|
TECLISTAMAB-CQYV 90 MG/ML SUBCUTANEOUS SOLUTION [236038]
|
Facility
|
OP
|
$7,647.61
|
|
|
Service Code
|
HCPCS J9380
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.32 |
| Max. Negotiated Rate |
$6,500.47 |
| Rate for Payer: Adventist Health Commercial |
$1,529.52
|
| 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 |
$4,907.47
|
| Rate for Payer: Blue Shield of California Commercial |
$38.10
|
| Rate for Payer: Cash Price |
$3,441.42
|
| 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: 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 |
$5,353.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.28
|
| Rate for Payer: EPIC Health Plan Senior |
$38.85
|
| Rate for Payer: Galaxy Health WC |
$6,500.47
|
| Rate for Payer: Global Benefits Group Commercial |
$4,588.57
|
| 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 |
$4,856.23
|
| 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 |
$1,835.43
|
| 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 |
$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: Temecula Valley Physicians Medical Group Commercial |
$4,588.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,588.57
|
| 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
|
| 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
|
|
|
TELISOTUZUMAB VEDOTIN-TLLV 100 MG INTRAVENOUS SOLUTION [246066]
|
Facility
|
IP
|
$16,776.00
|
|
|
Service Code
|
HCPCS J9326
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,355.20 |
| Max. Negotiated Rate |
$14,259.60 |
| Rate for Payer: Adventist Health Commercial |
$3,355.20
|
| Rate for Payer: Blue Shield of California Commercial |
$12,900.74
|
| Rate for Payer: Blue Shield of California Commercial |
$8,505.43
|
| Rate for Payer: Cash Price |
$7,549.20
|
| Rate for Payer: Cigna of CA HMO |
$11,743.20
|
| Rate for Payer: Cigna of CA PPO |
$11,743.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,743.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,710.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,710.40
|
| Rate for Payer: Galaxy Health WC |
$14,259.60
|
| Rate for Payer: Global Benefits Group Commercial |
$10,065.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,652.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,897.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,026.24
|
| Rate for Payer: Multiplan Commercial |
$13,420.80
|
| Rate for Payer: Networks By Design Commercial |
$8,388.00
|
| Rate for Payer: Prime Health Services Commercial |
$14,259.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,296.03
|
| Rate for Payer: United Healthcare All Other HMO |
$6,128.27
|
| Rate for Payer: United Healthcare HMO Rider |
$5,995.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,494.14
|
|
|
TELISOTUZUMAB VEDOTIN-TLLV 100 MG INTRAVENOUS SOLUTION [246066]
|
Facility
|
OP
|
$16,776.00
|
|
|
Service Code
|
HCPCS J9326
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$146.06 |
| Max. Negotiated Rate |
$14,259.60 |
| Rate for Payer: Adventist Health Commercial |
$3,355.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,003.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$219.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$160.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$146.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$357.18
|
| Rate for Payer: Cash Price |
$7,549.20
|
| Rate for Payer: Cash Price |
$7,549.20
|
| Rate for Payer: Cigna of CA HMO |
$11,743.20
|
| Rate for Payer: Cigna of CA PPO |
$11,743.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$219.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$160.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$146.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,743.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$241.00
|
| Rate for Payer: EPIC Health Plan Senior |
$160.67
|
| Rate for Payer: Galaxy Health WC |
$14,259.60
|
| Rate for Payer: Global Benefits Group Commercial |
$10,065.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$239.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$146.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$146.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,652.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$277.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$204.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,026.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$195.72
|
| Rate for Payer: Multiplan Commercial |
$13,420.80
|
| Rate for Payer: Networks By Design Commercial |
$8,388.00
|
| Rate for Payer: Prime Health Services Commercial |
$14,259.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,065.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,065.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,296.03
|
| Rate for Payer: United Healthcare All Other HMO |
$6,128.27
|
| Rate for Payer: United Healthcare HMO Rider |
$5,995.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,494.14
|
| Rate for Payer: Upland Medical Group Pediatric |
$146.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$219.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$160.67
|
| Rate for Payer: Vantage Medical Group Senior |
$146.06
|
|
|
TELISOTUZUMAB VEDOTIN-TLLV 20 MG INTRAVENOUS SOLUTION [246067]
|
Facility
|
IP
|
$3,355.20
|
|
|
Service Code
|
HCPCS J9326
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$671.04 |
| Max. Negotiated Rate |
$2,851.92 |
| Rate for Payer: Adventist Health Commercial |
$671.04
|
| Rate for Payer: Blue Shield of California Commercial |
$1,701.09
|
| Rate for Payer: Blue Shield of California Commercial |
$2,580.15
|
| Rate for Payer: Cash Price |
$1,509.84
|
| Rate for Payer: Cigna of CA HMO |
$2,348.64
|
| Rate for Payer: Cigna of CA PPO |
$2,348.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,348.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,342.08
|
| Rate for Payer: EPIC Health Plan Senior |
$1,342.08
|
| Rate for Payer: Galaxy Health WC |
$2,851.92
|
| Rate for Payer: Global Benefits Group Commercial |
$2,013.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,130.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,979.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$805.25
|
| Rate for Payer: Multiplan Commercial |
$2,684.16
|
| Rate for Payer: Networks By Design Commercial |
$1,677.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,851.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,259.21
|
| Rate for Payer: United Healthcare All Other HMO |
$1,225.65
|
| Rate for Payer: United Healthcare HMO Rider |
$1,199.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,098.83
|
|
|
TELISOTUZUMAB VEDOTIN-TLLV 20 MG INTRAVENOUS SOLUTION [246067]
|
Facility
|
OP
|
$3,355.20
|
|
|
Service Code
|
HCPCS J9326
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$146.06 |
| Max. Negotiated Rate |
$2,851.92 |
| Rate for Payer: Adventist Health Commercial |
$671.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,200.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$219.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$160.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$146.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$357.18
|
| Rate for Payer: Cash Price |
$1,509.84
|
| Rate for Payer: Cash Price |
$1,509.84
|
| Rate for Payer: Cigna of CA HMO |
$2,348.64
|
| Rate for Payer: Cigna of CA PPO |
$2,348.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$219.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$160.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$146.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,348.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$241.00
|
| Rate for Payer: EPIC Health Plan Senior |
$160.67
|
| Rate for Payer: Galaxy Health WC |
$2,851.92
|
| Rate for Payer: Global Benefits Group Commercial |
$2,013.12
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$239.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$146.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$146.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,130.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$277.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$204.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$805.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$195.72
|
| Rate for Payer: Multiplan Commercial |
$2,684.16
|
| Rate for Payer: Networks By Design Commercial |
$1,677.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,851.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,013.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,013.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,259.21
|
| Rate for Payer: United Healthcare All Other HMO |
$1,225.65
|
| Rate for Payer: United Healthcare HMO Rider |
$1,199.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,098.83
|
| Rate for Payer: Upland Medical Group Pediatric |
$146.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$219.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$160.67
|
| Rate for Payer: Vantage Medical Group Senior |
$146.06
|
|
|
TELMISARTAN 40 MG TABLET [24335]
|
Facility
|
OP
|
$5.61
|
|
|
Service Code
|
NDC 0597004037
|
| 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 |
$3.60
|
| Rate for Payer: Cash Price |
$2.52
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$3.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.31
|
| 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 0597004037
|
| 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 |
$2.84
|
| Rate for Payer: Blue Shield of California Commercial |
$4.31
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna of CA HMO |
$3.93
|
| Rate for Payer: Cigna of CA PPO |
$3.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$3.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.31
|
| 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 0597004137
|
| 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 |
$2.84
|
| Rate for Payer: Blue Shield of California Commercial |
$4.31
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna of CA HMO |
$3.93
|
| Rate for Payer: Cigna of CA PPO |
$3.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$3.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.31
|
| 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 0597004137
|
| 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 |
$3.60
|
| Rate for Payer: Cash Price |
$2.52
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$3.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.31
|
| 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
|
IP
|
$0.11
|
|
|
Service Code
|
NDC 0228207610
|
| 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 |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.06
|
| 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
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 6787714605
|
| 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 |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals 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 6787714601
|
| 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 |
$0.05
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.06
|
| 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
|
OP
|
$0.11
|
|
|
Service Code
|
NDC 0228207610
|
| 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 |
$0.05
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.06
|
| 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
|
OP
|
$0.10
|
|
|
Service Code
|
NDC 6787714605
|
| 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 |
$0.05
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
$0.11
|
|
|
Service Code
|
NDC 6787714601
|
| 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 |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.06
|
| 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 0378505001
|
| 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 |
$0.06
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.08
|
| 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 0378505001
|
| 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 |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.08
|
| 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
|
OP
|
$4.20
|
|
|
Service Code
|
NDC 0904643604
|
| 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 |
$2.70
|
| Rate for Payer: Cash Price |
$1.89
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.48
|
| 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
|
|
|
TEMAZEPAM 7.5 MG CAPSULE [11500]
|
Facility
|
IP
|
$4.20
|
|
|
Service Code
|
NDC 0904643604
|
| 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 |
$2.13
|
| Rate for Payer: Blue Shield of California Commercial |
$3.23
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.48
|
| 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
|
|
|
TEMOZOLOMIDE 100 MG INTRAVENOUS SOLUTION [97260]
|
Facility
|
OP
|
$1,203.73
|
|
|
Service Code
|
HCPCS J9328
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.41 |
| Max. Negotiated Rate |
$1,023.17 |
| Rate for Payer: Adventist Health Commercial |
$240.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$65.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.09
|
| Rate for Payer: Blue Shield of California Commercial |
$12.04
|
| Rate for Payer: Cash Price |
$541.68
|
| Rate for Payer: Cash Price |
$541.68
|
| Rate for Payer: Cigna of CA HMO |
$842.61
|
| Rate for Payer: Cigna of CA PPO |
$842.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$842.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.18
|
| Rate for Payer: EPIC Health Plan Senior |
$11.45
|
| Rate for Payer: Galaxy Health WC |
$1,023.17
|
| Rate for Payer: Global Benefits Group Commercial |
$722.24
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$17.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$764.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.95
|
| Rate for Payer: Multiplan Commercial |
$962.98
|
| Rate for Payer: Networks By Design Commercial |
$601.87
|
| Rate for Payer: Prime Health Services Commercial |
$1,023.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$722.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$722.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$451.76
|
| Rate for Payer: United Healthcare All Other HMO |
$439.72
|
| Rate for Payer: United Healthcare HMO Rider |
$430.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$394.22
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.45
|
| Rate for Payer: Vantage Medical Group Senior |
$11.45
|
|
|
TEMOZOLOMIDE 100 MG INTRAVENOUS SOLUTION [97260]
|
Facility
|
IP
|
$1,203.73
|
|
|
Service Code
|
HCPCS J9328
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$240.75 |
| Max. Negotiated Rate |
$1,023.17 |
| Rate for Payer: Adventist Health Commercial |
$240.75
|
| Rate for Payer: Blue Shield of California Commercial |
$610.29
|
| Rate for Payer: Blue Shield of California Commercial |
$925.67
|
| Rate for Payer: Cash Price |
$541.68
|
| Rate for Payer: Cigna of CA HMO |
$842.61
|
| Rate for Payer: Cigna of CA PPO |
$842.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$842.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$481.49
|
| Rate for Payer: EPIC Health Plan Senior |
$481.49
|
| Rate for Payer: Galaxy Health WC |
$1,023.17
|
| Rate for Payer: Global Benefits Group Commercial |
$722.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$764.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$710.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.90
|
| Rate for Payer: Multiplan Commercial |
$962.98
|
| Rate for Payer: Networks By Design Commercial |
$601.87
|
| Rate for Payer: Prime Health Services Commercial |
$1,023.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$451.76
|
| Rate for Payer: United Healthcare All Other HMO |
$439.72
|
| Rate for Payer: United Healthcare HMO Rider |
$430.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$394.22
|
|
|
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 |
$13.20
|
| Rate for Payer: Blue Shield of California Commercial |
$20.02
|
| Rate for Payer: Cash Price |
$11.71
|
| Rate for Payer: Cigna of CA HMO |
$18.22
|
| Rate for Payer: Cigna of CA PPO |
$18.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$16.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.36
|
| 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 |
$0.43 |
| Max. Negotiated Rate |
$22.13 |
| Rate for Payer: Adventist Health Commercial |
$5.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.76
|
| 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 |
$7.62
|
| Rate for Payer: Blue Shield of California Commercial |
$3.18
|
| Rate for Payer: Cash Price |
$11.71
|
| Rate for Payer: Cash Price |
$11.71
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.36
|
| 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
|
|
|
TEMSIROLIMUS 25 MG/ML (MUST BE DILUTED TO 10 MG/ML) INTRAVENOUS SOLN [82228]
|
Facility
|
OP
|
$1,547.87
|
|
|
Service Code
|
HCPCS J9330
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.68 |
| Max. Negotiated Rate |
$1,315.69 |
| Rate for Payer: Networks By Design Commercial |
$773.93
|
| Rate for Payer: Adventist Health Commercial |
$309.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$190.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$49.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.70
|
| Rate for Payer: Blue Shield of California Commercial |
$60.15
|
| Rate for Payer: Cash Price |
$696.54
|
| Rate for Payer: Cash Price |
$696.54
|
| Rate for Payer: Cigna of CA HMO |
$1,083.51
|
| Rate for Payer: Cigna of CA PPO |
$1,083.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,083.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.92
|
| Rate for Payer: EPIC Health Plan Senior |
$35.95
|
| Rate for Payer: Galaxy Health WC |
$1,315.69
|
| Rate for Payer: Global Benefits Group Commercial |
$928.72
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$53.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$32.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$982.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$45.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$371.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$43.79
|
| Rate for Payer: Multiplan Commercial |
$1,238.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,315.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$928.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$928.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$580.92
|
| Rate for Payer: United Healthcare All Other HMO |
$565.44
|
| Rate for Payer: United Healthcare HMO Rider |
$553.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$506.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$32.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.95
|
| Rate for Payer: Vantage Medical Group Senior |
$35.95
|
|
|
TEMSIROLIMUS 25 MG/ML (MUST BE DILUTED TO 10 MG/ML) INTRAVENOUS SOLN [82228]
|
Facility
|
IP
|
$1,547.87
|
|
|
Service Code
|
HCPCS J9330
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$309.57 |
| Max. Negotiated Rate |
$1,315.69 |
| Rate for Payer: Adventist Health Commercial |
$309.57
|
| Rate for Payer: Blue Shield of California Commercial |
$1,190.31
|
| Rate for Payer: Blue Shield of California Commercial |
$784.77
|
| Rate for Payer: Cash Price |
$696.54
|
| Rate for Payer: Cigna of CA HMO |
$1,083.51
|
| Rate for Payer: Cigna of CA PPO |
$1,083.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,083.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$619.15
|
| Rate for Payer: EPIC Health Plan Senior |
$619.15
|
| Rate for Payer: Galaxy Health WC |
$1,315.69
|
| Rate for Payer: Global Benefits Group Commercial |
$928.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$982.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$913.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$371.49
|
| Rate for Payer: Multiplan Commercial |
$1,238.30
|
| Rate for Payer: Networks By Design Commercial |
$773.93
|
| Rate for Payer: Prime Health Services Commercial |
$1,315.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$580.92
|
| Rate for Payer: United Healthcare All Other HMO |
$565.44
|
| Rate for Payer: United Healthcare HMO Rider |
$553.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$506.93
|
|
