|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [191168]
|
Facility
IP
|
$0.66
|
|
|
Service Code
|
NDC 81284-611-00
|
| Hospital Charge Code |
1721084
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Blue Shield of California Commercial |
$0.47
|
| Rate for Payer: Blue Shield of California EPN |
$0.34
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.56
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.53
|
| Rate for Payer: Networks By Design Commercial |
$0.43
|
| Rate for Payer: Prime Health Services Commercial |
$0.56
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [191168]
|
Facility
IP
|
$0.72
|
|
|
Service Code
|
NDC 55150-188-10
|
| Hospital Charge Code |
1721084
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Blue Shield of California Commercial |
$0.51
|
| Rate for Payer: Blue Shield of California EPN |
$0.37
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.61
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.58
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.61
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [191168]
|
Facility
OP
|
$0.66
|
|
|
Service Code
|
NDC 81284-611-00
|
| Hospital Charge Code |
1721084
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Cigna of CA PPO |
$0.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.39
|
| Rate for Payer: BCBS Transplant Transplant |
$0.40
|
| Rate for Payer: Blue Shield of California Commercial |
$0.49
|
| Rate for Payer: Blue Shield of California EPN |
$0.39
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.56
|
| Rate for Payer: Dignity Health Media |
$0.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.56
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.53
|
| Rate for Payer: Networks By Design Commercial |
$0.43
|
| Rate for Payer: Prime Health Services Commercial |
$0.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.33
|
| Rate for Payer: United Healthcare All Other HMO |
$0.33
|
| Rate for Payer: United Healthcare HMO Rider |
$0.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.56
|
| Rate for Payer: Vantage Medical Group Senior |
$0.56
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [191168]
|
Facility
IP
|
$1.44
|
|
|
Service Code
|
NDC 23155-166-41
|
| Hospital Charge Code |
1721084
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Blue Shield of California Commercial |
$1.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.74
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.15
|
| Rate for Payer: Networks By Design Commercial |
$0.94
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [191168]
|
Facility
OP
|
$0.66
|
|
|
Service Code
|
NDC 81284-611-10
|
| Hospital Charge Code |
1721084
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.39
|
| Rate for Payer: BCBS Transplant Transplant |
$0.40
|
| Rate for Payer: Blue Shield of California Commercial |
$0.49
|
| Rate for Payer: Blue Shield of California EPN |
$0.39
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.56
|
| Rate for Payer: Dignity Health Media |
$0.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.56
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.53
|
| Rate for Payer: Networks By Design Commercial |
$0.43
|
| Rate for Payer: Prime Health Services Commercial |
$0.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.33
|
| Rate for Payer: United Healthcare All Other HMO |
$0.33
|
| Rate for Payer: United Healthcare HMO Rider |
$0.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.56
|
| Rate for Payer: Vantage Medical Group Senior |
$0.56
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [191168]
|
Facility
OP
|
$0.72
|
|
|
Service Code
|
NDC 55150-188-10
|
| Hospital Charge Code |
1721084
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.61
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.43
|
| Rate for Payer: BCBS Transplant Transplant |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$0.53
|
| Rate for Payer: Blue Shield of California EPN |
$0.42
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cigna of CA HMO |
$0.46
|
| Rate for Payer: Cigna of CA PPO |
$0.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.61
|
| Rate for Payer: Dignity Health Media |
$0.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.61
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.58
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.36
|
| Rate for Payer: United Healthcare All Other HMO |
$0.36
|
| Rate for Payer: United Healthcare HMO Rider |
$0.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.61
|
| Rate for Payer: Vantage Medical Group Senior |
$0.61
|
|
|
TRANEXAMIC ACID 650 MG TABLET [104576]
|
Facility
IP
|
$5.01
|
|
|
Service Code
|
NDC 0591-3720-30
|
| Hospital Charge Code |
ERX104576
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$4.26 |
| Rate for Payer: Blue Shield of California Commercial |
$3.57
|
| Rate for Payer: Blue Shield of California EPN |
$2.57
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cigna of CA HMO |
$3.51
|
| Rate for Payer: Cigna of CA PPO |
$3.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.00
|
| Rate for Payer: Galaxy Health WC |
$4.26
|
| Rate for Payer: Global Benefits Group Commercial |
$3.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$4.01
|
| Rate for Payer: Networks By Design Commercial |
$3.26
|
| Rate for Payer: Prime Health Services Commercial |
$4.26
|
|
|
TRANEXAMIC ACID 650 MG TABLET [104576]
|
Facility
OP
|
$5.21
|
|
|
Service Code
|
NDC 69918-301-30
|
| Hospital Charge Code |
ERX104576
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.43
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.10
|
| Rate for Payer: BCBS Transplant Transplant |
$3.13
|
| Rate for Payer: Blue Shield of California Commercial |
$3.84
|
| Rate for Payer: Blue Shield of California EPN |
$3.04
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cigna of CA HMO |
$3.65
|
| Rate for Payer: Cigna of CA PPO |
$3.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.43
|
| Rate for Payer: Dignity Health Media |
$4.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.08
|
| Rate for Payer: Galaxy Health WC |
$4.43
|
| Rate for Payer: Global Benefits Group Commercial |
$3.13
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.25
|
| Rate for Payer: Multiplan Commercial |
$4.17
|
| Rate for Payer: Networks By Design Commercial |
$3.39
|
| Rate for Payer: Prime Health Services Commercial |
$4.43
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.60
|
| Rate for Payer: United Healthcare All Other HMO |
$2.60
|
| Rate for Payer: United Healthcare HMO Rider |
$2.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.43
|
| Rate for Payer: Vantage Medical Group Senior |
$4.43
|
|
|
TRANEXAMIC ACID 650 MG TABLET [104576]
|
Facility
IP
|
$3.20
|
|
|
Service Code
|
NDC 62559-265-30
|
| Hospital Charge Code |
ERX104576
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: Blue Shield of California Commercial |
$2.28
|
| Rate for Payer: Blue Shield of California EPN |
$1.64
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Cigna of CA HMO |
$2.24
|
| Rate for Payer: Cigna of CA PPO |
$2.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: Galaxy Health WC |
$2.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: Multiplan Commercial |
$2.56
|
| Rate for Payer: Networks By Design Commercial |
$2.08
|
| Rate for Payer: Prime Health Services Commercial |
$2.72
|
|
|
TRANEXAMIC ACID 650 MG TABLET [104576]
|
Facility
IP
|
$5.21
|
|
|
Service Code
|
NDC 69918-301-30
|
| Hospital Charge Code |
ERX104576
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: Blue Shield of California Commercial |
$3.71
|
| Rate for Payer: Blue Shield of California EPN |
$2.67
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cigna of CA HMO |
$3.65
|
| Rate for Payer: Cigna of CA PPO |
$3.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.08
|
| Rate for Payer: Galaxy Health WC |
$4.43
|
| Rate for Payer: Global Benefits Group Commercial |
$3.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.25
|
| Rate for Payer: Multiplan Commercial |
$4.17
|
| Rate for Payer: Networks By Design Commercial |
$3.39
|
| Rate for Payer: Prime Health Services Commercial |
$4.43
|
|
|
TRANEXAMIC ACID 650 MG TABLET [104576]
|
Facility
OP
|
$3.20
|
|
|
Service Code
|
NDC 62559-265-30
|
| Hospital Charge Code |
ERX104576
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.76
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.91
|
| Rate for Payer: BCBS Transplant Transplant |
$1.92
|
| Rate for Payer: Blue Shield of California Commercial |
$2.36
|
| Rate for Payer: Blue Shield of California EPN |
$1.87
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Cigna of CA HMO |
$2.24
|
| Rate for Payer: Cigna of CA PPO |
$2.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.72
|
| Rate for Payer: Dignity Health Media |
$2.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.28
|
| Rate for Payer: Galaxy Health WC |
$2.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.92
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: Multiplan Commercial |
$2.56
|
| Rate for Payer: Networks By Design Commercial |
$2.08
|
| Rate for Payer: Prime Health Services Commercial |
$2.72
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1.60
|
| Rate for Payer: United Healthcare HMO Rider |
$1.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.72
|
| Rate for Payer: Vantage Medical Group Senior |
$2.72
|
|
|
TRANEXAMIC ACID 650 MG TABLET [104576]
|
Facility
OP
|
$5.01
|
|
|
Service Code
|
NDC 0591-3720-30
|
| Hospital Charge Code |
ERX104576
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$4.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.76
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.98
|
| Rate for Payer: BCBS Transplant Transplant |
$3.01
|
| Rate for Payer: Blue Shield of California Commercial |
$3.69
|
| Rate for Payer: Blue Shield of California EPN |
$2.93
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cigna of CA HMO |
$3.51
|
| Rate for Payer: Cigna of CA PPO |
$3.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.26
|
| Rate for Payer: Dignity Health Media |
$4.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.00
|
| Rate for Payer: Galaxy Health WC |
$4.26
|
| Rate for Payer: Global Benefits Group Commercial |
$3.01
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$4.01
|
| Rate for Payer: Networks By Design Commercial |
$3.26
|
| Rate for Payer: Prime Health Services Commercial |
$4.26
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.26
|
| Rate for Payer: Vantage Medical Group Senior |
$4.26
|
|
|
TRANEXAMIC ACID ORAL SOLUTION (IV FORM) 5% (50 MG/ML) [40820838]
|
Facility
OP
|
$0.96
|
|
|
Service Code
|
NDC 9940-8208-38
|
| Hospital Charge Code |
NDG40820838
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.57
|
| Rate for Payer: BCBS Transplant Transplant |
$0.58
|
| Rate for Payer: Blue Shield of California Commercial |
$0.71
|
| Rate for Payer: Blue Shield of California EPN |
$0.56
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: Cigna of CA HMO |
$0.67
|
| Rate for Payer: Cigna of CA PPO |
$0.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.82
|
| Rate for Payer: Dignity Health Media |
$0.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.38
|
| Rate for Payer: Galaxy Health WC |
$0.82
|
| Rate for Payer: Global Benefits Group Commercial |
$0.58
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.77
|
| Rate for Payer: Networks By Design Commercial |
$0.62
|
| Rate for Payer: Prime Health Services Commercial |
$0.82
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.48
|
| Rate for Payer: United Healthcare All Other HMO |
$0.48
|
| Rate for Payer: United Healthcare HMO Rider |
$0.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.82
|
| Rate for Payer: Vantage Medical Group Senior |
$0.82
|
|
|
TRANEXAMIC ACID ORAL SOLUTION (IV FORM) 5% (50 MG/ML) [40820838]
|
Facility
IP
|
$0.96
|
|
|
Service Code
|
NDC 9940-8208-38
|
| Hospital Charge Code |
NDG40820838
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: Blue Shield of California Commercial |
$0.68
|
| Rate for Payer: Blue Shield of California EPN |
$0.49
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: Cigna of CA HMO |
$0.67
|
| Rate for Payer: Cigna of CA PPO |
$0.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: Galaxy Health WC |
$0.82
|
| Rate for Payer: Global Benefits Group Commercial |
$0.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.77
|
| Rate for Payer: Networks By Design Commercial |
$0.62
|
| Rate for Payer: Prime Health Services Commercial |
$0.82
|
|
|
TRANSIENT ISCHEMIA
|
Facility
IP
|
$10,261.24
|
|
|
Service Code
|
APR-DRG 0471
|
| Min. Negotiated Rate |
$7,871.45 |
| Max. Negotiated Rate |
$10,261.24 |
| Rate for Payer: IEHP Medi-Cal |
$7,871.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,261.24
|
|
|
TRANSIENT ISCHEMIA
|
Facility
IP
|
$11,711.92
|
|
|
Service Code
|
APR-DRG 0472
|
| Min. Negotiated Rate |
$8,984.28 |
| Max. Negotiated Rate |
$11,711.92 |
| Rate for Payer: IEHP Medi-Cal |
$8,984.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,711.92
|
|
|
TRANSIENT ISCHEMIA
|
Facility
IP
|
$14,709.08
|
|
|
Service Code
|
APR-DRG 0473
|
| Min. Negotiated Rate |
$11,283.41 |
| Max. Negotiated Rate |
$14,709.08 |
| Rate for Payer: IEHP Medi-Cal |
$11,283.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,709.08
|
|
|
TRANSIENT ISCHEMIA
|
Facility
IP
|
$23,929.30
|
|
|
Service Code
|
APR-DRG 0474
|
| Min. Negotiated Rate |
$18,356.29 |
| Max. Negotiated Rate |
$23,929.30 |
| Rate for Payer: IEHP Medi-Cal |
$18,356.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23,929.30
|
|
|
TRANSURETHRAL PROSTATECTOMY
|
Facility
IP
|
$11,309.35
|
|
|
Service Code
|
APR-DRG 4821
|
| Min. Negotiated Rate |
$8,675.46 |
| Max. Negotiated Rate |
$11,309.35 |
| Rate for Payer: IEHP Medi-Cal |
$8,675.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,309.35
|
|
|
TRANSURETHRAL PROSTATECTOMY
|
Facility
IP
|
$41,858.98
|
|
|
Service Code
|
APR-DRG 4824
|
| Min. Negotiated Rate |
$32,110.24 |
| Max. Negotiated Rate |
$41,858.98 |
| Rate for Payer: IEHP Medi-Cal |
$32,110.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41,858.98
|
|
|
TRANSURETHRAL PROSTATECTOMY
|
Facility
IP
|
$13,831.22
|
|
|
Service Code
|
APR-DRG 4822
|
| Min. Negotiated Rate |
$10,610.00 |
| Max. Negotiated Rate |
$13,831.22 |
| Rate for Payer: IEHP Medi-Cal |
$10,610.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,831.22
|
|
|
TRANSURETHRAL PROSTATECTOMY
|
Facility
IP
|
$25,154.76
|
|
|
Service Code
|
APR-DRG 4823
|
| Min. Negotiated Rate |
$19,296.35 |
| Max. Negotiated Rate |
$25,154.76 |
| Rate for Payer: IEHP Medi-Cal |
$19,296.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25,154.76
|
|
|
Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) unilateral; by injection(s) (includes imaging guidance, when performed)
|
Facility
OP
|
$7,385.00
|
|
|
Service Code
|
CPT 64486
|
| Min. Negotiated Rate |
$4,984.00 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
|
|
TRASTUZUMAB 150 MG INTRAVENOUS SOLUTION [216113]
|
Facility
IP
|
$1,870.10
|
|
|
Service Code
|
CPT J9355
|
| Hospital Charge Code |
ERX216113
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$448.82 |
| Max. Negotiated Rate |
$1,589.58 |
| Rate for Payer: Blue Shield of California Commercial |
$1,331.51
|
| Rate for Payer: Blue Shield of California EPN |
$957.49
|
| Rate for Payer: Cash Price |
$841.55
|
| Rate for Payer: Cigna of CA HMO |
$1,309.07
|
| Rate for Payer: Cigna of CA PPO |
$1,309.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$748.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$748.04
|
| Rate for Payer: Galaxy Health WC |
$1,589.58
|
| Rate for Payer: Global Benefits Group Commercial |
$1,122.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,247.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$712.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.82
|
| Rate for Payer: Multiplan Commercial |
$1,496.08
|
| Rate for Payer: Networks By Design Commercial |
$935.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,589.58
|
|
|
TRASTUZUMAB 150 MG INTRAVENOUS SOLUTION [216113]
|
Facility
OP
|
$1,870.10
|
|
|
Service Code
|
CPT J9355
|
| Hospital Charge Code |
ERX216113
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.46 |
| Max. Negotiated Rate |
$1,589.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$506.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$100.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$88.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$88.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.65
|
| Rate for Payer: BCBS Transplant Transplant |
$1,122.06
|
| Rate for Payer: Blue Shield of California Commercial |
$1,378.26
|
| Rate for Payer: Blue Shield of California EPN |
$124.67
|
| Rate for Payer: Cash Price |
$841.55
|
| Rate for Payer: Cash Price |
$841.55
|
| Rate for Payer: Cigna of CA HMO |
$1,309.07
|
| Rate for Payer: Cigna of CA PPO |
$1,309.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$120.70
|
| Rate for Payer: Dignity Health Media |
$80.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$88.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$80.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$80.46
|
| Rate for Payer: Galaxy Health WC |
$1,589.58
|
| Rate for Payer: Global Benefits Group Commercial |
$1,122.06
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,402.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$131.96
|
| Rate for Payer: Heritage Provider Network Transplant |
$131.96
|
| Rate for Payer: IEHP Medi-Cal |
$130.35
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$130.35
|
| Rate for Payer: IEHP Medicare Advantage |
$80.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,247.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$80.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$101.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$107.82
|
| Rate for Payer: Multiplan Commercial |
$1,496.08
|
| Rate for Payer: Networks By Design Commercial |
$935.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,589.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,122.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,122.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$935.05
|
| Rate for Payer: United Healthcare All Other HMO |
$935.05
|
| Rate for Payer: United Healthcare HMO Rider |
$935.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$935.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$120.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$88.51
|
| Rate for Payer: Vantage Medical Group Senior |
$80.46
|
|
