|
TEMAZEPAM 30 MG CAPSULE [7754]
|
Facility
|
IP
|
$0.14
|
|
|
Service Code
|
NDC 0378505001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
|
|
TEMAZEPAM 7.5 MG CAPSULE [11500]
|
Facility
|
OP
|
$4.20
|
|
|
Service Code
|
NDC 0904643604
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$3.78 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.44
|
| Rate for Payer: Blue Shield of California Commercial |
$2.66
|
| Rate for Payer: Blue Shield of California EPN |
$1.68
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Central Health Plan Commercial |
$3.36
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.94
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: Networks By Design Commercial |
$2.73
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
| Rate for Payer: Riverside University Health System MISP |
$1.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.10
|
| Rate for Payer: United Healthcare All Other HMO |
$2.10
|
| Rate for Payer: United Healthcare HMO Rider |
$2.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.57
|
| Rate for Payer: Vantage Medical Group Senior |
$3.57
|
|
|
TEMAZEPAM 7.5 MG CAPSULE [11500]
|
Facility
|
IP
|
$4.20
|
|
|
Service Code
|
NDC 0904643604
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$3.78 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Blue Shield of California Commercial |
$3.37
|
| Rate for Payer: Blue Shield of California EPN |
$2.12
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Central Health Plan Commercial |
$3.36
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: Networks By Design Commercial |
$2.73
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
|
|
TEMOZOLOMIDE 100 MG INTRAVENOUS SOLUTION [97260]
|
Facility
|
IP
|
$1,203.73
|
|
|
Service Code
|
HCPCS J9328
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$240.75 |
| Max. Negotiated Rate |
$1,083.36 |
| Rate for Payer: Adventist Health Commercial |
$240.75
|
| Rate for Payer: Blue Shield of California Commercial |
$965.39
|
| Rate for Payer: Blue Shield of California EPN |
$606.68
|
| Rate for Payer: Cash Price |
$541.68
|
| Rate for Payer: Central Health Plan Commercial |
$962.98
|
| Rate for Payer: Cigna of CA HMO |
$842.61
|
| Rate for Payer: Cigna of CA PPO |
$842.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$842.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$481.49
|
| Rate for Payer: EPIC Health Plan Senior |
$481.49
|
| Rate for Payer: Galaxy Health WC |
$1,023.17
|
| Rate for Payer: Global Benefits Group Commercial |
$722.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,083.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$764.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$710.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.75
|
| Rate for Payer: Multiplan Commercial |
$902.80
|
| Rate for Payer: Networks By Design Commercial |
$601.87
|
| Rate for Payer: Prime Health Services Commercial |
$1,023.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$451.76
|
| Rate for Payer: United Healthcare All Other HMO |
$439.72
|
| Rate for Payer: United Healthcare HMO Rider |
$430.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$394.22
|
|
|
TEMOZOLOMIDE 100 MG INTRAVENOUS SOLUTION [97260]
|
Facility
|
OP
|
$1,203.73
|
|
|
Service Code
|
HCPCS J9328
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$1,083.36 |
| Rate for Payer: Adventist Health Commercial |
$240.75
|
| Rate for Payer: Adventist Health Medi-Cal |
$10.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.69
|
| Rate for Payer: Blue Shield of California Commercial |
$13.24
|
| Rate for Payer: Blue Shield of California EPN |
$12.04
|
| Rate for Payer: Cash Price |
$541.68
|
| Rate for Payer: Cash Price |
$541.68
|
| Rate for Payer: Central Health Plan Commercial |
$962.98
|
| Rate for Payer: Cigna of CA HMO |
$842.61
|
| Rate for Payer: Cigna of CA PPO |
$842.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$842.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.18
|
| Rate for Payer: EPIC Health Plan Senior |
$11.45
|
| Rate for Payer: Galaxy Health WC |
$1,023.17
|
| Rate for Payer: Global Benefits Group Commercial |
$722.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,083.36
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$17.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$764.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.95
|
| Rate for Payer: Multiplan Commercial |
$902.80
|
| Rate for Payer: Networks By Design Commercial |
$601.87
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10.41
|
| Rate for Payer: Prime Health Services Commercial |
$1,023.17
|
| Rate for Payer: Prime Health Services Medicare |
$11.03
|
| Rate for Payer: Riverside University Health System MISP |
$11.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$722.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$722.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$451.76
|
| Rate for Payer: United Healthcare All Other HMO |
$439.72
|
| Rate for Payer: United Healthcare HMO Rider |
$430.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$394.22
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.45
|
| Rate for Payer: Vantage Medical Group Senior |
$11.45
|
|
|
TEMOZOLOMIDE ORAL SUSPENSION COMPOUND 10 MG/ML [4080346]
|
Facility
|
IP
|
$26.03
|
|
|
Service Code
|
HCPCS J8700
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$23.43 |
| Rate for Payer: Adventist Health Commercial |
$5.21
|
| Rate for Payer: Blue Shield of California Commercial |
$20.88
|
| Rate for Payer: Blue Shield of California EPN |
$13.12
|
| Rate for Payer: Cash Price |
$11.71
|
| Rate for Payer: Central Health Plan Commercial |
$20.82
|
| Rate for Payer: Cigna of CA HMO |
$18.22
|
| Rate for Payer: Cigna of CA PPO |
$18.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.41
|
| Rate for Payer: EPIC Health Plan Senior |
$10.41
|
| Rate for Payer: Galaxy Health WC |
$22.13
|
| Rate for Payer: Global Benefits Group Commercial |
$15.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.21
|
| Rate for Payer: Multiplan Commercial |
$19.52
|
| Rate for Payer: Networks By Design Commercial |
$13.02
|
| Rate for Payer: Prime Health Services Commercial |
$22.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.51
|
| Rate for Payer: United Healthcare HMO Rider |
$9.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.52
|
|
|
TEMOZOLOMIDE ORAL SUSPENSION COMPOUND 10 MG/ML [4080346]
|
Facility
|
OP
|
$26.03
|
|
|
Service Code
|
HCPCS J8700
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$23.43 |
| Rate for Payer: Adventist Health Commercial |
$5.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.36
|
| Rate for Payer: Blue Shield of California Commercial |
$3.50
|
| Rate for Payer: Blue Shield of California EPN |
$3.18
|
| Rate for Payer: Cash Price |
$11.71
|
| Rate for Payer: Cash Price |
$11.71
|
| Rate for Payer: Central Health Plan Commercial |
$20.82
|
| Rate for Payer: Cigna of CA HMO |
$18.22
|
| Rate for Payer: Cigna of CA PPO |
$18.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.41
|
| Rate for Payer: EPIC Health Plan Senior |
$10.41
|
| Rate for Payer: Galaxy Health WC |
$22.13
|
| Rate for Payer: Global Benefits Group Commercial |
$15.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.22
|
| Rate for Payer: Multiplan Commercial |
$19.52
|
| Rate for Payer: Networks By Design Commercial |
$13.02
|
| Rate for Payer: Prime Health Services Commercial |
$22.13
|
| Rate for Payer: Riverside University Health System MISP |
$10.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.51
|
| Rate for Payer: United Healthcare HMO Rider |
$9.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.13
|
| Rate for Payer: Vantage Medical Group Senior |
$22.13
|
|
|
TEMPORARY CLOSURE OF EYELIDS BY SUTURE (EG, FROST SUTURE)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 67875
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$362.44 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,282.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,923.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,410.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,282.15
|
| 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 |
$1,960.77
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,923.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,410.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,282.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,115.55
|
| Rate for Payer: EPIC Health Plan Senior |
$1,410.37
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,102.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$362.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,282.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$400.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,795.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,718.08
|
| Rate for Payer: Multiplan WC |
$1,960.77
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,282.15
|
| Rate for Payer: Preferred Health Network WC |
$2,000.79
|
| Rate for Payer: Prime Health Services Medicare |
$1,359.08
|
| Rate for Payer: Prime Health Services WC |
$1,940.77
|
| Rate for Payer: Riverside University Health System MISP |
$1,410.37
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,282.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,923.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,410.37
|
| Rate for Payer: Vantage Medical Group Senior |
$1,282.15
|
|
|
TEMSIROLIMUS 25 MG/ML (MUST BE DILUTED TO 10 MG/ML) INTRAVENOUS SOLN [82228]
|
Facility
|
IP
|
$1,547.87
|
|
|
Service Code
|
HCPCS J9330
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$309.57 |
| Max. Negotiated Rate |
$1,393.08 |
| Rate for Payer: Adventist Health Commercial |
$309.57
|
| Rate for Payer: Blue Shield of California Commercial |
$1,241.39
|
| Rate for Payer: Blue Shield of California EPN |
$780.13
|
| Rate for Payer: Cash Price |
$696.54
|
| Rate for Payer: Central Health Plan Commercial |
$1,238.30
|
| Rate for Payer: Cigna of CA HMO |
$1,083.51
|
| Rate for Payer: Cigna of CA PPO |
$1,083.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,083.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$619.15
|
| Rate for Payer: EPIC Health Plan Senior |
$619.15
|
| Rate for Payer: Galaxy Health WC |
$1,315.69
|
| Rate for Payer: Global Benefits Group Commercial |
$928.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,393.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$982.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$913.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$309.57
|
| Rate for Payer: Multiplan Commercial |
$1,160.90
|
| Rate for Payer: Networks By Design Commercial |
$773.93
|
| Rate for Payer: Prime Health Services Commercial |
$1,315.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$580.92
|
| Rate for Payer: United Healthcare All Other HMO |
$565.44
|
| Rate for Payer: United Healthcare HMO Rider |
$553.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$506.93
|
|
|
TEMSIROLIMUS 25 MG/ML (MUST BE DILUTED TO 10 MG/ML) INTRAVENOUS SOLN [82228]
|
Facility
|
OP
|
$1,547.87
|
|
|
Service Code
|
HCPCS J9330
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.68 |
| Max. Negotiated Rate |
$1,393.08 |
| Rate for Payer: Adventist Health Commercial |
$309.57
|
| Rate for Payer: Adventist Health Medi-Cal |
$32.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$187.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$49.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.62
|
| Rate for Payer: Blue Shield of California Commercial |
$66.17
|
| Rate for Payer: Blue Shield of California EPN |
$60.15
|
| Rate for Payer: Cash Price |
$696.54
|
| Rate for Payer: Cash Price |
$696.54
|
| Rate for Payer: Central Health Plan Commercial |
$1,238.30
|
| Rate for Payer: Cigna of CA HMO |
$1,083.51
|
| Rate for Payer: Cigna of CA PPO |
$1,083.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,083.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.92
|
| Rate for Payer: EPIC Health Plan Senior |
$35.95
|
| Rate for Payer: Galaxy Health WC |
$1,315.69
|
| Rate for Payer: Global Benefits Group Commercial |
$928.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,393.08
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$53.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$32.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$982.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$45.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$309.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$43.79
|
| Rate for Payer: Multiplan Commercial |
$1,160.90
|
| Rate for Payer: Networks By Design Commercial |
$773.93
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$32.68
|
| Rate for Payer: Prime Health Services Commercial |
$1,315.69
|
| Rate for Payer: Prime Health Services Medicare |
$34.64
|
| Rate for Payer: Riverside University Health System MISP |
$35.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$928.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$928.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$580.92
|
| Rate for Payer: United Healthcare All Other HMO |
$565.44
|
| Rate for Payer: United Healthcare HMO Rider |
$553.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$506.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$32.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.95
|
| Rate for Payer: Vantage Medical Group Senior |
$35.95
|
|
|
TENDONITIS, MYOSITIS AND BURSITIS WITH MCC
|
Facility
|
IP
|
$39,133.72
|
|
|
Service Code
|
MSDRG 557
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$39,133.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$39,133.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25,278.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35,391.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$35,324.87
|
| Rate for Payer: EPIC Health Plan Senior |
$23,549.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,409.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29,972.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28,688.07
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$21,409.01
|
| Rate for Payer: Prime Health Services Medicare |
$22,693.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC
|
Facility
|
IP
|
$23,508.13
|
|
|
Service Code
|
MSDRG 558
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$23,508.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$23,508.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15,185.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21,259.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$21,814.07
|
| Rate for Payer: EPIC Health Plan Senior |
$14,542.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,220.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,508.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17,715.67
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13,220.65
|
| Rate for Payer: Prime Health Services Medicare |
$14,013.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES
|
Facility
|
IP
|
$30,261.19
|
|
|
Service Code
|
APR-DRG 3173
|
| Min. Negotiated Rate |
$19,112.33 |
| Max. Negotiated Rate |
$30,261.19 |
| Rate for Payer: Adventist Health Medi-Cal |
$19,112.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22,775.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30,261.19
|
|
|
TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES
|
Facility
|
IP
|
$15,843.62
|
|
|
Service Code
|
APR-DRG 3171
|
| Min. Negotiated Rate |
$10,006.50 |
| Max. Negotiated Rate |
$15,843.62 |
| Rate for Payer: Adventist Health Medi-Cal |
$10,006.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11,924.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15,843.62
|
|
|
TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES
|
Facility
|
IP
|
$51,535.07
|
|
|
Service Code
|
APR-DRG 3174
|
| Min. Negotiated Rate |
$32,548.46 |
| Max. Negotiated Rate |
$51,535.07 |
| Rate for Payer: Adventist Health Medi-Cal |
$32,548.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$38,786.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$51,535.07
|
|
|
TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES
|
Facility
|
IP
|
$20,653.51
|
|
|
Service Code
|
APR-DRG 3172
|
| Min. Negotiated Rate |
$13,044.32 |
| Max. Negotiated Rate |
$20,653.51 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,044.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15,544.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20,653.51
|
|
|
TENDON SHEATH INCISION (EG, FOR TRIGGER FINGER)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 26055
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$72.36 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,068.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,068.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,240.00
|
| 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 |
$3,102.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,274.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,068.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,412.45
|
| Rate for Payer: EPIC Health Plan Senior |
$2,274.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,391.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$72.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$79.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,895.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,771.32
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Preferred Health Network WC |
$3,306.12
|
| Rate for Payer: Prime Health Services Medicare |
$2,192.24
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Riverside University Health System MISP |
$2,274.97
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,068.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2,068.15
|
|
|
TENDON TRANSPLANTATION OR TRANSFER, FLEXOR OR EXTENSOR, FOREARM AND/OR WRIST, SINGLE; EACH TENDON
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 25310
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$689.01 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,208.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,568.63
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$689.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$761.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,891.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Medicare |
$4,460.84
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,629.17
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
TENECTEPLASE 50 MG INTRAVENOUS SOLUTION [220772]
|
Facility
|
OP
|
$9,956.71
|
|
|
Service Code
|
HCPCS J3101
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$99.16 |
| Max. Negotiated Rate |
$8,961.04 |
| Rate for Payer: Adventist Health Commercial |
$1,991.34
|
| Rate for Payer: Adventist Health Commercial |
$2,051.08
|
| Rate for Payer: Adventist Health Medi-Cal |
$217.42
|
| Rate for Payer: Adventist Health Medi-Cal |
$217.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,006.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,006.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$271.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$271.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$239.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$239.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.74
|
| Rate for Payer: Blue Shield of California Commercial |
$206.65
|
| Rate for Payer: Blue Shield of California Commercial |
$206.65
|
| Rate for Payer: Blue Shield of California EPN |
$187.86
|
| Rate for Payer: Blue Shield of California EPN |
$187.86
|
| Rate for Payer: Cash Price |
$4,480.52
|
| Rate for Payer: Cash Price |
$4,614.94
|
| Rate for Payer: Cash Price |
$4,480.52
|
| Rate for Payer: Cash Price |
$4,614.94
|
| Rate for Payer: Central Health Plan Commercial |
$7,965.37
|
| Rate for Payer: Central Health Plan Commercial |
$8,204.34
|
| Rate for Payer: Cigna of CA HMO |
$6,969.70
|
| Rate for Payer: Cigna of CA HMO |
$7,178.79
|
| Rate for Payer: Cigna of CA PPO |
$6,969.70
|
| Rate for Payer: Cigna of CA PPO |
$7,178.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$271.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$271.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$239.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$239.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,178.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,969.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$358.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$358.74
|
| Rate for Payer: EPIC Health Plan Senior |
$239.16
|
| Rate for Payer: EPIC Health Plan Senior |
$239.16
|
| Rate for Payer: Galaxy Health WC |
$8,717.11
|
| Rate for Payer: Galaxy Health WC |
$8,463.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,974.03
|
| Rate for Payer: Global Benefits Group Commercial |
$6,153.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,229.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,961.04
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$356.57
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$356.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$217.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$217.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,512.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,322.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,614.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,722.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$304.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$304.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,991.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,051.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$291.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$291.34
|
| Rate for Payer: Multiplan Commercial |
$7,467.53
|
| Rate for Payer: Multiplan Commercial |
$7,691.56
|
| Rate for Payer: Networks By Design Commercial |
$4,978.35
|
| Rate for Payer: Networks By Design Commercial |
$5,127.71
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$217.42
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$217.42
|
| Rate for Payer: Prime Health Services Commercial |
$8,717.11
|
| Rate for Payer: Prime Health Services Commercial |
$8,463.20
|
| Rate for Payer: Prime Health Services Medicare |
$230.47
|
| Rate for Payer: Prime Health Services Medicare |
$230.47
|
| Rate for Payer: Riverside University Health System MISP |
$239.16
|
| Rate for Payer: Riverside University Health System MISP |
$239.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,153.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,974.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,974.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,153.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,848.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,736.75
|
| Rate for Payer: United Healthcare All Other HMO |
$3,746.30
|
| Rate for Payer: United Healthcare All Other HMO |
$3,637.19
|
| Rate for Payer: United Healthcare HMO Rider |
$3,665.29
|
| Rate for Payer: United Healthcare HMO Rider |
$3,558.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,358.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,260.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$217.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$217.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$271.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$271.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.16
|
| Rate for Payer: Vantage Medical Group Senior |
$239.16
|
| Rate for Payer: Vantage Medical Group Senior |
$239.16
|
|
|
TENECTEPLASE 50 MG INTRAVENOUS SOLUTION [220772]
|
Facility
|
IP
|
$9,956.71
|
|
|
Service Code
|
HCPCS J3101
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,991.34 |
| Max. Negotiated Rate |
$8,961.04 |
| Rate for Payer: Adventist Health Commercial |
$1,991.34
|
| Rate for Payer: Adventist Health Commercial |
$2,051.08
|
| Rate for Payer: Blue Shield of California Commercial |
$7,985.28
|
| Rate for Payer: Blue Shield of California Commercial |
$8,224.85
|
| Rate for Payer: Blue Shield of California EPN |
$5,168.73
|
| Rate for Payer: Blue Shield of California EPN |
$5,018.18
|
| Rate for Payer: Cash Price |
$4,480.52
|
| Rate for Payer: Cash Price |
$4,614.94
|
| Rate for Payer: Central Health Plan Commercial |
$7,965.37
|
| Rate for Payer: Central Health Plan Commercial |
$8,204.34
|
| Rate for Payer: Cigna of CA HMO |
$7,178.79
|
| Rate for Payer: Cigna of CA HMO |
$6,969.70
|
| Rate for Payer: Cigna of CA PPO |
$7,178.79
|
| Rate for Payer: Cigna of CA PPO |
$6,969.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,178.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,969.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,102.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,982.68
|
| Rate for Payer: EPIC Health Plan Senior |
$4,102.17
|
| Rate for Payer: EPIC Health Plan Senior |
$3,982.68
|
| Rate for Payer: Galaxy Health WC |
$8,463.20
|
| Rate for Payer: Galaxy Health WC |
$8,717.11
|
| Rate for Payer: Global Benefits Group Commercial |
$6,153.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,974.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,229.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,961.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,322.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,512.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,050.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,874.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,991.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,051.08
|
| Rate for Payer: Multiplan Commercial |
$7,691.56
|
| Rate for Payer: Multiplan Commercial |
$7,467.53
|
| Rate for Payer: Networks By Design Commercial |
$5,127.71
|
| Rate for Payer: Networks By Design Commercial |
$4,978.35
|
| Rate for Payer: Prime Health Services Commercial |
$8,463.20
|
| Rate for Payer: Prime Health Services Commercial |
$8,717.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,848.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,736.75
|
| Rate for Payer: United Healthcare All Other HMO |
$3,637.19
|
| Rate for Payer: United Healthcare All Other HMO |
$3,746.30
|
| Rate for Payer: United Healthcare HMO Rider |
$3,665.29
|
| Rate for Payer: United Healthcare HMO Rider |
$3,558.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,358.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,260.82
|
|
|
TENODESIS OF LONG TENDON OF BICEPS
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 23430
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$174.18 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,332.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,462.30
|
| Rate for Payer: Blue Shield of California Commercial |
$6,228.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,398.95
|
| Rate for Payer: EPIC Health Plan Senior |
$10,265.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15,305.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$174.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,065.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,505.82
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Preferred Health Network WC |
$14,757.45
|
| Rate for Payer: Prime Health Services Medicare |
$9,892.66
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Riverside University Health System MISP |
$10,265.97
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,332.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
TENOFOVIR ALAFENAMIDE 25 MG TABLET [216415]
|
Facility
|
OP
|
$64.67
|
|
|
Service Code
|
NDC 6195823011
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.93 |
| Max. Negotiated Rate |
$58.20 |
| Rate for Payer: Adventist Health Commercial |
$12.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.62
|
| Rate for Payer: Blue Shield of California Commercial |
$41.00
|
| Rate for Payer: Blue Shield of California EPN |
$25.80
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Central Health Plan Commercial |
$51.74
|
| Rate for Payer: Cigna of CA HMO |
$45.27
|
| Rate for Payer: Cigna of CA PPO |
$45.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$54.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.87
|
| Rate for Payer: EPIC Health Plan Senior |
$25.87
|
| Rate for Payer: Galaxy Health WC |
$54.97
|
| Rate for Payer: Global Benefits Group Commercial |
$38.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$45.27
|
| Rate for Payer: Multiplan Commercial |
$48.50
|
| Rate for Payer: Networks By Design Commercial |
$42.04
|
| Rate for Payer: Prime Health Services Commercial |
$54.97
|
| Rate for Payer: Riverside University Health System MISP |
$25.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.34
|
| Rate for Payer: United Healthcare All Other HMO |
$32.34
|
| Rate for Payer: United Healthcare HMO Rider |
$32.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$54.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.97
|
| Rate for Payer: Vantage Medical Group Senior |
$54.97
|
|
|
TENOFOVIR ALAFENAMIDE 25 MG TABLET [216415]
|
Facility
|
IP
|
$64.67
|
|
|
Service Code
|
NDC 6195823011
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.93 |
| Max. Negotiated Rate |
$58.20 |
| Rate for Payer: Adventist Health Commercial |
$12.93
|
| Rate for Payer: Blue Shield of California Commercial |
$51.87
|
| Rate for Payer: Blue Shield of California EPN |
$32.59
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Central Health Plan Commercial |
$51.74
|
| Rate for Payer: Cigna of CA HMO |
$45.27
|
| Rate for Payer: Cigna of CA PPO |
$45.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.87
|
| Rate for Payer: EPIC Health Plan Senior |
$25.87
|
| Rate for Payer: Galaxy Health WC |
$54.97
|
| Rate for Payer: Global Benefits Group Commercial |
$38.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.93
|
| Rate for Payer: Multiplan Commercial |
$48.50
|
| Rate for Payer: Networks By Design Commercial |
$42.04
|
| Rate for Payer: Prime Health Services Commercial |
$54.97
|
|
|
TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [31684]
|
Facility
|
OP
|
$1.15
|
|
|
Service Code
|
NDC 6909753302
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$1.03 |
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.67
|
| Rate for Payer: Blue Shield of California Commercial |
$0.73
|
| Rate for Payer: Blue Shield of California EPN |
$0.46
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Central Health Plan Commercial |
$0.92
|
| Rate for Payer: Cigna of CA HMO |
$0.81
|
| Rate for Payer: Cigna of CA PPO |
$0.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: EPIC Health Plan Senior |
$0.46
|
| Rate for Payer: Galaxy Health WC |
$0.98
|
| Rate for Payer: Global Benefits Group Commercial |
$0.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.81
|
| Rate for Payer: Multiplan Commercial |
$0.86
|
| Rate for Payer: Networks By Design Commercial |
$0.75
|
| Rate for Payer: Prime Health Services Commercial |
$0.98
|
| Rate for Payer: Riverside University Health System MISP |
$0.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.58
|
| Rate for Payer: United Healthcare All Other HMO |
$0.58
|
| Rate for Payer: United Healthcare HMO Rider |
$0.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.98
|
| Rate for Payer: Vantage Medical Group Senior |
$0.98
|
|
|
TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [31684]
|
Facility
|
OP
|
$2.82
|
|
|
Service Code
|
NDC 5026875811
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Adventist Health Commercial |
$0.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.64
|
| Rate for Payer: Blue Shield of California Commercial |
$1.79
|
| Rate for Payer: Blue Shield of California EPN |
$1.13
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Central Health Plan Commercial |
$2.26
|
| Rate for Payer: Cigna of CA HMO |
$1.97
|
| Rate for Payer: Cigna of CA PPO |
$1.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.13
|
| Rate for Payer: EPIC Health Plan Senior |
$1.13
|
| Rate for Payer: Galaxy Health WC |
$2.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.97
|
| Rate for Payer: Multiplan Commercial |
$2.12
|
| Rate for Payer: Networks By Design Commercial |
$1.83
|
| Rate for Payer: Prime Health Services Commercial |
$2.40
|
| Rate for Payer: Riverside University Health System MISP |
$1.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1.41
|
| Rate for Payer: United Healthcare HMO Rider |
$1.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.40
|
| Rate for Payer: Vantage Medical Group Senior |
$2.40
|
|
