: United Healthcare HMO Rider |
$38.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$99.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.25
|
| Rate for Payer: Vantage Medical Group Senior |
$66.59
|
|
|
TALIMOGENE LAHERPAREPVEC 10EXP8 (100 MILLION)PFU/ML SUSP FOR INJECTION [211749]
|
Facility
|
IP
|
$7,603.57
|
|
|
Service Code
|
CPT J9325
|
| Hospital Charge Code |
NDG211749
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,824.86 |
| Max. Negotiated Rate |
$6,463.03 |
| Rate for Payer: Blue Shield of California Commercial |
$5,413.74
|
| Rate for Payer: Blue Shield of California EPN |
$3,893.03
|
| Rate for Payer: Cash Price |
$3,421.61
|
| Rate for Payer: Cigna of CA HMO |
$5,322.50
|
| Rate for Payer: Cigna of CA PPO |
$5,322.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,041.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,041.43
|
| Rate for Payer: Galaxy Health WC |
$6,463.03
|
| Rate for Payer: Global Benefits Group Commercial |
$4,562.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,071.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,896.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,824.86
|
| Rate for Payer: Multiplan Commercial |
$6,082.86
|
| Rate for Payer: Networks By Design Commercial |
$3,801.78
|
| Rate for Payer: Prime Health Services Commercial |
$6,463.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,871.11
|
| Rate for Payer: United Healthcare All Other HMO |
$2,804.20
|
| Rate for Payer: United Healthcare HMO Rider |
$2,743.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,509.18
|
|
|
TALIMOGENE LAHERPAREPVEC 10EXP8 (100 MILLION)PFU/ML SUSP FOR INJECTION [211749]
|
Facility
|
OP
|
$7,603.57
|
|
|
Service Code
|
CPT J9325
|
| Hospital Charge Code |
NDG211749
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.16 |
| Max. Negotiated Rate |
$6,463.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$131.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$83.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.81
|
| Rate for Payer: Blue Distinction Transplant |
$4,562.14
|
| Rate for Payer: Blue Shield of California Commercial |
$5,603.83
|
| Rate for Payer: Blue Shield of California EPN |
$62.16
|
| Rate for Payer: Cash Price |
$3,421.61
|
| Rate for Payer: Cash Price |
$3,421.61
|
| Rate for Payer: Cigna of CA HMO |
$5,322.50
|
| Rate for Payer: Cigna of CA PPO |
$5,322.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$99.88
|
| Rate for Payer: Dignity Health Media |
$66.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$66.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$66.59
|
| Rate for Payer: Galaxy Health WC |
$6,463.03
|
| Rate for Payer: Global Benefits Group Commercial |
$4,562.14
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,702.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$109.20
|
| Rate for Payer: Heritage Provider Network Transplant |
$109.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$107.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$107.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$66.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,071.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$66.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,824.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$83.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$89.23
|
| Rate for Payer: Multiplan Commercial |
$6,082.86
|
| Rate for Payer: Networks By Design Commercial |
$3,801.78
|
| Rate for Payer: Prime Health Services Commercial |
$6,463.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,562.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,562.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,801.78
|
| Rate for Payer: United Healthcare All Other HMO |
$3,801.78
|
| Rate for Payer: United Healthcare HMO Rider |
$3,801.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,801.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$99.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.25
|
| Rate for Payer: Vantage Medical Group Senior |
$66.59
|
|
|
TAMOXIFEN 10 MG TABLET [7711]
|
Facility
|
IP
|
$0.46
|
|
|
Service Code
|
CPT S0187
|
| Hospital Charge Code |
1710109
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: Blue Shield of California Commercial |
$0.33
|
| Rate for Payer: Blue Shield of California Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Cigna of CA HMO |
$0.40
|
| Rate for Payer: Cigna of CA HMO |
$0.32
|
| Rate for Payer: Cigna of CA PPO |
$0.40
|
| Rate for Payer: Cigna of CA PPO |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$0.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.30
|
| Rate for Payer: Networks By Design Commercial |
$0.37
|
| Rate for Payer: Prime Health Services Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
|
|
TAMOXIFEN 10 MG TABLET [7711]
|
Facility
|
OP
|
$0.57
|
|
|
Service Code
|
CPT S0187
|
| Hospital Charge Code |
1710109
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$6.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.04
|
| Rate for Payer: Blue Distinction Transplant |
$0.34
|
| Rate for Payer: Blue Distinction Transplant |
$0.28
|
| Rate for Payer: Blue Shield of California Commercial |
$0.42
|
| Rate for Payer: Blue Shield of California Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.33
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.32
|
| Rate for Payer: Cigna of CA HMO |
$0.40
|
| Rate for Payer: Cigna of CA PPO |
$0.32
|
| Rate for Payer: Cigna of CA PPO |
$0.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.48
|
| Rate for Payer: Dignity Health Media |
$0.39
|
| Rate for Payer: Dignity Health Media |
$0.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$0.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.28
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.35
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.30
|
| Rate for Payer: Prime Health Services Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.29
|
| Rate for Payer: United Healthcare All Other HMO |
$0.23
|
| Rate for Payer: United Healthcare All Other HMO |
$0.29
|
| Rate for Payer: United Healthcare HMO Rider |
$0.29
|
| Rate for Payer: United Healthcare HMO Rider |
$0.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.39
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
|
|
TAMOXIFEN 20 MG TABLET [11498]
|
Facility
|
IP
|
$0.46
|
|
|
Service Code
|
NDC 51862-446-30
|
| Hospital Charge Code |
1710943
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: Blue Shield of California Commercial |
$0.33
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Cigna of CA HMO |
$0.32
|
| Rate for Payer: Cigna of CA PPO |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.30
|
| Rate for Payer: Prime Health Services Commercial |
$0.39
|
|
|
TAMOXIFEN 20 MG TABLET [11498]
|
Facility
|
OP
|
$0.46
|
|
|
Service Code
|
NDC 51862-446-30
|
| Hospital Charge Code |
1710943
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.27
|
| Rate for Payer: Blue Distinction Transplant |
$0.28
|
| Rate for Payer: Blue Shield of California Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Cigna of CA HMO |
$0.32
|
| Rate for Payer: Cigna of CA PPO |
$0.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.39
|
| Rate for Payer: Dignity Health Media |
$0.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.28
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.30
|
| Rate for Payer: Prime Health Services Commercial |
$0.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.23
|
| Rate for Payer: United Healthcare All Other HMO |
$0.23
|
| Rate for Payer: United Healthcare HMO Rider |
$0.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.39
|
| Rate for Payer: Vantage Medical Group Senior |
$0.39
|
|
|
TAMOXIFEN 20 MG TABLET [11498]
|
Facility
|
IP
|
$0.46
|
|
|
Service Code
|
NDC 59651-300-30
|
| Hospital Charge Code |
1710943
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: Blue Shield of California Commercial |
$0.33
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Cigna of CA HMO |
$0.32
|
| Rate for Payer: Cigna of CA PPO |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.30
|
| Rate for Payer: Prime Health Services Commercial |
$0.39
|
|
|
TAMOXIFEN 20 MG TABLET [11498]
|
Facility
|
OP
|
$0.46
|
|
|
Service Code
|
NDC 59651-300-30
|
| Hospital Charge Code |
1710943
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.27
|
| Rate for Payer: Blue Distinction Transplant |
$0.28
|
| Rate for Payer: Blue Shield of California Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Cigna of CA HMO |
$0.32
|
| Rate for Payer: Cigna of CA PPO |
$0.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.39
|
| Rate for Payer: Dignity Health Media |
$0.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.28
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.30
|
| Rate for Payer: Prime Health Services Commercial |
$0.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.23
|
| Rate for Payer: United Healthcare All Other HMO |
$0.23
|
| Rate for Payer: United Healthcare HMO Rider |
$0.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.39
|
| Rate for Payer: Vantage Medical Group Senior |
$0.39
|
|
|
TAMSULOSIN 0.4 MG CAPSULE [103890]
|
Facility
|
OP
|
$0.29
|
|
|
Service Code
|
NDC 62756-160-88
|
| Hospital Charge Code |
1711755
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Blue Distinction Transplant |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.25
|
| Rate for Payer: Dignity Health Media |
$0.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.25
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.19
|
| Rate for Payer: Prime Health Services Commercial |
$0.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.15
|
| Rate for Payer: United Healthcare All Other HMO |
$0.15
|
| Rate for Payer: United Healthcare HMO Rider |
$0.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: Vantage Medical Group Senior |
$0.25
|
|
|
TAMSULOSIN 0.4 MG CAPSULE [103890]
|
Facility
|
IP
|
$0.53
|
|
|
Service Code
|
NDC 0904-6401-61
|
| Hospital Charge Code |
1711755
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cigna of CA HMO |
$0.37
|
| Rate for Payer: Cigna of CA PPO |
$0.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.21
|
| Rate for Payer: Galaxy Health WC |
$0.45
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.42
|
| Rate for Payer: Networks By Design Commercial |
$0.34
|
| Rate for Payer: Prime Health Services Commercial |
$0.45
|
|
|
TAMSULOSIN 0.4 MG CAPSULE [103890]
|
Facility
|
OP
|
$0.07
|
|
|
Service Code
|
NDC 0904-6401-89
|
| Hospital Charge Code |
1711755
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: Blue Distinction Transplant |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$0.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.06
|
| Rate for Payer: Dignity Health Media |
$0.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Vantage Medical Group Senior |
$0.06
|
|
