|
TACROLIMUS XR 0.75 MG TABLET,EXTENDED RELEASE 24 HR [211104]
|
Facility
|
IP
|
$6.54
|
|
|
Service Code
|
HCPCS J7508
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$5.89 |
| Rate for Payer: Adventist Health Commercial |
$1.31
|
| Rate for Payer: Blue Shield of California Commercial |
$5.25
|
| Rate for Payer: Blue Shield of California EPN |
$3.30
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Central Health Plan Commercial |
$5.23
|
| Rate for Payer: Cigna of CA HMO |
$4.58
|
| Rate for Payer: Cigna of CA PPO |
$4.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.62
|
| Rate for Payer: EPIC Health Plan Senior |
$2.62
|
| Rate for Payer: Galaxy Health WC |
$5.56
|
| Rate for Payer: Global Benefits Group Commercial |
$3.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.31
|
| Rate for Payer: Multiplan Commercial |
$4.91
|
| Rate for Payer: Networks By Design Commercial |
$3.27
|
| Rate for Payer: Prime Health Services Commercial |
$5.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.45
|
| Rate for Payer: United Healthcare All Other HMO |
$2.39
|
| Rate for Payer: United Healthcare HMO Rider |
$2.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.14
|
|
|
TACROLIMUS XR 0.75 MG TABLET,EXTENDED RELEASE 24 HR [211104]
|
Facility
|
OP
|
$6.54
|
|
|
Service Code
|
HCPCS J7508
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$5.89 |
| Rate for Payer: Adventist Health Commercial |
$1.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.96
|
| Rate for Payer: Blue Shield of California Commercial |
$0.74
|
| Rate for Payer: Blue Shield of California EPN |
$0.67
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Central Health Plan Commercial |
$5.23
|
| Rate for Payer: Cigna of CA HMO |
$4.58
|
| Rate for Payer: Cigna of CA PPO |
$4.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.62
|
| Rate for Payer: EPIC Health Plan Senior |
$2.62
|
| Rate for Payer: Galaxy Health WC |
$5.56
|
| Rate for Payer: Global Benefits Group Commercial |
$3.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.58
|
| Rate for Payer: Multiplan Commercial |
$4.91
|
| Rate for Payer: Networks By Design Commercial |
$3.27
|
| Rate for Payer: Prime Health Services Commercial |
$5.56
|
| Rate for Payer: Riverside University Health System MISP |
$2.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.45
|
| Rate for Payer: United Healthcare All Other HMO |
$2.39
|
| Rate for Payer: United Healthcare HMO Rider |
$2.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.56
|
| Rate for Payer: Vantage Medical Group Senior |
$5.56
|
|
|
TACROLIMUS XR 1 MG TABLET,EXTENDED RELEASE 24 HR [211105]
|
Facility
|
OP
|
$8.72
|
|
|
Service Code
|
HCPCS J7508
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$7.85 |
| Rate for Payer: Adventist Health Commercial |
$1.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.96
|
| Rate for Payer: Blue Shield of California Commercial |
$0.74
|
| Rate for Payer: Blue Shield of California EPN |
$0.67
|
| Rate for Payer: Cash Price |
$3.92
|
| Rate for Payer: Cash Price |
$3.92
|
| Rate for Payer: Central Health Plan Commercial |
$6.98
|
| Rate for Payer: Cigna of CA HMO |
$6.10
|
| Rate for Payer: Cigna of CA PPO |
$6.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.49
|
| Rate for Payer: EPIC Health Plan Senior |
$3.49
|
| Rate for Payer: Galaxy Health WC |
$7.41
|
| Rate for Payer: Global Benefits Group Commercial |
$5.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.10
|
| Rate for Payer: Multiplan Commercial |
$6.54
|
| Rate for Payer: Networks By Design Commercial |
$4.36
|
| Rate for Payer: Prime Health Services Commercial |
$7.41
|
| Rate for Payer: Riverside University Health System MISP |
$3.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.27
|
| Rate for Payer: United Healthcare All Other HMO |
$3.19
|
| Rate for Payer: United Healthcare HMO Rider |
$3.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.41
|
| Rate for Payer: Vantage Medical Group Senior |
$7.41
|
|
|
TACROLIMUS XR 1 MG TABLET,EXTENDED RELEASE 24 HR [211105]
|
Facility
|
IP
|
$8.72
|
|
|
Service Code
|
HCPCS J7508
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$7.85 |
| Rate for Payer: Adventist Health Commercial |
$1.74
|
| Rate for Payer: Blue Shield of California Commercial |
$6.99
|
| Rate for Payer: Blue Shield of California EPN |
$4.39
|
| Rate for Payer: Cash Price |
$3.92
|
| Rate for Payer: Central Health Plan Commercial |
$6.98
|
| Rate for Payer: Cigna of CA HMO |
$6.10
|
| Rate for Payer: Cigna of CA PPO |
$6.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.49
|
| Rate for Payer: EPIC Health Plan Senior |
$3.49
|
| Rate for Payer: Galaxy Health WC |
$7.41
|
| Rate for Payer: Global Benefits Group Commercial |
$5.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.74
|
| Rate for Payer: Multiplan Commercial |
$6.54
|
| Rate for Payer: Networks By Design Commercial |
$4.36
|
| Rate for Payer: Prime Health Services Commercial |
$7.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.27
|
| Rate for Payer: United Healthcare All Other HMO |
$3.19
|
| Rate for Payer: United Healthcare HMO Rider |
$3.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.86
|
|
|
TACROLIMUS XR 4 MG TABLET,EXTENDED RELEASE 24 HR [211106]
|
Facility
|
IP
|
$34.89
|
|
|
Service Code
|
HCPCS J7508
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.98 |
| Max. Negotiated Rate |
$31.40 |
| Rate for Payer: Adventist Health Commercial |
$6.98
|
| Rate for Payer: Blue Shield of California Commercial |
$27.98
|
| Rate for Payer: Blue Shield of California EPN |
$17.58
|
| Rate for Payer: Cash Price |
$15.70
|
| Rate for Payer: Central Health Plan Commercial |
$27.91
|
| Rate for Payer: Cigna of CA HMO |
$24.42
|
| Rate for Payer: Cigna of CA PPO |
$24.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.96
|
| Rate for Payer: EPIC Health Plan Senior |
$13.96
|
| Rate for Payer: Galaxy Health WC |
$29.66
|
| Rate for Payer: Global Benefits Group Commercial |
$20.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.98
|
| Rate for Payer: Multiplan Commercial |
$26.17
|
| Rate for Payer: Networks By Design Commercial |
$17.45
|
| Rate for Payer: Prime Health Services Commercial |
$29.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.09
|
| Rate for Payer: United Healthcare All Other HMO |
$12.75
|
| Rate for Payer: United Healthcare HMO Rider |
$12.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.43
|
|
|
TACROLIMUS XR 4 MG TABLET,EXTENDED RELEASE 24 HR [211106]
|
Facility
|
OP
|
$34.89
|
|
|
Service Code
|
HCPCS J7508
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$31.40 |
| Rate for Payer: Adventist Health Commercial |
$6.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.96
|
| Rate for Payer: Blue Shield of California Commercial |
$0.74
|
| Rate for Payer: Blue Shield of California EPN |
$0.67
|
| Rate for Payer: Cash Price |
$15.70
|
| Rate for Payer: Cash Price |
$15.70
|
| Rate for Payer: Central Health Plan Commercial |
$27.91
|
| Rate for Payer: Cigna of CA HMO |
$24.42
|
| Rate for Payer: Cigna of CA PPO |
$24.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.96
|
| Rate for Payer: EPIC Health Plan Senior |
$13.96
|
| Rate for Payer: Galaxy Health WC |
$29.66
|
| Rate for Payer: Global Benefits Group Commercial |
$20.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.42
|
| Rate for Payer: Multiplan Commercial |
$26.17
|
| Rate for Payer: Networks By Design Commercial |
$17.45
|
| Rate for Payer: Prime Health Services Commercial |
$29.66
|
| Rate for Payer: Riverside University Health System MISP |
$13.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.09
|
| Rate for Payer: United Healthcare All Other HMO |
$12.75
|
| Rate for Payer: United Healthcare HMO Rider |
$12.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.66
|
| Rate for Payer: Vantage Medical Group Senior |
$29.66
|
|
|
TADALAFIL 20 MG TABLET [36986]
|
Facility
|
OP
|
$3.88
|
|
|
Service Code
|
NDC 5026873913
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$3.49 |
| Rate for Payer: Adventist Health Commercial |
$0.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.26
|
| Rate for Payer: Blue Shield of California Commercial |
$2.46
|
| Rate for Payer: Blue Shield of California EPN |
$1.55
|
| Rate for Payer: Cash Price |
$1.75
|
| Rate for Payer: Central Health Plan Commercial |
$3.10
|
| Rate for Payer: Cigna of CA HMO |
$2.72
|
| Rate for Payer: Cigna of CA PPO |
$2.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.55
|
| Rate for Payer: EPIC Health Plan Senior |
$1.55
|
| Rate for Payer: Galaxy Health WC |
$3.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.72
|
| Rate for Payer: Multiplan Commercial |
$2.91
|
| Rate for Payer: Networks By Design Commercial |
$2.52
|
| Rate for Payer: Prime Health Services Commercial |
$3.30
|
| Rate for Payer: Riverside University Health System MISP |
$1.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.94
|
| Rate for Payer: United Healthcare All Other HMO |
$1.94
|
| Rate for Payer: United Healthcare HMO Rider |
$1.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3.30
|
|
|
TADALAFIL 20 MG TABLET [36986]
|
Facility
|
OP
|
$0.44
|
|
|
Service Code
|
NDC 4354705103
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.28
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Central Health Plan Commercial |
$0.35
|
| Rate for Payer: Cigna of CA HMO |
$0.31
|
| Rate for Payer: Cigna of CA PPO |
$0.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Senior |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$0.33
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
| Rate for Payer: Riverside University Health System MISP |
$0.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO |
$0.22
|
| Rate for Payer: United Healthcare HMO Rider |
$0.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Vantage Medical Group Senior |
$0.37
|
|
|
TADALAFIL 20 MG TABLET [36986]
|
Facility
|
IP
|
$0.44
|
|
|
Service Code
|
NDC 4354705103
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Central Health Plan Commercial |
$0.35
|
| Rate for Payer: Cigna of CA HMO |
$0.31
|
| Rate for Payer: Cigna of CA PPO |
$0.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Senior |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.33
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
|
|
TADALAFIL 20 MG TABLET [36986]
|
Facility
|
OP
|
$3.88
|
|
|
Service Code
|
NDC 5026873911
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$3.49 |
| Rate for Payer: Adventist Health Commercial |
$0.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.26
|
| Rate for Payer: Blue Shield of California Commercial |
$2.46
|
| Rate for Payer: Blue Shield of California EPN |
$1.55
|
| Rate for Payer: Cash Price |
$1.75
|
| Rate for Payer: Central Health Plan Commercial |
$3.10
|
| Rate for Payer: Cigna of CA HMO |
$2.72
|
| Rate for Payer: Cigna of CA PPO |
$2.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.55
|
| Rate for Payer: EPIC Health Plan Senior |
$1.55
|
| Rate for Payer: Galaxy Health WC |
$3.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.72
|
| Rate for Payer: Multiplan Commercial |
$2.91
|
| Rate for Payer: Networks By Design Commercial |
$2.52
|
| Rate for Payer: Prime Health Services Commercial |
$3.30
|
| Rate for Payer: Riverside University Health System MISP |
$1.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.94
|
| Rate for Payer: United Healthcare All Other HMO |
$1.94
|
| Rate for Payer: United Healthcare HMO Rider |
$1.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3.30
|
|
|
TADALAFIL 20 MG TABLET [36986]
|
Facility
|
IP
|
$3.88
|
|
|
Service Code
|
NDC 5026873911
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$3.49 |
| Rate for Payer: Adventist Health Commercial |
$0.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3.11
|
| Rate for Payer: Blue Shield of California EPN |
$1.96
|
| Rate for Payer: Cash Price |
$1.75
|
| Rate for Payer: Central Health Plan Commercial |
$3.10
|
| Rate for Payer: Cigna of CA HMO |
$2.72
|
| Rate for Payer: Cigna of CA PPO |
$2.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.55
|
| Rate for Payer: EPIC Health Plan Senior |
$1.55
|
| Rate for Payer: Galaxy Health WC |
$3.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$2.91
|
| Rate for Payer: Networks By Design Commercial |
$2.52
|
| Rate for Payer: Prime Health Services Commercial |
$3.30
|
|
|
TADALAFIL 20 MG TABLET [36986]
|
Facility
|
IP
|
$3.88
|
|
|
Service Code
|
NDC 5026873913
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$3.49 |
| Rate for Payer: Adventist Health Commercial |
$0.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3.11
|
| Rate for Payer: Blue Shield of California EPN |
$1.96
|
| Rate for Payer: Cash Price |
$1.75
|
| Rate for Payer: Central Health Plan Commercial |
$3.10
|
| Rate for Payer: Cigna of CA HMO |
$2.72
|
| Rate for Payer: Cigna of CA PPO |
$2.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.55
|
| Rate for Payer: EPIC Health Plan Senior |
$1.55
|
| Rate for Payer: Galaxy Health WC |
$3.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$2.91
|
| Rate for Payer: Networks By Design Commercial |
$2.52
|
| Rate for Payer: Prime Health Services Commercial |
$3.30
|
|
|
TADALAFIL 20 MG TABLET (PULMONARY HYPERTENSION) [214774]
|
Facility
|
IP
|
$0.60
|
|
|
Service Code
|
NDC 2724112302
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.48
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
|
|
TADALAFIL 20 MG TABLET (PULMONARY HYPERTENSION) [214774]
|
Facility
|
OP
|
$0.60
|
|
|
Service Code
|
NDC 3334227809
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.35
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.48
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
| Rate for Payer: Riverside University Health System MISP |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
|
TADALAFIL 20 MG TABLET (PULMONARY HYPERTENSION) [214774]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 6909752603
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.58
|
| Rate for Payer: Blue Shield of California Commercial |
$0.63
|
| Rate for Payer: Blue Shield of California EPN |
$0.40
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Central Health Plan Commercial |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Senior |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
| Rate for Payer: Riverside University Health System MISP |
$0.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
TADALAFIL 20 MG TABLET (PULMONARY HYPERTENSION) [214774]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 6909752603
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.80
|
| Rate for Payer: Blue Shield of California EPN |
$0.50
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Central Health Plan Commercial |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Senior |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
|
|
TADALAFIL 20 MG TABLET (PULMONARY HYPERTENSION) [214774]
|
Facility
|
OP
|
$0.60
|
|
|
Service Code
|
NDC 2724112302
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.35
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.48
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
| Rate for Payer: Riverside University Health System MISP |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
|
TADALAFIL 20 MG TABLET (PULMONARY HYPERTENSION) [214774]
|
Facility
|
IP
|
$0.60
|
|
|
Service Code
|
NDC 3334227809
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.48
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
|
|
TADALAFIL 5 MG TABLET [37400]
|
Facility
|
IP
|
$0.36
|
|
|
Service Code
|
NDC 4359857530
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Central Health Plan Commercial |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
|
|
TADALAFIL 5 MG TABLET [37400]
|
Facility
|
OP
|
$0.36
|
|
|
Service Code
|
NDC 4359857530
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.21
|
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Central Health Plan Commercial |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
| Rate for Payer: Riverside University Health System MISP |
$0.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
|
TADALAFIL 5 MG TABLET [37400]
|
Facility
|
IP
|
$0.40
|
|
|
Service Code
|
NDC 2724111203
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Central Health Plan Commercial |
$0.32
|
| Rate for Payer: Cigna of CA HMO |
$0.28
|
| Rate for Payer: Cigna of CA PPO |
$0.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Senior |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.30
|
| Rate for Payer: Networks By Design Commercial |
$0.26
|
| Rate for Payer: Prime Health Services Commercial |
$0.34
|
|
|
TADALAFIL 5 MG TABLET [37400]
|
Facility
|
OP
|
$0.40
|
|
|
Service Code
|
NDC 2724111203
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.23
|
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Central Health Plan Commercial |
$0.32
|
| Rate for Payer: Cigna of CA HMO |
$0.28
|
| Rate for Payer: Cigna of CA PPO |
$0.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Senior |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$0.30
|
| Rate for Payer: Networks By Design Commercial |
$0.26
|
| Rate for Payer: Prime Health Services Commercial |
$0.34
|
| Rate for Payer: Riverside University Health System MISP |
$0.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.20
|
| Rate for Payer: United Healthcare All Other HMO |
$0.20
|
| Rate for Payer: United Healthcare HMO Rider |
$0.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Vantage Medical Group Senior |
$0.34
|
|
|
TADALAFIL ORAL SUSPENSION COMPOUND 5 MG/ML [4081077]
|
Facility
|
IP
|
$0.15
|
|
|
Service Code
|
NDC 99994081077
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Central Health Plan Commercial |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.13
|
|
|
TADALAFIL ORAL SUSPENSION COMPOUND 5 MG/ML [4081077]
|
Facility
|
OP
|
$0.15
|
|
|
Service Code
|
NDC 99994081077
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Central Health Plan Commercial |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.13
|
| Rate for Payer: Riverside University Health System MISP |
$0.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Vantage Medical Group Senior |
$0.13
|
|
|
TAFASITAMAB-CXIX 200 MG INTRAVENOUS SOLUTION [228997]
|
Facility
|
IP
|
$1,708.80
|
|
|
Service Code
|
HCPCS J9349
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$341.76 |
| Max. Negotiated Rate |
$1,537.92 |
| Rate for Payer: Adventist Health Commercial |
$341.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1,370.46
|
| Rate for Payer: Blue Shield of California EPN |
$861.24
|
| Rate for Payer: Cash Price |
$768.96
|
| Rate for Payer: Central Health Plan Commercial |
$1,367.04
|
| Rate for Payer: Cigna of CA HMO |
$1,196.16
|
| Rate for Payer: Cigna of CA PPO |
$1,196.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,196.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$683.52
|
| Rate for Payer: EPIC Health Plan Senior |
$683.52
|
| Rate for Payer: Galaxy Health WC |
$1,452.48
|
| Rate for Payer: Global Benefits Group Commercial |
$1,025.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,537.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,085.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,008.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$341.76
|
| Rate for Payer: Multiplan Commercial |
$1,281.60
|
| Rate for Payer: Networks By Design Commercial |
$854.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,452.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$641.31
|
| Rate for Payer: United Healthcare All Other HMO |
$624.22
|
| Rate for Payer: United Healthcare HMO Rider |
$610.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$559.63
|
|
