|
TENECTEPLASE 50 MG INTRAVENOUS SOLUTION [220772]
|
Facility
|
OP
|
$7,462.63
|
|
|
Service Code
|
CPT J3101
|
| Hospital Charge Code |
ERX220772
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$106.79 |
| Max. Negotiated Rate |
$6,343.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$963.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$963.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$191.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$191.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$168.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$168.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$168.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$168.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.79
|
| Rate for Payer: Blue Distinction Transplant |
$5,312.35
|
| Rate for Payer: Blue Distinction Transplant |
$4,477.58
|
| Rate for Payer: Blue Shield of California Commercial |
$6,525.33
|
| Rate for Payer: Blue Shield of California Commercial |
$5,499.96
|
| Rate for Payer: Blue Shield of California EPN |
$149.25
|
| Rate for Payer: Blue Shield of California EPN |
$149.25
|
| Rate for Payer: Cash Price |
$3,984.26
|
| Rate for Payer: Cash Price |
$3,358.18
|
| Rate for Payer: Cash Price |
$3,984.26
|
| Rate for Payer: Cash Price |
$3,358.18
|
| Rate for Payer: Cigna of CA HMO |
$6,197.74
|
| Rate for Payer: Cigna of CA HMO |
$5,223.84
|
| Rate for Payer: Cigna of CA PPO |
$5,223.84
|
| Rate for Payer: Cigna of CA PPO |
$6,197.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$229.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$229.67
|
| Rate for Payer: Dignity Health Media |
$153.11
|
| Rate for Payer: Dignity Health Media |
$153.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$168.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$168.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$206.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$206.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$153.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$153.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$153.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$153.11
|
| Rate for Payer: Galaxy Health WC |
$6,343.24
|
| Rate for Payer: Galaxy Health WC |
$7,525.82
|
| Rate for Payer: Global Benefits Group Commercial |
$4,477.58
|
| Rate for Payer: Global Benefits Group Commercial |
$5,312.35
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,596.97
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,640.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$251.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$251.11
|
| Rate for Payer: Heritage Provider Network Transplant |
$251.11
|
| Rate for Payer: Heritage Provider Network Transplant |
$251.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$248.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$248.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$248.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$248.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$153.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$153.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,977.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,905.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,373.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,843.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$153.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$153.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,791.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,124.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$192.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$192.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$205.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$205.17
|
| Rate for Payer: Multiplan Commercial |
$5,970.10
|
| Rate for Payer: Multiplan Commercial |
$7,083.13
|
| Rate for Payer: Networks By Design Commercial |
$4,426.96
|
| Rate for Payer: Networks By Design Commercial |
$3,731.32
|
| Rate for Payer: Prime Health Services Commercial |
$6,343.24
|
| Rate for Payer: Prime Health Services Commercial |
$7,525.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,312.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,477.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,477.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,312.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,426.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,731.32
|
| Rate for Payer: United Healthcare All Other HMO |
$3,731.32
|
| Rate for Payer: United Healthcare All Other HMO |
$4,426.96
|
| Rate for Payer: United Healthcare HMO Rider |
$3,731.32
|
| Rate for Payer: United Healthcare HMO Rider |
$4,426.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,426.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,731.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$229.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$229.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$168.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$168.43
|
| Rate for Payer: Vantage Medical Group Senior |
$153.11
|
| Rate for Payer: Vantage Medical Group Senior |
$153.11
|
|
|
TENECTEPLASE 50 MG INTRAVENOUS SOLUTION [220772]
|
Facility
|
IP
|
$7,462.63
|
|
|
Service Code
|
CPT J3101
|
| Hospital Charge Code |
ERX220772
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,791.03 |
| Max. Negotiated Rate |
$6,343.24 |
| Rate for Payer: Blue Shield of California Commercial |
$5,313.39
|
| Rate for Payer: Blue Shield of California Commercial |
$6,303.98
|
| Rate for Payer: Blue Shield of California EPN |
$3,820.87
|
| Rate for Payer: Blue Shield of California EPN |
$4,533.20
|
| Rate for Payer: Cash Price |
$3,358.18
|
| Rate for Payer: Cash Price |
$3,984.26
|
| Rate for Payer: Cigna of CA HMO |
$5,223.84
|
| Rate for Payer: Cigna of CA HMO |
$6,197.74
|
| Rate for Payer: Cigna of CA PPO |
$6,197.74
|
| Rate for Payer: Cigna of CA PPO |
$5,223.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,541.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,985.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,985.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,541.56
|
| Rate for Payer: Galaxy Health WC |
$6,343.24
|
| Rate for Payer: Galaxy Health WC |
$7,525.82
|
| Rate for Payer: Global Benefits Group Commercial |
$5,312.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,477.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,905.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,977.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,843.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,373.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,791.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,124.94
|
| Rate for Payer: Multiplan Commercial |
$5,970.10
|
| Rate for Payer: Multiplan Commercial |
$7,083.13
|
| Rate for Payer: Networks By Design Commercial |
$3,731.32
|
| Rate for Payer: Networks By Design Commercial |
$4,426.96
|
| Rate for Payer: Prime Health Services Commercial |
$6,343.24
|
| Rate for Payer: Prime Health Services Commercial |
$7,525.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,817.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,343.24
|
| Rate for Payer: United Healthcare All Other HMO |
$2,752.22
|
| Rate for Payer: United Healthcare All Other HMO |
$3,265.32
|
| Rate for Payer: United Healthcare HMO Rider |
$2,692.52
|
| Rate for Payer: United Healthcare HMO Rider |
$3,194.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,462.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,921.79
|
|
|
TENOFOVIR ALAFENAMIDE 25 MG TABLET [216415]
|
Facility
|
OP
|
$54.97
|
|
|
Service Code
|
NDC 61958-2301-1
|
| Hospital Charge Code |
ERX216415
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.19 |
| Max. Negotiated Rate |
$46.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$36.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.75
|
| Rate for Payer: Blue Distinction Transplant |
$32.98
|
| Rate for Payer: Blue Shield of California Commercial |
$40.51
|
| Rate for Payer: Blue Shield of California EPN |
$32.10
|
| Rate for Payer: Cash Price |
$24.74
|
| Rate for Payer: Cigna of CA HMO |
$38.48
|
| Rate for Payer: Cigna of CA PPO |
$38.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.72
|
| Rate for Payer: Dignity Health Media |
$46.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.99
|
| Rate for Payer: Galaxy Health WC |
$46.72
|
| Rate for Payer: Global Benefits Group Commercial |
$32.98
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$41.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.19
|
| Rate for Payer: Multiplan Commercial |
$43.98
|
| Rate for Payer: Networks By Design Commercial |
$35.73
|
| Rate for Payer: Prime Health Services Commercial |
$46.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.48
|
| Rate for Payer: United Healthcare All Other HMO |
$27.48
|
| Rate for Payer: United Healthcare HMO Rider |
$27.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.72
|
| Rate for Payer: Vantage Medical Group Senior |
$46.72
|
|
|
TENOFOVIR ALAFENAMIDE 25 MG TABLET [216415]
|
Facility
|
IP
|
$54.97
|
|
|
Service Code
|
NDC 61958-2301-1
|
| Hospital Charge Code |
ERX216415
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.19 |
| Max. Negotiated Rate |
$46.72 |
| Rate for Payer: Blue Shield of California Commercial |
$39.14
|
| Rate for Payer: Blue Shield of California EPN |
$28.14
|
| Rate for Payer: Cash Price |
$24.74
|
| Rate for Payer: Cigna of CA HMO |
$38.48
|
| Rate for Payer: Cigna of CA PPO |
$38.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.99
|
| Rate for Payer: Galaxy Health WC |
$46.72
|
| Rate for Payer: Global Benefits Group Commercial |
$32.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.19
|
| Rate for Payer: Multiplan Commercial |
$43.98
|
| Rate for Payer: Networks By Design Commercial |
$35.73
|
| Rate for Payer: Prime Health Services Commercial |
$46.72
|
|
|
TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [31684]
|
Facility
|
OP
|
$4.21
|
|
|
Service Code
|
NDC 50268-758-11
|
| Hospital Charge Code |
1710955
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$3.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.51
|
| Rate for Payer: Blue Distinction Transplant |
$2.53
|
| Rate for Payer: Blue Shield of California Commercial |
$3.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.46
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cigna of CA HMO |
$2.95
|
| Rate for Payer: Cigna of CA PPO |
$2.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.58
|
| Rate for Payer: Dignity Health Media |
$3.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$3.58
|
| Rate for Payer: Global Benefits Group Commercial |
$2.53
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: Multiplan Commercial |
$3.37
|
| Rate for Payer: Networks By Design Commercial |
$2.74
|
| Rate for Payer: Prime Health Services Commercial |
$3.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.10
|
| Rate for Payer: United Healthcare All Other HMO |
$2.10
|
| Rate for Payer: United Healthcare HMO Rider |
$2.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.58
|
| Rate for Payer: Vantage Medical Group Senior |
$3.58
|
|
|
TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [31684]
|
Facility
|
OP
|
$4.21
|
|
|
Service Code
|
NDC 50268-758-12
|
| Hospital Charge Code |
1710955
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$3.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.51
|
| Rate for Payer: Blue Distinction Transplant |
$2.53
|
| Rate for Payer: Blue Shield of California Commercial |
$3.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.46
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cigna of CA HMO |
$2.95
|
| Rate for Payer: Cigna of CA PPO |
$2.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.58
|
| Rate for Payer: Dignity Health Media |
$3.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$3.58
|
| Rate for Payer: Global Benefits Group Commercial |
$2.53
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: Multiplan Commercial |
$3.37
|
| Rate for Payer: Networks By Design Commercial |
$2.74
|
| Rate for Payer: Prime Health Services Commercial |
$3.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.10
|
| Rate for Payer: United Healthcare All Other HMO |
$2.10
|
| Rate for Payer: United Healthcare HMO Rider |
$2.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.58
|
| Rate for Payer: Vantage Medical Group Senior |
$3.58
|
|
|
TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [31684]
|
Facility
|
IP
|
$1.15
|
|
|
Service Code
|
NDC 69097-533-02
|
| Hospital Charge Code |
1710955
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Blue Shield of California Commercial |
$0.82
|
| Rate for Payer: Blue Shield of California EPN |
$0.59
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cigna of CA HMO |
$0.81
|
| Rate for Payer: Cigna of CA PPO |
$0.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: Galaxy Health WC |
$0.98
|
| Rate for Payer: Global Benefits Group Commercial |
$0.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$0.92
|
| Rate for Payer: Networks By Design Commercial |
$0.75
|
| Rate for Payer: Prime Health Services Commercial |
$0.98
|
|
|
TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [31684]
|
Facility
|
OP
|
$1.15
|
|
|
Service Code
|
NDC 69097-533-02
|
| Hospital Charge Code |
1710955
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.69
|
| Rate for Payer: Blue Distinction Transplant |
$0.69
|
| Rate for Payer: Blue Shield of California Commercial |
$0.85
|
| Rate for Payer: Blue Shield of California EPN |
$0.67
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cigna of CA HMO |
$0.81
|
| Rate for Payer: Cigna of CA PPO |
$0.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.98
|
| Rate for Payer: Dignity Health Media |
$0.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.46
|
| Rate for Payer: Galaxy Health WC |
$0.98
|
| Rate for Payer: Global Benefits Group Commercial |
$0.69
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$0.92
|
| Rate for Payer: Networks By Design Commercial |
$0.75
|
| Rate for Payer: Prime Health Services Commercial |
$0.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.58
|
| Rate for Payer: United Healthcare All Other HMO |
$0.58
|
| Rate for Payer: United Healthcare HMO Rider |
$0.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.98
|
| Rate for Payer: Vantage Medical Group Senior |
$0.98
|
|
|
TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [31684]
|
Facility
|
IP
|
$4.21
|
|
|
Service Code
|
NDC 50268-758-11
|
| Hospital Charge Code |
1710955
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$3.58 |
| Rate for Payer: Blue Shield of California Commercial |
$3.00
|
| Rate for Payer: Blue Shield of California EPN |
$2.16
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cigna of CA HMO |
$2.95
|
| Rate for Payer: Cigna of CA PPO |
$2.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$3.58
|
| Rate for Payer: Global Benefits Group Commercial |
$2.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: Multiplan Commercial |
$3.37
|
| Rate for Payer: Networks By Design Commercial |
$2.74
|
| Rate for Payer: Prime Health Services Commercial |
$3.58
|
|
|
TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [31684]
|
Facility
|
IP
|
$4.21
|
|
|
Service Code
|
NDC 50268-758-12
|
| Hospital Charge Code |
1710955
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$3.58 |
| Rate for Payer: Blue Shield of California Commercial |
$3.00
|
| Rate for Payer: Blue Shield of California EPN |
$2.16
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cigna of CA HMO |
$2.95
|
| Rate for Payer: Cigna of CA PPO |
$2.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$3.58
|
| Rate for Payer: Global Benefits Group Commercial |
$2.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: Multiplan Commercial |
$3.37
|
| Rate for Payer: Networks By Design Commercial |
$2.74
|
| Rate for Payer: Prime Health Services Commercial |
$3.58
|
|
|
TERAZOSIN 1 MG CAPSULE [14550]
|
Facility
|
IP
|
$0.28
|
|
|
Service Code
|
NDC 51079-936-01
|
| Hospital Charge Code |
1711490
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| 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: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| 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 |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.24
|
|
|
TERAZOSIN 1 MG CAPSULE [14550]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 59746-383-06
|
| Hospital Charge Code |
1711490
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
|
|
TERAZOSIN 1 MG CAPSULE [14550]
|
Facility
|
OP
|
$0.28
|
|
|
Service Code
|
NDC 51079-936-20
|
| Hospital Charge Code |
1711490
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.15
|
| 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 |
$0.16
|
| 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 |
$0.24
|
| Rate for Payer: Dignity Health Media |
$0.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.21
|
| 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 |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.24
|
| 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 |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO |
$0.14
|
| Rate for Payer: United Healthcare HMO Rider |
$0.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: Vantage Medical Group Senior |
$0.24
|
|
|
TERAZOSIN 1 MG CAPSULE [14550]
|
Facility
|
IP
|
$0.28
|
|
|
Service Code
|
NDC 51079-936-20
|
| Hospital Charge Code |
1711490
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| 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: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| 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 |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.24
|
|
|
TERAZOSIN 1 MG CAPSULE [14550]
|
Facility
|
OP
|
$0.28
|
|
|
Service Code
|
NDC 51079-936-01
|
| Hospital Charge Code |
1711490
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.15
|
| 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 |
$0.16
|
| 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 |
$0.24
|
| Rate for Payer: Dignity Health Media |
$0.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.21
|
| 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 |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.24
|
| 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 |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO |
$0.14
|
| Rate for Payer: United Healthcare HMO Rider |
$0.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: Vantage Medical Group Senior |
$0.24
|
|
|
TERAZOSIN 1 MG CAPSULE [14550]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 59746-383-06
|
| Hospital Charge Code |
1711490
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.13
|
| Rate for Payer: Blue Distinction Transplant |
$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 |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
| Rate for Payer: Dignity Health Media |
$0.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
|
|
TERAZOSIN 2 MG CAPSULE [14551]
|
Facility
|
OP
|
$0.21
|
|
|
Service Code
|
NDC 59746-384-10
|
| Hospital Charge Code |
1711491
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.13
|
| Rate for Payer: Blue Distinction Transplant |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.18
|
| Rate for Payer: Dignity Health Media |
$0.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: Vantage Medical Group Senior |
$0.18
|
|
|
TERAZOSIN 2 MG CAPSULE [14551]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 59746-384-06
|
| Hospital Charge Code |
1711491
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.13
|
| Rate for Payer: Blue Distinction Transplant |
$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 |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
| Rate for Payer: Dignity Health Media |
$0.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
|
|
TERAZOSIN 2 MG CAPSULE [14551]
|
Facility
|
IP
|
$0.21
|
|
|
Service Code
|
NDC 59746-384-10
|
| Hospital Charge Code |
1711491
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.18
|
|
|
TERAZOSIN 2 MG CAPSULE [14551]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 59746-384-06
|
| Hospital Charge Code |
1711491
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
|
|
TERAZOSIN 5 MG CAPSULE [14553]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 59746-385-06
|
| Hospital Charge Code |
1712151
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.13
|
| Rate for Payer: Blue Distinction Transplant |
$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 |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
| Rate for Payer: Dignity Health Media |
$0.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
|
|
TERAZOSIN 5 MG CAPSULE [14553]
|
Facility
|
OP
|
$1.01
|
|
|
Service Code
|
NDC 50268-766-15
|
| Hospital Charge Code |
1712151
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.60
|
| Rate for Payer: Blue Distinction Transplant |
$0.61
|
| Rate for Payer: Blue Shield of California Commercial |
$0.74
|
| Rate for Payer: Blue Shield of California EPN |
$0.59
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.71
|
| Rate for Payer: Cigna of CA PPO |
$0.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.86
|
| Rate for Payer: Dignity Health Media |
$0.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.86
|
| Rate for Payer: Global Benefits Group Commercial |
$0.61
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.76
|
| 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 |
$0.81
|
| Rate for Payer: Networks By Design Commercial |
$0.66
|
| Rate for Payer: Prime Health Services Commercial |
$0.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.51
|
| Rate for Payer: United Healthcare All Other HMO |
$0.51
|
| Rate for Payer: United Healthcare HMO Rider |
$0.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.86
|
| Rate for Payer: Vantage Medical Group Senior |
$0.86
|
|
|
TERAZOSIN 5 MG CAPSULE [14553]
|
Facility
|
IP
|
$1.01
|
|
|
Service Code
|
NDC 50268-766-15
|
| Hospital Charge Code |
1712151
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.86 |
| Rate for Payer: Blue Shield of California Commercial |
$0.72
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.71
|
| Rate for Payer: Cigna of CA PPO |
$0.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.86
|
| Rate for Payer: Global Benefits Group Commercial |
$0.61
|
| 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 |
$0.81
|
| Rate for Payer: Networks By Design Commercial |
$0.66
|
| Rate for Payer: Prime Health Services Commercial |
$0.86
|
|
|
TERAZOSIN 5 MG CAPSULE [14553]
|
Facility
|
OP
|
$1.01
|
|
|
Service Code
|
NDC 50268-766-11
|
| Hospital Charge Code |
1712151
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.60
|
| Rate for Payer: Blue Distinction Transplant |
$0.61
|
| Rate for Payer: Blue Shield of California Commercial |
$0.74
|
| Rate for Payer: Blue Shield of California EPN |
$0.59
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.71
|
| Rate for Payer: Cigna of CA PPO |
$0.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.86
|
| Rate for Payer: Dignity Health Media |
$0.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.86
|
| Rate for Payer: Global Benefits Group Commercial |
$0.61
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.76
|
| 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 |
$0.81
|
| Rate for Payer: Networks By Design Commercial |
$0.66
|
| Rate for Payer: Prime Health Services Commercial |
$0.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.51
|
| Rate for Payer: United Healthcare All Other HMO |
$0.51
|
| Rate for Payer: United Healthcare HMO Rider |
$0.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.86
|
| Rate for Payer: Vantage Medical Group Senior |
$0.86
|
|
|
TERAZOSIN 5 MG CAPSULE [14553]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 59746-385-06
|
| Hospital Charge Code |
1712151
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
|
