|
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
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 30 MG CAPSULE [7754]
|
Facility
IP
|
$0.14
|
|
|
Service Code
|
NDC 0378-5050-01
|
| Hospital Charge Code |
1730141
|
|
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 30 MG CAPSULE [7754]
|
Facility
OP
|
$0.14
|
|
|
Service Code
|
NDC 0378-5050-01
|
| Hospital Charge Code |
1730141
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: BCBS Transplant Transplant |
$0.08
|
| 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: 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 7.5 MG CAPSULE [11500]
|
Facility
OP
|
$4.20
|
|
|
Service Code
|
NDC 0904-6436-04
|
| Hospital Charge Code |
1730166
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.50
|
| Rate for Payer: BCBS Transplant Transplant |
$2.52
|
| Rate for Payer: Blue Shield of California Commercial |
$3.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.45
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.57
|
| Rate for Payer: Dignity Health Media |
$3.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.80
|
| 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 |
$3.36
|
| Rate for Payer: Networks By Design Commercial |
$2.73
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.52
|
| 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 |
$3.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.57
|
| Rate for Payer: Vantage Medical Group Senior |
$3.57
|
|
|
TEMAZEPAM 7.5 MG CAPSULE [11500]
|
Facility
IP
|
$4.20
|
|
|
Service Code
|
NDC 0904-6436-04
|
| Hospital Charge Code |
1730166
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Blue Shield of California Commercial |
$2.99
|
| Rate for Payer: Blue Shield of California EPN |
$2.15
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.80
|
| 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 |
$3.36
|
| Rate for Payer: Networks By Design Commercial |
$2.73
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
|
|
TEMOZOLOMIDE 100 MG INTRAVENOUS SOLUTION [97260]
|
Facility
OP
|
$1,203.73
|
|
|
Service Code
|
CPT J9328
|
| Hospital Charge Code |
1755760
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$1,023.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$65.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.09
|
| Rate for Payer: BCBS Transplant Transplant |
$722.24
|
| Rate for Payer: Blue Shield of California Commercial |
$887.15
|
| Rate for Payer: Blue Shield of California EPN |
$12.04
|
| Rate for Payer: Cash Price |
$541.68
|
| Rate for Payer: Cash Price |
$541.68
|
| Rate for Payer: Cigna of CA HMO |
$842.61
|
| Rate for Payer: Cigna of CA PPO |
$842.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.60
|
| Rate for Payer: Dignity Health Media |
$10.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$10.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.40
|
| Rate for Payer: Galaxy Health WC |
$1,023.17
|
| Rate for Payer: Global Benefits Group Commercial |
$722.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$902.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.06
|
| Rate for Payer: Heritage Provider Network Transplant |
$17.06
|
| Rate for Payer: IEHP Medi-Cal |
$16.85
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$16.85
|
| Rate for Payer: IEHP Medicare Advantage |
$10.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$802.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.94
|
| Rate for Payer: Multiplan Commercial |
$962.98
|
| Rate for Payer: Networks By Design Commercial |
$601.86
|
| Rate for Payer: Prime Health Services Commercial |
$1,023.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$722.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$722.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$601.86
|
| Rate for Payer: United Healthcare All Other HMO |
$601.86
|
| Rate for Payer: United Healthcare HMO Rider |
$601.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$601.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.44
|
| Rate for Payer: Vantage Medical Group Senior |
$10.40
|
|
|
TEMOZOLOMIDE 100 MG INTRAVENOUS SOLUTION [97260]
|
Facility
IP
|
$1,203.73
|
|
|
Service Code
|
CPT J9328
|
| Hospital Charge Code |
1755760
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$288.90 |
| Max. Negotiated Rate |
$1,023.17 |
| Rate for Payer: Blue Shield of California Commercial |
$857.06
|
| Rate for Payer: Blue Shield of California EPN |
$616.31
|
| Rate for Payer: Cash Price |
$541.68
|
| Rate for Payer: Cigna of CA HMO |
$842.61
|
| Rate for Payer: Cigna of CA PPO |
$842.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$481.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$481.49
|
| Rate for Payer: Galaxy Health WC |
$1,023.17
|
| Rate for Payer: Global Benefits Group Commercial |
$722.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$802.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$458.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.90
|
| Rate for Payer: Multiplan Commercial |
$962.98
|
| Rate for Payer: Networks By Design Commercial |
$601.86
|
| Rate for Payer: Prime Health Services Commercial |
$1,023.17
|
|
|
TEMOZOLOMIDE ORAL SUSPENSION COMPOUND 10 MG/ML [4080346]
|
Facility
IP
|
$26.03
|
|
|
Service Code
|
CPT J8700
|
| Hospital Charge Code |
1715241
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$22.13 |
| Rate for Payer: Blue Shield of California Commercial |
$18.53
|
| Rate for Payer: Blue Shield of California EPN |
$13.33
|
| Rate for Payer: Cash Price |
$11.71
|
| Rate for Payer: Cigna of CA HMO |
$18.22
|
| Rate for Payer: Cigna of CA PPO |
$18.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.41
|
| Rate for Payer: Galaxy Health WC |
$22.13
|
| Rate for Payer: Global Benefits Group Commercial |
$15.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$20.82
|
| Rate for Payer: Networks By Design Commercial |
$13.02
|
| Rate for Payer: Prime Health Services Commercial |
$22.13
|
|
|
TEMOZOLOMIDE ORAL SUSPENSION COMPOUND 10 MG/ML [4080346]
|
Facility
OP
|
$26.03
|
|
|
Service Code
|
CPT J8700
|
| Hospital Charge Code |
1715241
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$22.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.35
|
| Rate for Payer: BCBS Transplant Transplant |
$15.62
|
| Rate for Payer: Blue Shield of California Commercial |
$19.18
|
| Rate for Payer: Blue Shield of California EPN |
$3.73
|
| Rate for Payer: Cash Price |
$11.71
|
| Rate for Payer: Cash Price |
$11.71
|
| Rate for Payer: Cigna of CA HMO |
$18.22
|
| Rate for Payer: Cigna of CA PPO |
$18.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.13
|
| Rate for Payer: Dignity Health Media |
$22.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.41
|
| Rate for Payer: Galaxy Health WC |
$22.13
|
| Rate for Payer: Global Benefits Group Commercial |
$15.62
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$19.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$20.82
|
| Rate for Payer: Networks By Design Commercial |
$13.02
|
| Rate for Payer: Prime Health Services Commercial |
$22.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.02
|
| Rate for Payer: United Healthcare All Other HMO |
$13.02
|
| Rate for Payer: United Healthcare HMO Rider |
$13.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.13
|
| Rate for Payer: Vantage Medical Group Senior |
$22.13
|
|
|
TEMSIROLIMUS 30 MG/3 ML (10 MG/ML) (FIRST DILUTION) INTRAVENOUS SOLN [82228]
|
Facility
IP
|
$1,547.87
|
|
|
Service Code
|
CPT J9330
|
| Hospital Charge Code |
1720968
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$371.49 |
| Max. Negotiated Rate |
$1,315.69 |
| Rate for Payer: Blue Shield of California Commercial |
$1,102.08
|
| Rate for Payer: Blue Shield of California EPN |
$792.51
|
| Rate for Payer: Cash Price |
$696.54
|
| Rate for Payer: Cigna of CA HMO |
$1,083.51
|
| Rate for Payer: Cigna of CA PPO |
$1,083.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$619.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$619.15
|
| Rate for Payer: Galaxy Health WC |
$1,315.69
|
| Rate for Payer: Global Benefits Group Commercial |
$928.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,032.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$589.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$371.49
|
| Rate for Payer: Multiplan Commercial |
$1,238.30
|
| Rate for Payer: Networks By Design Commercial |
$773.94
|
| Rate for Payer: Prime Health Services Commercial |
$1,315.69
|
|
|
TEMSIROLIMUS 30 MG/3 ML (10 MG/ML) (FIRST DILUTION) INTRAVENOUS SOLN [82228]
|
Facility
OP
|
$1,547.87
|
|
|
Service Code
|
CPT J9330
|
| Hospital Charge Code |
1720968
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.99 |
| Max. Negotiated Rate |
$1,315.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$194.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$38.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$34.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$34.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$102.37
|
| Rate for Payer: BCBS Transplant Transplant |
$928.72
|
| Rate for Payer: Blue Shield of California Commercial |
$1,140.78
|
| Rate for Payer: Blue Shield of California EPN |
$61.91
|
| Rate for Payer: Cash Price |
$696.54
|
| Rate for Payer: Cash Price |
$696.54
|
| Rate for Payer: Cigna of CA HMO |
$1,083.51
|
| Rate for Payer: Cigna of CA PPO |
$1,083.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.49
|
| Rate for Payer: Dignity Health Media |
$30.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.84
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$30.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$30.99
|
| Rate for Payer: Galaxy Health WC |
$1,315.69
|
| Rate for Payer: Global Benefits Group Commercial |
$928.72
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,160.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.83
|
| Rate for Payer: Heritage Provider Network Transplant |
$50.83
|
| Rate for Payer: IEHP Medi-Cal |
$50.21
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$50.21
|
| Rate for Payer: IEHP Medicare Advantage |
$30.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,032.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$371.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.53
|
| Rate for Payer: Multiplan Commercial |
$1,238.30
|
| Rate for Payer: Networks By Design Commercial |
$773.94
|
| Rate for Payer: Prime Health Services Commercial |
$1,315.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$928.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$928.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$773.94
|
| Rate for Payer: United Healthcare All Other HMO |
$773.94
|
| Rate for Payer: United Healthcare HMO Rider |
$773.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$773.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.09
|
| Rate for Payer: Vantage Medical Group Senior |
$30.99
|
|
|
TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES
|
Facility
IP
|
$19,378.59
|
|
|
Service Code
|
APR-DRG 3172
|
| Min. Negotiated Rate |
$14,865.42 |
| Max. Negotiated Rate |
$19,378.59 |
| Rate for Payer: IEHP Medi-Cal |
$14,865.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19,378.59
|
|
|
TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES
|
Facility
IP
|
$29,756.89
|
|
|
Service Code
|
APR-DRG 3173
|
| Min. Negotiated Rate |
$22,826.67 |
| Max. Negotiated Rate |
$29,756.89 |
| Rate for Payer: IEHP Medi-Cal |
$22,826.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29,756.89
|
|
|
TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES
|
Facility
IP
|
$14,982.18
|
|
|
Service Code
|
APR-DRG 3171
|
| Min. Negotiated Rate |
$11,492.91 |
| Max. Negotiated Rate |
$14,982.18 |
| Rate for Payer: IEHP Medi-Cal |
$11,492.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,982.18
|
|
|
TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES
|
Facility
IP
|
$54,345.91
|
|
|
Service Code
|
APR-DRG 3174
|
| Min. Negotiated Rate |
$41,689.03 |
| Max. Negotiated Rate |
$54,345.91 |
| Rate for Payer: IEHP Medi-Cal |
$41,689.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54,345.91
|
|
|
Tendon sheath incision (eg, for trigger finger)
|
Facility
OP
|
$7,385.00
|
|
|
Service Code
|
CPT 26055
|
| Min. Negotiated Rate |
$79.93 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Dignity Health Media |
$2,008.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,208.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,710.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,008.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,293.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,293.27
|
| Rate for Payer: IEHP Medi-Cal |
$3,253.11
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,253.11
|
| Rate for Payer: IEHP Medicare Advantage |
$2,008.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,690.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.09
|
|
|
TENECTEPLASE 50 MG INTRAVENOUS SOLUTION [220772]
|
Facility
IP
|
$8,853.91
|
|
|
Service Code
|
CPT J3101
|
| Hospital Charge Code |
ERX220772
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,124.94 |
| Max. Negotiated Rate |
$7,525.82 |
| Rate for Payer: Blue Shield of California Commercial |
$6,303.98
|
| Rate for Payer: Blue Shield of California Commercial |
$5,313.39
|
| 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 |
$3,984.26
|
| 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: EPIC Health Plan Commercial |
$3,541.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,985.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,541.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,985.05
|
| Rate for Payer: Galaxy Health WC |
$7,525.82
|
| Rate for Payer: Galaxy Health WC |
$6,343.24
|
| 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 |
$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 |
$2,843.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,373.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,124.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,791.03
|
| Rate for Payer: Multiplan Commercial |
$7,083.13
|
| Rate for Payer: Multiplan Commercial |
$5,970.10
|
| 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
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$191.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$191.39
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$168.43
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$168.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$168.43
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$4,477.58
|
| Rate for Payer: BCBS Transplant Transplant |
$5,312.35
|
| Rate for Payer: Blue Shield of California Commercial |
$5,499.96
|
| Rate for Payer: Blue Shield of California Commercial |
$6,525.33
|
| 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 |
$3,358.18
|
| 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: Cigna of CA HMO |
$5,223.84
|
| Rate for Payer: Cigna of CA HMO |
$6,197.74
|
| 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 |
$7,525.82
|
| Rate for Payer: Galaxy Health WC |
$6,343.24
|
| Rate for Payer: Global Benefits Group Commercial |
$5,312.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,477.58
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,596.97
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant 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: IEHP Medi-Cal |
$248.04
|
| Rate for Payer: IEHP Medi-Cal |
$248.04
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$248.04
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$248.04
|
| Rate for Payer: IEHP Medicare Advantage |
$153.11
|
| Rate for Payer: IEHP Medicare Advantage |
$153.11
|
| 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 |
$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 |
$7,083.13
|
| Rate for Payer: Multiplan Commercial |
$5,970.10
|
| 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: 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 |
$5,312.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,477.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,731.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,426.96
|
| Rate for Payer: United Healthcare All Other HMO |
$4,426.96
|
| Rate for Payer: United Healthcare All Other HMO |
$3,731.32
|
| Rate for Payer: United Healthcare HMO Rider |
$4,426.96
|
| Rate for Payer: United Healthcare HMO Rider |
$3,731.32
|
| 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
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$46.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$30.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$30.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.75
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$32.98
|
| 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
|
$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: AlphaCare Medical Group Commercial/Exchange |
$0.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.69
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$0.69
|
| 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
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: Galaxy Health WC |
$3.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.51
|
| Rate for Payer: BCBS Transplant 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: Global Benefits Group Commercial |
$2.53
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$2.53
|
| 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 50268-758-11
|
| 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: AlphaCare Medical Group Commercial/Exchange |
$3.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.51
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$2.53
|
| 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
|
$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
|
|
