|
TOPIRAMATE 50 MG TABLET [37616]
|
Facility
|
OP
|
$0.11
|
|
|
Service Code
|
NDC 6838213914
|
| 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
|
|
|
TOPIRAMATE CRUSHED TABLET 25 MG/ML [40820386]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 6846210860
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$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: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
|
|
TOPIRAMATE CRUSHED TABLET 25 MG/ML [40820386]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 6838213814
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$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: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
|
|
TOPIRAMATE CRUSHED TABLET 25 MG/ML [40820386]
|
Facility
|
IP
|
$0.36
|
|
|
Service Code
|
NDC 6808434201
|
| 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
|
|
|
TOPIRAMATE CRUSHED TABLET 25 MG/ML [40820386]
|
Facility
|
OP
|
$0.18
|
|
|
Service Code
|
NDC 6275670786
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.12
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Senior |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Vantage Medical Group Senior |
$0.15
|
|
|
TOPIRAMATE CRUSHED TABLET 25 MG/ML [40820386]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 6838213814
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| 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 |
$0.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.05
|
| 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 |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
| 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 |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
TOPIRAMATE CRUSHED TABLET 25 MG/ML [40820386]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 6846210860
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| 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 |
$0.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.05
|
| 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 |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
| 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 |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
TOPIRAMATE CRUSHED TABLET 25 MG/ML [40820386]
|
Facility
|
OP
|
$0.36
|
|
|
Service Code
|
NDC 6808434211
|
| 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
|
|
|
TOPIRAMATE CRUSHED TABLET 25 MG/ML [40820386]
|
Facility
|
IP
|
$0.18
|
|
|
Service Code
|
NDC 6275670786
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Senior |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
|
|
TOPIRAMATE CRUSHED TABLET 25 MG/ML [40820386]
|
Facility
|
IP
|
$0.36
|
|
|
Service Code
|
NDC 6808434211
|
| 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
|
|
|
TOPIRAMATE CRUSHED TABLET 25 MG/ML [40820386]
|
Facility
|
OP
|
$0.36
|
|
|
Service Code
|
NDC 6808434201
|
| 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
|
|
|
TOPIRAMATE ORAL SOLUTION COMPOUND 6 MG/ML [4080352]
|
Facility
|
OP
|
$6.04
|
|
|
Service Code
|
NDC 9994080352
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$5.13 |
| Rate for Payer: Adventist Health Commercial |
$1.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.88
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cigna of CA HMO |
$4.23
|
| Rate for Payer: Cigna of CA PPO |
$4.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.42
|
| Rate for Payer: EPIC Health Plan Senior |
$2.42
|
| Rate for Payer: Galaxy Health WC |
$5.13
|
| Rate for Payer: Global Benefits Group Commercial |
$3.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.23
|
| Rate for Payer: Multiplan Commercial |
$4.83
|
| Rate for Payer: Networks By Design Commercial |
$3.93
|
| Rate for Payer: Prime Health Services Commercial |
$5.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.02
|
| Rate for Payer: United Healthcare All Other HMO |
$3.02
|
| Rate for Payer: United Healthcare HMO Rider |
$3.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.13
|
| Rate for Payer: Vantage Medical Group Senior |
$5.13
|
|
|
TOPIRAMATE ORAL SOLUTION COMPOUND 6 MG/ML [4080352]
|
Facility
|
IP
|
$6.04
|
|
|
Service Code
|
NDC 9994080352
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$5.13 |
| Rate for Payer: Adventist Health Commercial |
$1.21
|
| Rate for Payer: Blue Shield of California Commercial |
$3.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4.64
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cigna of CA HMO |
$4.23
|
| Rate for Payer: Cigna of CA PPO |
$4.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.42
|
| Rate for Payer: EPIC Health Plan Senior |
$2.42
|
| Rate for Payer: Galaxy Health WC |
$5.13
|
| Rate for Payer: Global Benefits Group Commercial |
$3.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.45
|
| Rate for Payer: Multiplan Commercial |
$4.83
|
| Rate for Payer: Networks By Design Commercial |
$3.93
|
| Rate for Payer: Prime Health Services Commercial |
$5.13
|
|
|
TOPOTECAN 4 MG/4 ML (1 MG/ML) INTRAVENOUS SOLUTION [108590]
|
Facility
|
IP
|
$43.02
|
|
|
Service Code
|
HCPCS J9351
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$36.57 |
| Rate for Payer: Adventist Health Commercial |
$8.60
|
| Rate for Payer: Blue Shield of California Commercial |
$21.81
|
| Rate for Payer: Blue Shield of California Commercial |
$33.08
|
| Rate for Payer: Cash Price |
$19.36
|
| Rate for Payer: Cigna of CA HMO |
$30.11
|
| Rate for Payer: Cigna of CA PPO |
$30.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.21
|
| Rate for Payer: EPIC Health Plan Senior |
$17.21
|
| Rate for Payer: Galaxy Health WC |
$36.57
|
| Rate for Payer: Global Benefits Group Commercial |
$25.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.32
|
| Rate for Payer: Multiplan Commercial |
$34.42
|
| Rate for Payer: Networks By Design Commercial |
$21.51
|
| Rate for Payer: Prime Health Services Commercial |
$36.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.15
|
| Rate for Payer: United Healthcare All Other HMO |
$15.72
|
| Rate for Payer: United Healthcare HMO Rider |
$15.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.09
|
|
|
TOPOTECAN 4 MG/4 ML (1 MG/ML) INTRAVENOUS SOLUTION [108590]
|
Facility
|
OP
|
$43.02
|
|
|
Service Code
|
HCPCS J9351
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$71.70 |
| Rate for Payer: Adventist Health Commercial |
$8.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.70
|
| Rate for Payer: Blue Shield of California Commercial |
$4.20
|
| Rate for Payer: Cash Price |
$19.36
|
| Rate for Payer: Cash Price |
$19.36
|
| Rate for Payer: Cigna of CA HMO |
$30.11
|
| Rate for Payer: Cigna of CA PPO |
$30.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.21
|
| Rate for Payer: EPIC Health Plan Senior |
$17.21
|
| Rate for Payer: Galaxy Health WC |
$36.57
|
| Rate for Payer: Global Benefits Group Commercial |
$25.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.11
|
| Rate for Payer: Multiplan Commercial |
$34.42
|
| Rate for Payer: Networks By Design Commercial |
$21.51
|
| Rate for Payer: Prime Health Services Commercial |
$36.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.15
|
| Rate for Payer: United Healthcare All Other HMO |
$15.72
|
| Rate for Payer: United Healthcare HMO Rider |
$15.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.57
|
| Rate for Payer: Vantage Medical Group Senior |
$36.57
|
|
|
TOPOTECAN 4 MG INTRAVENOUS SOLUTION [17285]
|
Facility
|
OP
|
$163.24
|
|
|
Service Code
|
HCPCS J9351
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$138.75 |
| Rate for Payer: Adventist Health Commercial |
$32.65
|
| Rate for Payer: Adventist Health Commercial |
$56.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$138.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$155.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$211.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$122.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.70
|
| Rate for Payer: Blue Shield of California Commercial |
$4.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4.20
|
| Rate for Payer: Cash Price |
$73.46
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cash Price |
$73.46
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cigna of CA HMO |
$197.40
|
| Rate for Payer: Cigna of CA HMO |
$114.27
|
| Rate for Payer: Cigna of CA PPO |
$197.40
|
| Rate for Payer: Cigna of CA PPO |
$114.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$138.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$138.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$239.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$138.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$114.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$197.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.80
|
| Rate for Payer: EPIC Health Plan Senior |
$112.80
|
| Rate for Payer: EPIC Health Plan Senior |
$65.30
|
| Rate for Payer: Galaxy Health WC |
$239.70
|
| Rate for Payer: Galaxy Health WC |
$138.75
|
| Rate for Payer: Global Benefits Group Commercial |
$169.20
|
| Rate for Payer: Global Benefits Group Commercial |
$97.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$103.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$179.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$166.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$96.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$114.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$197.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$114.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$197.40
|
| Rate for Payer: Multiplan Commercial |
$225.60
|
| Rate for Payer: Multiplan Commercial |
$130.59
|
| Rate for Payer: Networks By Design Commercial |
$141.00
|
| Rate for Payer: Networks By Design Commercial |
$81.62
|
| Rate for Payer: Prime Health Services Commercial |
$138.75
|
| Rate for Payer: Prime Health Services Commercial |
$239.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$169.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$169.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$61.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.83
|
| Rate for Payer: United Healthcare All Other HMO |
$59.63
|
| Rate for Payer: United Healthcare All Other HMO |
$103.01
|
| Rate for Payer: United Healthcare HMO Rider |
$100.79
|
| Rate for Payer: United Healthcare HMO Rider |
$58.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$138.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.70
|
| Rate for Payer: Vantage Medical Group Senior |
$138.75
|
| Rate for Payer: Vantage Medical Group Senior |
$239.70
|
|
|
TOPOTECAN 4 MG INTRAVENOUS SOLUTION [17285]
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
HCPCS J9351
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$239.70 |
| Rate for Payer: Adventist Health Commercial |
$56.40
|
| Rate for Payer: Adventist Health Commercial |
$32.65
|
| Rate for Payer: Blue Shield of California Commercial |
$82.76
|
| Rate for Payer: Blue Shield of California Commercial |
$142.97
|
| Rate for Payer: Blue Shield of California Commercial |
$216.86
|
| Rate for Payer: Blue Shield of California Commercial |
$125.53
|
| Rate for Payer: Cash Price |
$73.46
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cigna of CA HMO |
$197.40
|
| Rate for Payer: Cigna of CA HMO |
$114.27
|
| Rate for Payer: Cigna of CA PPO |
$114.27
|
| Rate for Payer: Cigna of CA PPO |
$197.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$114.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$197.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.80
|
| Rate for Payer: EPIC Health Plan Senior |
$65.30
|
| Rate for Payer: EPIC Health Plan Senior |
$112.80
|
| Rate for Payer: Galaxy Health WC |
$138.75
|
| Rate for Payer: Galaxy Health WC |
$239.70
|
| Rate for Payer: Global Benefits Group Commercial |
$169.20
|
| Rate for Payer: Global Benefits Group Commercial |
$97.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$103.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$179.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$96.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$166.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.68
|
| Rate for Payer: Multiplan Commercial |
$130.59
|
| Rate for Payer: Multiplan Commercial |
$225.60
|
| Rate for Payer: Networks By Design Commercial |
$141.00
|
| Rate for Payer: Networks By Design Commercial |
$81.62
|
| Rate for Payer: Prime Health Services Commercial |
$239.70
|
| Rate for Payer: Prime Health Services Commercial |
$138.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$61.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.83
|
| Rate for Payer: United Healthcare All Other HMO |
$103.01
|
| Rate for Payer: United Healthcare All Other HMO |
$59.63
|
| Rate for Payer: United Healthcare HMO Rider |
$58.34
|
| Rate for Payer: United Healthcare HMO Rider |
$100.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.36
|
|
|
TORIPALIMAB-TPZI 240 MG/6 ML (40 MG/ML) INTRAVENOUS SOLUTION [240076]
|
Facility
|
OP
|
$1,999.55
|
|
|
Service Code
|
HCPCS J3263
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.89 |
| Max. Negotiated Rate |
$1,699.62 |
| Rate for Payer: Adventist Health Commercial |
$399.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$245.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.72
|
| Rate for Payer: Blue Shield of California Commercial |
$45.35
|
| Rate for Payer: Cash Price |
$899.80
|
| Rate for Payer: Cash Price |
$899.80
|
| Rate for Payer: Cigna of CA HMO |
$1,399.68
|
| Rate for Payer: Cigna of CA PPO |
$1,399.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$44.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,399.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.47
|
| Rate for Payer: EPIC Health Plan Senior |
$44.98
|
| Rate for Payer: Galaxy Health WC |
$1,699.62
|
| Rate for Payer: Global Benefits Group Commercial |
$1,199.73
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$67.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$40.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,269.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$54.79
|
| Rate for Payer: Multiplan Commercial |
$1,599.64
|
| Rate for Payer: Networks By Design Commercial |
$999.77
|
| Rate for Payer: Prime Health Services Commercial |
$1,699.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,199.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,199.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$750.43
|
| Rate for Payer: United Healthcare All Other HMO |
$730.44
|
| Rate for Payer: United Healthcare HMO Rider |
$714.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$654.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$40.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.98
|
| Rate for Payer: Vantage Medical Group Senior |
$44.98
|
|
|
TORIPALIMAB-TPZI 240 MG/6 ML (40 MG/ML) INTRAVENOUS SOLUTION [240076]
|
Facility
|
IP
|
$1,999.55
|
|
|
Service Code
|
HCPCS J3263
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$399.91 |
| Max. Negotiated Rate |
$1,699.62 |
| Rate for Payer: Adventist Health Commercial |
$399.91
|
| Rate for Payer: Blue Shield of California Commercial |
$1,013.77
|
| Rate for Payer: Blue Shield of California Commercial |
$1,537.65
|
| Rate for Payer: Cash Price |
$899.80
|
| Rate for Payer: Cigna of CA HMO |
$1,399.68
|
| Rate for Payer: Cigna of CA PPO |
$1,399.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,399.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$799.82
|
| Rate for Payer: EPIC Health Plan Senior |
$799.82
|
| Rate for Payer: Galaxy Health WC |
$1,699.62
|
| Rate for Payer: Global Benefits Group Commercial |
$1,199.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,269.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,179.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.89
|
| Rate for Payer: Multiplan Commercial |
$1,599.64
|
| Rate for Payer: Networks By Design Commercial |
$999.77
|
| Rate for Payer: Prime Health Services Commercial |
$1,699.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$750.43
|
| Rate for Payer: United Healthcare All Other HMO |
$730.44
|
| Rate for Payer: United Healthcare HMO Rider |
$714.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$654.85
|
|
|
TORSEMIDE 100 MG TABLET [18294]
|
Facility
|
IP
|
$0.49
|
|
|
Service Code
|
NDC 5026875715
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.39
|
| Rate for Payer: Networks By Design Commercial |
$0.32
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
|
|
TORSEMIDE 100 MG TABLET [18294]
|
Facility
|
OP
|
$0.54
|
|
|
Service Code
|
NDC 3172253201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.35
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cigna of CA HMO |
$0.38
|
| Rate for Payer: Cigna of CA PPO |
$0.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Senior |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.46
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$0.43
|
| Rate for Payer: Networks By Design Commercial |
$0.35
|
| Rate for Payer: Prime Health Services Commercial |
$0.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.27
|
| Rate for Payer: United Healthcare All Other HMO |
$0.27
|
| Rate for Payer: United Healthcare HMO Rider |
$0.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.46
|
| Rate for Payer: Vantage Medical Group Senior |
$0.46
|
|
|
TORSEMIDE 100 MG TABLET [18294]
|
Facility
|
OP
|
$0.49
|
|
|
Service Code
|
NDC 5026875711
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.31
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$0.39
|
| Rate for Payer: Networks By Design Commercial |
$0.32
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.25
|
| Rate for Payer: United Healthcare All Other HMO |
$0.25
|
| Rate for Payer: United Healthcare HMO Rider |
$0.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.42
|
| Rate for Payer: Vantage Medical Group Senior |
$0.42
|
|
|
TORSEMIDE 100 MG TABLET [18294]
|
Facility
|
IP
|
$0.54
|
|
|
Service Code
|
NDC 3172253201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California Commercial |
$0.42
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cigna of CA HMO |
$0.38
|
| Rate for Payer: Cigna of CA PPO |
$0.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Senior |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.46
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.43
|
| Rate for Payer: Networks By Design Commercial |
$0.35
|
| Rate for Payer: Prime Health Services Commercial |
$0.46
|
|
|
TORSEMIDE 100 MG TABLET [18294]
|
Facility
|
IP
|
$0.49
|
|
|
Service Code
|
NDC 5026875711
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.39
|
| Rate for Payer: Networks By Design Commercial |
$0.32
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
|
|
TORSEMIDE 100 MG TABLET [18294]
|
Facility
|
OP
|
$0.49
|
|
|
Service Code
|
NDC 5026875715
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.31
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$0.39
|
| Rate for Payer: Networks By Design Commercial |
$0.32
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.25
|
| Rate for Payer: United Healthcare All Other HMO |
$0.25
|
| Rate for Payer: United Healthcare HMO Rider |
$0.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.42
|
| Rate for Payer: Vantage Medical Group Senior |
$0.42
|
|
