|
SYNCOPE AND COLLAPSE
|
Facility
|
IP
|
$22,037.24
|
|
|
Service Code
|
APR-DRG 2044
|
| Min. Negotiated Rate |
$13,918.26 |
| Max. Negotiated Rate |
$22,037.24 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,918.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16,585.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22,037.24
|
|
|
TACROLIMUS 0.03 % TOPICAL OINTMENT [29442]
|
Facility
|
IP
|
$2.80
|
|
|
Service Code
|
NDC 4580239000
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$2.52 |
| Rate for Payer: Adventist Health Commercial |
$0.56
|
| Rate for Payer: Blue Shield of California Commercial |
$2.25
|
| Rate for Payer: Blue Shield of California EPN |
$1.41
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: Central Health Plan Commercial |
$2.24
|
| Rate for Payer: Cigna of CA HMO |
$1.96
|
| Rate for Payer: Cigna of CA PPO |
$1.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.12
|
| Rate for Payer: EPIC Health Plan Senior |
$1.12
|
| Rate for Payer: Galaxy Health WC |
$2.38
|
| Rate for Payer: Global Benefits Group Commercial |
$1.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$2.10
|
| Rate for Payer: Networks By Design Commercial |
$1.82
|
| Rate for Payer: Prime Health Services Commercial |
$2.38
|
|
|
TACROLIMUS 0.03 % TOPICAL OINTMENT [29442]
|
Facility
|
OP
|
$2.80
|
|
|
Service Code
|
NDC 4580239000
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$2.52 |
| Rate for Payer: Adventist Health Commercial |
$0.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.63
|
| Rate for Payer: Blue Shield of California Commercial |
$1.78
|
| Rate for Payer: Blue Shield of California EPN |
$1.12
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: Central Health Plan Commercial |
$2.24
|
| Rate for Payer: Cigna of CA HMO |
$1.96
|
| Rate for Payer: Cigna of CA PPO |
$1.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.12
|
| Rate for Payer: EPIC Health Plan Senior |
$1.12
|
| Rate for Payer: Galaxy Health WC |
$2.38
|
| Rate for Payer: Global Benefits Group Commercial |
$1.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.96
|
| Rate for Payer: Multiplan Commercial |
$2.10
|
| Rate for Payer: Networks By Design Commercial |
$1.82
|
| Rate for Payer: Prime Health Services Commercial |
$2.38
|
| Rate for Payer: Riverside University Health System MISP |
$1.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.40
|
| Rate for Payer: United Healthcare All Other HMO |
$1.40
|
| Rate for Payer: United Healthcare HMO Rider |
$1.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.38
|
| Rate for Payer: Vantage Medical Group Senior |
$2.38
|
|
|
TACROLIMUS 0.1 % TOPICAL OINTMENT [29443]
|
Facility
|
IP
|
$5.42
|
|
|
Service Code
|
NDC 0168041630
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$4.88 |
| Rate for Payer: Adventist Health Commercial |
$1.08
|
| Rate for Payer: Blue Shield of California Commercial |
$4.35
|
| Rate for Payer: Blue Shield of California EPN |
$2.73
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Central Health Plan Commercial |
$4.34
|
| Rate for Payer: Cigna of CA HMO |
$3.79
|
| Rate for Payer: Cigna of CA PPO |
$3.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.17
|
| Rate for Payer: EPIC Health Plan Senior |
$2.17
|
| Rate for Payer: Galaxy Health WC |
$4.61
|
| Rate for Payer: Global Benefits Group Commercial |
$3.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: Multiplan Commercial |
$4.07
|
| Rate for Payer: Networks By Design Commercial |
$3.52
|
| Rate for Payer: Prime Health Services Commercial |
$4.61
|
|
|
TACROLIMUS 0.1 % TOPICAL OINTMENT [29443]
|
Facility
|
OP
|
$2.40
|
|
|
Service Code
|
NDC 4580270001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.16 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.96
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Central Health Plan Commercial |
$1.92
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Senior |
$0.96
|
| Rate for Payer: Galaxy Health WC |
$2.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.68
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$1.56
|
| Rate for Payer: Prime Health Services Commercial |
$2.04
|
| Rate for Payer: Riverside University Health System MISP |
$0.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.20
|
| Rate for Payer: United Healthcare All Other HMO |
$1.20
|
| Rate for Payer: United Healthcare HMO Rider |
$1.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2.04
|
|
|
TACROLIMUS 0.1 % TOPICAL OINTMENT [29443]
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 6846253465
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Adventist Health Commercial |
$0.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3.21
|
| Rate for Payer: Blue Shield of California EPN |
$2.02
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Central Health Plan Commercial |
$3.20
|
| Rate for Payer: Cigna of CA HMO |
$2.80
|
| Rate for Payer: Cigna of CA PPO |
$2.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1.60
|
| Rate for Payer: Galaxy Health WC |
$3.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$3.00
|
| Rate for Payer: Networks By Design Commercial |
$2.60
|
| Rate for Payer: Prime Health Services Commercial |
$3.40
|
|
|
TACROLIMUS 0.1 % TOPICAL OINTMENT [29443]
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 1672942210
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Adventist Health Commercial |
$0.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.33
|
| Rate for Payer: Blue Shield of California Commercial |
$2.54
|
| Rate for Payer: Blue Shield of California EPN |
$1.60
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Central Health Plan Commercial |
$3.20
|
| Rate for Payer: Cigna of CA HMO |
$2.80
|
| Rate for Payer: Cigna of CA PPO |
$2.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1.60
|
| Rate for Payer: Galaxy Health WC |
$3.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.80
|
| Rate for Payer: Multiplan Commercial |
$3.00
|
| Rate for Payer: Networks By Design Commercial |
$2.60
|
| Rate for Payer: Prime Health Services Commercial |
$3.40
|
| Rate for Payer: Riverside University Health System MISP |
$1.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.40
|
| Rate for Payer: Vantage Medical Group Senior |
$3.40
|
|
|
TACROLIMUS 0.1 % TOPICAL OINTMENT [29443]
|
Facility
|
IP
|
$2.40
|
|
|
Service Code
|
NDC 4580270001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.16 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California Commercial |
$1.92
|
| Rate for Payer: Blue Shield of California EPN |
$1.21
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Central Health Plan Commercial |
$1.92
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Senior |
$0.96
|
| Rate for Payer: Galaxy Health WC |
$2.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$1.56
|
| Rate for Payer: Prime Health Services Commercial |
$2.04
|
|
|
TACROLIMUS 0.1 % TOPICAL OINTMENT [29443]
|
Facility
|
OP
|
$5.42
|
|
|
Service Code
|
NDC 0168041660
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$4.88 |
| Rate for Payer: Adventist Health Commercial |
$1.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.15
|
| Rate for Payer: Blue Shield of California Commercial |
$3.44
|
| Rate for Payer: Blue Shield of California EPN |
$2.16
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Central Health Plan Commercial |
$4.34
|
| Rate for Payer: Cigna of CA HMO |
$3.79
|
| Rate for Payer: Cigna of CA PPO |
$3.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.17
|
| Rate for Payer: EPIC Health Plan Senior |
$2.17
|
| Rate for Payer: Galaxy Health WC |
$4.61
|
| Rate for Payer: Global Benefits Group Commercial |
$3.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.79
|
| Rate for Payer: Multiplan Commercial |
$4.07
|
| Rate for Payer: Networks By Design Commercial |
$3.52
|
| Rate for Payer: Prime Health Services Commercial |
$4.61
|
| Rate for Payer: Riverside University Health System MISP |
$2.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.71
|
| Rate for Payer: United Healthcare All Other HMO |
$2.71
|
| Rate for Payer: United Healthcare HMO Rider |
$2.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.61
|
| Rate for Payer: Vantage Medical Group Senior |
$4.61
|
|
|
TACROLIMUS 0.1 % TOPICAL OINTMENT [29443]
|
Facility
|
IP
|
$5.42
|
|
|
Service Code
|
NDC 0168041660
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$4.88 |
| Rate for Payer: Adventist Health Commercial |
$1.08
|
| Rate for Payer: Blue Shield of California Commercial |
$4.35
|
| Rate for Payer: Blue Shield of California EPN |
$2.73
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Central Health Plan Commercial |
$4.34
|
| Rate for Payer: Cigna of CA HMO |
$3.79
|
| Rate for Payer: Cigna of CA PPO |
$3.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.17
|
| Rate for Payer: EPIC Health Plan Senior |
$2.17
|
| Rate for Payer: Galaxy Health WC |
$4.61
|
| Rate for Payer: Global Benefits Group Commercial |
$3.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: Multiplan Commercial |
$4.07
|
| Rate for Payer: Networks By Design Commercial |
$3.52
|
| Rate for Payer: Prime Health Services Commercial |
$4.61
|
|
|
TACROLIMUS 0.1 % TOPICAL OINTMENT [29443]
|
Facility
|
OP
|
$5.42
|
|
|
Service Code
|
NDC 0168041630
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$4.88 |
| Rate for Payer: Adventist Health Commercial |
$1.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.15
|
| Rate for Payer: Blue Shield of California Commercial |
$3.44
|
| Rate for Payer: Blue Shield of California EPN |
$2.16
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Central Health Plan Commercial |
$4.34
|
| Rate for Payer: Cigna of CA HMO |
$3.79
|
| Rate for Payer: Cigna of CA PPO |
$3.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.17
|
| Rate for Payer: EPIC Health Plan Senior |
$2.17
|
| Rate for Payer: Galaxy Health WC |
$4.61
|
| Rate for Payer: Global Benefits Group Commercial |
$3.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.79
|
| Rate for Payer: Multiplan Commercial |
$4.07
|
| Rate for Payer: Networks By Design Commercial |
$3.52
|
| Rate for Payer: Prime Health Services Commercial |
$4.61
|
| Rate for Payer: Riverside University Health System MISP |
$2.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.71
|
| Rate for Payer: United Healthcare All Other HMO |
$2.71
|
| Rate for Payer: United Healthcare HMO Rider |
$2.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.61
|
| Rate for Payer: Vantage Medical Group Senior |
$4.61
|
|
|
TACROLIMUS 0.1 % TOPICAL OINTMENT [29443]
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 6846253465
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Adventist Health Commercial |
$0.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.33
|
| Rate for Payer: Blue Shield of California Commercial |
$2.54
|
| Rate for Payer: Blue Shield of California EPN |
$1.60
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Central Health Plan Commercial |
$3.20
|
| Rate for Payer: Cigna of CA HMO |
$2.80
|
| Rate for Payer: Cigna of CA PPO |
$2.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1.60
|
| Rate for Payer: Galaxy Health WC |
$3.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.80
|
| Rate for Payer: Multiplan Commercial |
$3.00
|
| Rate for Payer: Networks By Design Commercial |
$2.60
|
| Rate for Payer: Prime Health Services Commercial |
$3.40
|
| Rate for Payer: Riverside University Health System MISP |
$1.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.40
|
| Rate for Payer: Vantage Medical Group Senior |
$3.40
|
|
|
TACROLIMUS 0.1 % TOPICAL OINTMENT [29443]
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 1672942210
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Adventist Health Commercial |
$0.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3.21
|
| Rate for Payer: Blue Shield of California EPN |
$2.02
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Central Health Plan Commercial |
$3.20
|
| Rate for Payer: Cigna of CA HMO |
$2.80
|
| Rate for Payer: Cigna of CA PPO |
$2.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1.60
|
| Rate for Payer: Galaxy Health WC |
$3.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$3.00
|
| Rate for Payer: Networks By Design Commercial |
$2.60
|
| Rate for Payer: Prime Health Services Commercial |
$3.40
|
|
|
TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE [24914]
|
Facility
|
IP
|
$1.32
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.19 |
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Adventist Health Commercial |
$0.91
|
| Rate for Payer: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California Commercial |
$3.67
|
| Rate for Payer: Blue Shield of California Commercial |
$1.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.67
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$2.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.28
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$3.66
|
| Rate for Payer: Central Health Plan Commercial |
$0.32
|
| Rate for Payer: Central Health Plan Commercial |
$0.16
|
| Rate for Payer: Central Health Plan Commercial |
$0.45
|
| Rate for Payer: Central Health Plan Commercial |
$1.06
|
| Rate for Payer: Cigna of CA HMO |
$3.20
|
| Rate for Payer: Cigna of CA HMO |
$0.39
|
| Rate for Payer: Cigna of CA HMO |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.28
|
| Rate for Payer: Cigna of CA HMO |
$0.92
|
| Rate for Payer: Cigna of CA PPO |
$0.28
|
| Rate for Payer: Cigna of CA PPO |
$0.14
|
| Rate for Payer: Cigna of CA PPO |
$3.20
|
| Rate for Payer: Cigna of CA PPO |
$0.92
|
| Rate for Payer: Cigna of CA PPO |
$0.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Senior |
$0.22
|
| Rate for Payer: EPIC Health Plan Senior |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$0.16
|
| Rate for Payer: EPIC Health Plan Senior |
$1.83
|
| Rate for Payer: EPIC Health Plan Senior |
$0.53
|
| Rate for Payer: Galaxy Health WC |
$1.12
|
| Rate for Payer: Galaxy Health WC |
$0.17
|
| Rate for Payer: Galaxy Health WC |
$3.88
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$0.34
|
| Rate for Payer: Global Benefits Group Commercial |
$2.74
|
| Rate for Payer: Global Benefits Group Commercial |
$0.79
|
| Rate for Payer: Global Benefits Group Commercial |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$3.43
|
| Rate for Payer: Multiplan Commercial |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$0.99
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$2.29
|
| Rate for Payer: Networks By Design Commercial |
$0.66
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.28
|
| Rate for Payer: Prime Health Services Commercial |
$3.88
|
| Rate for Payer: Prime Health Services Commercial |
$0.34
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
| Rate for Payer: Prime Health Services Commercial |
$0.17
|
| Rate for Payer: Prime Health Services Commercial |
$1.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.20
|
| Rate for Payer: United Healthcare All Other HMO |
$0.15
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.48
|
| Rate for Payer: United Healthcare All Other HMO |
$1.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1.63
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.20
|
| Rate for Payer: United Healthcare HMO Rider |
$0.14
|
| Rate for Payer: United Healthcare HMO Rider |
$0.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.18
|
|
|
TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE [24914]
|
Facility
|
OP
|
$0.56
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$9.44 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Adventist Health Commercial |
$0.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.44
|
| Rate for Payer: Blue Shield of California Commercial |
$0.96
|
| Rate for Payer: Blue Shield of California Commercial |
$0.96
|
| Rate for Payer: Blue Shield of California Commercial |
$0.96
|
| Rate for Payer: Blue Shield of California Commercial |
$0.96
|
| Rate for Payer: Blue Shield of California Commercial |
$0.96
|
| Rate for Payer: Blue Shield of California EPN |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$0.87
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.45
|
| Rate for Payer: Central Health Plan Commercial |
$0.16
|
| Rate for Payer: Central Health Plan Commercial |
$1.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.32
|
| Rate for Payer: Central Health Plan Commercial |
$3.66
|
| Rate for Payer: Cigna of CA HMO |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.28
|
| Rate for Payer: Cigna of CA HMO |
$3.20
|
| Rate for Payer: Cigna of CA HMO |
$0.92
|
| Rate for Payer: Cigna of CA HMO |
$0.39
|
| Rate for Payer: Cigna of CA PPO |
$0.28
|
| Rate for Payer: Cigna of CA PPO |
$3.20
|
| Rate for Payer: Cigna of CA PPO |
$0.39
|
| Rate for Payer: Cigna of CA PPO |
$0.92
|
| Rate for Payer: Cigna of CA PPO |
$0.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Senior |
$0.22
|
| Rate for Payer: EPIC Health Plan Senior |
$0.16
|
| Rate for Payer: EPIC Health Plan Senior |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$0.53
|
| Rate for Payer: EPIC Health Plan Senior |
$1.83
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$0.17
|
| Rate for Payer: Galaxy Health WC |
$0.34
|
| Rate for Payer: Galaxy Health WC |
$1.12
|
| Rate for Payer: Galaxy Health WC |
$3.88
|
| Rate for Payer: Global Benefits Group Commercial |
$0.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.79
|
| Rate for Payer: Global Benefits Group Commercial |
$2.74
|
| Rate for Payer: Global Benefits Group Commercial |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.92
|
| Rate for Payer: Multiplan Commercial |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$3.43
|
| Rate for Payer: Multiplan Commercial |
$0.99
|
| Rate for Payer: Multiplan Commercial |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.66
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$2.29
|
| Rate for Payer: Networks By Design Commercial |
$0.28
|
| Rate for Payer: Prime Health Services Commercial |
$0.34
|
| Rate for Payer: Prime Health Services Commercial |
$0.17
|
| Rate for Payer: Prime Health Services Commercial |
$1.12
|
| Rate for Payer: Prime Health Services Commercial |
$3.88
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
| Rate for Payer: Riverside University Health System MISP |
$1.83
|
| Rate for Payer: Riverside University Health System MISP |
$0.22
|
| Rate for Payer: Riverside University Health System MISP |
$0.08
|
| Rate for Payer: Riverside University Health System MISP |
$0.53
|
| Rate for Payer: Riverside University Health System MISP |
$0.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.15
|
| Rate for Payer: United Healthcare All Other HMO |
$0.15
|
| Rate for Payer: United Healthcare All Other HMO |
$0.48
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.20
|
| Rate for Payer: United Healthcare All Other HMO |
$1.67
|
| Rate for Payer: United Healthcare HMO Rider |
$0.20
|
| Rate for Payer: United Healthcare HMO Rider |
$0.47
|
| Rate for Payer: United Healthcare HMO Rider |
$0.14
|
| Rate for Payer: United Healthcare HMO Rider |
$1.63
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.88
|
| Rate for Payer: Vantage Medical Group Senior |
$1.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.34
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$3.88
|
| Rate for Payer: Vantage Medical Group Senior |
$0.17
|
|
|
TACROLIMUS 0.5 MG/ML COMPOUNDED ORAL SUSPENSION [40840050]
|
Facility
|
OP
|
$3.62
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$9.44 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.44
|
| Rate for Payer: Blue Shield of California Commercial |
$0.96
|
| Rate for Payer: Blue Shield of California EPN |
$0.87
|
| Rate for Payer: Cash Price |
$1.63
|
| Rate for Payer: Cash Price |
$1.63
|
| Rate for Payer: Central Health Plan Commercial |
$2.90
|
| Rate for Payer: Cigna of CA HMO |
$2.53
|
| Rate for Payer: Cigna of CA PPO |
$2.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.45
|
| Rate for Payer: EPIC Health Plan Senior |
$1.45
|
| Rate for Payer: Galaxy Health WC |
$3.08
|
| Rate for Payer: Global Benefits Group Commercial |
$2.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.53
|
| Rate for Payer: Multiplan Commercial |
$2.71
|
| Rate for Payer: Networks By Design Commercial |
$1.81
|
| Rate for Payer: Prime Health Services Commercial |
$3.08
|
| Rate for Payer: Riverside University Health System MISP |
$1.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.36
|
| Rate for Payer: United Healthcare All Other HMO |
$1.32
|
| Rate for Payer: United Healthcare HMO Rider |
$1.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.08
|
| Rate for Payer: Vantage Medical Group Senior |
$3.08
|
|
|
TACROLIMUS 0.5 MG/ML COMPOUNDED ORAL SUSPENSION [40840050]
|
Facility
|
IP
|
$3.62
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.26 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Blue Shield of California Commercial |
$2.90
|
| Rate for Payer: Blue Shield of California EPN |
$1.82
|
| Rate for Payer: Cash Price |
$1.63
|
| Rate for Payer: Central Health Plan Commercial |
$2.90
|
| Rate for Payer: Cigna of CA HMO |
$2.53
|
| Rate for Payer: Cigna of CA PPO |
$2.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.45
|
| Rate for Payer: EPIC Health Plan Senior |
$1.45
|
| Rate for Payer: Galaxy Health WC |
$3.08
|
| Rate for Payer: Global Benefits Group Commercial |
$2.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$2.71
|
| Rate for Payer: Networks By Design Commercial |
$1.81
|
| Rate for Payer: Prime Health Services Commercial |
$3.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.36
|
| Rate for Payer: United Healthcare All Other HMO |
$1.32
|
| Rate for Payer: United Healthcare HMO Rider |
$1.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.19
|
|
|
TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE [12933]
|
Facility
|
IP
|
$1.38
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.24 |
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Adventist Health Commercial |
$0.33
|
| Rate for Payer: Blue Shield of California Commercial |
$0.56
|
| Rate for Payer: Blue Shield of California Commercial |
$1.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.28
|
| Rate for Payer: Blue Shield of California Commercial |
$0.88
|
| Rate for Payer: Blue Shield of California EPN |
$0.70
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.83
|
| Rate for Payer: Blue Shield of California EPN |
$0.55
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Central Health Plan Commercial |
$1.31
|
| Rate for Payer: Central Health Plan Commercial |
$0.56
|
| Rate for Payer: Central Health Plan Commercial |
$0.28
|
| Rate for Payer: Central Health Plan Commercial |
$0.88
|
| Rate for Payer: Central Health Plan Commercial |
$1.10
|
| Rate for Payer: Cigna of CA HMO |
$1.15
|
| Rate for Payer: Cigna of CA HMO |
$0.77
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA HMO |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.97
|
| Rate for Payer: Cigna of CA PPO |
$0.49
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$1.15
|
| Rate for Payer: Cigna of CA PPO |
$0.97
|
| Rate for Payer: Cigna of CA PPO |
$0.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.28
|
| Rate for Payer: EPIC Health Plan Senior |
$0.66
|
| Rate for Payer: EPIC Health Plan Senior |
$0.55
|
| Rate for Payer: Galaxy Health WC |
$1.17
|
| Rate for Payer: Galaxy Health WC |
$0.30
|
| Rate for Payer: Galaxy Health WC |
$1.39
|
| Rate for Payer: Galaxy Health WC |
$0.94
|
| Rate for Payer: Galaxy Health WC |
$0.60
|
| Rate for Payer: Global Benefits Group Commercial |
$0.98
|
| Rate for Payer: Global Benefits Group Commercial |
$0.83
|
| Rate for Payer: Global Benefits Group Commercial |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.66
|
| Rate for Payer: Global Benefits Group Commercial |
$0.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$1.23
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: Multiplan Commercial |
$0.53
|
| Rate for Payer: Multiplan Commercial |
$1.03
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.82
|
| Rate for Payer: Networks By Design Commercial |
$0.69
|
| Rate for Payer: Networks By Design Commercial |
$0.35
|
| Rate for Payer: Networks By Design Commercial |
$0.55
|
| Rate for Payer: Prime Health Services Commercial |
$1.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.60
|
| Rate for Payer: Prime Health Services Commercial |
$0.94
|
| Rate for Payer: Prime Health Services Commercial |
$0.30
|
| Rate for Payer: Prime Health Services Commercial |
$1.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.52
|
| Rate for Payer: United Healthcare All Other HMO |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO |
$0.26
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.60
|
| Rate for Payer: United Healthcare HMO Rider |
$0.59
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.39
|
| Rate for Payer: United Healthcare HMO Rider |
$0.25
|
| Rate for Payer: United Healthcare HMO Rider |
$0.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.36
|
|
|
TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE [12933]
|
Facility
|
OP
|
$1.10
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$9.44 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Adventist Health Commercial |
$0.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.44
|
| Rate for Payer: Blue Shield of California Commercial |
$0.96
|
| Rate for Payer: Blue Shield of California Commercial |
$0.96
|
| Rate for Payer: Blue Shield of California Commercial |
$0.96
|
| Rate for Payer: Blue Shield of California Commercial |
$0.96
|
| Rate for Payer: Blue Shield of California Commercial |
$0.96
|
| Rate for Payer: Blue Shield of California EPN |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$0.87
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Central Health Plan Commercial |
$0.88
|
| Rate for Payer: Central Health Plan Commercial |
$0.28
|
| Rate for Payer: Central Health Plan Commercial |
$1.10
|
| Rate for Payer: Central Health Plan Commercial |
$0.56
|
| Rate for Payer: Central Health Plan Commercial |
$1.31
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA HMO |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$1.15
|
| Rate for Payer: Cigna of CA HMO |
$0.97
|
| Rate for Payer: Cigna of CA HMO |
$0.77
|
| Rate for Payer: Cigna of CA PPO |
$0.49
|
| Rate for Payer: Cigna of CA PPO |
$1.15
|
| Rate for Payer: Cigna of CA PPO |
$0.77
|
| Rate for Payer: Cigna of CA PPO |
$0.97
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.28
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.55
|
| Rate for Payer: EPIC Health Plan Senior |
$0.66
|
| Rate for Payer: Galaxy Health WC |
$0.94
|
| Rate for Payer: Galaxy Health WC |
$0.30
|
| Rate for Payer: Galaxy Health WC |
$0.60
|
| Rate for Payer: Galaxy Health WC |
$1.17
|
| Rate for Payer: Galaxy Health WC |
$1.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.83
|
| Rate for Payer: Global Benefits Group Commercial |
$0.98
|
| Rate for Payer: Global Benefits Group Commercial |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.97
|
| Rate for Payer: Multiplan Commercial |
$0.53
|
| Rate for Payer: Multiplan Commercial |
$1.23
|
| Rate for Payer: Multiplan Commercial |
$1.03
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.69
|
| Rate for Payer: Networks By Design Commercial |
$0.35
|
| Rate for Payer: Networks By Design Commercial |
$0.82
|
| Rate for Payer: Networks By Design Commercial |
$0.55
|
| Rate for Payer: Prime Health Services Commercial |
$0.60
|
| Rate for Payer: Prime Health Services Commercial |
$0.30
|
| Rate for Payer: Prime Health Services Commercial |
$1.17
|
| Rate for Payer: Prime Health Services Commercial |
$1.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.94
|
| Rate for Payer: Riverside University Health System MISP |
$0.66
|
| Rate for Payer: Riverside University Health System MISP |
$0.44
|
| Rate for Payer: Riverside University Health System MISP |
$0.14
|
| Rate for Payer: Riverside University Health System MISP |
$0.55
|
| Rate for Payer: Riverside University Health System MISP |
$0.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.26
|
| Rate for Payer: United Healthcare All Other HMO |
$0.26
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO |
$0.60
|
| Rate for Payer: United Healthcare HMO Rider |
$0.39
|
| Rate for Payer: United Healthcare HMO Rider |
$0.49
|
| Rate for Payer: United Healthcare HMO Rider |
$0.25
|
| Rate for Payer: United Healthcare HMO Rider |
$0.59
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1.17
|
| Rate for Payer: Vantage Medical Group Senior |
$0.60
|
| Rate for Payer: Vantage Medical Group Senior |
$0.94
|
| Rate for Payer: Vantage Medical Group Senior |
$1.39
|
| Rate for Payer: Vantage Medical Group Senior |
$0.30
|
|
|
TACROLIMUS 5 MG CAPSULE, IMMEDIATE-RELEASE [12934]
|
Facility
|
IP
|
$3.50
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$3.15 |
| Rate for Payer: Adventist Health Commercial |
$0.70
|
| Rate for Payer: Adventist Health Commercial |
$1.08
|
| Rate for Payer: Adventist Health Commercial |
$9.15
|
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California Commercial |
$2.81
|
| Rate for Payer: Blue Shield of California Commercial |
$0.96
|
| Rate for Payer: Blue Shield of California Commercial |
$4.33
|
| Rate for Payer: Blue Shield of California Commercial |
$36.68
|
| Rate for Payer: Blue Shield of California EPN |
$1.76
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Blue Shield of California EPN |
$23.05
|
| Rate for Payer: Blue Shield of California EPN |
$2.72
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$20.58
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Central Health Plan Commercial |
$4.32
|
| Rate for Payer: Central Health Plan Commercial |
$2.80
|
| Rate for Payer: Central Health Plan Commercial |
$0.96
|
| Rate for Payer: Central Health Plan Commercial |
$36.58
|
| Rate for Payer: Cigna of CA HMO |
$2.45
|
| Rate for Payer: Cigna of CA HMO |
$32.01
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$2.45
|
| Rate for Payer: Cigna of CA PPO |
$32.01
|
| Rate for Payer: Cigna of CA PPO |
$3.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Senior |
$1.40
|
| Rate for Payer: EPIC Health Plan Senior |
$18.29
|
| Rate for Payer: EPIC Health Plan Senior |
$2.16
|
| Rate for Payer: EPIC Health Plan Senior |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$38.87
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Galaxy Health WC |
$2.98
|
| Rate for Payer: Galaxy Health WC |
$4.59
|
| Rate for Payer: Global Benefits Group Commercial |
$3.24
|
| Rate for Payer: Global Benefits Group Commercial |
$2.10
|
| Rate for Payer: Global Benefits Group Commercial |
$27.44
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.15
|
| Rate for Payer: Multiplan Commercial |
$4.05
|
| Rate for Payer: Multiplan Commercial |
$2.62
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$34.30
|
| Rate for Payer: Networks By Design Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Networks By Design Commercial |
$22.86
|
| Rate for Payer: Networks By Design Commercial |
$1.75
|
| Rate for Payer: Prime Health Services Commercial |
$38.87
|
| Rate for Payer: Prime Health Services Commercial |
$2.98
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
| Rate for Payer: Prime Health Services Commercial |
$4.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.31
|
| Rate for Payer: United Healthcare All Other HMO |
$1.28
|
| Rate for Payer: United Healthcare All Other HMO |
$0.44
|
| Rate for Payer: United Healthcare All Other HMO |
$1.97
|
| Rate for Payer: United Healthcare All Other HMO |
$16.71
|
| Rate for Payer: United Healthcare HMO Rider |
$0.43
|
| Rate for Payer: United Healthcare HMO Rider |
$16.34
|
| Rate for Payer: United Healthcare HMO Rider |
$1.93
|
| Rate for Payer: United Healthcare HMO Rider |
$1.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.98
|
|
|
TACROLIMUS 5 MG CAPSULE, IMMEDIATE-RELEASE [12934]
|
Facility
|
OP
|
$5.40
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$9.44 |
| Rate for Payer: Adventist Health Commercial |
$1.08
|
| Rate for Payer: Adventist Health Commercial |
$0.70
|
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Adventist Health Commercial |
$9.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.44
|
| Rate for Payer: Blue Shield of California Commercial |
$0.96
|
| Rate for Payer: Blue Shield of California Commercial |
$0.96
|
| Rate for Payer: Blue Shield of California Commercial |
$0.96
|
| Rate for Payer: Blue Shield of California Commercial |
$0.96
|
| Rate for Payer: Blue Shield of California EPN |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$0.87
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$20.58
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$20.58
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Central Health Plan Commercial |
$0.96
|
| Rate for Payer: Central Health Plan Commercial |
$2.80
|
| Rate for Payer: Central Health Plan Commercial |
$36.58
|
| Rate for Payer: Central Health Plan Commercial |
$4.32
|
| Rate for Payer: Cigna of CA HMO |
$2.45
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA HMO |
$32.01
|
| Rate for Payer: Cigna of CA PPO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$2.45
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$32.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Senior |
$18.29
|
| Rate for Payer: EPIC Health Plan Senior |
$2.16
|
| Rate for Payer: EPIC Health Plan Senior |
$0.48
|
| Rate for Payer: EPIC Health Plan Senior |
$1.40
|
| Rate for Payer: Galaxy Health WC |
$38.87
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Galaxy Health WC |
$2.98
|
| Rate for Payer: Galaxy Health WC |
$4.59
|
| Rate for Payer: Global Benefits Group Commercial |
$3.24
|
| Rate for Payer: Global Benefits Group Commercial |
$2.10
|
| Rate for Payer: Global Benefits Group Commercial |
$27.44
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.84
|
| Rate for Payer: Multiplan Commercial |
$2.62
|
| Rate for Payer: Multiplan Commercial |
$34.30
|
| Rate for Payer: Multiplan Commercial |
$4.05
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: Networks By Design Commercial |
$1.75
|
| Rate for Payer: Networks By Design Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$22.86
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Prime Health Services Commercial |
$38.87
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
| Rate for Payer: Prime Health Services Commercial |
$2.98
|
| Rate for Payer: Prime Health Services Commercial |
$4.59
|
| Rate for Payer: Riverside University Health System MISP |
$1.40
|
| Rate for Payer: Riverside University Health System MISP |
$18.29
|
| Rate for Payer: Riverside University Health System MISP |
$0.48
|
| Rate for Payer: Riverside University Health System MISP |
$2.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.03
|
| Rate for Payer: United Healthcare All Other HMO |
$1.28
|
| Rate for Payer: United Healthcare All Other HMO |
$1.97
|
| Rate for Payer: United Healthcare All Other HMO |
$0.44
|
| Rate for Payer: United Healthcare All Other HMO |
$16.71
|
| Rate for Payer: United Healthcare HMO Rider |
$16.34
|
| Rate for Payer: United Healthcare HMO Rider |
$0.43
|
| Rate for Payer: United Healthcare HMO Rider |
$1.25
|
| Rate for Payer: United Healthcare HMO Rider |
$1.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.59
|
| Rate for Payer: Vantage Medical Group Senior |
$38.87
|
| Rate for Payer: Vantage Medical Group Senior |
$1.02
|
| Rate for Payer: Vantage Medical Group Senior |
$2.98
|
| Rate for Payer: Vantage Medical Group Senior |
$4.59
|
|
|
TACROLIMUS 5 MG/ML INTRAVENOUS SOLUTION [12935]
|
Facility
|
OP
|
$315.21
|
|
|
Service Code
|
HCPCS J7525
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.04 |
| Max. Negotiated Rate |
$1,580.62 |
| Rate for Payer: Adventist Health Commercial |
$63.04
|
| Rate for Payer: Adventist Health Medi-Cal |
$268.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,580.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$402.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$295.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$268.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$218.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$272.45
|
| Rate for Payer: Blue Shield of California Commercial |
$326.83
|
| Rate for Payer: Blue Shield of California EPN |
$297.12
|
| Rate for Payer: Cash Price |
$141.84
|
| Rate for Payer: Cash Price |
$141.84
|
| Rate for Payer: Central Health Plan Commercial |
$252.17
|
| Rate for Payer: Cigna of CA HMO |
$220.65
|
| Rate for Payer: Cigna of CA PPO |
$220.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$335.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$295.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$295.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$220.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$442.50
|
| Rate for Payer: EPIC Health Plan Senior |
$295.00
|
| Rate for Payer: Galaxy Health WC |
$267.93
|
| Rate for Payer: Global Benefits Group Commercial |
$189.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$283.69
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$439.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$268.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$268.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$200.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$114.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$375.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$359.36
|
| Rate for Payer: Multiplan Commercial |
$236.41
|
| Rate for Payer: Networks By Design Commercial |
$157.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$268.18
|
| Rate for Payer: Prime Health Services Commercial |
$267.93
|
| Rate for Payer: Prime Health Services Medicare |
$284.27
|
| Rate for Payer: Riverside University Health System MISP |
$295.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$189.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$189.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$118.30
|
| Rate for Payer: United Healthcare All Other HMO |
$115.15
|
| Rate for Payer: United Healthcare HMO Rider |
$112.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$103.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$268.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$335.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$295.00
|
| Rate for Payer: Vantage Medical Group Senior |
$295.00
|
|
|
TACROLIMUS 5 MG/ML INTRAVENOUS SOLUTION [12935]
|
Facility
|
IP
|
$315.21
|
|
|
Service Code
|
HCPCS J7525
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.04 |
| Max. Negotiated Rate |
$283.69 |
| Rate for Payer: Adventist Health Commercial |
$63.04
|
| Rate for Payer: Blue Shield of California Commercial |
$252.80
|
| Rate for Payer: Blue Shield of California EPN |
$158.87
|
| Rate for Payer: Cash Price |
$141.84
|
| Rate for Payer: Central Health Plan Commercial |
$252.17
|
| Rate for Payer: Cigna of CA HMO |
$220.65
|
| Rate for Payer: Cigna of CA PPO |
$220.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$220.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.08
|
| Rate for Payer: EPIC Health Plan Senior |
$126.08
|
| Rate for Payer: Galaxy Health WC |
$267.93
|
| Rate for Payer: Global Benefits Group Commercial |
$189.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$283.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$200.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$185.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.04
|
| Rate for Payer: Multiplan Commercial |
$236.41
|
| Rate for Payer: Networks By Design Commercial |
$157.60
|
| Rate for Payer: Prime Health Services Commercial |
$267.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$118.30
|
| Rate for Payer: United Healthcare All Other HMO |
$115.15
|
| Rate for Payer: United Healthcare HMO Rider |
$112.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$103.23
|
|
|
TACROLIMUS ORAL SUSPENSION COMPOUND 0.5 MG/ML [4080345]
|
Facility
|
OP
|
$2.61
|
|
|
Service Code
|
NDC 9994080345
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.35 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1.65
|
| Rate for Payer: Blue Shield of California EPN |
$1.04
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Central Health Plan Commercial |
$2.09
|
| Rate for Payer: Cigna of CA HMO |
$1.83
|
| Rate for Payer: Cigna of CA PPO |
$1.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: EPIC Health Plan Senior |
$1.04
|
| Rate for Payer: Galaxy Health WC |
$2.22
|
| Rate for Payer: Global Benefits Group Commercial |
$1.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.83
|
| Rate for Payer: Multiplan Commercial |
$1.96
|
| Rate for Payer: Networks By Design Commercial |
$1.70
|
| Rate for Payer: Prime Health Services Commercial |
$2.22
|
| Rate for Payer: Riverside University Health System MISP |
$1.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.30
|
| Rate for Payer: United Healthcare All Other HMO |
$1.30
|
| Rate for Payer: United Healthcare HMO Rider |
$1.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.22
|
| Rate for Payer: Vantage Medical Group Senior |
$2.22
|
|
|
TACROLIMUS ORAL SUSPENSION COMPOUND 0.5 MG/ML [4080345]
|
Facility
|
IP
|
$2.61
|
|
|
Service Code
|
NDC 9994080345
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.35 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California Commercial |
$2.09
|
| Rate for Payer: Blue Shield of California EPN |
$1.32
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Central Health Plan Commercial |
$2.09
|
| Rate for Payer: Cigna of CA HMO |
$1.83
|
| Rate for Payer: Cigna of CA PPO |
$1.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: EPIC Health Plan Senior |
$1.04
|
| Rate for Payer: Galaxy Health WC |
$2.22
|
| Rate for Payer: Global Benefits Group Commercial |
$1.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Multiplan Commercial |
$1.96
|
| Rate for Payer: Networks By Design Commercial |
$1.70
|
| Rate for Payer: Prime Health Services Commercial |
$2.22
|
|
