|
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
|
IP
|
$0.29
|
|
|
Service Code
|
NDC 6275616088
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.25
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.19
|
| Rate for Payer: Prime Health Services Commercial |
$0.25
|
|
|
TAMSULOSIN 0.4 MG CAPSULE [103890]
|
Facility
|
OP
|
$0.29
|
|
|
Service Code
|
NDC 6275616088
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.19
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.25
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.19
|
| Rate for Payer: Prime Health Services Commercial |
$0.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.15
|
| Rate for Payer: United Healthcare All Other HMO |
$0.15
|
| Rate for Payer: United Healthcare HMO Rider |
$0.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: Vantage Medical Group Senior |
$0.25
|
|
|
TAMSULOSIN 0.4 MG CAPSULE [103890]
|
Facility
|
IP
|
$0.71
|
|
|
Service Code
|
NDC 6808429901
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$0.55
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: EPIC Health Plan Senior |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.60
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.57
|
| Rate for Payer: Networks By Design Commercial |
$0.46
|
| Rate for Payer: Prime Health Services Commercial |
$0.60
|
|
|
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
|
$0.71
|
|
|
Service Code
|
NDC 6808429911
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.46
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: EPIC Health Plan Senior |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.60
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$0.57
|
| Rate for Payer: Networks By Design Commercial |
$0.46
|
| Rate for Payer: Prime Health Services Commercial |
$0.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.36
|
| Rate for Payer: United Healthcare All Other HMO |
$0.36
|
| Rate for Payer: United Healthcare HMO Rider |
$0.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.60
|
| Rate for Payer: Vantage Medical Group Senior |
$0.60
|
|
|
TAMSULOSIN 0.4 MG CAPSULE [103890]
|
Facility
|
IP
|
$0.71
|
|
|
Service Code
|
NDC 6808429911
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$0.55
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: EPIC Health Plan Senior |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.60
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.57
|
| Rate for Payer: Networks By Design Commercial |
$0.46
|
| Rate for Payer: Prime Health Services Commercial |
$0.60
|
|
|
Tandem Auto-Auto Transplant
|
Facility
|
IP
|
$229,925.00
|
|
|
Service Code
|
MSDRG 016
|
| Min. Negotiated Rate |
$229,925.00 |
| Max. Negotiated Rate |
$229,925.00 |
| Rate for Payer: OptumHealth Care Solutions (URN) Commercial |
$229,925.00
|
|
|
Tandem Auto-Auto Transplant
|
Facility
|
IP
|
$229,925.00
|
|
|
Service Code
|
MSDRG 017
|
| Min. Negotiated Rate |
$229,925.00 |
| Max. Negotiated Rate |
$229,925.00 |
| Rate for Payer: OptumHealth Care Solutions (URN) Commercial |
$229,925.00
|
|
|
Tandem Transplant (Auto to Auto, Auto to Mini Allo, Auto to Allo)
|
Facility
|
IP
|
$176,000.00
|
|
|
Service Code
|
MSDRG 016
|
| Min. Negotiated Rate |
$176,000.00 |
| Max. Negotiated Rate |
$176,000.00 |
| Rate for Payer: Blue Shield of California Transplant |
$176,000.00
|
|
|
Tandem Transplant (Auto to Auto, Auto to Mini Allo, Auto to Allo)
|
Facility
|
IP
|
$176,000.00
|
|
|
Service Code
|
MSDRG 017
|
| Min. Negotiated Rate |
$176,000.00 |
| Max. Negotiated Rate |
$176,000.00 |
| Rate for Payer: Blue Shield of California Transplant |
$176,000.00
|
|
|
Tandem Transplant (Auto to Auto, Auto to Mini Allo, Auto to Allo)
|
Facility
|
IP
|
$176,000.00
|
|
|
Service Code
|
MSDRG 014
|
| Min. Negotiated Rate |
$176,000.00 |
| Max. Negotiated Rate |
$176,000.00 |
| Rate for Payer: Blue Shield of California Transplant |
$176,000.00
|
|
|
TAPENTADOL 50 MG TABLET [98253]
|
Facility
|
IP
|
$16.05
|
|
|
Service Code
|
NDC 2451005010
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$13.64 |
| Rate for Payer: Adventist Health Commercial |
$3.21
|
| Rate for Payer: Blue Shield of California Commercial |
$12.34
|
| Rate for Payer: Blue Shield of California Commercial |
$8.14
|
| Rate for Payer: Cash Price |
$7.22
|
| Rate for Payer: Cigna of CA HMO |
$11.23
|
| Rate for Payer: Cigna of CA PPO |
$11.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.42
|
| Rate for Payer: EPIC Health Plan Senior |
$6.42
|
| Rate for Payer: Galaxy Health WC |
$13.64
|
| Rate for Payer: Global Benefits Group Commercial |
$9.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.85
|
| Rate for Payer: Multiplan Commercial |
$12.84
|
| Rate for Payer: Networks By Design Commercial |
$10.43
|
| Rate for Payer: Prime Health Services Commercial |
$13.64
|
|
|
TAPENTADOL 50 MG TABLET [98253]
|
Facility
|
OP
|
$16.05
|
|
|
Service Code
|
NDC 2451005010
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$13.64 |
| Rate for Payer: Adventist Health Commercial |
$3.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.30
|
| Rate for Payer: Cash Price |
$7.22
|
| Rate for Payer: Cigna of CA HMO |
$11.23
|
| Rate for Payer: Cigna of CA PPO |
$11.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.42
|
| Rate for Payer: EPIC Health Plan Senior |
$6.42
|
| Rate for Payer: Galaxy Health WC |
$13.64
|
| Rate for Payer: Global Benefits Group Commercial |
$9.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.23
|
| Rate for Payer: Multiplan Commercial |
$12.84
|
| Rate for Payer: Networks By Design Commercial |
$10.43
|
| Rate for Payer: Prime Health Services Commercial |
$13.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.03
|
| Rate for Payer: United Healthcare All Other HMO |
$8.03
|
| Rate for Payer: United Healthcare HMO Rider |
$8.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.64
|
| Rate for Payer: Vantage Medical Group Senior |
$13.64
|
|
|
TARLATAMAB-DLLE 10 MG INTRAVENOUS SOLUTION [241611]
|
Facility
|
IP
|
$18,540.00
|
|
|
Service Code
|
HCPCS J9026
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,708.00 |
| Max. Negotiated Rate |
$15,759.00 |
| Rate for Payer: Adventist Health Commercial |
$3,708.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,257.26
|
| Rate for Payer: Blue Shield of California Commercial |
$9,399.78
|
| Rate for Payer: Cash Price |
$8,343.00
|
| Rate for Payer: Cigna of CA HMO |
$12,978.00
|
| Rate for Payer: Cigna of CA PPO |
$12,978.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,978.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,416.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7,416.00
|
| Rate for Payer: Galaxy Health WC |
$15,759.00
|
| Rate for Payer: Global Benefits Group Commercial |
$11,124.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,772.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,938.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,449.60
|
| Rate for Payer: Multiplan Commercial |
$14,832.00
|
| Rate for Payer: Networks By Design Commercial |
$9,270.00
|
| Rate for Payer: Prime Health Services Commercial |
$15,759.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,958.06
|
| Rate for Payer: United Healthcare All Other HMO |
$6,772.66
|
| Rate for Payer: United Healthcare HMO Rider |
$6,626.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,071.85
|
|
|
TARLATAMAB-DLLE 10 MG INTRAVENOUS SOLUTION [241611]
|
Facility
|
OP
|
$18,540.00
|
|
|
Service Code
|
HCPCS J9026
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,612.42 |
| Max. Negotiated Rate |
$15,759.00 |
| Rate for Payer: Adventist Health Commercial |
$3,708.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,879.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,015.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,773.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,773.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,832.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1,800.00
|
| Rate for Payer: Cash Price |
$8,343.00
|
| Rate for Payer: Cash Price |
$8,343.00
|
| Rate for Payer: Cigna of CA HMO |
$12,978.00
|
| Rate for Payer: Cigna of CA PPO |
$12,978.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,015.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,773.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,773.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,978.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,660.49
|
| Rate for Payer: EPIC Health Plan Senior |
$1,773.66
|
| Rate for Payer: Galaxy Health WC |
$15,759.00
|
| Rate for Payer: Global Benefits Group Commercial |
$11,124.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,644.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,612.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,612.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,772.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,976.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,257.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,449.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,031.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,160.64
|
| Rate for Payer: Multiplan Commercial |
$14,832.00
|
| Rate for Payer: Networks By Design Commercial |
$9,270.00
|
| Rate for Payer: Prime Health Services Commercial |
$15,759.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,124.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,124.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,958.06
|
| Rate for Payer: United Healthcare All Other HMO |
$6,772.66
|
| Rate for Payer: United Healthcare HMO Rider |
$6,626.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,071.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,612.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,015.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,773.66
|
| Rate for Payer: Vantage Medical Group Senior |
$1,773.66
|
|
|
TARLATAMAB-DLLE 1 MG INTRAVENOUS SOLUTION [241612]
|
Facility
|
OP
|
$1,854.00
|
|
|
Service Code
|
HCPCS J9026
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$370.80 |
| Max. Negotiated Rate |
$9,879.27 |
| Rate for Payer: Adventist Health Commercial |
$370.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,879.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,015.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,773.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,773.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,832.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1,800.00
|
| Rate for Payer: Cash Price |
$834.30
|
| Rate for Payer: Cash Price |
$834.30
|
| Rate for Payer: Cigna of CA HMO |
$1,297.80
|
| Rate for Payer: Cigna of CA PPO |
$1,297.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,015.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,773.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,773.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,297.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,660.49
|
| Rate for Payer: EPIC Health Plan Senior |
$1,773.66
|
| Rate for Payer: Galaxy Health WC |
$1,575.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,112.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,644.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,612.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,612.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,177.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,976.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,257.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,031.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,160.64
|
| Rate for Payer: Multiplan Commercial |
$1,483.20
|
| Rate for Payer: Networks By Design Commercial |
$927.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,575.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,112.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,112.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$695.81
|
| Rate for Payer: United Healthcare All Other HMO |
$677.27
|
| Rate for Payer: United Healthcare HMO Rider |
$662.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$607.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,612.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,015.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,773.66
|
| Rate for Payer: Vantage Medical Group Senior |
$1,773.66
|
|
|
TARLATAMAB-DLLE 1 MG INTRAVENOUS SOLUTION [241612]
|
Facility
|
IP
|
$1,854.00
|
|
|
Service Code
|
HCPCS J9026
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$370.80 |
| Max. Negotiated Rate |
$1,575.90 |
| Rate for Payer: Adventist Health Commercial |
$370.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,425.73
|
| Rate for Payer: Blue Shield of California Commercial |
$939.98
|
| Rate for Payer: Cash Price |
$834.30
|
| Rate for Payer: Cigna of CA HMO |
$1,297.80
|
| Rate for Payer: Cigna of CA PPO |
$1,297.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,297.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$741.60
|
| Rate for Payer: EPIC Health Plan Senior |
$741.60
|
| Rate for Payer: Galaxy Health WC |
$1,575.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,112.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,177.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,093.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.96
|
| Rate for Payer: Multiplan Commercial |
$1,483.20
|
| Rate for Payer: Networks By Design Commercial |
$927.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,575.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$695.81
|
| Rate for Payer: United Healthcare All Other HMO |
$677.27
|
| Rate for Payer: United Healthcare HMO Rider |
$662.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$607.18
|
|
|
TAZEMETOSTAT 200 MG TABLET [226994]
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
NDC 7260710000
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$21.40 |
| Max. Negotiated Rate |
$90.95 |
| Rate for Payer: Adventist Health Commercial |
$21.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$70.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$80.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.66
|
| Rate for Payer: Cash Price |
$48.15
|
| Rate for Payer: Cigna of CA HMO |
$74.90
|
| Rate for Payer: Cigna of CA PPO |
$74.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.80
|
| Rate for Payer: EPIC Health Plan Senior |
$42.80
|
| Rate for Payer: Galaxy Health WC |
$90.95
|
| Rate for Payer: Global Benefits Group Commercial |
$64.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$63.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74.90
|
| Rate for Payer: Multiplan Commercial |
$85.60
|
| Rate for Payer: Networks By Design Commercial |
$69.55
|
| Rate for Payer: Prime Health Services Commercial |
$90.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$64.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$64.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.50
|
| Rate for Payer: United Healthcare All Other HMO |
$53.50
|
| Rate for Payer: United Healthcare HMO Rider |
$53.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.95
|
| Rate for Payer: Vantage Medical Group Senior |
$90.95
|
|
|
TAZEMETOSTAT 200 MG TABLET [226994]
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
NDC 7260710000
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$21.40 |
| Max. Negotiated Rate |
$90.95 |
| Rate for Payer: Adventist Health Commercial |
$21.40
|
| Rate for Payer: Blue Shield of California Commercial |
$54.25
|
| Rate for Payer: Blue Shield of California Commercial |
$82.28
|
| Rate for Payer: Cash Price |
$48.15
|
| Rate for Payer: Cigna of CA HMO |
$74.90
|
| Rate for Payer: Cigna of CA PPO |
$74.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.80
|
| Rate for Payer: EPIC Health Plan Senior |
$42.80
|
| Rate for Payer: Galaxy Health WC |
$90.95
|
| Rate for Payer: Global Benefits Group Commercial |
$64.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$63.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.68
|
| Rate for Payer: Multiplan Commercial |
$85.60
|
| Rate for Payer: Networks By Design Commercial |
$69.55
|
| Rate for Payer: Prime Health Services Commercial |
$90.95
|
|
|
TEBENTAFUSP-TEBN 100 MCG/0.5 ML INTRAVENOUS SOLUTION [233477]
|
Facility
|
IP
|
$51,624.00
|
|
|
Service Code
|
HCPCS J9274
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10,324.80 |
| Max. Negotiated Rate |
$43,880.40 |
| Rate for Payer: Adventist Health Commercial |
$10,324.80
|
| Rate for Payer: Blue Shield of California Commercial |
$26,173.37
|
| Rate for Payer: Blue Shield of California Commercial |
$39,698.86
|
| Rate for Payer: Cash Price |
$23,230.80
|
| Rate for Payer: Cigna of CA HMO |
$36,136.80
|
| Rate for Payer: Cigna of CA PPO |
$36,136.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36,136.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,649.60
|
| Rate for Payer: EPIC Health Plan Senior |
$20,649.60
|
| Rate for Payer: Galaxy Health WC |
$43,880.40
|
| Rate for Payer: Global Benefits Group Commercial |
$30,974.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32,781.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30,458.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,389.76
|
| Rate for Payer: Multiplan Commercial |
$41,299.20
|
| Rate for Payer: Networks By Design Commercial |
$25,812.00
|
| Rate for Payer: Prime Health Services Commercial |
$43,880.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$19,374.49
|
| Rate for Payer: United Healthcare All Other HMO |
$18,858.25
|
| Rate for Payer: United Healthcare HMO Rider |
$18,450.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,906.86
|
|
|
TEBENTAFUSP-TEBN 100 MCG/0.5 ML INTRAVENOUS SOLUTION [233477]
|
Facility
|
OP
|
$51,624.00
|
|
|
Service Code
|
HCPCS J9274
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$228.01 |
| Max. Negotiated Rate |
$43,880.40 |
| Rate for Payer: Adventist Health Commercial |
$10,324.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,350.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$285.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$250.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$479.22
|
| Rate for Payer: Blue Shield of California Commercial |
$243.12
|
| Rate for Payer: Cash Price |
$23,230.80
|
| Rate for Payer: Cash Price |
$23,230.80
|
| Rate for Payer: Cigna of CA HMO |
$36,136.80
|
| Rate for Payer: Cigna of CA PPO |
$36,136.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$285.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$250.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$250.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36,136.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.22
|
| Rate for Payer: EPIC Health Plan Senior |
$250.81
|
| Rate for Payer: Galaxy Health WC |
$43,880.40
|
| Rate for Payer: Global Benefits Group Commercial |
$30,974.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$373.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$228.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$228.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32,781.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$422.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$319.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,389.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$287.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$305.53
|
| Rate for Payer: Multiplan Commercial |
$41,299.20
|
| Rate for Payer: Networks By Design Commercial |
$25,812.00
|
| Rate for Payer: Prime Health Services Commercial |
$43,880.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30,974.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30,974.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$19,374.49
|
| Rate for Payer: United Healthcare All Other HMO |
$18,858.25
|
| Rate for Payer: United Healthcare HMO Rider |
$18,450.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,906.86
|
| Rate for Payer: Upland Medical Group Pediatric |
$228.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$285.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$250.81
|
| Rate for Payer: Vantage Medical Group Senior |
$250.81
|
|
|
TECLISTAMAB-CQYV 10 MG/ML SUBCUTANEOUS SOLUTION [236039]
|
Facility
|
IP
|
$849.73
|
|
|
Service Code
|
HCPCS J9380
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$169.95 |
| Max. Negotiated Rate |
$722.27 |
| Rate for Payer: Adventist Health Commercial |
$169.95
|
| Rate for Payer: Blue Shield of California Commercial |
$430.81
|
| Rate for Payer: Blue Shield of California Commercial |
$653.44
|
| Rate for Payer: Cash Price |
$382.38
|
| Rate for Payer: Cigna of CA HMO |
$594.81
|
| Rate for Payer: Cigna of CA PPO |
$594.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$594.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$339.89
|
| Rate for Payer: EPIC Health Plan Senior |
$339.89
|
| Rate for Payer: Galaxy Health WC |
$722.27
|
| Rate for Payer: Global Benefits Group Commercial |
$509.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$539.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$501.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.94
|
| Rate for Payer: Multiplan Commercial |
$679.78
|
| Rate for Payer: Networks By Design Commercial |
$424.87
|
| Rate for Payer: Prime Health Services Commercial |
$722.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$318.90
|
| Rate for Payer: United Healthcare All Other HMO |
$310.41
|
| Rate for Payer: United Healthcare HMO Rider |
$303.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$278.29
|
|
|
TECLISTAMAB-CQYV 10 MG/ML SUBCUTANEOUS SOLUTION [236039]
|
Facility
|
OP
|
$849.73
|
|
|
Service Code
|
HCPCS J9380
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.32 |
| Max. Negotiated Rate |
$722.27 |
| Rate for Payer: Adventist Health Commercial |
$169.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$203.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$545.27
|
| Rate for Payer: Blue Shield of California Commercial |
$38.10
|
| Rate for Payer: Cash Price |
$382.38
|
| Rate for Payer: Cash Price |
$382.38
|
| Rate for Payer: Cigna of CA HMO |
$594.81
|
| Rate for Payer: Cigna of CA PPO |
$594.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$594.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.28
|
| Rate for Payer: EPIC Health Plan Senior |
$38.85
|
| Rate for Payer: Galaxy Health WC |
$722.27
|
| Rate for Payer: Global Benefits Group Commercial |
$509.84
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$539.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$74.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.33
|
| Rate for Payer: Multiplan Commercial |
$679.78
|
| Rate for Payer: Networks By Design Commercial |
$424.87
|
| Rate for Payer: Prime Health Services Commercial |
$722.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$509.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$509.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$318.90
|
| Rate for Payer: United Healthcare All Other HMO |
$310.41
|
| Rate for Payer: United Healthcare HMO Rider |
$303.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$278.29
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.85
|
| Rate for Payer: Vantage Medical Group Senior |
$38.85
|
|
|
TECLISTAMAB-CQYV 90 MG/ML SUBCUTANEOUS SOLUTION [236038]
|
Facility
|
IP
|
$7,647.61
|
|
|
Service Code
|
HCPCS J9380
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,529.52 |
| Max. Negotiated Rate |
$6,500.47 |
| Rate for Payer: Adventist Health Commercial |
$1,529.52
|
| Rate for Payer: Blue Shield of California Commercial |
$3,877.34
|
| Rate for Payer: Blue Shield of California Commercial |
$5,881.01
|
| Rate for Payer: Cash Price |
$3,441.42
|
| Rate for Payer: Cigna of CA HMO |
$5,353.33
|
| Rate for Payer: Cigna of CA PPO |
$5,353.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,353.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,059.04
|
| Rate for Payer: EPIC Health Plan Senior |
$3,059.04
|
| Rate for Payer: Galaxy Health WC |
$6,500.47
|
| Rate for Payer: Global Benefits Group Commercial |
$4,588.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,856.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,512.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,835.43
|
| Rate for Payer: Multiplan Commercial |
$6,118.09
|
| Rate for Payer: Networks By Design Commercial |
$3,823.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,500.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,870.15
|
| Rate for Payer: United Healthcare All Other HMO |
$2,793.67
|
| Rate for Payer: United Healthcare HMO Rider |
$2,733.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,504.59
|
|
