|
TADALAFIL 20 MG TABLET (PULMONARY HYPERTENSION) [214774]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 6909752603
|
| 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 |
$0.51
|
| Rate for Payer: Blue Shield of California Commercial |
$0.77
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$0.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.59
|
| 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
|
$1.00
|
|
|
Service Code
|
NDC 6909752603
|
| 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 |
$0.64
|
| Rate for Payer: Cash Price |
$0.45
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$0.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.59
|
| 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
|
$0.60
|
|
|
Service Code
|
NDC 2724112302
|
| 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: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.42
|
| 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 Foundation Hospitals Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| 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
|
|
|
TADALAFIL 20 MG TABLET (PULMONARY HYPERTENSION) [214774]
|
Facility
|
OP
|
$0.60
|
|
|
Service Code
|
NDC 3334227809
|
| 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 |
$0.39
|
| Rate for Payer: Cash Price |
$0.27
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.42
|
| 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 Foundation Hospitals Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.35
|
| 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
|
$0.60
|
|
|
Service Code
|
NDC 3334227809
|
| 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: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.42
|
| 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 Foundation Hospitals Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| 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
|
|
|
TADALAFIL 20 MG TABLET (PULMONARY HYPERTENSION) [214774]
|
Facility
|
OP
|
$0.60
|
|
|
Service Code
|
NDC 2724112302
|
| 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 |
$0.39
|
| Rate for Payer: Cash Price |
$0.27
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.42
|
| 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 Foundation Hospitals Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.35
|
| 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 5 MG TABLET [37400]
|
Facility
|
IP
|
$0.40
|
|
|
Service Code
|
NDC 2724111203
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.31
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.28
|
| Rate for Payer: Cigna of CA PPO |
$0.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Senior |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.32
|
| Rate for Payer: Networks By Design Commercial |
$0.26
|
| Rate for Payer: Prime Health Services Commercial |
$0.34
|
|
|
TADALAFIL 5 MG TABLET [37400]
|
Facility
|
OP
|
$0.36
|
|
|
Service Code
|
NDC 4359857530
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.23
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
|
TADALAFIL 5 MG TABLET [37400]
|
Facility
|
OP
|
$0.40
|
|
|
Service Code
|
NDC 2724111203
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.26
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.28
|
| Rate for Payer: Cigna of CA PPO |
$0.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Senior |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$0.32
|
| Rate for Payer: Networks By Design Commercial |
$0.26
|
| Rate for Payer: Prime Health Services Commercial |
$0.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.20
|
| Rate for Payer: United Healthcare All Other HMO |
$0.20
|
| Rate for Payer: United Healthcare HMO Rider |
$0.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Vantage Medical Group Senior |
$0.34
|
|
|
TADALAFIL 5 MG TABLET [37400]
|
Facility
|
IP
|
$0.36
|
|
|
Service Code
|
NDC 4359857530
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.28
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
|
|
TADALAFIL ORAL SUSPENSION COMPOUND 5 MG/ML [4081077]
|
Facility
|
IP
|
$0.15
|
|
|
Service Code
|
NDC 99994081077
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.13
|
|
|
TADALAFIL ORAL SUSPENSION COMPOUND 5 MG/ML [4081077]
|
Facility
|
OP
|
$0.15
|
|
|
Service Code
|
NDC 99994081077
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.13
|
| 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 |
$0.10
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Vantage Medical Group Senior |
$0.13
|
|
|
TAFASITAMAB-CXIX 200 MG INTRAVENOUS SOLUTION [228997]
|
Facility
|
IP
|
$1,708.80
|
|
|
Service Code
|
HCPCS J9349
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$341.76 |
| Max. Negotiated Rate |
$1,452.48 |
| Rate for Payer: Adventist Health Commercial |
$341.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1,314.07
|
| Rate for Payer: Blue Shield of California Commercial |
$866.36
|
| Rate for Payer: Cash Price |
$768.96
|
| Rate for Payer: Cigna of CA HMO |
$1,196.16
|
| Rate for Payer: Cigna of CA PPO |
$1,196.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,196.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$683.52
|
| Rate for Payer: EPIC Health Plan Senior |
$683.52
|
| Rate for Payer: Galaxy Health WC |
$1,452.48
|
| Rate for Payer: Global Benefits Group Commercial |
$1,025.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,085.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,008.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$410.11
|
| Rate for Payer: Multiplan Commercial |
$1,367.04
|
| Rate for Payer: Networks By Design Commercial |
$854.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,452.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$641.31
|
| Rate for Payer: United Healthcare All Other HMO |
$624.22
|
| Rate for Payer: United Healthcare HMO Rider |
$610.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$559.63
|
|
|
TAFASITAMAB-CXIX 200 MG INTRAVENOUS SOLUTION [228997]
|
Facility
|
OP
|
$1,708.80
|
|
|
Service Code
|
HCPCS J9349
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.43 |
| Max. Negotiated Rate |
$1,452.48 |
| Rate for Payer: Adventist Health Commercial |
$341.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.66
|
| Rate for Payer: Blue Shield of California Commercial |
$16.18
|
| Rate for Payer: Cash Price |
$768.96
|
| Rate for Payer: Cash Price |
$768.96
|
| Rate for Payer: Cigna of CA HMO |
$1,196.16
|
| Rate for Payer: Cigna of CA PPO |
$1,196.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,196.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.81
|
| Rate for Payer: EPIC Health Plan Senior |
$15.87
|
| Rate for Payer: Galaxy Health WC |
$1,452.48
|
| Rate for Payer: Global Benefits Group Commercial |
$1,025.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,085.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$410.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.34
|
| Rate for Payer: Multiplan Commercial |
$1,367.04
|
| Rate for Payer: Networks By Design Commercial |
$854.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,452.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,025.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,025.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$641.31
|
| Rate for Payer: United Healthcare All Other HMO |
$624.22
|
| Rate for Payer: United Healthcare HMO Rider |
$610.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$559.63
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.87
|
| Rate for Payer: Vantage Medical Group Senior |
$15.87
|
|
|
TALIMOGENE LAHERPAREPVEC 10EXP6 (1 MILLION) PFU/ML SUSP FOR INJECTION [211748]
|
Facility
|
IP
|
$88.03
|
|
|
Service Code
|
HCPCS J9325
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.61 |
| Max. Negotiated Rate |
$74.83 |
| Rate for Payer: Adventist Health Commercial |
$17.61
|
| Rate for Payer: Blue Shield of California Commercial |
$44.63
|
| Rate for Payer: Blue Shield of California Commercial |
$67.70
|
| Rate for Payer: Cash Price |
$39.61
|
| Rate for Payer: Cigna of CA HMO |
$61.62
|
| Rate for Payer: Cigna of CA PPO |
$61.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.21
|
| Rate for Payer: EPIC Health Plan Senior |
$35.21
|
| Rate for Payer: Galaxy Health WC |
$74.83
|
| Rate for Payer: Global Benefits Group Commercial |
$52.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.13
|
| Rate for Payer: Multiplan Commercial |
$70.42
|
| Rate for Payer: Networks By Design Commercial |
$44.02
|
| Rate for Payer: Prime Health Services Commercial |
$74.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.04
|
| Rate for Payer: United Healthcare All Other HMO |
$32.16
|
| Rate for Payer: United Healthcare HMO Rider |
$31.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.83
|
|
|
TALIMOGENE LAHERPAREPVEC 10EXP6 (1 MILLION) PFU/ML SUSP FOR INJECTION [211748]
|
Facility
|
OP
|
$88.03
|
|
|
Service Code
|
HCPCS J9325
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.61 |
| Max. Negotiated Rate |
$140.49 |
| Rate for Payer: Adventist Health Commercial |
$17.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$138.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$116.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$85.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$77.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.44
|
| Rate for Payer: Blue Shield of California Commercial |
$79.84
|
| Rate for Payer: Cash Price |
$39.61
|
| Rate for Payer: Cash Price |
$39.61
|
| Rate for Payer: Cigna of CA HMO |
$61.62
|
| Rate for Payer: Cigna of CA PPO |
$61.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.61
|
| Rate for Payer: EPIC Health Plan Senior |
$85.07
|
| Rate for Payer: Galaxy Health WC |
$74.83
|
| Rate for Payer: Global Benefits Group Commercial |
$52.82
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$126.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$77.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$77.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$140.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$108.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$97.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$103.64
|
| Rate for Payer: Multiplan Commercial |
$70.42
|
| Rate for Payer: Networks By Design Commercial |
$44.02
|
| Rate for Payer: Prime Health Services Commercial |
$74.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.04
|
| Rate for Payer: United Healthcare All Other HMO |
$32.16
|
| Rate for Payer: United Healthcare HMO Rider |
$31.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.83
|
| Rate for Payer: Upland Medical Group Pediatric |
$77.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.07
|
| Rate for Payer: Vantage Medical Group Senior |
$85.07
|
|
|
TALIMOGENE LAHERPAREPVEC 10EXP8 (100 MILLION)PFU/ML SUSP FOR INJECTION [211749]
|
Facility
|
OP
|
$8,802.10
|
|
|
Service Code
|
HCPCS J9325
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.34 |
| Max. Negotiated Rate |
$7,481.78 |
| Rate for Payer: Adventist Health Commercial |
$1,760.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$138.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$116.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$85.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$77.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.44
|
| Rate for Payer: Blue Shield of California Commercial |
$79.84
|
| Rate for Payer: Cash Price |
$3,960.94
|
| Rate for Payer: Cash Price |
$3,960.94
|
| Rate for Payer: Cigna of CA HMO |
$6,161.47
|
| Rate for Payer: Cigna of CA PPO |
$6,161.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,161.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.61
|
| Rate for Payer: EPIC Health Plan Senior |
$85.07
|
| Rate for Payer: Galaxy Health WC |
$7,481.78
|
| Rate for Payer: Global Benefits Group Commercial |
$5,281.26
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$126.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$77.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$77.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,589.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$140.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$108.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,112.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$97.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$103.64
|
| Rate for Payer: Multiplan Commercial |
$7,041.68
|
| Rate for Payer: Networks By Design Commercial |
$4,401.05
|
| Rate for Payer: Prime Health Services Commercial |
$7,481.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,281.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,281.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,303.43
|
| Rate for Payer: United Healthcare All Other HMO |
$3,215.41
|
| Rate for Payer: United Healthcare HMO Rider |
$3,145.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,882.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$77.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.07
|
| Rate for Payer: Vantage Medical Group Senior |
$85.07
|
|
|
TALIMOGENE LAHERPAREPVEC 10EXP8 (100 MILLION)PFU/ML SUSP FOR INJECTION [211749]
|
Facility
|
IP
|
$8,802.10
|
|
|
Service Code
|
HCPCS J9325
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,760.42 |
| Max. Negotiated Rate |
$7,481.78 |
| Rate for Payer: Adventist Health Commercial |
$1,760.42
|
| Rate for Payer: Blue Shield of California Commercial |
$4,462.66
|
| Rate for Payer: Blue Shield of California Commercial |
$6,768.81
|
| Rate for Payer: Cash Price |
$3,960.94
|
| Rate for Payer: Cigna of CA HMO |
$6,161.47
|
| Rate for Payer: Cigna of CA PPO |
$6,161.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,161.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,520.84
|
| Rate for Payer: EPIC Health Plan Senior |
$3,520.84
|
| Rate for Payer: Galaxy Health WC |
$7,481.78
|
| Rate for Payer: Global Benefits Group Commercial |
$5,281.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,589.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,193.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,112.50
|
| Rate for Payer: Multiplan Commercial |
$7,041.68
|
| Rate for Payer: Networks By Design Commercial |
$4,401.05
|
| Rate for Payer: Prime Health Services Commercial |
$7,481.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,303.43
|
| Rate for Payer: United Healthcare All Other HMO |
$3,215.41
|
| Rate for Payer: United Healthcare HMO Rider |
$3,145.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,882.69
|
|
|
TAMOXIFEN 10 MG TABLET [7711]
|
Facility
|
IP
|
$0.46
|
|
|
Service Code
|
HCPCS S0187
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California Commercial |
$0.35
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Cigna of CA HMO |
$0.32
|
| Rate for Payer: Cigna of CA PPO |
$0.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Senior |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.30
|
| Rate for Payer: Prime Health Services Commercial |
$0.39
|
|
|
TAMOXIFEN 10 MG TABLET [7711]
|
Facility
|
OP
|
$0.46
|
|
|
Service Code
|
HCPCS S0187
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$7.24 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.24
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Cigna of CA HMO |
$0.32
|
| Rate for Payer: Cigna of CA PPO |
$0.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Senior |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.30
|
| Rate for Payer: Prime Health Services Commercial |
$0.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.23
|
| Rate for Payer: United Healthcare All Other HMO |
$0.23
|
| Rate for Payer: United Healthcare HMO Rider |
$0.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.39
|
| Rate for Payer: Vantage Medical Group Senior |
$0.39
|
|
|
TAMOXIFEN 20 MG TABLET [11498]
|
Facility
|
OP
|
$0.46
|
|
|
Service Code
|
NDC 5965130030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.30
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Cigna of CA HMO |
$0.32
|
| Rate for Payer: Cigna of CA PPO |
$0.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Senior |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.30
|
| Rate for Payer: Prime Health Services Commercial |
$0.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.23
|
| Rate for Payer: United Healthcare All Other HMO |
$0.23
|
| Rate for Payer: United Healthcare HMO Rider |
$0.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.39
|
| Rate for Payer: Vantage Medical Group Senior |
$0.39
|
|
|
TAMOXIFEN 20 MG TABLET [11498]
|
Facility
|
IP
|
$0.46
|
|
|
Service Code
|
NDC 5965130030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California Commercial |
$0.35
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Cigna of CA HMO |
$0.32
|
| Rate for Payer: Cigna of CA PPO |
$0.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Senior |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.30
|
| Rate for Payer: Prime Health Services Commercial |
$0.39
|
|
|
TAMSULOSIN 0.4 MG CAPSULE [103890]
|
Facility
|
IP
|
$0.33
|
|
|
Service Code
|
NDC 6838213201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.23
|
| Rate for Payer: Cigna of CA PPO |
$0.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: EPIC Health Plan Senior |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.28
|
|
|
TAMSULOSIN 0.4 MG CAPSULE [103890]
|
Facility
|
OP
|
$0.33
|
|
|
Service Code
|
NDC 6838213201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.21
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.23
|
| Rate for Payer: Cigna of CA PPO |
$0.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: EPIC Health Plan Senior |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Vantage Medical Group Senior |
$0.28
|
|
|
TAMSULOSIN 0.4 MG CAPSULE [103890]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 6586259801
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| 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 |
$0.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
