|
TAPENTADOL 50 MG TABLET [98253]
|
Facility
|
IP
|
$14.61
|
|
|
Service Code
|
NDC 24510-050-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$12.42 |
| Rate for Payer: Adventist Health Commercial |
$2.92
|
| Rate for Payer: Blue Shield of California Commercial |
$10.78
|
| Rate for Payer: Blue Shield of California EPN |
$7.10
|
| Rate for Payer: Cash Price |
$8.03
|
| Rate for Payer: Cigna of CA HMO |
$10.23
|
| Rate for Payer: Cigna of CA PPO |
$10.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.84
|
| Rate for Payer: EPIC Health Plan Senior |
$5.84
|
| Rate for Payer: Galaxy Health WC |
$12.42
|
| Rate for Payer: Global Benefits Group Commercial |
$8.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.51
|
| Rate for Payer: Multiplan Commercial |
$11.69
|
| Rate for Payer: Networks By Design Commercial |
$9.50
|
| Rate for Payer: Prime Health Services Commercial |
$12.42
|
|
|
TAZEMETOSTAT 200 MG TABLET [226994]
|
Facility
|
IP
|
$103.88
|
|
|
Service Code
|
NDC 72607-100-00
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$20.78 |
| Max. Negotiated Rate |
$88.30 |
| Rate for Payer: Adventist Health Commercial |
$20.78
|
| Rate for Payer: Blue Shield of California Commercial |
$76.66
|
| Rate for Payer: Blue Shield of California EPN |
$50.49
|
| Rate for Payer: Cash Price |
$57.13
|
| Rate for Payer: Cigna of CA HMO |
$72.72
|
| Rate for Payer: Cigna of CA PPO |
$72.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.55
|
| Rate for Payer: EPIC Health Plan Senior |
$41.55
|
| Rate for Payer: Galaxy Health WC |
$88.30
|
| Rate for Payer: Global Benefits Group Commercial |
$62.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$64.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.93
|
| Rate for Payer: Multiplan Commercial |
$83.10
|
| Rate for Payer: Networks By Design Commercial |
$67.52
|
| Rate for Payer: Prime Health Services Commercial |
$88.30
|
|
|
TAZEMETOSTAT 200 MG TABLET [226994]
|
Facility
|
OP
|
$103.88
|
|
|
Service Code
|
NDC 72607-100-00
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$20.78 |
| Max. Negotiated Rate |
$88.30 |
| Rate for Payer: Adventist Health Commercial |
$20.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$88.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$57.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$77.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.79
|
| Rate for Payer: Cash Price |
$57.13
|
| Rate for Payer: Cigna of CA HMO |
$72.72
|
| Rate for Payer: Cigna of CA PPO |
$72.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$88.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$88.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$88.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.55
|
| Rate for Payer: EPIC Health Plan Senior |
$41.55
|
| Rate for Payer: Galaxy Health WC |
$88.30
|
| Rate for Payer: Global Benefits Group Commercial |
$62.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$64.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$72.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$72.72
|
| Rate for Payer: Multiplan Commercial |
$83.10
|
| Rate for Payer: Networks By Design Commercial |
$67.52
|
| Rate for Payer: Prime Health Services Commercial |
$88.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$62.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$62.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$51.94
|
| Rate for Payer: United Healthcare All Other HMO |
$51.94
|
| Rate for Payer: United Healthcare HMO Rider |
$51.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$88.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$88.30
|
| Rate for Payer: Vantage Medical Group Senior |
$88.30
|
|
|
TECLISTAMAB-CQYV 10 MG/ML SUBCUTANEOUS SOLUTION [236039]
|
Facility
|
IP
|
$819.41
|
|
|
Service Code
|
HCPCS J9380
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$163.88 |
| Max. Negotiated Rate |
$696.50 |
| Rate for Payer: Adventist Health Commercial |
$163.88
|
| Rate for Payer: Blue Shield of California Commercial |
$604.72
|
| Rate for Payer: Blue Shield of California EPN |
$398.23
|
| Rate for Payer: Cash Price |
$450.68
|
| Rate for Payer: Cigna of CA HMO |
$573.59
|
| Rate for Payer: Cigna of CA PPO |
$573.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$327.76
|
| Rate for Payer: EPIC Health Plan Senior |
$327.76
|
| Rate for Payer: Galaxy Health WC |
$696.50
|
| Rate for Payer: Global Benefits Group Commercial |
$491.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$546.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$312.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.66
|
| Rate for Payer: Multiplan Commercial |
$655.53
|
| Rate for Payer: Networks By Design Commercial |
$409.70
|
| Rate for Payer: Prime Health Services Commercial |
$696.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$307.52
|
| Rate for Payer: United Healthcare All Other HMO |
$299.33
|
| Rate for Payer: United Healthcare HMO Rider |
$292.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$268.36
|
|
|
TECLISTAMAB-CQYV 10 MG/ML SUBCUTANEOUS SOLUTION [236039]
|
Facility
|
OP
|
$819.41
|
|
|
Service Code
|
HCPCS J9380
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.42 |
| Max. Negotiated Rate |
$696.50 |
| Rate for Payer: Adventist Health Commercial |
$163.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$537.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.44
|
| Rate for Payer: Blue Shield of California Commercial |
$38.10
|
| Rate for Payer: Blue Shield of California EPN |
$38.10
|
| Rate for Payer: Cash Price |
$450.68
|
| Rate for Payer: Cash Price |
$450.68
|
| Rate for Payer: Cigna of CA HMO |
$573.59
|
| Rate for Payer: Cigna of CA PPO |
$573.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.91
|
| Rate for Payer: EPIC Health Plan Senior |
$33.27
|
| Rate for Payer: Galaxy Health WC |
$696.50
|
| Rate for Payer: Global Benefits Group Commercial |
$491.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$546.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.58
|
| Rate for Payer: Multiplan Commercial |
$655.53
|
| Rate for Payer: Networks By Design Commercial |
$409.70
|
| Rate for Payer: Prime Health Services Commercial |
$696.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$491.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$491.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$307.52
|
| Rate for Payer: United Healthcare All Other HMO |
$299.33
|
| Rate for Payer: United Healthcare HMO Rider |
$292.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$268.36
|
| Rate for Payer: Upland Medical Group Pediatric |
$33.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.59
|
| Rate for Payer: Vantage Medical Group Senior |
$36.59
|
|
|
TELMISARTAN 40 MG TABLET [24335]
|
Facility
|
OP
|
$5.61
|
|
|
Service Code
|
NDC 0597-0040-37
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$4.77 |
| Rate for Payer: Adventist Health Commercial |
$1.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.45
|
| Rate for Payer: Cash Price |
$3.09
|
| Rate for Payer: Cigna of CA HMO |
$3.93
|
| Rate for Payer: Cigna of CA PPO |
$3.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.24
|
| Rate for Payer: EPIC Health Plan Senior |
$2.24
|
| Rate for Payer: Galaxy Health WC |
$4.77
|
| Rate for Payer: Global Benefits Group Commercial |
$3.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.93
|
| Rate for Payer: Multiplan Commercial |
$4.49
|
| Rate for Payer: Networks By Design Commercial |
$3.65
|
| Rate for Payer: Prime Health Services Commercial |
$4.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.81
|
| Rate for Payer: United Healthcare All Other HMO |
$2.81
|
| Rate for Payer: United Healthcare HMO Rider |
$2.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.77
|
| Rate for Payer: Vantage Medical Group Senior |
$4.77
|
|
|
TELMISARTAN 40 MG TABLET [24335]
|
Facility
|
IP
|
$5.61
|
|
|
Service Code
|
NDC 0597-0040-37
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$4.77 |
| Rate for Payer: Adventist Health Commercial |
$1.12
|
| Rate for Payer: Blue Shield of California Commercial |
$4.14
|
| Rate for Payer: Blue Shield of California EPN |
$2.73
|
| Rate for Payer: Cash Price |
$3.09
|
| Rate for Payer: Cigna of CA HMO |
$3.93
|
| Rate for Payer: Cigna of CA PPO |
$3.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.24
|
| Rate for Payer: EPIC Health Plan Senior |
$2.24
|
| Rate for Payer: Galaxy Health WC |
$4.77
|
| Rate for Payer: Global Benefits Group Commercial |
$3.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.35
|
| Rate for Payer: Multiplan Commercial |
$4.49
|
| Rate for Payer: Networks By Design Commercial |
$3.65
|
| Rate for Payer: Prime Health Services Commercial |
$4.77
|
|
|
TELMISARTAN 80 MG TABLET [24336]
|
Facility
|
IP
|
$5.61
|
|
|
Service Code
|
NDC 0597-0041-37
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$4.77 |
| Rate for Payer: Adventist Health Commercial |
$1.12
|
| Rate for Payer: Blue Shield of California Commercial |
$4.14
|
| Rate for Payer: Blue Shield of California EPN |
$2.73
|
| Rate for Payer: Cash Price |
$3.09
|
| Rate for Payer: Cigna of CA HMO |
$3.93
|
| Rate for Payer: Cigna of CA PPO |
$3.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.24
|
| Rate for Payer: EPIC Health Plan Senior |
$2.24
|
| Rate for Payer: Galaxy Health WC |
$4.77
|
| Rate for Payer: Global Benefits Group Commercial |
$3.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.35
|
| Rate for Payer: Multiplan Commercial |
$4.49
|
| Rate for Payer: Networks By Design Commercial |
$3.65
|
| Rate for Payer: Prime Health Services Commercial |
$4.77
|
|
|
TELMISARTAN 80 MG TABLET [24336]
|
Facility
|
OP
|
$5.61
|
|
|
Service Code
|
NDC 0597-0041-37
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$4.77 |
| Rate for Payer: Adventist Health Commercial |
$1.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.45
|
| Rate for Payer: Cash Price |
$3.09
|
| Rate for Payer: Cigna of CA HMO |
$3.93
|
| Rate for Payer: Cigna of CA PPO |
$3.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.24
|
| Rate for Payer: EPIC Health Plan Senior |
$2.24
|
| Rate for Payer: Galaxy Health WC |
$4.77
|
| Rate for Payer: Global Benefits Group Commercial |
$3.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.93
|
| Rate for Payer: Multiplan Commercial |
$4.49
|
| Rate for Payer: Networks By Design Commercial |
$3.65
|
| Rate for Payer: Prime Health Services Commercial |
$4.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.81
|
| Rate for Payer: United Healthcare All Other HMO |
$2.81
|
| Rate for Payer: United Healthcare HMO Rider |
$2.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.77
|
| Rate for Payer: Vantage Medical Group Senior |
$4.77
|
|
|
TEMAZEPAM 15 MG CAPSULE [7753]
|
Facility
|
OP
|
$0.11
|
|
|
Service Code
|
NDC 0228-2076-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
TEMAZEPAM 15 MG CAPSULE [7753]
|
Facility
|
IP
|
$0.11
|
|
|
Service Code
|
NDC 0228-2076-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
TEMAZEPAM 15 MG CAPSULE [7753]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
NDC 67877-146-05
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
TEMAZEPAM 15 MG CAPSULE [7753]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 67877-146-05
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
TEMAZEPAM 15 MG CAPSULE [7753]
|
Facility
|
OP
|
$0.11
|
|
|
Service Code
|
NDC 67877-146-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
TEMAZEPAM 15 MG CAPSULE [7753]
|
Facility
|
IP
|
$0.11
|
|
|
Service Code
|
NDC 67877-146-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
TEMAZEPAM 30 MG CAPSULE [7754]
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
NDC 0378-5050-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.12
|
|
|
TEMAZEPAM 30 MG CAPSULE [7754]
|
Facility
|
IP
|
$0.14
|
|
|
Service Code
|
NDC 0378-5050-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
|
|
TEMAZEPAM 7.5 MG CAPSULE [11500]
|
Facility
|
IP
|
$4.20
|
|
|
Service Code
|
NDC 0904-6436-04
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Blue Shield of California Commercial |
$3.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.04
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: Multiplan Commercial |
$3.36
|
| Rate for Payer: Networks By Design Commercial |
$2.73
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
|
|
TEMAZEPAM 7.5 MG CAPSULE [11500]
|
Facility
|
OP
|
$4.20
|
|
|
Service Code
|
NDC 0904-6436-04
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.58
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.94
|
| Rate for Payer: Multiplan Commercial |
$3.36
|
| Rate for Payer: Networks By Design Commercial |
$2.73
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.10
|
| Rate for Payer: United Healthcare All Other HMO |
$2.10
|
| Rate for Payer: United Healthcare HMO Rider |
$2.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.57
|
| Rate for Payer: Vantage Medical Group Senior |
$3.57
|
|
|
TEMOZOLOMIDE ORAL SUSPENSION COMPOUND 10 MG/ML [4080346]
|
Facility
|
IP
|
$26.03
|
|
|
Service Code
|
HCPCS J8700
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$22.13 |
| Rate for Payer: Adventist Health Commercial |
$5.21
|
| Rate for Payer: Blue Shield of California Commercial |
$19.21
|
| Rate for Payer: Blue Shield of California EPN |
$12.65
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Cigna of CA HMO |
$18.22
|
| Rate for Payer: Cigna of CA PPO |
$18.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.41
|
| Rate for Payer: EPIC Health Plan Senior |
$10.41
|
| Rate for Payer: Galaxy Health WC |
$22.13
|
| Rate for Payer: Global Benefits Group Commercial |
$15.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$20.82
|
| Rate for Payer: Networks By Design Commercial |
$13.02
|
| Rate for Payer: Prime Health Services Commercial |
$22.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.51
|
| Rate for Payer: United Healthcare HMO Rider |
$9.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.52
|
|
|
TEMOZOLOMIDE ORAL SUSPENSION COMPOUND 10 MG/ML [4080346]
|
Facility
|
OP
|
$26.03
|
|
|
Service Code
|
HCPCS J8700
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$22.13 |
| Rate for Payer: Adventist Health Commercial |
$5.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3.18
|
| Rate for Payer: Blue Shield of California EPN |
$3.18
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Cigna of CA HMO |
$18.22
|
| Rate for Payer: Cigna of CA PPO |
$18.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.41
|
| Rate for Payer: EPIC Health Plan Senior |
$10.41
|
| Rate for Payer: Galaxy Health WC |
$22.13
|
| Rate for Payer: Global Benefits Group Commercial |
$15.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.22
|
| Rate for Payer: Multiplan Commercial |
$20.82
|
| Rate for Payer: Networks By Design Commercial |
$13.02
|
| Rate for Payer: Prime Health Services Commercial |
$22.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.51
|
| Rate for Payer: United Healthcare HMO Rider |
$9.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.13
|
| Rate for Payer: Vantage Medical Group Senior |
$22.13
|
|
|
TENOFOVIR ALAFENAMIDE 25 MG TABLET [216415]
|
Facility
|
IP
|
$61.07
|
|
|
Service Code
|
NDC 61958-2301-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.21 |
| Max. Negotiated Rate |
$51.91 |
| Rate for Payer: Adventist Health Commercial |
$12.21
|
| Rate for Payer: Blue Shield of California Commercial |
$45.07
|
| Rate for Payer: Blue Shield of California EPN |
$29.68
|
| Rate for Payer: Cash Price |
$33.59
|
| Rate for Payer: Cigna of CA HMO |
$42.75
|
| Rate for Payer: Cigna of CA PPO |
$42.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.43
|
| Rate for Payer: EPIC Health Plan Senior |
$24.43
|
| Rate for Payer: Galaxy Health WC |
$51.91
|
| Rate for Payer: Global Benefits Group Commercial |
$36.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.66
|
| Rate for Payer: Multiplan Commercial |
$48.86
|
| Rate for Payer: Networks By Design Commercial |
$39.70
|
| Rate for Payer: Prime Health Services Commercial |
$51.91
|
|
|
TENOFOVIR ALAFENAMIDE 25 MG TABLET [216415]
|
Facility
|
OP
|
$61.07
|
|
|
Service Code
|
NDC 61958-2301-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.21 |
| Max. Negotiated Rate |
$51.91 |
| Rate for Payer: Adventist Health Commercial |
$12.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.50
|
| Rate for Payer: Cash Price |
$33.59
|
| Rate for Payer: Cigna of CA HMO |
$42.75
|
| Rate for Payer: Cigna of CA PPO |
$42.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.43
|
| Rate for Payer: EPIC Health Plan Senior |
$24.43
|
| Rate for Payer: Galaxy Health WC |
$51.91
|
| Rate for Payer: Global Benefits Group Commercial |
$36.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.75
|
| Rate for Payer: Multiplan Commercial |
$48.86
|
| Rate for Payer: Networks By Design Commercial |
$39.70
|
| Rate for Payer: Prime Health Services Commercial |
$51.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.54
|
| Rate for Payer: United Healthcare All Other HMO |
$30.54
|
| Rate for Payer: United Healthcare HMO Rider |
$30.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.91
|
| Rate for Payer: Vantage Medical Group Senior |
$51.91
|
|
|
TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [31684]
|
Facility
|
IP
|
$2.82
|
|
|
Service Code
|
NDC 50268-758-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: Adventist Health Commercial |
$0.56
|
| Rate for Payer: Blue Shield of California Commercial |
$2.08
|
| Rate for Payer: Blue Shield of California EPN |
$1.37
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Cigna of CA HMO |
$1.97
|
| Rate for Payer: Cigna of CA PPO |
$1.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.13
|
| Rate for Payer: EPIC Health Plan Senior |
$1.13
|
| Rate for Payer: Galaxy Health WC |
$2.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: Multiplan Commercial |
$2.26
|
| Rate for Payer: Networks By Design Commercial |
$1.83
|
| Rate for Payer: Prime Health Services Commercial |
$2.40
|
|
|
TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [31684]
|
Facility
|
IP
|
$1.15
|
|
|
Service Code
|
NDC 69097-533-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California Commercial |
$0.85
|
| Rate for Payer: Blue Shield of California EPN |
$0.56
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cigna of CA HMO |
$0.81
|
| Rate for Payer: Cigna of CA PPO |
$0.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: EPIC Health Plan Senior |
$0.46
|
| Rate for Payer: Galaxy Health WC |
$0.98
|
| Rate for Payer: Global Benefits Group Commercial |
$0.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$0.92
|
| Rate for Payer: Networks By Design Commercial |
$0.75
|
| Rate for Payer: Prime Health Services Commercial |
$0.98
|
|
