|
TAMSULOSIN 0.4 MG CAPSULE [103890]
|
Facility
IP
|
$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: 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: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| 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
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$0.04
|
| 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
|
|
|
TAPENTADOL 50 MG TABLET [98253]
|
Facility
OP
|
$11.56
|
|
|
Service Code
|
NDC 24510-050-10
|
| Hospital Charge Code |
1730175
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$9.83 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.89
|
| Rate for Payer: BCBS Transplant Transplant |
$6.94
|
| Rate for Payer: Blue Shield of California Commercial |
$8.52
|
| Rate for Payer: Blue Shield of California EPN |
$6.75
|
| Rate for Payer: Cash Price |
$5.20
|
| Rate for Payer: Cigna of CA HMO |
$8.09
|
| Rate for Payer: Cigna of CA PPO |
$8.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.83
|
| Rate for Payer: Dignity Health Media |
$9.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.62
|
| Rate for Payer: Galaxy Health WC |
$9.83
|
| Rate for Payer: Global Benefits Group Commercial |
$6.94
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.77
|
| Rate for Payer: Multiplan Commercial |
$9.25
|
| Rate for Payer: Networks By Design Commercial |
$7.51
|
| Rate for Payer: Prime Health Services Commercial |
$9.83
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.83
|
| Rate for Payer: Vantage Medical Group Senior |
$9.83
|
|
|
TAPENTADOL 50 MG TABLET [98253]
|
Facility
IP
|
$11.56
|
|
|
Service Code
|
NDC 24510-050-10
|
| Hospital Charge Code |
1730175
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$9.83 |
| Rate for Payer: Blue Shield of California Commercial |
$8.23
|
| Rate for Payer: Blue Shield of California EPN |
$5.92
|
| Rate for Payer: Cash Price |
$5.20
|
| Rate for Payer: Cigna of CA HMO |
$8.09
|
| Rate for Payer: Cigna of CA PPO |
$8.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.62
|
| Rate for Payer: Galaxy Health WC |
$9.83
|
| Rate for Payer: Global Benefits Group Commercial |
$6.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.77
|
| Rate for Payer: Multiplan Commercial |
$9.25
|
| Rate for Payer: Networks By Design Commercial |
$7.51
|
| Rate for Payer: Prime Health Services Commercial |
$9.83
|
|
|
TAVR Implant Device - #2944
|
Facility
IP
|
$34,169.00
|
|
|
Service Code
|
ICD 02RF38Z
|
| Min. Negotiated Rate |
$34,169.00 |
| Max. Negotiated Rate |
$34,169.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,169.00
|
|
|
TAZEMETOSTAT 200 MG TABLET [226994]
|
Facility
OP
|
$88.73
|
|
|
Service Code
|
NDC 72607-100-00
|
| Hospital Charge Code |
ERX226994
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$21.30 |
| Max. Negotiated Rate |
$75.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$58.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$75.42
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$48.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$48.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.87
|
| Rate for Payer: BCBS Transplant Transplant |
$53.24
|
| Rate for Payer: Blue Shield of California Commercial |
$65.39
|
| Rate for Payer: Blue Shield of California EPN |
$51.82
|
| Rate for Payer: Cash Price |
$39.93
|
| Rate for Payer: Cigna of CA HMO |
$62.11
|
| Rate for Payer: Cigna of CA PPO |
$62.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.42
|
| Rate for Payer: Dignity Health Media |
$75.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$75.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$35.49
|
| Rate for Payer: Galaxy Health WC |
$75.42
|
| Rate for Payer: Global Benefits Group Commercial |
$53.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$66.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.30
|
| Rate for Payer: Multiplan Commercial |
$70.98
|
| Rate for Payer: Networks By Design Commercial |
$57.67
|
| Rate for Payer: Prime Health Services Commercial |
$75.42
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$53.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$53.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$44.36
|
| Rate for Payer: United Healthcare All Other HMO |
$44.36
|
| Rate for Payer: United Healthcare HMO Rider |
$44.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$75.42
|
| Rate for Payer: Vantage Medical Group Senior |
$75.42
|
|
|
TAZEMETOSTAT 200 MG TABLET [226994]
|
Facility
IP
|
$88.73
|
|
|
Service Code
|
NDC 72607-100-00
|
| Hospital Charge Code |
ERX226994
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$21.30 |
| Max. Negotiated Rate |
$75.42 |
| Rate for Payer: Blue Shield of California Commercial |
$63.18
|
| Rate for Payer: Blue Shield of California EPN |
$45.43
|
| Rate for Payer: Cash Price |
$39.93
|
| Rate for Payer: Cigna of CA HMO |
$62.11
|
| Rate for Payer: Cigna of CA PPO |
$62.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.49
|
| Rate for Payer: Galaxy Health WC |
$75.42
|
| Rate for Payer: Global Benefits Group Commercial |
$53.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.30
|
| Rate for Payer: Multiplan Commercial |
$70.98
|
| Rate for Payer: Networks By Design Commercial |
$57.67
|
| Rate for Payer: Prime Health Services Commercial |
$75.42
|
|
|
TEBENTAFUSP-TEBN 100 MCG/0.5 ML INTRAVENOUS SOLUTION [233477]
|
Facility
IP
|
$47,304.00
|
|
|
Service Code
|
CPT J9274
|
| Hospital Charge Code |
NDG233477
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11,352.96 |
| Max. Negotiated Rate |
$40,208.40 |
| Rate for Payer: Blue Shield of California Commercial |
$33,680.45
|
| Rate for Payer: Blue Shield of California EPN |
$24,219.65
|
| Rate for Payer: Cash Price |
$21,286.80
|
| Rate for Payer: Cigna of CA HMO |
$33,112.80
|
| Rate for Payer: Cigna of CA PPO |
$33,112.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,921.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$18,921.60
|
| Rate for Payer: Galaxy Health WC |
$40,208.40
|
| Rate for Payer: Global Benefits Group Commercial |
$28,382.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31,551.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,022.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,352.96
|
| Rate for Payer: Multiplan Commercial |
$37,843.20
|
| Rate for Payer: Networks By Design Commercial |
$23,652.00
|
| Rate for Payer: Prime Health Services Commercial |
$40,208.40
|
|
|
TEBENTAFUSP-TEBN 100 MCG/0.5 ML INTRAVENOUS SOLUTION [233477]
|
Facility
OP
|
$47,304.00
|
|
|
Service Code
|
CPT J9274
|
| Hospital Charge Code |
NDG233477
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$208.93 |
| Max. Negotiated Rate |
$40,208.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,314.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$261.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$229.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$229.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$399.81
|
| Rate for Payer: BCBS Transplant Transplant |
$28,382.40
|
| Rate for Payer: Blue Shield of California Commercial |
$34,863.05
|
| Rate for Payer: Blue Shield of California EPN |
$27,625.54
|
| Rate for Payer: Cash Price |
$21,286.80
|
| Rate for Payer: Cash Price |
$21,286.80
|
| Rate for Payer: Cigna of CA HMO |
$33,112.80
|
| Rate for Payer: Cigna of CA PPO |
$33,112.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$261.16
|
| Rate for Payer: Dignity Health Media |
$229.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$208.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$208.93
|
| Rate for Payer: Galaxy Health WC |
$40,208.40
|
| Rate for Payer: Global Benefits Group Commercial |
$28,382.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$35,478.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$342.64
|
| Rate for Payer: Heritage Provider Network Transplant |
$342.64
|
| Rate for Payer: IEHP Medi-Cal |
$338.46
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$338.46
|
| Rate for Payer: IEHP Medicare Advantage |
$208.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31,551.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$405.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$208.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,352.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$263.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$279.96
|
| Rate for Payer: Multiplan Commercial |
$37,843.20
|
| Rate for Payer: Networks By Design Commercial |
$23,652.00
|
| Rate for Payer: Prime Health Services Commercial |
$40,208.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28,382.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28,382.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$23,652.00
|
| Rate for Payer: United Healthcare All Other HMO |
$23,652.00
|
| Rate for Payer: United Healthcare HMO Rider |
$23,652.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23,652.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$261.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.82
|
| Rate for Payer: Vantage Medical Group Senior |
$229.82
|
|
|
TECLISTAMAB-CQYV 10 MG/ML SUBCUTANEOUS SOLUTION [236039]
|
Facility
OP
|
$708.00
|
|
|
Service Code
|
CPT J9380
|
| Hospital Charge Code |
NDG236039
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.85 |
| Max. Negotiated Rate |
$601.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$194.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$38.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$33.93
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$33.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.83
|
| Rate for Payer: BCBS Transplant Transplant |
$424.80
|
| Rate for Payer: Blue Shield of California Commercial |
$521.80
|
| Rate for Payer: Blue Shield of California EPN |
$413.47
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cigna of CA HMO |
$495.60
|
| Rate for Payer: Cigna of CA PPO |
$495.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.56
|
| Rate for Payer: Dignity Health Media |
$33.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.64
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$30.85
|
| Rate for Payer: EPIC Health Plan Transplant |
$30.85
|
| Rate for Payer: Galaxy Health WC |
$601.80
|
| Rate for Payer: Global Benefits Group Commercial |
$424.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$531.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.59
|
| Rate for Payer: Heritage Provider Network Transplant |
$50.59
|
| Rate for Payer: IEHP Medi-Cal |
$49.97
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$49.97
|
| Rate for Payer: IEHP Medicare Advantage |
$30.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$472.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.33
|
| Rate for Payer: Multiplan Commercial |
$566.40
|
| Rate for Payer: Networks By Design Commercial |
$354.00
|
| Rate for Payer: Prime Health Services Commercial |
$601.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$424.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$424.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$354.00
|
| Rate for Payer: United Healthcare All Other HMO |
$354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$354.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$354.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.93
|
| Rate for Payer: Vantage Medical Group Senior |
$33.93
|
|
|
TECLISTAMAB-CQYV 10 MG/ML SUBCUTANEOUS SOLUTION [236039]
|
Facility
IP
|
$708.00
|
|
|
Service Code
|
CPT J9380
|
| Hospital Charge Code |
NDG236039
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$169.92 |
| Max. Negotiated Rate |
$601.80 |
| Rate for Payer: Blue Shield of California Commercial |
$504.10
|
| Rate for Payer: Blue Shield of California EPN |
$362.50
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cigna of CA HMO |
$495.60
|
| Rate for Payer: Cigna of CA PPO |
$495.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$283.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$283.20
|
| Rate for Payer: Galaxy Health WC |
$601.80
|
| Rate for Payer: Global Benefits Group Commercial |
$424.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$472.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$269.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.92
|
| Rate for Payer: Multiplan Commercial |
$566.40
|
| Rate for Payer: Networks By Design Commercial |
$354.00
|
| Rate for Payer: Prime Health Services Commercial |
$601.80
|
|
|
TECLISTAMAB-CQYV 90 MG/ML SUBCUTANEOUS SOLUTION [236038]
|
Facility
IP
|
$6,372.00
|
|
|
Service Code
|
CPT J9380
|
| Hospital Charge Code |
NDG236038
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,529.28 |
| Max. Negotiated Rate |
$5,416.20 |
| Rate for Payer: Blue Shield of California Commercial |
$4,536.86
|
| Rate for Payer: Blue Shield of California EPN |
$3,262.46
|
| Rate for Payer: Cash Price |
$2,867.40
|
| Rate for Payer: Cigna of CA HMO |
$4,460.40
|
| Rate for Payer: Cigna of CA PPO |
$4,460.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,548.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,548.80
|
| Rate for Payer: Galaxy Health WC |
$5,416.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,823.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,250.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,427.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,529.28
|
| Rate for Payer: Multiplan Commercial |
$5,097.60
|
| Rate for Payer: Networks By Design Commercial |
$3,186.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,416.20
|
|
|
TECLISTAMAB-CQYV 90 MG/ML SUBCUTANEOUS SOLUTION [236038]
|
Facility
OP
|
$6,372.00
|
|
|
Service Code
|
CPT J9380
|
| Hospital Charge Code |
NDG236038
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.85 |
| Max. Negotiated Rate |
$5,416.20 |
| Rate for Payer: Dignity Health Medi-Cal |
$33.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$194.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$38.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$33.93
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$33.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,796.44
|
| Rate for Payer: BCBS Transplant Transplant |
$3,823.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,696.16
|
| Rate for Payer: Blue Shield of California EPN |
$3,721.25
|
| Rate for Payer: Cash Price |
$2,867.40
|
| Rate for Payer: Cash Price |
$2,867.40
|
| Rate for Payer: Cigna of CA HMO |
$4,460.40
|
| Rate for Payer: Cigna of CA PPO |
$4,460.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.56
|
| Rate for Payer: Dignity Health Media |
$33.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.64
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$30.85
|
| Rate for Payer: EPIC Health Plan Transplant |
$30.85
|
| Rate for Payer: Galaxy Health WC |
$5,416.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,823.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,779.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.59
|
| Rate for Payer: Heritage Provider Network Transplant |
$50.59
|
| Rate for Payer: IEHP Medi-Cal |
$49.97
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$49.97
|
| Rate for Payer: IEHP Medicare Advantage |
$30.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,250.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,529.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.33
|
| Rate for Payer: Multiplan Commercial |
$5,097.60
|
| Rate for Payer: Networks By Design Commercial |
$3,186.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,416.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,823.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,823.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,186.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,186.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,186.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,186.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.93
|
| Rate for Payer: Vantage Medical Group Senior |
$33.93
|
|
|
TEDIZOLID 200 MG INTRAVENOUS SOLUTION [206225]
|
Facility
OP
|
$369.29
|
|
|
Service Code
|
CPT J3090
|
| Hospital Charge Code |
ERX206225
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$313.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.49
|
| Rate for Payer: BCBS Transplant Transplant |
$221.57
|
| Rate for Payer: Blue Shield of California Commercial |
$272.17
|
| Rate for Payer: Blue Shield of California EPN |
$1.85
|
| Rate for Payer: Cash Price |
$166.18
|
| Rate for Payer: Cash Price |
$166.18
|
| Rate for Payer: Cigna of CA HMO |
$258.50
|
| Rate for Payer: Cigna of CA PPO |
$258.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.67
|
| Rate for Payer: Dignity Health Media |
$1.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.78
|
| Rate for Payer: Galaxy Health WC |
$313.90
|
| Rate for Payer: Global Benefits Group Commercial |
$221.57
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$276.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.92
|
| Rate for Payer: Heritage Provider Network Transplant |
$2.92
|
| Rate for Payer: IEHP Medi-Cal |
$2.89
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$2.89
|
| Rate for Payer: IEHP Medicare Advantage |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$246.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.39
|
| Rate for Payer: Multiplan Commercial |
$295.43
|
| Rate for Payer: Networks By Design Commercial |
$184.64
|
| Rate for Payer: Prime Health Services Commercial |
$313.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$221.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$221.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$184.64
|
| Rate for Payer: United Healthcare All Other HMO |
$184.64
|
| Rate for Payer: United Healthcare HMO Rider |
$184.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$184.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.96
|
| Rate for Payer: Vantage Medical Group Senior |
$1.78
|
|
|
TEDIZOLID 200 MG INTRAVENOUS SOLUTION [206225]
|
Facility
IP
|
$369.29
|
|
|
Service Code
|
CPT J3090
|
| Hospital Charge Code |
ERX206225
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$88.63 |
| Max. Negotiated Rate |
$313.90 |
| Rate for Payer: Blue Shield of California Commercial |
$262.93
|
| Rate for Payer: Blue Shield of California EPN |
$189.08
|
| Rate for Payer: Cash Price |
$166.18
|
| Rate for Payer: Cigna of CA HMO |
$258.50
|
| Rate for Payer: Cigna of CA PPO |
$258.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$147.72
|
| Rate for Payer: Galaxy Health WC |
$313.90
|
| Rate for Payer: Global Benefits Group Commercial |
$221.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$246.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.63
|
| Rate for Payer: Multiplan Commercial |
$295.43
|
| Rate for Payer: Networks By Design Commercial |
$184.64
|
| Rate for Payer: Prime Health Services Commercial |
$313.90
|
|
|
TELMISARTAN 40 MG TABLET [24335]
|
Facility
OP
|
$5.61
|
|
|
Service Code
|
NDC 0597-0040-37
|
| Hospital Charge Code |
1710970
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$4.77 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.34
|
| Rate for Payer: BCBS Transplant Transplant |
$3.37
|
| Rate for Payer: Blue Shield of California Commercial |
$4.13
|
| Rate for Payer: Blue Shield of California EPN |
$3.28
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna of CA HMO |
$3.93
|
| Rate for Payer: Cigna of CA PPO |
$3.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.77
|
| Rate for Payer: Dignity Health Media |
$4.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.24
|
| Rate for Payer: Galaxy Health WC |
$4.77
|
| Rate for Payer: Global Benefits Group Commercial |
$3.37
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.35
|
| Rate for Payer: Multiplan Commercial |
$4.49
|
| Rate for Payer: Networks By Design Commercial |
$3.65
|
| Rate for Payer: Prime Health Services Commercial |
$4.77
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.80
|
| Rate for Payer: United Healthcare All Other HMO |
$2.80
|
| Rate for Payer: United Healthcare HMO Rider |
$2.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.77
|
| Rate for Payer: Vantage Medical Group Senior |
$4.77
|
|
|
TELMISARTAN 40 MG TABLET [24335]
|
Facility
IP
|
$5.61
|
|
|
Service Code
|
NDC 0597-0040-37
|
| Hospital Charge Code |
1710970
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$4.77 |
| Rate for Payer: Blue Shield of California Commercial |
$3.99
|
| Rate for Payer: Blue Shield of California EPN |
$2.87
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna of CA HMO |
$3.93
|
| Rate for Payer: Cigna of CA PPO |
$3.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.24
|
| Rate for Payer: Galaxy Health WC |
$4.77
|
| Rate for Payer: Global Benefits Group Commercial |
$3.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.35
|
| Rate for Payer: Multiplan Commercial |
$4.49
|
| Rate for Payer: Networks By Design Commercial |
$3.65
|
| Rate for Payer: Prime Health Services Commercial |
$4.77
|
|
|
TELMISARTAN 80 MG TABLET [24336]
|
Facility
IP
|
$5.61
|
|
|
Service Code
|
NDC 0597-0041-37
|
| Hospital Charge Code |
1710961
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$4.77 |
| Rate for Payer: Blue Shield of California Commercial |
$3.99
|
| Rate for Payer: Blue Shield of California EPN |
$2.87
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna of CA HMO |
$3.93
|
| Rate for Payer: Cigna of CA PPO |
$3.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.24
|
| Rate for Payer: Galaxy Health WC |
$4.77
|
| Rate for Payer: Global Benefits Group Commercial |
$3.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.35
|
| Rate for Payer: Multiplan Commercial |
$4.49
|
| Rate for Payer: Networks By Design Commercial |
$3.65
|
| Rate for Payer: Prime Health Services Commercial |
$4.77
|
|
|
TELMISARTAN 80 MG TABLET [24336]
|
Facility
OP
|
$5.61
|
|
|
Service Code
|
NDC 0597-0041-37
|
| Hospital Charge Code |
1710961
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$4.77 |
| Rate for Payer: Galaxy Health WC |
$4.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.34
|
| Rate for Payer: BCBS Transplant Transplant |
$3.37
|
| Rate for Payer: Blue Shield of California Commercial |
$4.13
|
| Rate for Payer: Blue Shield of California EPN |
$3.28
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna of CA HMO |
$3.93
|
| Rate for Payer: Cigna of CA PPO |
$3.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.77
|
| Rate for Payer: Dignity Health Media |
$4.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.24
|
| Rate for Payer: Global Benefits Group Commercial |
$3.37
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.35
|
| Rate for Payer: Multiplan Commercial |
$4.49
|
| Rate for Payer: Networks By Design Commercial |
$3.65
|
| Rate for Payer: Prime Health Services Commercial |
$4.77
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.80
|
| Rate for Payer: United Healthcare All Other HMO |
$2.80
|
| Rate for Payer: United Healthcare HMO Rider |
$2.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.77
|
| Rate for Payer: Vantage Medical Group Senior |
$4.77
|
|
|
TEMAZEPAM 15 MG CAPSULE [7753]
|
Facility
OP
|
$0.11
|
|
|
Service Code
|
NDC 67877-146-01
|
| Hospital Charge Code |
1730140
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.07
|
| Rate for Payer: BCBS Transplant Transplant |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Media |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
TEMAZEPAM 15 MG CAPSULE [7753]
|
Facility
IP
|
$0.14
|
|
|
Service Code
|
NDC 65162-556-10
|
| Hospital Charge Code |
1730140
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
|
|
TEMAZEPAM 15 MG CAPSULE [7753]
|
Facility
OP
|
$0.14
|
|
|
Service Code
|
NDC 65162-556-10
|
| Hospital Charge Code |
1730140
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: BCBS Transplant Transplant |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.12
|
| Rate for Payer: Dignity Health Media |
$0.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.12
|
|
|
TEMAZEPAM 15 MG CAPSULE [7753]
|
Facility
IP
|
$0.11
|
|
|
Service Code
|
NDC 67877-146-05
|
| Hospital Charge Code |
1730140
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
TEMAZEPAM 15 MG CAPSULE [7753]
|
Facility
OP
|
$0.11
|
|
|
Service Code
|
NDC 67877-146-05
|
| Hospital Charge Code |
1730140
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.07
|
| Rate for Payer: BCBS Transplant Transplant |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Media |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
TEMAZEPAM 15 MG CAPSULE [7753]
|
Facility
IP
|
$0.11
|
|
|
Service Code
|
NDC 0228-2076-10
|
| Hospital Charge Code |
1730140
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
