|
TAFASITAMAB-CXIX 200 MG INTRAVENOUS SOLUTION [228997]
|
Facility
|
OP
|
$1,708.80
|
|
|
Service Code
|
HCPCS J9349
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.43 |
| Max. Negotiated Rate |
$1,537.92 |
| Rate for Payer: Adventist Health Commercial |
$341.76
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.64
|
| Rate for Payer: Blue Shield of California Commercial |
$17.80
|
| Rate for Payer: Blue Shield of California EPN |
$16.18
|
| Rate for Payer: Cash Price |
$768.96
|
| 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: Dignity Health Commercial/Exchange |
$18.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,196.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.81
|
| Rate for Payer: EPIC Health Plan Senior |
$15.87
|
| 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: Heritage Provider Network Commercial/Senior |
$23.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,085.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$341.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.34
|
| Rate for Payer: Multiplan Commercial |
$1,281.60
|
| Rate for Payer: Networks By Design Commercial |
$854.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.43
|
| Rate for Payer: Prime Health Services Commercial |
$1,452.48
|
| Rate for Payer: Prime Health Services Medicare |
$15.30
|
| Rate for Payer: Riverside University Health System MISP |
$15.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,025.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,025.28
|
| 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
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.87
|
| Rate for Payer: Vantage Medical Group Senior |
$15.87
|
|
|
TALIMOGENE LAHERPAREPVEC 10EXP6 (1 MILLION) PFU/ML SUSP FOR INJECTION [211748]
|
Facility
|
IP
|
$88.03
|
|
|
Service Code
|
HCPCS J9325
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.61 |
| Max. Negotiated Rate |
$79.23 |
| Rate for Payer: Adventist Health Commercial |
$17.61
|
| Rate for Payer: Blue Shield of California Commercial |
$70.60
|
| Rate for Payer: Blue Shield of California EPN |
$44.37
|
| Rate for Payer: Cash Price |
$39.61
|
| Rate for Payer: Central Health Plan Commercial |
$70.42
|
| Rate for Payer: Cigna of CA HMO |
$61.62
|
| Rate for Payer: Cigna of CA PPO |
$61.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.21
|
| Rate for Payer: EPIC Health Plan Senior |
$35.21
|
| Rate for Payer: Galaxy Health WC |
$74.83
|
| Rate for Payer: Global Benefits Group Commercial |
$52.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.61
|
| Rate for Payer: Multiplan Commercial |
$66.02
|
| Rate for Payer: Networks By Design Commercial |
$44.02
|
| Rate for Payer: Prime Health Services Commercial |
$74.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.04
|
| Rate for Payer: United Healthcare All Other HMO |
$32.16
|
| Rate for Payer: United Healthcare HMO Rider |
$31.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.83
|
|
|
TALIMOGENE LAHERPAREPVEC 10EXP6 (1 MILLION) PFU/ML SUSP FOR INJECTION [211748]
|
Facility
|
OP
|
$88.03
|
|
|
Service Code
|
HCPCS J9325
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.61 |
| Max. Negotiated Rate |
$140.49 |
| Rate for Payer: Adventist Health Commercial |
$17.61
|
| Rate for Payer: Adventist Health Medi-Cal |
$77.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$138.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$116.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$85.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$77.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.69
|
| Rate for Payer: Blue Shield of California Commercial |
$87.82
|
| Rate for Payer: Blue Shield of California EPN |
$79.84
|
| Rate for Payer: Cash Price |
$39.61
|
| Rate for Payer: Cash Price |
$39.61
|
| Rate for Payer: Central Health Plan Commercial |
$70.42
|
| Rate for Payer: Cigna of CA HMO |
$61.62
|
| Rate for Payer: Cigna of CA PPO |
$61.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.61
|
| Rate for Payer: EPIC Health Plan Senior |
$85.07
|
| Rate for Payer: Galaxy Health WC |
$74.83
|
| Rate for Payer: Global Benefits Group Commercial |
$52.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.23
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$126.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$77.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$77.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$140.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$108.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$103.64
|
| Rate for Payer: Multiplan Commercial |
$66.02
|
| Rate for Payer: Networks By Design Commercial |
$44.02
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$77.34
|
| Rate for Payer: Prime Health Services Commercial |
$74.83
|
| Rate for Payer: Prime Health Services Medicare |
$81.98
|
| Rate for Payer: Riverside University Health System MISP |
$85.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.04
|
| Rate for Payer: United Healthcare All Other HMO |
$32.16
|
| Rate for Payer: United Healthcare HMO Rider |
$31.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.83
|
| Rate for Payer: Upland Medical Group Pediatric |
$77.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.07
|
| Rate for Payer: Vantage Medical Group Senior |
$85.07
|
|
|
TALIMOGENE LAHERPAREPVEC 10EXP8 (100 MILLION)PFU/ML SUSP FOR INJECTION [211749]
|
Facility
|
IP
|
$8,802.10
|
|
|
Service Code
|
HCPCS J9325
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,760.42 |
| Max. Negotiated Rate |
$7,921.89 |
| Rate for Payer: Adventist Health Commercial |
$1,760.42
|
| Rate for Payer: Blue Shield of California Commercial |
$7,059.28
|
| Rate for Payer: Blue Shield of California EPN |
$4,436.26
|
| Rate for Payer: Cash Price |
$3,960.94
|
| Rate for Payer: Central Health Plan Commercial |
$7,041.68
|
| Rate for Payer: Cigna of CA HMO |
$6,161.47
|
| Rate for Payer: Cigna of CA PPO |
$6,161.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,161.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,520.84
|
| Rate for Payer: EPIC Health Plan Senior |
$3,520.84
|
| Rate for Payer: Galaxy Health WC |
$7,481.78
|
| Rate for Payer: Global Benefits Group Commercial |
$5,281.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,921.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,589.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,193.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,760.42
|
| Rate for Payer: Multiplan Commercial |
$6,601.57
|
| Rate for Payer: Networks By Design Commercial |
$4,401.05
|
| Rate for Payer: Prime Health Services Commercial |
$7,481.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,303.43
|
| Rate for Payer: United Healthcare All Other HMO |
$3,215.41
|
| Rate for Payer: United Healthcare HMO Rider |
$3,145.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,882.69
|
|
|
TALIMOGENE LAHERPAREPVEC 10EXP8 (100 MILLION)PFU/ML SUSP FOR INJECTION [211749]
|
Facility
|
OP
|
$8,802.10
|
|
|
Service Code
|
HCPCS J9325
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.34 |
| Max. Negotiated Rate |
$7,921.89 |
| Rate for Payer: Adventist Health Commercial |
$1,760.42
|
| Rate for Payer: Adventist Health Medi-Cal |
$77.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$138.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$116.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$85.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$77.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.69
|
| Rate for Payer: Blue Shield of California Commercial |
$87.82
|
| Rate for Payer: Blue Shield of California EPN |
$79.84
|
| Rate for Payer: Cash Price |
$3,960.94
|
| Rate for Payer: Cash Price |
$3,960.94
|
| Rate for Payer: Central Health Plan Commercial |
$7,041.68
|
| Rate for Payer: Cigna of CA HMO |
$6,161.47
|
| Rate for Payer: Cigna of CA PPO |
$6,161.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,161.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.61
|
| Rate for Payer: EPIC Health Plan Senior |
$85.07
|
| Rate for Payer: Galaxy Health WC |
$7,481.78
|
| Rate for Payer: Global Benefits Group Commercial |
$5,281.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,921.89
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$126.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$77.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$77.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,589.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$140.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$108.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,760.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$103.64
|
| Rate for Payer: Multiplan Commercial |
$6,601.57
|
| Rate for Payer: Networks By Design Commercial |
$4,401.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$77.34
|
| Rate for Payer: Prime Health Services Commercial |
$7,481.78
|
| Rate for Payer: Prime Health Services Medicare |
$81.98
|
| Rate for Payer: Riverside University Health System MISP |
$85.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,281.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,281.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,303.43
|
| Rate for Payer: United Healthcare All Other HMO |
$3,215.41
|
| Rate for Payer: United Healthcare HMO Rider |
$3,145.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,882.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$77.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.07
|
| Rate for Payer: Vantage Medical Group Senior |
$85.07
|
|
|
TAMOXIFEN 10 MG TABLET [7711]
|
Facility
|
OP
|
$0.46
|
|
|
Service Code
|
HCPCS S0187
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.00
|
| 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 |
$0.21
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Central Health Plan Commercial |
$0.37
|
| Rate for Payer: Cigna of CA HMO |
$0.32
|
| Rate for Payer: Cigna of CA PPO |
$0.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Senior |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: Networks By Design Commercial |
$0.30
|
| Rate for Payer: Prime Health Services Commercial |
$0.39
|
| Rate for Payer: Riverside University Health System MISP |
$0.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.23
|
| Rate for Payer: United Healthcare All Other HMO |
$0.23
|
| Rate for Payer: United Healthcare HMO Rider |
$0.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.39
|
| Rate for Payer: Vantage Medical Group Senior |
$0.39
|
|
|
TAMOXIFEN 10 MG TABLET [7711]
|
Facility
|
IP
|
$0.46
|
|
|
Service Code
|
HCPCS S0187
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Central Health Plan Commercial |
$0.37
|
| Rate for Payer: Cigna of CA HMO |
$0.32
|
| Rate for Payer: Cigna of CA PPO |
$0.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Senior |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: Networks By Design Commercial |
$0.30
|
| Rate for Payer: Prime Health Services Commercial |
$0.39
|
|
|
TAMOXIFEN 20 MG TABLET [11498]
|
Facility
|
OP
|
$0.46
|
|
|
Service Code
|
NDC 5965130030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.27
|
| 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 |
$0.21
|
| Rate for Payer: Central Health Plan Commercial |
$0.37
|
| Rate for Payer: Cigna of CA HMO |
$0.32
|
| Rate for Payer: Cigna of CA PPO |
$0.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Senior |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: Networks By Design Commercial |
$0.30
|
| Rate for Payer: Prime Health Services Commercial |
$0.39
|
| Rate for Payer: Riverside University Health System MISP |
$0.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.23
|
| Rate for Payer: United Healthcare All Other HMO |
$0.23
|
| Rate for Payer: United Healthcare HMO Rider |
$0.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.39
|
| Rate for Payer: Vantage Medical Group Senior |
$0.39
|
|
|
TAMOXIFEN 20 MG TABLET [11498]
|
Facility
|
IP
|
$0.46
|
|
|
Service Code
|
NDC 5965130030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Central Health Plan Commercial |
$0.37
|
| Rate for Payer: Cigna of CA HMO |
$0.32
|
| Rate for Payer: Cigna of CA PPO |
$0.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Senior |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: Networks By Design Commercial |
$0.30
|
| Rate for Payer: Prime Health Services Commercial |
$0.39
|
|
|
TAMSULOSIN 0.4 MG CAPSULE [103890]
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
NDC 6586259801
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
|
|
TAMSULOSIN 0.4 MG CAPSULE [103890]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 6586259801
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
| Rate for Payer: Riverside University Health System MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
|
TAMSULOSIN 0.4 MG CAPSULE [103890]
|
Facility
|
IP
|
$0.71
|
|
|
Service Code
|
NDC 6808429901
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Central Health Plan Commercial |
$0.57
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: EPIC Health Plan Senior |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.60
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.53
|
| Rate for Payer: Networks By Design Commercial |
$0.46
|
| Rate for Payer: Prime Health Services Commercial |
$0.60
|
|
|
TAMSULOSIN 0.4 MG CAPSULE [103890]
|
Facility
|
IP
|
$0.33
|
|
|
Service Code
|
NDC 6838213201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.23
|
| Rate for Payer: Cigna of CA PPO |
$0.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: EPIC Health Plan Senior |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.28
|
|
|
TAMSULOSIN 0.4 MG CAPSULE [103890]
|
Facility
|
IP
|
$0.29
|
|
|
Service Code
|
NDC 6275616088
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Central Health Plan Commercial |
$0.23
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.25
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.19
|
| Rate for Payer: Prime Health Services Commercial |
$0.25
|
|
|
TAMSULOSIN 0.4 MG CAPSULE [103890]
|
Facility
|
IP
|
$0.71
|
|
|
Service Code
|
NDC 6808429911
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Central Health Plan Commercial |
$0.57
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: EPIC Health Plan Senior |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.60
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.53
|
| Rate for Payer: Networks By Design Commercial |
$0.46
|
| Rate for Payer: Prime Health Services Commercial |
$0.60
|
|
|
TAMSULOSIN 0.4 MG CAPSULE [103890]
|
Facility
|
OP
|
$0.33
|
|
|
Service Code
|
NDC 6838213201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.23
|
| Rate for Payer: Cigna of CA PPO |
$0.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: EPIC Health Plan Senior |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.28
|
| Rate for Payer: Riverside University Health System MISP |
$0.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Vantage Medical Group Senior |
$0.28
|
|
|
TAMSULOSIN 0.4 MG CAPSULE [103890]
|
Facility
|
OP
|
$0.29
|
|
|
Service Code
|
NDC 6275616088
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Central Health Plan Commercial |
$0.23
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.25
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.19
|
| Rate for Payer: Prime Health Services Commercial |
$0.25
|
| Rate for Payer: Riverside University Health System MISP |
$0.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.15
|
| Rate for Payer: United Healthcare All Other HMO |
$0.15
|
| Rate for Payer: United Healthcare HMO Rider |
$0.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: Vantage Medical Group Senior |
$0.25
|
|
|
TAMSULOSIN 0.4 MG CAPSULE [103890]
|
Facility
|
OP
|
$0.71
|
|
|
Service Code
|
NDC 6808429901
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.41
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.28
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Central Health Plan Commercial |
$0.57
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: EPIC Health Plan Senior |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.60
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$0.53
|
| Rate for Payer: Networks By Design Commercial |
$0.46
|
| Rate for Payer: Prime Health Services Commercial |
$0.60
|
| Rate for Payer: Riverside University Health System MISP |
$0.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.36
|
| Rate for Payer: United Healthcare All Other HMO |
$0.36
|
| Rate for Payer: United Healthcare HMO Rider |
$0.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.60
|
| Rate for Payer: Vantage Medical Group Senior |
$0.60
|
|
|
TAMSULOSIN 0.4 MG CAPSULE [103890]
|
Facility
|
OP
|
$0.71
|
|
|
Service Code
|
NDC 6808429911
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.41
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.28
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Central Health Plan Commercial |
$0.57
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: EPIC Health Plan Senior |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.60
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$0.53
|
| Rate for Payer: Networks By Design Commercial |
$0.46
|
| Rate for Payer: Prime Health Services Commercial |
$0.60
|
| Rate for Payer: Riverside University Health System MISP |
$0.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.36
|
| Rate for Payer: United Healthcare All Other HMO |
$0.36
|
| Rate for Payer: United Healthcare HMO Rider |
$0.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.60
|
| Rate for Payer: Vantage Medical Group Senior |
$0.60
|
|
|
TANGENTIAL BIOPSY OF SKIN (EG, SHAVE, SCOOP, SAUCERIZE, CURETTE); SINGLE LESION
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 11102
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$153.68 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$522.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$153.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$169.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$731.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$522.85
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Medicare |
$554.22
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$575.13
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
TAPENTADOL 50 MG TABLET [98253]
|
Facility
|
OP
|
$16.05
|
|
|
Service Code
|
NDC 2451005010
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$14.45 |
| Rate for Payer: Adventist Health Commercial |
$3.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.34
|
| Rate for Payer: Blue Shield of California Commercial |
$10.18
|
| Rate for Payer: Blue Shield of California EPN |
$6.40
|
| Rate for Payer: Cash Price |
$7.22
|
| Rate for Payer: Central Health Plan Commercial |
$12.84
|
| Rate for Payer: Cigna of CA HMO |
$11.23
|
| Rate for Payer: Cigna of CA PPO |
$11.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.42
|
| Rate for Payer: EPIC Health Plan Senior |
$6.42
|
| Rate for Payer: Galaxy Health WC |
$13.64
|
| Rate for Payer: Global Benefits Group Commercial |
$9.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.23
|
| Rate for Payer: Multiplan Commercial |
$12.04
|
| Rate for Payer: Networks By Design Commercial |
$10.43
|
| Rate for Payer: Prime Health Services Commercial |
$13.64
|
| Rate for Payer: Riverside University Health System MISP |
$6.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.03
|
| Rate for Payer: United Healthcare All Other HMO |
$8.03
|
| Rate for Payer: United Healthcare HMO Rider |
$8.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.64
|
| Rate for Payer: Vantage Medical Group Senior |
$13.64
|
|
|
TAPENTADOL 50 MG TABLET [98253]
|
Facility
|
IP
|
$16.05
|
|
|
Service Code
|
NDC 2451005010
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$14.45 |
| Rate for Payer: Adventist Health Commercial |
$3.21
|
| Rate for Payer: Blue Shield of California Commercial |
$12.87
|
| Rate for Payer: Blue Shield of California EPN |
$8.09
|
| Rate for Payer: Cash Price |
$7.22
|
| Rate for Payer: Central Health Plan Commercial |
$12.84
|
| Rate for Payer: Cigna of CA HMO |
$11.23
|
| Rate for Payer: Cigna of CA PPO |
$11.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.42
|
| Rate for Payer: EPIC Health Plan Senior |
$6.42
|
| Rate for Payer: Galaxy Health WC |
$13.64
|
| Rate for Payer: Global Benefits Group Commercial |
$9.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.21
|
| Rate for Payer: Multiplan Commercial |
$12.04
|
| Rate for Payer: Networks By Design Commercial |
$10.43
|
| Rate for Payer: Prime Health Services Commercial |
$13.64
|
|
|
TARLATAMAB-DLLE 10 MG INTRAVENOUS SOLUTION [241611]
|
Facility
|
IP
|
$18,540.00
|
|
|
Service Code
|
HCPCS J9026
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,708.00 |
| Max. Negotiated Rate |
$16,686.00 |
| Rate for Payer: Adventist Health Commercial |
$3,708.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,869.08
|
| Rate for Payer: Blue Shield of California EPN |
$9,344.16
|
| Rate for Payer: Cash Price |
$8,343.00
|
| Rate for Payer: Central Health Plan Commercial |
$14,832.00
|
| Rate for Payer: Cigna of CA HMO |
$12,978.00
|
| Rate for Payer: Cigna of CA PPO |
$12,978.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,978.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,416.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7,416.00
|
| Rate for Payer: Galaxy Health WC |
$15,759.00
|
| Rate for Payer: Global Benefits Group Commercial |
$11,124.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,686.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,772.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,938.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,708.00
|
| Rate for Payer: Multiplan Commercial |
$13,905.00
|
| Rate for Payer: Networks By Design Commercial |
$9,270.00
|
| Rate for Payer: Prime Health Services Commercial |
$15,759.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,958.06
|
| Rate for Payer: United Healthcare All Other HMO |
$6,772.66
|
| Rate for Payer: United Healthcare HMO Rider |
$6,626.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,071.85
|
|
|
TARLATAMAB-DLLE 10 MG INTRAVENOUS SOLUTION [241611]
|
Facility
|
OP
|
$18,540.00
|
|
|
Service Code
|
HCPCS J9026
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,612.42 |
| Max. Negotiated Rate |
$16,686.00 |
| Rate for Payer: Adventist Health Commercial |
$3,708.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,612.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,734.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,015.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,773.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,773.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,968.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,704.64
|
| Rate for Payer: Blue Shield of California Commercial |
$1,980.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,800.00
|
| Rate for Payer: Cash Price |
$8,343.00
|
| Rate for Payer: Cash Price |
$8,343.00
|
| Rate for Payer: Central Health Plan Commercial |
$14,832.00
|
| Rate for Payer: Cigna of CA HMO |
$12,978.00
|
| Rate for Payer: Cigna of CA PPO |
$12,978.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,015.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,773.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,773.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,978.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,660.49
|
| Rate for Payer: EPIC Health Plan Senior |
$1,773.66
|
| Rate for Payer: Galaxy Health WC |
$15,759.00
|
| Rate for Payer: Global Benefits Group Commercial |
$11,124.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,686.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,644.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,612.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,612.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,772.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,976.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,257.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,708.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,160.64
|
| Rate for Payer: Multiplan Commercial |
$13,905.00
|
| Rate for Payer: Networks By Design Commercial |
$9,270.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,612.42
|
| Rate for Payer: Prime Health Services Commercial |
$15,759.00
|
| Rate for Payer: Prime Health Services Medicare |
$1,709.17
|
| Rate for Payer: Riverside University Health System MISP |
$1,773.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,124.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,124.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,958.06
|
| Rate for Payer: United Healthcare All Other HMO |
$6,772.66
|
| Rate for Payer: United Healthcare HMO Rider |
$6,626.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,071.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,612.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,015.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,773.66
|
| Rate for Payer: Vantage Medical Group Senior |
$1,773.66
|
|
|
TARLATAMAB-DLLE 1 MG INTRAVENOUS SOLUTION [241612]
|
Facility
|
IP
|
$1,854.00
|
|
|
Service Code
|
HCPCS J9026
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$370.80 |
| Max. Negotiated Rate |
$1,668.60 |
| Rate for Payer: Adventist Health Commercial |
$370.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,486.91
|
| Rate for Payer: Blue Shield of California EPN |
$934.42
|
| Rate for Payer: Cash Price |
$834.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,483.20
|
| Rate for Payer: Cigna of CA HMO |
$1,297.80
|
| Rate for Payer: Cigna of CA PPO |
$1,297.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,297.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$741.60
|
| Rate for Payer: EPIC Health Plan Senior |
$741.60
|
| Rate for Payer: Galaxy Health WC |
$1,575.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,112.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,668.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,177.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,093.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$370.80
|
| Rate for Payer: Multiplan Commercial |
$1,390.50
|
| Rate for Payer: Networks By Design Commercial |
$927.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,575.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$695.81
|
| Rate for Payer: United Healthcare All Other HMO |
$677.27
|
| Rate for Payer: United Healthcare HMO Rider |
$662.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$607.18
|
|
