|
TACROLIMUS 0.5 MG/ML COMPOUNDED ORAL SUSPENSION [40840050]
|
Facility
|
OP
|
$3.62
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$3.08 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.97
|
| Rate for Payer: Blue Shield of California Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$0.87
|
| Rate for Payer: Cash Price |
$1.99
|
| Rate for Payer: Cash Price |
$1.99
|
| Rate for Payer: Cigna of CA HMO |
$2.53
|
| Rate for Payer: Cigna of CA PPO |
$2.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.45
|
| Rate for Payer: EPIC Health Plan Senior |
$1.45
|
| Rate for Payer: Galaxy Health WC |
$3.08
|
| Rate for Payer: Global Benefits Group Commercial |
$2.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.53
|
| Rate for Payer: Multiplan Commercial |
$2.90
|
| Rate for Payer: Networks By Design Commercial |
$1.81
|
| Rate for Payer: Prime Health Services Commercial |
$3.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.36
|
| Rate for Payer: United Healthcare All Other HMO |
$1.32
|
| Rate for Payer: United Healthcare HMO Rider |
$1.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.08
|
| Rate for Payer: Vantage Medical Group Senior |
$3.08
|
|
|
TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE [12933]
|
Facility
|
OP
|
$1.38
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$1.97 |
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Adventist Health Commercial |
$0.33
|
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.97
|
| Rate for Payer: Blue Shield of California Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$0.87
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cash Price |
$0.38
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cash Price |
$0.61
|
| Rate for Payer: Cash Price |
$0.61
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cash Price |
$0.38
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA HMO |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.97
|
| Rate for Payer: Cigna of CA HMO |
$0.77
|
| Rate for Payer: Cigna of CA HMO |
$1.15
|
| Rate for Payer: Cigna of CA PPO |
$1.15
|
| Rate for Payer: Cigna of CA PPO |
$0.49
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.97
|
| Rate for Payer: Cigna of CA PPO |
$0.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.66
|
| Rate for Payer: EPIC Health Plan Senior |
$0.55
|
| Rate for Payer: EPIC Health Plan Senior |
$0.28
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$1.17
|
| Rate for Payer: Galaxy Health WC |
$1.39
|
| Rate for Payer: Galaxy Health WC |
$0.30
|
| Rate for Payer: Galaxy Health WC |
$0.60
|
| Rate for Payer: Galaxy Health WC |
$0.94
|
| Rate for Payer: Global Benefits Group Commercial |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.98
|
| Rate for Payer: Global Benefits Group Commercial |
$0.66
|
| Rate for Payer: Global Benefits Group Commercial |
$0.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.15
|
| Rate for Payer: Multiplan Commercial |
$0.88
|
| Rate for Payer: Multiplan Commercial |
$1.31
|
| Rate for Payer: Multiplan Commercial |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$1.10
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.82
|
| Rate for Payer: Networks By Design Commercial |
$0.35
|
| Rate for Payer: Networks By Design Commercial |
$0.55
|
| Rate for Payer: Networks By Design Commercial |
$0.69
|
| Rate for Payer: Prime Health Services Commercial |
$1.17
|
| Rate for Payer: Prime Health Services Commercial |
$0.94
|
| Rate for Payer: Prime Health Services Commercial |
$1.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.60
|
| Rate for Payer: Prime Health Services Commercial |
$0.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.62
|
| Rate for Payer: United Healthcare All Other HMO |
$0.60
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.26
|
| Rate for Payer: United Healthcare All Other HMO |
$0.40
|
| Rate for Payer: United Healthcare HMO Rider |
$0.25
|
| Rate for Payer: United Healthcare HMO Rider |
$0.59
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.39
|
| Rate for Payer: United Healthcare HMO Rider |
$0.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.94
|
| Rate for Payer: Vantage Medical Group Senior |
$1.39
|
| Rate for Payer: Vantage Medical Group Senior |
$0.30
|
| Rate for Payer: Vantage Medical Group Senior |
$0.60
|
| Rate for Payer: Vantage Medical Group Senior |
$0.94
|
| Rate for Payer: Vantage Medical Group Senior |
$1.17
|
|
|
TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE [12933]
|
Facility
|
IP
|
$1.64
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.39 |
| Rate for Payer: Adventist Health Commercial |
$0.33
|
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$1.21
|
| Rate for Payer: Blue Shield of California Commercial |
$0.81
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Blue Shield of California EPN |
$0.34
|
| Rate for Payer: Blue Shield of California EPN |
$0.67
|
| Rate for Payer: Blue Shield of California EPN |
$0.80
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cash Price |
$0.38
|
| Rate for Payer: Cash Price |
$0.61
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cigna of CA HMO |
$0.97
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA HMO |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.77
|
| Rate for Payer: Cigna of CA HMO |
$1.15
|
| Rate for Payer: Cigna of CA PPO |
$0.97
|
| Rate for Payer: Cigna of CA PPO |
$0.77
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.49
|
| Rate for Payer: Cigna of CA PPO |
$1.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.55
|
| Rate for Payer: EPIC Health Plan Senior |
$0.66
|
| Rate for Payer: EPIC Health Plan Senior |
$0.55
|
| Rate for Payer: EPIC Health Plan Senior |
$0.28
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.30
|
| Rate for Payer: Galaxy Health WC |
$1.17
|
| Rate for Payer: Galaxy Health WC |
$1.39
|
| Rate for Payer: Galaxy Health WC |
$0.94
|
| Rate for Payer: Galaxy Health WC |
$0.60
|
| Rate for Payer: Global Benefits Group Commercial |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.66
|
| Rate for Payer: Global Benefits Group Commercial |
$0.98
|
| Rate for Payer: Global Benefits Group Commercial |
$0.83
|
| Rate for Payer: Global Benefits Group Commercial |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$1.10
|
| Rate for Payer: Multiplan Commercial |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$0.88
|
| Rate for Payer: Multiplan Commercial |
$1.31
|
| Rate for Payer: Networks By Design Commercial |
$0.82
|
| Rate for Payer: Networks By Design Commercial |
$0.55
|
| Rate for Payer: Networks By Design Commercial |
$0.35
|
| Rate for Payer: Networks By Design Commercial |
$0.69
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$1.39
|
| Rate for Payer: Prime Health Services Commercial |
$1.17
|
| Rate for Payer: Prime Health Services Commercial |
$0.94
|
| Rate for Payer: Prime Health Services Commercial |
$0.60
|
| Rate for Payer: Prime Health Services Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.41
|
| Rate for Payer: United Healthcare All Other HMO |
$0.60
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.26
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.40
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.39
|
| Rate for Payer: United Healthcare HMO Rider |
$0.59
|
| Rate for Payer: United Healthcare HMO Rider |
$0.49
|
| Rate for Payer: United Healthcare HMO Rider |
$0.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
|
|
TACROLIMUS 5 MG CAPSULE, IMMEDIATE-RELEASE [12934]
|
Facility
|
OP
|
$44.40
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$37.74 |
| Rate for Payer: Adventist Health Commercial |
$8.88
|
| Rate for Payer: Adventist Health Commercial |
$1.08
|
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Adventist Health Commercial |
$0.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.97
|
| Rate for Payer: Blue Shield of California Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$0.87
|
| Rate for Payer: Cash Price |
$24.42
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cash Price |
$24.42
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA HMO |
$2.45
|
| Rate for Payer: Cigna of CA HMO |
$31.08
|
| Rate for Payer: Cigna of CA PPO |
$2.45
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| Rate for Payer: Cigna of CA PPO |
$3.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.76
|
| Rate for Payer: EPIC Health Plan Senior |
$17.76
|
| Rate for Payer: EPIC Health Plan Senior |
$0.48
|
| Rate for Payer: EPIC Health Plan Senior |
$1.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2.16
|
| Rate for Payer: Galaxy Health WC |
$2.98
|
| Rate for Payer: Galaxy Health WC |
$37.74
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Galaxy Health WC |
$4.59
|
| Rate for Payer: Global Benefits Group Commercial |
$26.64
|
| Rate for Payer: Global Benefits Group Commercial |
$2.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Global Benefits Group Commercial |
$3.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.45
|
| Rate for Payer: Multiplan Commercial |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$4.32
|
| Rate for Payer: Multiplan Commercial |
$35.52
|
| Rate for Payer: Multiplan Commercial |
$2.80
|
| Rate for Payer: Networks By Design Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$1.75
|
| Rate for Payer: Networks By Design Commercial |
$22.20
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Prime Health Services Commercial |
$37.74
|
| Rate for Payer: Prime Health Services Commercial |
$4.59
|
| Rate for Payer: Prime Health Services Commercial |
$2.98
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.45
|
| Rate for Payer: United Healthcare All Other HMO |
$16.22
|
| Rate for Payer: United Healthcare All Other HMO |
$1.97
|
| Rate for Payer: United Healthcare All Other HMO |
$1.28
|
| Rate for Payer: United Healthcare All Other HMO |
$0.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1.93
|
| Rate for Payer: United Healthcare HMO Rider |
$15.87
|
| Rate for Payer: United Healthcare HMO Rider |
$1.25
|
| Rate for Payer: United Healthcare HMO Rider |
$0.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: Vantage Medical Group Senior |
$37.74
|
| Rate for Payer: Vantage Medical Group Senior |
$4.59
|
| Rate for Payer: Vantage Medical Group Senior |
$1.02
|
| Rate for Payer: Vantage Medical Group Senior |
$2.98
|
|
|
TACROLIMUS 5 MG CAPSULE, IMMEDIATE-RELEASE [12934]
|
Facility
|
IP
|
$3.50
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$2.98 |
| Rate for Payer: Adventist Health Commercial |
$0.70
|
| Rate for Payer: Adventist Health Commercial |
$1.08
|
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Adventist Health Commercial |
$8.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.89
|
| Rate for Payer: Blue Shield of California Commercial |
$3.99
|
| Rate for Payer: Blue Shield of California Commercial |
$32.77
|
| Rate for Payer: Blue Shield of California Commercial |
$2.58
|
| Rate for Payer: Blue Shield of California EPN |
$0.58
|
| Rate for Payer: Blue Shield of California EPN |
$1.70
|
| Rate for Payer: Blue Shield of California EPN |
$21.58
|
| Rate for Payer: Blue Shield of California EPN |
$2.62
|
| Rate for Payer: Cash Price |
$24.42
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA HMO |
$31.08
|
| Rate for Payer: Cigna of CA HMO |
$2.45
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$2.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Senior |
$0.48
|
| Rate for Payer: EPIC Health Plan Senior |
$17.76
|
| Rate for Payer: EPIC Health Plan Senior |
$1.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2.16
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Galaxy Health WC |
$2.98
|
| Rate for Payer: Galaxy Health WC |
$37.74
|
| Rate for Payer: Galaxy Health WC |
$4.59
|
| Rate for Payer: Global Benefits Group Commercial |
$3.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Global Benefits Group Commercial |
$26.64
|
| Rate for Payer: Global Benefits Group Commercial |
$2.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.30
|
| Rate for Payer: Multiplan Commercial |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$35.52
|
| Rate for Payer: Multiplan Commercial |
$2.80
|
| Rate for Payer: Multiplan Commercial |
$4.32
|
| Rate for Payer: Networks By Design Commercial |
$1.75
|
| Rate for Payer: Networks By Design Commercial |
$22.20
|
| Rate for Payer: Networks By Design Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Prime Health Services Commercial |
$37.74
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
| Rate for Payer: Prime Health Services Commercial |
$4.59
|
| Rate for Payer: Prime Health Services Commercial |
$2.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.03
|
| Rate for Payer: United Healthcare All Other HMO |
$1.28
|
| Rate for Payer: United Healthcare All Other HMO |
$1.97
|
| Rate for Payer: United Healthcare All Other HMO |
$16.22
|
| Rate for Payer: United Healthcare All Other HMO |
$0.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1.25
|
| Rate for Payer: United Healthcare HMO Rider |
$0.43
|
| Rate for Payer: United Healthcare HMO Rider |
$1.93
|
| Rate for Payer: United Healthcare HMO Rider |
$15.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.54
|
|
|
TACROLIMUS 5 MG/ML INTRAVENOUS SOLUTION [12935]
|
Facility
|
OP
|
$306.03
|
|
|
Service Code
|
HCPCS J7525
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.21 |
| Max. Negotiated Rate |
$692.76 |
| Rate for Payer: Adventist Health Commercial |
$61.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$200.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$393.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$288.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$692.76
|
| Rate for Payer: Blue Shield of California Commercial |
$297.12
|
| Rate for Payer: Blue Shield of California EPN |
$297.12
|
| Rate for Payer: Cash Price |
$168.32
|
| Rate for Payer: Cash Price |
$168.32
|
| Rate for Payer: Cigna of CA HMO |
$214.22
|
| Rate for Payer: Cigna of CA PPO |
$214.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$327.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$288.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$288.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$354.01
|
| Rate for Payer: EPIC Health Plan Senior |
$262.23
|
| Rate for Payer: Galaxy Health WC |
$260.13
|
| Rate for Payer: Global Benefits Group Commercial |
$183.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$430.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$255.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$262.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$204.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$262.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$330.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$351.39
|
| Rate for Payer: Multiplan Commercial |
$244.82
|
| Rate for Payer: Networks By Design Commercial |
$153.01
|
| Rate for Payer: Prime Health Services Commercial |
$260.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$183.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$183.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.85
|
| Rate for Payer: United Healthcare All Other HMO |
$111.79
|
| Rate for Payer: United Healthcare HMO Rider |
$109.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.22
|
| Rate for Payer: Upland Medical Group Pediatric |
$262.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$327.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$288.45
|
| Rate for Payer: Vantage Medical Group Senior |
$288.45
|
|
|
TACROLIMUS 5 MG/ML INTRAVENOUS SOLUTION [12935]
|
Facility
|
IP
|
$306.03
|
|
|
Service Code
|
HCPCS J7525
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.21 |
| Max. Negotiated Rate |
$260.13 |
| Rate for Payer: Adventist Health Commercial |
$61.21
|
| Rate for Payer: Blue Shield of California Commercial |
$225.85
|
| Rate for Payer: Blue Shield of California EPN |
$148.73
|
| Rate for Payer: Cash Price |
$168.32
|
| Rate for Payer: Cigna of CA HMO |
$214.22
|
| Rate for Payer: Cigna of CA PPO |
$214.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.41
|
| Rate for Payer: EPIC Health Plan Senior |
$122.41
|
| Rate for Payer: Galaxy Health WC |
$260.13
|
| Rate for Payer: Global Benefits Group Commercial |
$183.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$204.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$189.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.45
|
| Rate for Payer: Multiplan Commercial |
$244.82
|
| Rate for Payer: Networks By Design Commercial |
$153.01
|
| Rate for Payer: Prime Health Services Commercial |
$260.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.85
|
| Rate for Payer: United Healthcare All Other HMO |
$111.79
|
| Rate for Payer: United Healthcare HMO Rider |
$109.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.22
|
|
|
TACROLIMUS ORAL SUSPENSION COMPOUND 0.5 MG/ML [4080345]
|
Facility
|
OP
|
$2.61
|
|
|
Service Code
|
NDC 9994-0803-45
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.60
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Cigna of CA HMO |
$1.83
|
| Rate for Payer: Cigna of CA PPO |
$1.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: EPIC Health Plan Senior |
$1.04
|
| Rate for Payer: Galaxy Health WC |
$2.22
|
| Rate for Payer: Global Benefits Group Commercial |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.83
|
| Rate for Payer: Multiplan Commercial |
$2.09
|
| Rate for Payer: Networks By Design Commercial |
$1.70
|
| Rate for Payer: Prime Health Services Commercial |
$2.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.30
|
| Rate for Payer: United Healthcare All Other HMO |
$1.30
|
| Rate for Payer: United Healthcare HMO Rider |
$1.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.22
|
| Rate for Payer: Vantage Medical Group Senior |
$2.22
|
|
|
TACROLIMUS ORAL SUSPENSION COMPOUND 0.5 MG/ML [4080345]
|
Facility
|
IP
|
$2.61
|
|
|
Service Code
|
NDC 9994-0803-45
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1.93
|
| Rate for Payer: Blue Shield of California EPN |
$1.27
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Cigna of CA HMO |
$1.83
|
| Rate for Payer: Cigna of CA PPO |
$1.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: EPIC Health Plan Senior |
$1.04
|
| Rate for Payer: Galaxy Health WC |
$2.22
|
| Rate for Payer: Global Benefits Group Commercial |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.63
|
| Rate for Payer: Multiplan Commercial |
$2.09
|
| Rate for Payer: Networks By Design Commercial |
$1.70
|
| Rate for Payer: Prime Health Services Commercial |
$2.22
|
|
|
TACROLIMUS XR 0.75 MG TABLET,EXTENDED RELEASE 24 HR [211104]
|
Facility
|
IP
|
$6.37
|
|
|
Service Code
|
HCPCS J7508
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$5.41 |
| Rate for Payer: Adventist Health Commercial |
$1.27
|
| Rate for Payer: Blue Shield of California Commercial |
$4.70
|
| Rate for Payer: Blue Shield of California EPN |
$3.10
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cigna of CA HMO |
$4.46
|
| Rate for Payer: Cigna of CA PPO |
$4.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.55
|
| Rate for Payer: EPIC Health Plan Senior |
$2.55
|
| Rate for Payer: Galaxy Health WC |
$5.41
|
| Rate for Payer: Global Benefits Group Commercial |
$3.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.53
|
| Rate for Payer: Multiplan Commercial |
$5.10
|
| Rate for Payer: Networks By Design Commercial |
$3.19
|
| Rate for Payer: Prime Health Services Commercial |
$5.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.39
|
| Rate for Payer: United Healthcare All Other HMO |
$2.33
|
| Rate for Payer: United Healthcare HMO Rider |
$2.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.09
|
|
|
TACROLIMUS XR 0.75 MG TABLET,EXTENDED RELEASE 24 HR [211104]
|
Facility
|
OP
|
$6.37
|
|
|
Service Code
|
HCPCS J7508
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$5.41 |
| Rate for Payer: Adventist Health Commercial |
$1.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.56
|
| Rate for Payer: Blue Shield of California Commercial |
$0.67
|
| Rate for Payer: Blue Shield of California EPN |
$0.67
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cigna of CA HMO |
$4.46
|
| Rate for Payer: Cigna of CA PPO |
$4.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.55
|
| Rate for Payer: EPIC Health Plan Senior |
$2.55
|
| Rate for Payer: Galaxy Health WC |
$5.41
|
| Rate for Payer: Global Benefits Group Commercial |
$3.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.46
|
| Rate for Payer: Multiplan Commercial |
$5.10
|
| Rate for Payer: Networks By Design Commercial |
$3.19
|
| Rate for Payer: Prime Health Services Commercial |
$5.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.39
|
| Rate for Payer: United Healthcare All Other HMO |
$2.33
|
| Rate for Payer: United Healthcare HMO Rider |
$2.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.41
|
| Rate for Payer: Vantage Medical Group Senior |
$5.41
|
|
|
TACROLIMUS XR 1 MG TABLET,EXTENDED RELEASE 24 HR [211105]
|
Facility
|
OP
|
$8.49
|
|
|
Service Code
|
HCPCS J7508
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$7.22 |
| Rate for Payer: Adventist Health Commercial |
$1.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.56
|
| Rate for Payer: Blue Shield of California Commercial |
$0.67
|
| Rate for Payer: Blue Shield of California EPN |
$0.67
|
| Rate for Payer: Cash Price |
$4.67
|
| Rate for Payer: Cash Price |
$4.67
|
| Rate for Payer: Cigna of CA HMO |
$5.94
|
| Rate for Payer: Cigna of CA PPO |
$5.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3.40
|
| Rate for Payer: Galaxy Health WC |
$7.22
|
| Rate for Payer: Global Benefits Group Commercial |
$5.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.94
|
| Rate for Payer: Multiplan Commercial |
$6.79
|
| Rate for Payer: Networks By Design Commercial |
$4.25
|
| Rate for Payer: Prime Health Services Commercial |
$7.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.19
|
| Rate for Payer: United Healthcare All Other HMO |
$3.10
|
| Rate for Payer: United Healthcare HMO Rider |
$3.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.22
|
| Rate for Payer: Vantage Medical Group Senior |
$7.22
|
|
|
TACROLIMUS XR 1 MG TABLET,EXTENDED RELEASE 24 HR [211105]
|
Facility
|
IP
|
$8.49
|
|
|
Service Code
|
HCPCS J7508
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$7.22 |
| Rate for Payer: Adventist Health Commercial |
$1.70
|
| Rate for Payer: Blue Shield of California Commercial |
$6.27
|
| Rate for Payer: Blue Shield of California EPN |
$4.13
|
| Rate for Payer: Cash Price |
$4.67
|
| Rate for Payer: Cigna of CA HMO |
$5.94
|
| Rate for Payer: Cigna of CA PPO |
$5.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3.40
|
| Rate for Payer: Galaxy Health WC |
$7.22
|
| Rate for Payer: Global Benefits Group Commercial |
$5.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.04
|
| Rate for Payer: Multiplan Commercial |
$6.79
|
| Rate for Payer: Networks By Design Commercial |
$4.25
|
| Rate for Payer: Prime Health Services Commercial |
$7.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.19
|
| Rate for Payer: United Healthcare All Other HMO |
$3.10
|
| Rate for Payer: United Healthcare HMO Rider |
$3.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.78
|
|
|
TACROLIMUS XR 4 MG TABLET,EXTENDED RELEASE 24 HR [211106]
|
Facility
|
OP
|
$33.95
|
|
|
Service Code
|
HCPCS J7508
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$28.86 |
| Rate for Payer: Adventist Health Commercial |
$6.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.56
|
| Rate for Payer: Blue Shield of California Commercial |
$0.67
|
| Rate for Payer: Blue Shield of California EPN |
$0.67
|
| Rate for Payer: Cash Price |
$18.67
|
| Rate for Payer: Cash Price |
$18.67
|
| Rate for Payer: Cigna of CA HMO |
$23.77
|
| Rate for Payer: Cigna of CA PPO |
$23.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.58
|
| Rate for Payer: EPIC Health Plan Senior |
$13.58
|
| Rate for Payer: Galaxy Health WC |
$28.86
|
| Rate for Payer: Global Benefits Group Commercial |
$20.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.77
|
| Rate for Payer: Multiplan Commercial |
$27.16
|
| Rate for Payer: Networks By Design Commercial |
$16.98
|
| Rate for Payer: Prime Health Services Commercial |
$28.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.74
|
| Rate for Payer: United Healthcare All Other HMO |
$12.40
|
| Rate for Payer: United Healthcare HMO Rider |
$12.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.86
|
| Rate for Payer: Vantage Medical Group Senior |
$28.86
|
|
|
TACROLIMUS XR 4 MG TABLET,EXTENDED RELEASE 24 HR [211106]
|
Facility
|
IP
|
$33.95
|
|
|
Service Code
|
HCPCS J7508
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$28.86 |
| Rate for Payer: Adventist Health Commercial |
$6.79
|
| Rate for Payer: Blue Shield of California Commercial |
$25.06
|
| Rate for Payer: Blue Shield of California EPN |
$16.50
|
| Rate for Payer: Cash Price |
$18.67
|
| Rate for Payer: Cigna of CA HMO |
$23.77
|
| Rate for Payer: Cigna of CA PPO |
$23.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.58
|
| Rate for Payer: EPIC Health Plan Senior |
$13.58
|
| Rate for Payer: Galaxy Health WC |
$28.86
|
| Rate for Payer: Global Benefits Group Commercial |
$20.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.15
|
| Rate for Payer: Multiplan Commercial |
$27.16
|
| Rate for Payer: Networks By Design Commercial |
$16.98
|
| Rate for Payer: Prime Health Services Commercial |
$28.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.74
|
| Rate for Payer: United Healthcare All Other HMO |
$12.40
|
| Rate for Payer: United Healthcare HMO Rider |
$12.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.12
|
|
|
TADALAFIL 20 MG TABLET [36986]
|
Facility
|
IP
|
$0.44
|
|
|
Service Code
|
NDC 43547-051-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cigna of CA HMO |
$0.31
|
| Rate for Payer: Cigna of CA PPO |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Senior |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
|
|
TADALAFIL 20 MG TABLET [36986]
|
Facility
|
OP
|
$0.44
|
|
|
Service Code
|
NDC 43547-051-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.27
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cigna of CA HMO |
$0.31
|
| Rate for Payer: Cigna of CA PPO |
$0.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Senior |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO |
$0.22
|
| Rate for Payer: United Healthcare HMO Rider |
$0.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Vantage Medical Group Senior |
$0.37
|
|
|
TADALAFIL 20 MG TABLET [36986]
|
Facility
|
OP
|
$3.88
|
|
|
Service Code
|
NDC 50268-739-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$3.30 |
| Rate for Payer: Adventist Health Commercial |
$0.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.38
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cigna of CA HMO |
$2.72
|
| Rate for Payer: Cigna of CA PPO |
$2.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.55
|
| Rate for Payer: EPIC Health Plan Senior |
$1.55
|
| Rate for Payer: Galaxy Health WC |
$3.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.72
|
| Rate for Payer: Multiplan Commercial |
$3.10
|
| Rate for Payer: Networks By Design Commercial |
$2.52
|
| Rate for Payer: Prime Health Services Commercial |
$3.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.94
|
| Rate for Payer: United Healthcare All Other HMO |
$1.94
|
| Rate for Payer: United Healthcare HMO Rider |
$1.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3.30
|
|
|
TADALAFIL 20 MG TABLET [36986]
|
Facility
|
OP
|
$3.88
|
|
|
Service Code
|
NDC 50268-739-13
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$3.30 |
| Rate for Payer: Adventist Health Commercial |
$0.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.38
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cigna of CA HMO |
$2.72
|
| Rate for Payer: Cigna of CA PPO |
$2.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.55
|
| Rate for Payer: EPIC Health Plan Senior |
$1.55
|
| Rate for Payer: Galaxy Health WC |
$3.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.72
|
| Rate for Payer: Multiplan Commercial |
$3.10
|
| Rate for Payer: Networks By Design Commercial |
$2.52
|
| Rate for Payer: Prime Health Services Commercial |
$3.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.94
|
| Rate for Payer: United Healthcare All Other HMO |
$1.94
|
| Rate for Payer: United Healthcare HMO Rider |
$1.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3.30
|
|
|
TADALAFIL 20 MG TABLET [36986]
|
Facility
|
IP
|
$3.88
|
|
|
Service Code
|
NDC 50268-739-13
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$3.30 |
| Rate for Payer: Adventist Health Commercial |
$0.78
|
| Rate for Payer: Blue Shield of California Commercial |
$2.86
|
| Rate for Payer: Blue Shield of California EPN |
$1.89
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cigna of CA HMO |
$2.72
|
| Rate for Payer: Cigna of CA PPO |
$2.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.55
|
| Rate for Payer: EPIC Health Plan Senior |
$1.55
|
| Rate for Payer: Galaxy Health WC |
$3.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.93
|
| Rate for Payer: Multiplan Commercial |
$3.10
|
| Rate for Payer: Networks By Design Commercial |
$2.52
|
| Rate for Payer: Prime Health Services Commercial |
$3.30
|
|
|
TADALAFIL 20 MG TABLET [36986]
|
Facility
|
IP
|
$3.88
|
|
|
Service Code
|
NDC 50268-739-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$3.30 |
| Rate for Payer: Adventist Health Commercial |
$0.78
|
| Rate for Payer: Blue Shield of California Commercial |
$2.86
|
| Rate for Payer: Blue Shield of California EPN |
$1.89
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cigna of CA HMO |
$2.72
|
| Rate for Payer: Cigna of CA PPO |
$2.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.55
|
| Rate for Payer: EPIC Health Plan Senior |
$1.55
|
| Rate for Payer: Galaxy Health WC |
$3.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.93
|
| Rate for Payer: Multiplan Commercial |
$3.10
|
| Rate for Payer: Networks By Design Commercial |
$2.52
|
| Rate for Payer: Prime Health Services Commercial |
$3.30
|
|
|
TADALAFIL 20 MG TABLET (PULMONARY HYPERTENSION) [214774]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 27241-123-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.61
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Senior |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
TADALAFIL 20 MG TABLET (PULMONARY HYPERTENSION) [214774]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 27241-123-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.74
|
| Rate for Payer: Blue Shield of California EPN |
$0.49
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Senior |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
|
|
TADALAFIL 20 MG TABLET (PULMONARY HYPERTENSION) [214774]
|
Facility
|
OP
|
$0.60
|
|
|
Service Code
|
NDC 33342-278-09
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.37
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
|
TADALAFIL 20 MG TABLET (PULMONARY HYPERTENSION) [214774]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 69097-526-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.74
|
| Rate for Payer: Blue Shield of California EPN |
$0.49
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Senior |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
|
