|
TIMOLOL MALEATE 0.5 % ONCE DAILY EYE DROPS [70283]
|
Facility
|
IP
|
$70.19
|
|
|
Service Code
|
NDC 8226004505
|
| Hospital Charge Code |
901700030
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.04 |
| Max. Negotiated Rate |
$63.17 |
| Rate for Payer: Adventist Health Commercial |
$14.04
|
| Rate for Payer: Blue Shield of California Commercial |
$56.29
|
| Rate for Payer: Blue Shield of California EPN |
$35.38
|
| Rate for Payer: Cash Price |
$31.59
|
| Rate for Payer: Central Health Plan Commercial |
$56.15
|
| Rate for Payer: Cigna of CA HMO |
$49.13
|
| Rate for Payer: Cigna of CA PPO |
$49.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.08
|
| Rate for Payer: EPIC Health Plan Senior |
$28.08
|
| Rate for Payer: Galaxy Health WC |
$59.66
|
| Rate for Payer: Global Benefits Group Commercial |
$42.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.04
|
| Rate for Payer: Multiplan Commercial |
$52.64
|
| Rate for Payer: Networks By Design Commercial |
$45.62
|
| Rate for Payer: Prime Health Services Commercial |
$59.66
|
|
|
TIMOLOL MALEATE 0.5 % ONCE DAILY EYE DROPS [70283]
|
Facility
|
OP
|
$70.19
|
|
|
Service Code
|
NDC 8226004505
|
| Hospital Charge Code |
901700030
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.04 |
| Max. Negotiated Rate |
$63.17 |
| Rate for Payer: Adventist Health Commercial |
$14.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$33.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.83
|
| Rate for Payer: Blue Shield of California Commercial |
$44.50
|
| Rate for Payer: Blue Shield of California EPN |
$28.01
|
| Rate for Payer: Cash Price |
$31.59
|
| Rate for Payer: Central Health Plan Commercial |
$56.15
|
| Rate for Payer: Cigna of CA HMO |
$49.13
|
| Rate for Payer: Cigna of CA PPO |
$49.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.08
|
| Rate for Payer: EPIC Health Plan Senior |
$28.08
|
| Rate for Payer: Galaxy Health WC |
$59.66
|
| Rate for Payer: Global Benefits Group Commercial |
$42.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.13
|
| Rate for Payer: Multiplan Commercial |
$52.64
|
| Rate for Payer: Networks By Design Commercial |
$45.62
|
| Rate for Payer: Prime Health Services Commercial |
$59.66
|
| Rate for Payer: Riverside University Health System MISP |
$28.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.09
|
| Rate for Payer: United Healthcare All Other HMO |
$35.09
|
| Rate for Payer: United Healthcare HMO Rider |
$35.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.66
|
| Rate for Payer: Vantage Medical Group Senior |
$59.66
|
|
|
TIMOLOL MALEATE 0.5 % ONCE DAILY EYE DROPS [70283]
|
Facility
|
OP
|
$58.79
|
|
|
Service Code
|
NDC 7006951701
|
| Hospital Charge Code |
901700030
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$52.91 |
| Rate for Payer: Adventist Health Commercial |
$11.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$49.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.20
|
| Rate for Payer: Blue Shield of California Commercial |
$37.27
|
| Rate for Payer: Blue Shield of California EPN |
$23.46
|
| Rate for Payer: Cash Price |
$26.46
|
| Rate for Payer: Central Health Plan Commercial |
$47.03
|
| Rate for Payer: Cigna of CA HMO |
$41.15
|
| Rate for Payer: Cigna of CA PPO |
$41.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$49.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$49.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$49.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.52
|
| Rate for Payer: EPIC Health Plan Senior |
$23.52
|
| Rate for Payer: Galaxy Health WC |
$49.97
|
| Rate for Payer: Global Benefits Group Commercial |
$35.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$41.15
|
| Rate for Payer: Multiplan Commercial |
$44.09
|
| Rate for Payer: Networks By Design Commercial |
$38.21
|
| Rate for Payer: Prime Health Services Commercial |
$49.97
|
| Rate for Payer: Riverside University Health System MISP |
$23.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.39
|
| Rate for Payer: United Healthcare All Other HMO |
$29.39
|
| Rate for Payer: United Healthcare HMO Rider |
$29.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$49.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$49.97
|
| Rate for Payer: Vantage Medical Group Senior |
$49.97
|
|
|
TINIDAZOLE 500 MG TABLET [38907]
|
Facility
|
IP
|
$4.24
|
|
|
Service Code
|
NDC 6498042712
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: Adventist Health Commercial |
$0.85
|
| Rate for Payer: Blue Shield of California Commercial |
$3.40
|
| Rate for Payer: Blue Shield of California EPN |
$2.14
|
| Rate for Payer: Cash Price |
$1.91
|
| Rate for Payer: Central Health Plan Commercial |
$3.39
|
| Rate for Payer: Cigna of CA HMO |
$2.97
|
| Rate for Payer: Cigna of CA PPO |
$2.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.70
|
| Rate for Payer: EPIC Health Plan Senior |
$1.70
|
| Rate for Payer: Galaxy Health WC |
$3.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.85
|
| Rate for Payer: Multiplan Commercial |
$3.18
|
| Rate for Payer: Networks By Design Commercial |
$2.76
|
| Rate for Payer: Prime Health Services Commercial |
$3.60
|
|
|
TINIDAZOLE 500 MG TABLET [38907]
|
Facility
|
OP
|
$4.24
|
|
|
Service Code
|
NDC 6498042712
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: Adventist Health Commercial |
$0.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.47
|
| Rate for Payer: Blue Shield of California Commercial |
$2.69
|
| Rate for Payer: Blue Shield of California EPN |
$1.69
|
| Rate for Payer: Cash Price |
$1.91
|
| Rate for Payer: Central Health Plan Commercial |
$3.39
|
| Rate for Payer: Cigna of CA HMO |
$2.97
|
| Rate for Payer: Cigna of CA PPO |
$2.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.70
|
| Rate for Payer: EPIC Health Plan Senior |
$1.70
|
| Rate for Payer: Galaxy Health WC |
$3.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.97
|
| Rate for Payer: Multiplan Commercial |
$3.18
|
| Rate for Payer: Networks By Design Commercial |
$2.76
|
| Rate for Payer: Prime Health Services Commercial |
$3.60
|
| Rate for Payer: Riverside University Health System MISP |
$1.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.12
|
| Rate for Payer: United Healthcare All Other HMO |
$2.12
|
| Rate for Payer: United Healthcare HMO Rider |
$2.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.60
|
| Rate for Payer: Vantage Medical Group Senior |
$3.60
|
|
|
TIOTROPIUM BROMIDE 18 MCG CAPSULE WITH INHALATION DEVICE [38315]
|
Facility
|
IP
|
$14.60
|
|
|
Service Code
|
NDC 0597007575
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$13.14 |
| Rate for Payer: Adventist Health Commercial |
$2.92
|
| Rate for Payer: Blue Shield of California Commercial |
$11.71
|
| Rate for Payer: Blue Shield of California EPN |
$7.36
|
| Rate for Payer: Cash Price |
$6.57
|
| Rate for Payer: Central Health Plan Commercial |
$11.68
|
| Rate for Payer: Cigna of CA HMO |
$10.22
|
| Rate for Payer: Cigna of CA PPO |
$10.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.84
|
| Rate for Payer: EPIC Health Plan Senior |
$5.84
|
| Rate for Payer: Galaxy Health WC |
$12.41
|
| Rate for Payer: Global Benefits Group Commercial |
$8.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.92
|
| Rate for Payer: Multiplan Commercial |
$10.95
|
| Rate for Payer: Networks By Design Commercial |
$9.49
|
| Rate for Payer: Prime Health Services Commercial |
$12.41
|
|
|
TIOTROPIUM BROMIDE 18 MCG CAPSULE WITH INHALATION DEVICE [38315]
|
Facility
|
OP
|
$14.60
|
|
|
Service Code
|
NDC 0597007575
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$13.14 |
| Rate for Payer: Adventist Health Commercial |
$2.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.49
|
| Rate for Payer: Blue Shield of California Commercial |
$9.26
|
| Rate for Payer: Blue Shield of California EPN |
$5.83
|
| Rate for Payer: Cash Price |
$6.57
|
| Rate for Payer: Central Health Plan Commercial |
$11.68
|
| Rate for Payer: Cigna of CA HMO |
$10.22
|
| Rate for Payer: Cigna of CA PPO |
$10.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.84
|
| Rate for Payer: EPIC Health Plan Senior |
$5.84
|
| Rate for Payer: Galaxy Health WC |
$12.41
|
| Rate for Payer: Global Benefits Group Commercial |
$8.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.22
|
| Rate for Payer: Multiplan Commercial |
$10.95
|
| Rate for Payer: Networks By Design Commercial |
$9.49
|
| Rate for Payer: Prime Health Services Commercial |
$12.41
|
| Rate for Payer: Riverside University Health System MISP |
$5.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.30
|
| Rate for Payer: United Healthcare All Other HMO |
$7.30
|
| Rate for Payer: United Healthcare HMO Rider |
$7.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.41
|
| Rate for Payer: Vantage Medical Group Senior |
$12.41
|
|
|
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION MIST FOR INHALATION [207738]
|
Facility
|
OP
|
$22.50
|
|
|
Service Code
|
NDC 0597010051
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$20.25 |
| Rate for Payer: Adventist Health Commercial |
$4.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.09
|
| Rate for Payer: Blue Shield of California Commercial |
$14.27
|
| Rate for Payer: Blue Shield of California EPN |
$8.98
|
| Rate for Payer: Cash Price |
$10.12
|
| Rate for Payer: Central Health Plan Commercial |
$18.00
|
| Rate for Payer: Cigna of CA HMO |
$15.75
|
| Rate for Payer: Cigna of CA PPO |
$15.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.00
|
| Rate for Payer: EPIC Health Plan Senior |
$9.00
|
| Rate for Payer: Galaxy Health WC |
$19.12
|
| Rate for Payer: Global Benefits Group Commercial |
$13.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.75
|
| Rate for Payer: Multiplan Commercial |
$16.88
|
| Rate for Payer: Networks By Design Commercial |
$14.62
|
| Rate for Payer: Prime Health Services Commercial |
$19.12
|
| Rate for Payer: Riverside University Health System MISP |
$9.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.25
|
| Rate for Payer: United Healthcare All Other HMO |
$11.25
|
| Rate for Payer: United Healthcare HMO Rider |
$11.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.12
|
| Rate for Payer: Vantage Medical Group Senior |
$19.12
|
|
|
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION MIST FOR INHALATION [207738]
|
Facility
|
IP
|
$22.50
|
|
|
Service Code
|
NDC 0597010051
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$20.25 |
| Rate for Payer: Adventist Health Commercial |
$4.50
|
| Rate for Payer: Blue Shield of California Commercial |
$18.05
|
| Rate for Payer: Blue Shield of California EPN |
$11.34
|
| Rate for Payer: Cash Price |
$10.12
|
| Rate for Payer: Central Health Plan Commercial |
$18.00
|
| Rate for Payer: Cigna of CA HMO |
$15.75
|
| Rate for Payer: Cigna of CA PPO |
$15.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.00
|
| Rate for Payer: EPIC Health Plan Senior |
$9.00
|
| Rate for Payer: Galaxy Health WC |
$19.12
|
| Rate for Payer: Global Benefits Group Commercial |
$13.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$16.88
|
| Rate for Payer: Networks By Design Commercial |
$14.62
|
| Rate for Payer: Prime Health Services Commercial |
$19.12
|
|
|
TIROFIBAN 12.5 MG/250 ML (50 MCG/ML)-0.9 % SODIUM CHLORIDE INTRAVENOUS [120194]
|
Facility
|
IP
|
$1.15
|
|
|
Service Code
|
HCPCS J3246
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$1.03 |
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.92
|
| Rate for Payer: Blue Shield of California Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California Commercial |
$0.62
|
| Rate for Payer: Blue Shield of California EPN |
$0.39
|
| Rate for Payer: Blue Shield of California EPN |
$0.58
|
| Rate for Payer: Blue Shield of California EPN |
$0.55
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Central Health Plan Commercial |
$0.87
|
| Rate for Payer: Central Health Plan Commercial |
$0.62
|
| Rate for Payer: Central Health Plan Commercial |
$0.92
|
| Rate for Payer: Cigna of CA HMO |
$0.81
|
| Rate for Payer: Cigna of CA HMO |
$0.54
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.81
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.31
|
| Rate for Payer: EPIC Health Plan Senior |
$0.46
|
| Rate for Payer: Galaxy Health WC |
$0.93
|
| Rate for Payer: Galaxy Health WC |
$0.65
|
| Rate for Payer: Galaxy Health WC |
$0.98
|
| Rate for Payer: Global Benefits Group Commercial |
$0.69
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Global Benefits Group Commercial |
$0.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
| Rate for Payer: Multiplan Commercial |
$0.58
|
| Rate for Payer: Networks By Design Commercial |
$0.58
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Networks By Design Commercial |
$0.55
|
| Rate for Payer: Prime Health Services Commercial |
$0.93
|
| Rate for Payer: Prime Health Services Commercial |
$0.98
|
| Rate for Payer: Prime Health Services Commercial |
$0.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.41
|
| Rate for Payer: United Healthcare All Other HMO |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO |
$0.28
|
| Rate for Payer: United Healthcare All Other HMO |
$0.42
|
| Rate for Payer: United Healthcare HMO Rider |
$0.28
|
| Rate for Payer: United Healthcare HMO Rider |
$0.39
|
| Rate for Payer: United Healthcare HMO Rider |
$0.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.25
|
|
|
TIROFIBAN 12.5 MG/250 ML (50 MCG/ML)-0.9 % SODIUM CHLORIDE INTRAVENOUS [120194]
|
Facility
|
OP
|
$1.09
|
|
|
Service Code
|
HCPCS J3246
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$21.97 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.93
|
| 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 Medi-Cal |
$0.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.08
|
| Rate for Payer: Blue Shield of California Commercial |
$4.22
|
| Rate for Payer: Blue Shield of California Commercial |
$4.22
|
| Rate for Payer: Blue Shield of California Commercial |
$4.22
|
| Rate for Payer: Blue Shield of California EPN |
$3.84
|
| Rate for Payer: Blue Shield of California EPN |
$3.84
|
| Rate for Payer: Blue Shield of California EPN |
$3.84
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Central Health Plan Commercial |
$0.87
|
| Rate for Payer: Central Health Plan Commercial |
$0.62
|
| Rate for Payer: Central Health Plan Commercial |
$0.92
|
| Rate for Payer: Cigna of CA HMO |
$0.54
|
| Rate for Payer: Cigna of CA HMO |
$0.81
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.54
|
| Rate for Payer: Cigna of CA PPO |
$0.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.31
|
| Rate for Payer: EPIC Health Plan Senior |
$0.46
|
| Rate for Payer: Galaxy Health WC |
$0.65
|
| Rate for Payer: Galaxy Health WC |
$0.93
|
| Rate for Payer: Galaxy Health WC |
$0.98
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Global Benefits Group Commercial |
$0.46
|
| Rate for Payer: Global Benefits Group Commercial |
$0.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.81
|
| Rate for Payer: Multiplan Commercial |
$0.58
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
| Rate for Payer: Multiplan Commercial |
$0.86
|
| Rate for Payer: Networks By Design Commercial |
$0.55
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Networks By Design Commercial |
$0.58
|
| Rate for Payer: Prime Health Services Commercial |
$0.98
|
| Rate for Payer: Prime Health Services Commercial |
$0.93
|
| Rate for Payer: Prime Health Services Commercial |
$0.65
|
| Rate for Payer: Riverside University Health System MISP |
$0.44
|
| Rate for Payer: Riverside University Health System MISP |
$0.46
|
| Rate for Payer: Riverside University Health System MISP |
$0.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.41
|
| Rate for Payer: United Healthcare All Other HMO |
$0.42
|
| Rate for Payer: United Healthcare All Other HMO |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO |
$0.28
|
| Rate for Payer: United Healthcare HMO Rider |
$0.39
|
| Rate for Payer: United Healthcare HMO Rider |
$0.41
|
| Rate for Payer: United Healthcare HMO Rider |
$0.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.65
|
| Rate for Payer: Vantage Medical Group Senior |
$0.98
|
| Rate for Payer: Vantage Medical Group Senior |
$0.65
|
| Rate for Payer: Vantage Medical Group Senior |
$0.93
|
|
|
TIROFIBAN 12.5 MG/250 ML (50 MCG/ML) IN NS CONT IV INFUSION [4085694]
|
Facility
|
IP
|
$1.15
|
|
|
Service Code
|
HCPCS J3246
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$1.03 |
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.92
|
| Rate for Payer: Blue Shield of California Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California Commercial |
$0.62
|
| Rate for Payer: Blue Shield of California EPN |
$0.39
|
| Rate for Payer: Blue Shield of California EPN |
$0.58
|
| Rate for Payer: Blue Shield of California EPN |
$0.55
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Central Health Plan Commercial |
$0.87
|
| Rate for Payer: Central Health Plan Commercial |
$0.62
|
| Rate for Payer: Central Health Plan Commercial |
$0.92
|
| Rate for Payer: Cigna of CA HMO |
$0.81
|
| Rate for Payer: Cigna of CA HMO |
$0.54
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.81
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.31
|
| Rate for Payer: EPIC Health Plan Senior |
$0.46
|
| Rate for Payer: Galaxy Health WC |
$0.93
|
| Rate for Payer: Galaxy Health WC |
$0.65
|
| Rate for Payer: Galaxy Health WC |
$0.98
|
| Rate for Payer: Global Benefits Group Commercial |
$0.69
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Global Benefits Group Commercial |
$0.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
| Rate for Payer: Multiplan Commercial |
$0.58
|
| Rate for Payer: Networks By Design Commercial |
$0.58
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Networks By Design Commercial |
$0.55
|
| Rate for Payer: Prime Health Services Commercial |
$0.93
|
| Rate for Payer: Prime Health Services Commercial |
$0.98
|
| Rate for Payer: Prime Health Services Commercial |
$0.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.41
|
| Rate for Payer: United Healthcare All Other HMO |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO |
$0.28
|
| Rate for Payer: United Healthcare All Other HMO |
$0.42
|
| Rate for Payer: United Healthcare HMO Rider |
$0.28
|
| Rate for Payer: United Healthcare HMO Rider |
$0.39
|
| Rate for Payer: United Healthcare HMO Rider |
$0.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.25
|
|
|
TIROFIBAN 12.5 MG/250 ML (50 MCG/ML) IN NS CONT IV INFUSION [4085694]
|
Facility
|
OP
|
$1.09
|
|
|
Service Code
|
HCPCS J3246
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$21.97 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.93
|
| 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 Medi-Cal |
$0.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.08
|
| Rate for Payer: Blue Shield of California Commercial |
$4.22
|
| Rate for Payer: Blue Shield of California Commercial |
$4.22
|
| Rate for Payer: Blue Shield of California Commercial |
$4.22
|
| Rate for Payer: Blue Shield of California EPN |
$3.84
|
| Rate for Payer: Blue Shield of California EPN |
$3.84
|
| Rate for Payer: Blue Shield of California EPN |
$3.84
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Central Health Plan Commercial |
$0.87
|
| Rate for Payer: Central Health Plan Commercial |
$0.62
|
| Rate for Payer: Central Health Plan Commercial |
$0.92
|
| Rate for Payer: Cigna of CA HMO |
$0.54
|
| Rate for Payer: Cigna of CA HMO |
$0.81
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.54
|
| Rate for Payer: Cigna of CA PPO |
$0.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.31
|
| Rate for Payer: EPIC Health Plan Senior |
$0.46
|
| Rate for Payer: Galaxy Health WC |
$0.65
|
| Rate for Payer: Galaxy Health WC |
$0.93
|
| Rate for Payer: Galaxy Health WC |
$0.98
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Global Benefits Group Commercial |
$0.46
|
| Rate for Payer: Global Benefits Group Commercial |
$0.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.81
|
| Rate for Payer: Multiplan Commercial |
$0.58
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
| Rate for Payer: Multiplan Commercial |
$0.86
|
| Rate for Payer: Networks By Design Commercial |
$0.55
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Networks By Design Commercial |
$0.58
|
| Rate for Payer: Prime Health Services Commercial |
$0.98
|
| Rate for Payer: Prime Health Services Commercial |
$0.93
|
| Rate for Payer: Prime Health Services Commercial |
$0.65
|
| Rate for Payer: Riverside University Health System MISP |
$0.44
|
| Rate for Payer: Riverside University Health System MISP |
$0.46
|
| Rate for Payer: Riverside University Health System MISP |
$0.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.41
|
| Rate for Payer: United Healthcare All Other HMO |
$0.42
|
| Rate for Payer: United Healthcare All Other HMO |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO |
$0.28
|
| Rate for Payer: United Healthcare HMO Rider |
$0.39
|
| Rate for Payer: United Healthcare HMO Rider |
$0.41
|
| Rate for Payer: United Healthcare HMO Rider |
$0.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.65
|
| Rate for Payer: Vantage Medical Group Senior |
$0.98
|
| Rate for Payer: Vantage Medical Group Senior |
$0.65
|
| Rate for Payer: Vantage Medical Group Senior |
$0.93
|
|
|
TISLELIZUMAB-JSGR 10 MG/ML INTRAVENOUS SOLUTION [242397]
|
Facility
|
IP
|
$668.88
|
|
|
Service Code
|
HCPCS J9329
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$133.78 |
| Max. Negotiated Rate |
$601.99 |
| Rate for Payer: Adventist Health Commercial |
$133.78
|
| Rate for Payer: Blue Shield of California Commercial |
$536.44
|
| Rate for Payer: Blue Shield of California EPN |
$337.12
|
| Rate for Payer: Cash Price |
$301.00
|
| Rate for Payer: Central Health Plan Commercial |
$535.10
|
| Rate for Payer: Cigna of CA HMO |
$468.22
|
| Rate for Payer: Cigna of CA PPO |
$468.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$468.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$267.55
|
| Rate for Payer: EPIC Health Plan Senior |
$267.55
|
| Rate for Payer: Galaxy Health WC |
$568.55
|
| Rate for Payer: Global Benefits Group Commercial |
$401.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$601.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$424.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$394.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.78
|
| Rate for Payer: Multiplan Commercial |
$501.66
|
| Rate for Payer: Networks By Design Commercial |
$334.44
|
| Rate for Payer: Prime Health Services Commercial |
$568.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$251.03
|
| Rate for Payer: United Healthcare All Other HMO |
$244.34
|
| Rate for Payer: United Healthcare HMO Rider |
$239.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.06
|
|
|
TISLELIZUMAB-JSGR 10 MG/ML INTRAVENOUS SOLUTION [242397]
|
Facility
|
OP
|
$668.88
|
|
|
Service Code
|
HCPCS J9329
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.17 |
| Max. Negotiated Rate |
$601.99 |
| Rate for Payer: Adventist Health Commercial |
$133.78
|
| Rate for Payer: Adventist Health Medi-Cal |
$58.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$333.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$63.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$103.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.54
|
| Rate for Payer: Blue Shield of California Commercial |
$68.69
|
| Rate for Payer: Blue Shield of California EPN |
$62.45
|
| Rate for Payer: Cash Price |
$301.00
|
| Rate for Payer: Cash Price |
$301.00
|
| Rate for Payer: Central Health Plan Commercial |
$535.10
|
| Rate for Payer: Cigna of CA HMO |
$468.22
|
| Rate for Payer: Cigna of CA PPO |
$468.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$63.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$63.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$468.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.98
|
| Rate for Payer: EPIC Health Plan Senior |
$63.99
|
| Rate for Payer: Galaxy Health WC |
$568.55
|
| Rate for Payer: Global Benefits Group Commercial |
$401.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$601.99
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$95.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$58.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$424.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$110.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$77.95
|
| Rate for Payer: Multiplan Commercial |
$501.66
|
| Rate for Payer: Networks By Design Commercial |
$334.44
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$58.17
|
| Rate for Payer: Prime Health Services Commercial |
$568.55
|
| Rate for Payer: Prime Health Services Medicare |
$61.66
|
| Rate for Payer: Riverside University Health System MISP |
$63.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$401.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$401.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$251.03
|
| Rate for Payer: United Healthcare All Other HMO |
$244.34
|
| Rate for Payer: United Healthcare HMO Rider |
$239.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.06
|
| Rate for Payer: Upland Medical Group Pediatric |
$58.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.99
|
| Rate for Payer: Vantage Medical Group Senior |
$63.99
|
|
|
TISOTUMAB VEDOTIN-TFTV 40 MG INTRAVENOUS SOLUTION [232793]
|
Facility
|
IP
|
$9,227.32
|
|
|
Service Code
|
HCPCS J9273
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,845.46 |
| Max. Negotiated Rate |
$8,304.59 |
| Rate for Payer: Adventist Health Commercial |
$1,845.46
|
| Rate for Payer: Blue Shield of California Commercial |
$7,400.31
|
| Rate for Payer: Blue Shield of California EPN |
$4,650.57
|
| Rate for Payer: Cash Price |
$4,152.29
|
| Rate for Payer: Central Health Plan Commercial |
$7,381.86
|
| Rate for Payer: Cigna of CA HMO |
$6,459.12
|
| Rate for Payer: Cigna of CA PPO |
$6,459.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,459.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,690.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,690.93
|
| Rate for Payer: Galaxy Health WC |
$7,843.22
|
| Rate for Payer: Global Benefits Group Commercial |
$5,536.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,304.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,859.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,444.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,845.46
|
| Rate for Payer: Multiplan Commercial |
$6,920.49
|
| Rate for Payer: Networks By Design Commercial |
$4,613.66
|
| Rate for Payer: Prime Health Services Commercial |
$7,843.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,463.01
|
| Rate for Payer: United Healthcare All Other HMO |
$3,370.74
|
| Rate for Payer: United Healthcare HMO Rider |
$3,297.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,021.95
|
|
|
TISOTUMAB VEDOTIN-TFTV 40 MG INTRAVENOUS SOLUTION [232793]
|
Facility
|
OP
|
$9,227.32
|
|
|
Service Code
|
HCPCS J9273
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$196.12 |
| Max. Negotiated Rate |
$8,304.59 |
| Rate for Payer: Adventist Health Commercial |
$1,845.46
|
| Rate for Payer: Adventist Health Medi-Cal |
$196.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,169.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$294.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$215.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$196.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$302.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$377.46
|
| Rate for Payer: Blue Shield of California Commercial |
$235.06
|
| Rate for Payer: Blue Shield of California EPN |
$213.69
|
| Rate for Payer: Cash Price |
$4,152.29
|
| Rate for Payer: Cash Price |
$4,152.29
|
| Rate for Payer: Central Health Plan Commercial |
$7,381.86
|
| Rate for Payer: Cigna of CA HMO |
$6,459.12
|
| Rate for Payer: Cigna of CA PPO |
$6,459.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$215.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$215.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,459.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$323.60
|
| Rate for Payer: EPIC Health Plan Senior |
$215.73
|
| Rate for Payer: Galaxy Health WC |
$7,843.22
|
| Rate for Payer: Global Benefits Group Commercial |
$5,536.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,304.59
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$321.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$196.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$196.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,859.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$372.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$274.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,845.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$262.80
|
| Rate for Payer: Multiplan Commercial |
$6,920.49
|
| Rate for Payer: Networks By Design Commercial |
$4,613.66
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$196.12
|
| Rate for Payer: Prime Health Services Commercial |
$7,843.22
|
| Rate for Payer: Prime Health Services Medicare |
$207.89
|
| Rate for Payer: Riverside University Health System MISP |
$215.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,536.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,536.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,463.01
|
| Rate for Payer: United Healthcare All Other HMO |
$3,370.74
|
| Rate for Payer: United Healthcare HMO Rider |
$3,297.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,021.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$196.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$215.73
|
| Rate for Payer: Vantage Medical Group Senior |
$215.73
|
|
|
TISSUE EXPANDER PLACEMENT IN BREAST RECONSTRUCTION, INCLUDING SUBSEQUENT EXPANSION(S)
|
Facility
|
OP
|
$35,941.35
|
|
|
Service Code
|
CPT 19357
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$243.98 |
| Max. Negotiated Rate |
$35,941.35 |
| Rate for Payer: Adventist Health Medi-Cal |
$17,724.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26,586.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19,497.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17,724.61
|
| 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 |
$35,222.52
|
| Rate for Payer: Blue Shield of California Commercial |
$7,080.44
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26,586.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$19,497.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17,724.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,245.61
|
| Rate for Payer: EPIC Health Plan Senior |
$19,497.07
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29,068.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$243.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17,724.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$269.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24,814.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23,750.98
|
| Rate for Payer: Multiplan WC |
$35,222.52
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17,724.61
|
| Rate for Payer: Preferred Health Network WC |
$35,941.35
|
| Rate for Payer: Prime Health Services Medicare |
$18,788.09
|
| Rate for Payer: Prime Health Services WC |
$34,863.11
|
| Rate for Payer: Riverside University Health System MISP |
$19,497.07
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$17,724.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26,586.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19,497.07
|
| Rate for Payer: Vantage Medical Group Senior |
$17,724.61
|
|
|
TIZANIDINE 2 MG TABLET [14792]
|
Facility
|
OP
|
$0.20
|
|
|
Service Code
|
NDC 6050502513
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.14
|
| Rate for Payer: Cigna of CA PPO |
$0.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.17
|
| Rate for Payer: Global Benefits Group Commercial |
$0.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Networks By Design Commercial |
$0.13
|
| Rate for Payer: Prime Health Services Commercial |
$0.17
|
| Rate for Payer: Riverside University Health System MISP |
$0.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Vantage Medical Group Senior |
$0.17
|
|
|
TIZANIDINE 2 MG TABLET [14792]
|
Facility
|
OP
|
$1.29
|
|
|
Service Code
|
NDC 6808477595
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.75
|
| Rate for Payer: Blue Shield of California Commercial |
$0.82
|
| Rate for Payer: Blue Shield of California EPN |
$0.51
|
| Rate for Payer: Cash Price |
$0.58
|
| Rate for Payer: Central Health Plan Commercial |
$1.03
|
| Rate for Payer: Cigna of CA HMO |
$0.90
|
| Rate for Payer: Cigna of CA PPO |
$0.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: EPIC Health Plan Senior |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$0.97
|
| Rate for Payer: Networks By Design Commercial |
$0.84
|
| Rate for Payer: Prime Health Services Commercial |
$1.10
|
| Rate for Payer: Riverside University Health System MISP |
$0.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.65
|
| Rate for Payer: United Healthcare All Other HMO |
$0.65
|
| Rate for Payer: United Healthcare HMO Rider |
$0.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1.10
|
|
|
TIZANIDINE 2 MG TABLET [14792]
|
Facility
|
OP
|
$1.29
|
|
|
Service Code
|
NDC 6808477525
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.75
|
| Rate for Payer: Blue Shield of California Commercial |
$0.82
|
| Rate for Payer: Blue Shield of California EPN |
$0.51
|
| Rate for Payer: Cash Price |
$0.58
|
| Rate for Payer: Central Health Plan Commercial |
$1.03
|
| Rate for Payer: Cigna of CA HMO |
$0.90
|
| Rate for Payer: Cigna of CA PPO |
$0.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: EPIC Health Plan Senior |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$0.97
|
| Rate for Payer: Networks By Design Commercial |
$0.84
|
| Rate for Payer: Prime Health Services Commercial |
$1.10
|
| Rate for Payer: Riverside University Health System MISP |
$0.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.65
|
| Rate for Payer: United Healthcare All Other HMO |
$0.65
|
| Rate for Payer: United Healthcare HMO Rider |
$0.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1.10
|
|
|
TIZANIDINE 2 MG TABLET [14792]
|
Facility
|
IP
|
$1.29
|
|
|
Service Code
|
NDC 6808477525
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.65
|
| Rate for Payer: Cash Price |
$0.58
|
| Rate for Payer: Central Health Plan Commercial |
$1.03
|
| Rate for Payer: Cigna of CA HMO |
$0.90
|
| Rate for Payer: Cigna of CA PPO |
$0.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: EPIC Health Plan Senior |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.97
|
| Rate for Payer: Networks By Design Commercial |
$0.84
|
| Rate for Payer: Prime Health Services Commercial |
$1.10
|
|
|
TIZANIDINE 2 MG TABLET [14792]
|
Facility
|
IP
|
$1.29
|
|
|
Service Code
|
NDC 6808477595
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.65
|
| Rate for Payer: Cash Price |
$0.58
|
| Rate for Payer: Central Health Plan Commercial |
$1.03
|
| Rate for Payer: Cigna of CA HMO |
$0.90
|
| Rate for Payer: Cigna of CA PPO |
$0.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: EPIC Health Plan Senior |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.97
|
| Rate for Payer: Networks By Design Commercial |
$0.84
|
| Rate for Payer: Prime Health Services Commercial |
$1.10
|
|
|
TIZANIDINE 2 MG TABLET [14792]
|
Facility
|
IP
|
$0.20
|
|
|
Service Code
|
NDC 6050502513
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.14
|
| Rate for Payer: Cigna of CA PPO |
$0.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.17
|
| Rate for Payer: Global Benefits Group Commercial |
$0.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Networks By Design Commercial |
$0.13
|
| Rate for Payer: Prime Health Services Commercial |
$0.17
|
|
|
TIZANIDINE 4 MG TABLET [14793]
|
Facility
|
IP
|
$0.12
|
|
|
Service Code
|
NDC 2930016915
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
|
