|
TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE [12933]
|
Facility
OP
|
$0.70
|
|
|
Service Code
|
CPT J7507
|
| Hospital Charge Code |
1712166
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$8.29 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.61
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.39
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.29
|
| Rate for Payer: BCBS Transplant Transplant |
$0.67
|
| Rate for Payer: BCBS Transplant Transplant |
$0.42
|
| Rate for Payer: BCBS Transplant Transplant |
$5.02
|
| Rate for Payer: BCBS Transplant Transplant |
$0.66
|
| Rate for Payer: BCBS Transplant Transplant |
$0.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1.46
|
| Rate for Payer: Blue Shield of California Commercial |
$1.46
|
| Rate for Payer: Blue Shield of California Commercial |
$1.46
|
| Rate for Payer: Blue Shield of California Commercial |
$1.46
|
| Rate for Payer: Blue Shield of California Commercial |
$1.46
|
| Rate for Payer: Blue Shield of California EPN |
$1.33
|
| Rate for Payer: Blue Shield of California EPN |
$1.33
|
| Rate for Payer: Blue Shield of California EPN |
$1.33
|
| Rate for Payer: Blue Shield of California EPN |
$1.33
|
| Rate for Payer: Blue Shield of California EPN |
$1.33
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$3.77
|
| Rate for Payer: Cash Price |
$3.77
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Central Health Plan Commercial |
$6.70
|
| Rate for Payer: Central Health Plan Commercial |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$0.70
|
| Rate for Payer: Central Health Plan Commercial |
$0.88
|
| Rate for Payer: Central Health Plan Commercial |
$0.56
|
| Rate for Payer: Cigna of CA HMO |
$0.78
|
| Rate for Payer: Cigna of CA HMO |
$0.61
|
| Rate for Payer: Cigna of CA HMO |
$5.86
|
| Rate for Payer: Cigna of CA HMO |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.77
|
| Rate for Payer: Cigna of CA PPO |
$0.78
|
| Rate for Payer: Cigna of CA PPO |
$0.61
|
| Rate for Payer: Cigna of CA PPO |
$0.49
|
| Rate for Payer: Cigna of CA PPO |
$0.77
|
| Rate for Payer: Cigna of CA PPO |
$5.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.74
|
| Rate for Payer: Galaxy Health WC |
$0.60
|
| Rate for Payer: Galaxy Health WC |
$7.11
|
| Rate for Payer: Galaxy Health WC |
$0.95
|
| Rate for Payer: Galaxy Health WC |
$0.94
|
| Rate for Payer: Global Benefits Group Commercial |
$5.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.66
|
| Rate for Payer: Global Benefits Group Commercial |
$0.67
|
| Rate for Payer: Global Benefits Group Commercial |
$0.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.78
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.53
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.28
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.83
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.65
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.84
|
| Rate for Payer: IEHP medi-cal |
$0.24
|
| Rate for Payer: IEHP medi-cal |
$0.24
|
| Rate for Payer: IEHP medi-cal |
$0.24
|
| Rate for Payer: IEHP medi-cal |
$0.24
|
| Rate for Payer: IEHP medi-cal |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$6.28
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: Multiplan Commercial |
$0.65
|
| Rate for Payer: Multiplan Commercial |
$0.53
|
| Rate for Payer: Multiplan Commercial |
$0.84
|
| Rate for Payer: Networks By Design Commercial |
$0.35
|
| Rate for Payer: Networks By Design Commercial |
$4.18
|
| Rate for Payer: Networks By Design Commercial |
$0.55
|
| Rate for Payer: Networks By Design Commercial |
$0.44
|
| Rate for Payer: Networks By Design Commercial |
$0.56
|
| Rate for Payer: Prime Health Services Commercial |
$0.95
|
| Rate for Payer: Prime Health Services Commercial |
$0.74
|
| Rate for Payer: Prime Health Services Commercial |
$0.94
|
| Rate for Payer: Prime Health Services Commercial |
$0.60
|
| Rate for Payer: Prime Health Services Commercial |
$7.11
|
| Rate for Payer: Riverside University Health MISP |
$3.35
|
| Rate for Payer: Riverside University Health MISP |
$0.35
|
| Rate for Payer: Riverside University Health MISP |
$0.44
|
| Rate for Payer: Riverside University Health MISP |
$0.45
|
| Rate for Payer: Riverside University Health MISP |
$0.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.55
|
| Rate for Payer: United Healthcare All Other HMO |
$0.35
|
| Rate for Payer: United Healthcare All Other HMO |
$0.44
|
| Rate for Payer: United Healthcare All Other HMO |
$0.56
|
| Rate for Payer: United Healthcare All Other HMO |
$4.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.55
|
| Rate for Payer: United Healthcare HMO Rider |
$0.44
|
| Rate for Payer: United Healthcare HMO Rider |
$0.56
|
| Rate for Payer: United Healthcare HMO Rider |
$0.35
|
| Rate for Payer: United Healthcare HMO Rider |
$0.55
|
| Rate for Payer: United Healthcare HMO Rider |
$4.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.11
|
| Rate for Payer: Vantage Medical Group Senior |
$0.95
|
| Rate for Payer: Vantage Medical Group Senior |
$0.74
|
| Rate for Payer: Vantage Medical Group Senior |
$7.11
|
| Rate for Payer: Vantage Medical Group Senior |
$0.60
|
| Rate for Payer: Vantage Medical Group Senior |
$0.94
|
|
|
TACROLIMUS 5 MG CAPSULE, IMMEDIATE-RELEASE [12934]
|
Facility
IP
|
$3.50
|
|
|
Service Code
|
CPT J7507
|
| Hospital Charge Code |
1712165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$3.15 |
| Rate for Payer: Blue Shield of California Commercial |
$2.62
|
| Rate for Payer: Blue Shield of California Commercial |
$3.10
|
| Rate for Payer: Blue Shield of California Commercial |
$31.39
|
| Rate for Payer: Blue Shield of California Commercial |
$4.05
|
| Rate for Payer: Blue Shield of California EPN |
$2.21
|
| Rate for Payer: Blue Shield of California EPN |
$1.87
|
| Rate for Payer: Blue Shield of California EPN |
$2.88
|
| Rate for Payer: Blue Shield of California EPN |
$22.35
|
| Rate for Payer: Cash Price |
$1.86
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Cash Price |
$18.83
|
| Rate for Payer: Central Health Plan Commercial |
$3.31
|
| Rate for Payer: Central Health Plan Commercial |
$2.80
|
| Rate for Payer: Central Health Plan Commercial |
$33.48
|
| Rate for Payer: Central Health Plan Commercial |
$4.32
|
| Rate for Payer: Cigna of CA HMO |
$29.30
|
| Rate for Payer: Cigna of CA HMO |
$2.45
|
| Rate for Payer: Cigna of CA HMO |
$2.90
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$2.45
|
| Rate for Payer: Cigna of CA PPO |
$2.90
|
| Rate for Payer: Cigna of CA PPO |
$29.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.40
|
| Rate for Payer: Galaxy Health WC |
$4.59
|
| Rate for Payer: Galaxy Health WC |
$2.98
|
| Rate for Payer: Galaxy Health WC |
$35.57
|
| Rate for Payer: Galaxy Health WC |
$3.52
|
| Rate for Payer: Global Benefits Group Commercial |
$2.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.24
|
| Rate for Payer: Global Benefits Group Commercial |
$25.11
|
| Rate for Payer: Global Benefits Group Commercial |
$2.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$3.10
|
| Rate for Payer: Multiplan Commercial |
$4.05
|
| Rate for Payer: Multiplan Commercial |
$2.62
|
| Rate for Payer: Multiplan Commercial |
$31.39
|
| Rate for Payer: Networks By Design Commercial |
$1.75
|
| Rate for Payer: Networks By Design Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$20.92
|
| Rate for Payer: Networks By Design Commercial |
$2.07
|
| Rate for Payer: Prime Health Services Commercial |
$2.98
|
| Rate for Payer: Prime Health Services Commercial |
$35.57
|
| Rate for Payer: Prime Health Services Commercial |
$3.52
|
| Rate for Payer: Prime Health Services Commercial |
$4.59
|
|
|
TACROLIMUS 5 MG CAPSULE, IMMEDIATE-RELEASE [12934]
|
Facility
OP
|
$3.50
|
|
|
Service Code
|
CPT J7507
|
| Hospital Charge Code |
1712165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$8.29 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$35.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$23.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$23.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.97
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.29
|
| Rate for Payer: BCBS Transplant Transplant |
$2.48
|
| Rate for Payer: BCBS Transplant Transplant |
$2.10
|
| Rate for Payer: BCBS Transplant Transplant |
$25.11
|
| Rate for Payer: BCBS Transplant Transplant |
$3.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1.46
|
| Rate for Payer: Blue Shield of California Commercial |
$1.46
|
| Rate for Payer: Blue Shield of California Commercial |
$1.46
|
| Rate for Payer: Blue Shield of California Commercial |
$1.46
|
| Rate for Payer: Blue Shield of California EPN |
$1.33
|
| Rate for Payer: Blue Shield of California EPN |
$1.33
|
| Rate for Payer: Blue Shield of California EPN |
$1.33
|
| Rate for Payer: Blue Shield of California EPN |
$1.33
|
| Rate for Payer: Cash Price |
$18.83
|
| Rate for Payer: Cash Price |
$18.83
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Cash Price |
$1.86
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$1.86
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Central Health Plan Commercial |
$33.48
|
| Rate for Payer: Central Health Plan Commercial |
$2.80
|
| Rate for Payer: Central Health Plan Commercial |
$3.31
|
| Rate for Payer: Central Health Plan Commercial |
$4.32
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA HMO |
$29.30
|
| Rate for Payer: Cigna of CA HMO |
$2.90
|
| Rate for Payer: Cigna of CA HMO |
$2.45
|
| Rate for Payer: Cigna of CA PPO |
$29.30
|
| Rate for Payer: Cigna of CA PPO |
$2.90
|
| Rate for Payer: Cigna of CA PPO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$2.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.74
|
| Rate for Payer: Galaxy Health WC |
$2.98
|
| Rate for Payer: Galaxy Health WC |
$3.52
|
| Rate for Payer: Galaxy Health WC |
$4.59
|
| Rate for Payer: Galaxy Health WC |
$35.57
|
| Rate for Payer: Global Benefits Group Commercial |
$3.24
|
| Rate for Payer: Global Benefits Group Commercial |
$25.11
|
| Rate for Payer: Global Benefits Group Commercial |
$2.48
|
| Rate for Payer: Global Benefits Group Commercial |
$2.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.66
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.05
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.62
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$31.39
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.10
|
| Rate for Payer: IEHP medi-cal |
$0.24
|
| Rate for Payer: IEHP medi-cal |
$0.24
|
| Rate for Payer: IEHP medi-cal |
$0.24
|
| Rate for Payer: IEHP medi-cal |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$31.39
|
| Rate for Payer: Multiplan Commercial |
$3.10
|
| Rate for Payer: Multiplan Commercial |
$2.62
|
| Rate for Payer: Multiplan Commercial |
$4.05
|
| Rate for Payer: Networks By Design Commercial |
$1.75
|
| Rate for Payer: Networks By Design Commercial |
$2.07
|
| Rate for Payer: Networks By Design Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$20.92
|
| Rate for Payer: Prime Health Services Commercial |
$3.52
|
| Rate for Payer: Prime Health Services Commercial |
$35.57
|
| Rate for Payer: Prime Health Services Commercial |
$4.59
|
| Rate for Payer: Prime Health Services Commercial |
$2.98
|
| Rate for Payer: Riverside University Health MISP |
$1.66
|
| Rate for Payer: Riverside University Health MISP |
$1.40
|
| Rate for Payer: Riverside University Health MISP |
$16.74
|
| Rate for Payer: Riverside University Health MISP |
$2.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2.07
|
| Rate for Payer: United Healthcare All Other HMO |
$1.75
|
| Rate for Payer: United Healthcare All Other HMO |
$2.70
|
| Rate for Payer: United Healthcare All Other HMO |
$20.92
|
| Rate for Payer: United Healthcare HMO Rider |
$2.07
|
| Rate for Payer: United Healthcare HMO Rider |
$2.70
|
| Rate for Payer: United Healthcare HMO Rider |
$1.75
|
| Rate for Payer: United Healthcare HMO Rider |
$20.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.59
|
| Rate for Payer: Vantage Medical Group Senior |
$4.59
|
| Rate for Payer: Vantage Medical Group Senior |
$3.52
|
| Rate for Payer: Vantage Medical Group Senior |
$35.57
|
| Rate for Payer: Vantage Medical Group Senior |
$2.98
|
|
|
TACROLIMUS ORAL SUSPENSION COMPOUND 0.5 MG/ML [4080345]
|
Facility
IP
|
$2.61
|
|
|
Service Code
|
NDC 9994-0803-45
|
| Hospital Charge Code |
1715948
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.35 |
| Rate for Payer: Blue Shield of California Commercial |
$1.96
|
| Rate for Payer: Blue Shield of California EPN |
$1.39
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Central Health Plan Commercial |
$2.09
|
| Rate for Payer: Cigna of CA HMO |
$1.83
|
| Rate for Payer: Cigna of CA PPO |
$1.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: Galaxy Health WC |
$2.22
|
| Rate for Payer: Global Benefits Group Commercial |
$1.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Multiplan Commercial |
$1.96
|
| Rate for Payer: Networks By Design Commercial |
$1.70
|
| Rate for Payer: Prime Health Services Commercial |
$2.22
|
|
|
TACROLIMUS ORAL SUSPENSION COMPOUND 0.5 MG/ML [4080345]
|
Facility
OP
|
$2.61
|
|
|
Service Code
|
NDC 9994-0803-45
|
| Hospital Charge Code |
1715948
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.54
|
| Rate for Payer: BCBS Transplant Transplant |
$1.57
|
| Rate for Payer: Blue Shield of California Commercial |
$1.64
|
| Rate for Payer: Blue Shield of California EPN |
$1.28
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Central Health Plan Commercial |
$2.09
|
| Rate for Payer: Cigna of CA HMO |
$1.83
|
| Rate for Payer: Cigna of CA PPO |
$1.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.04
|
| Rate for Payer: Galaxy Health WC |
$2.22
|
| Rate for Payer: Global Benefits Group Commercial |
$1.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.35
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.96
|
| Rate for Payer: IEHP medi-cal |
$0.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Multiplan Commercial |
$1.96
|
| Rate for Payer: Networks By Design Commercial |
$1.70
|
| Rate for Payer: Prime Health Services Commercial |
$2.22
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.57
|
| Rate for Payer: Riverside University Health MISP |
$1.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.30
|
| Rate for Payer: United Healthcare All Other HMO |
$1.30
|
| Rate for Payer: United Healthcare HMO Rider |
$1.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.22
|
| Rate for Payer: Vantage Medical Group Senior |
$2.22
|
|
|
TACROLIMUS XR 0.75 MG TABLET,EXTENDED RELEASE 24 HR [211104]
|
Facility
IP
|
$5.91
|
|
|
Service Code
|
CPT J7508
|
| Hospital Charge Code |
ERX211104
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$5.32 |
| Rate for Payer: Blue Shield of California Commercial |
$4.43
|
| Rate for Payer: Blue Shield of California EPN |
$3.16
|
| Rate for Payer: Cash Price |
$2.66
|
| Rate for Payer: Central Health Plan Commercial |
$4.73
|
| Rate for Payer: Cigna of CA HMO |
$4.14
|
| Rate for Payer: Cigna of CA PPO |
$4.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.36
|
| Rate for Payer: Galaxy Health WC |
$5.02
|
| Rate for Payer: Global Benefits Group Commercial |
$3.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$4.43
|
| Rate for Payer: Networks By Design Commercial |
$2.96
|
| Rate for Payer: Prime Health Services Commercial |
$5.02
|
|
|
TACROLIMUS XR 0.75 MG TABLET,EXTENDED RELEASE 24 HR [211104]
|
Facility
OP
|
$5.91
|
|
|
Service Code
|
CPT J7508
|
| Hospital Charge Code |
ERX211104
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$5.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.84
|
| Rate for Payer: BCBS Transplant Transplant |
$3.55
|
| Rate for Payer: Blue Shield of California Commercial |
$0.63
|
| Rate for Payer: Blue Shield of California EPN |
$0.57
|
| Rate for Payer: Cash Price |
$2.66
|
| Rate for Payer: Cash Price |
$2.66
|
| Rate for Payer: Central Health Plan Commercial |
$4.73
|
| Rate for Payer: Cigna of CA HMO |
$4.14
|
| Rate for Payer: Cigna of CA PPO |
$4.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.36
|
| Rate for Payer: Galaxy Health WC |
$5.02
|
| Rate for Payer: Global Benefits Group Commercial |
$3.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.32
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.43
|
| Rate for Payer: IEHP medi-cal |
$0.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$4.43
|
| Rate for Payer: Networks By Design Commercial |
$2.96
|
| Rate for Payer: Prime Health Services Commercial |
$5.02
|
| Rate for Payer: Riverside University Health MISP |
$2.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.96
|
| Rate for Payer: United Healthcare All Other HMO |
$2.96
|
| Rate for Payer: United Healthcare HMO Rider |
$2.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.02
|
| Rate for Payer: Vantage Medical Group Senior |
$5.02
|
|
|
TACROLIMUS XR 1 MG TABLET,EXTENDED RELEASE 24 HR [211105]
|
Facility
IP
|
$7.88
|
|
|
Service Code
|
CPT J7503
|
| Hospital Charge Code |
ERX211105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$7.09 |
| Rate for Payer: Blue Shield of California Commercial |
$5.91
|
| Rate for Payer: Blue Shield of California EPN |
$4.21
|
| Rate for Payer: Cash Price |
$3.55
|
| Rate for Payer: Central Health Plan Commercial |
$6.30
|
| Rate for Payer: Cigna of CA HMO |
$5.52
|
| Rate for Payer: Cigna of CA PPO |
$5.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.15
|
| Rate for Payer: Galaxy Health WC |
$6.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.58
|
| Rate for Payer: Multiplan Commercial |
$5.91
|
| Rate for Payer: Networks By Design Commercial |
$3.94
|
| Rate for Payer: Prime Health Services Commercial |
$6.70
|
|
|
TACROLIMUS XR 1 MG TABLET,EXTENDED RELEASE 24 HR [211105]
|
Facility
OP
|
$7.88
|
|
|
Service Code
|
CPT J7503
|
| Hospital Charge Code |
ERX211105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$10.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.11
|
| Rate for Payer: BCBS Transplant Transplant |
$4.73
|
| Rate for Payer: Blue Shield of California Commercial |
$1.79
|
| Rate for Payer: Blue Shield of California EPN |
$1.63
|
| Rate for Payer: Cash Price |
$3.55
|
| Rate for Payer: Cash Price |
$3.55
|
| Rate for Payer: Central Health Plan Commercial |
$6.30
|
| Rate for Payer: Cigna of CA HMO |
$5.52
|
| Rate for Payer: Cigna of CA PPO |
$5.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.15
|
| Rate for Payer: Galaxy Health WC |
$6.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.09
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.91
|
| Rate for Payer: IEHP medi-cal |
$1.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.58
|
| Rate for Payer: Multiplan Commercial |
$5.91
|
| Rate for Payer: Networks By Design Commercial |
$3.94
|
| Rate for Payer: Prime Health Services Commercial |
$6.70
|
| Rate for Payer: Riverside University Health MISP |
$3.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.94
|
| Rate for Payer: United Healthcare All Other HMO |
$3.94
|
| Rate for Payer: United Healthcare HMO Rider |
$3.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.70
|
| Rate for Payer: Vantage Medical Group Senior |
$6.70
|
|
|
TACROLIMUS XR 4 MG TABLET,EXTENDED RELEASE 24 HR [211106]
|
Facility
OP
|
$31.52
|
|
|
Service Code
|
CPT J7503
|
| Hospital Charge Code |
ERX211106
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$28.37 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$26.79
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.11
|
| Rate for Payer: BCBS Transplant Transplant |
$18.91
|
| Rate for Payer: Blue Shield of California Commercial |
$1.79
|
| Rate for Payer: Blue Shield of California EPN |
$1.63
|
| Rate for Payer: Cash Price |
$14.18
|
| Rate for Payer: Cash Price |
$14.18
|
| Rate for Payer: Central Health Plan Commercial |
$25.22
|
| Rate for Payer: Cigna of CA HMO |
$22.06
|
| Rate for Payer: Cigna of CA PPO |
$22.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.61
|
| Rate for Payer: Galaxy Health WC |
$26.79
|
| Rate for Payer: Global Benefits Group Commercial |
$18.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.37
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$23.64
|
| Rate for Payer: IEHP medi-cal |
$1.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$23.64
|
| Rate for Payer: Networks By Design Commercial |
$15.76
|
| Rate for Payer: Prime Health Services Commercial |
$26.79
|
| Rate for Payer: Riverside University Health MISP |
$12.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.76
|
| Rate for Payer: United Healthcare All Other HMO |
$15.76
|
| Rate for Payer: United Healthcare HMO Rider |
$15.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.79
|
| Rate for Payer: Vantage Medical Group Senior |
$26.79
|
|
|
TACROLIMUS XR 4 MG TABLET,EXTENDED RELEASE 24 HR [211106]
|
Facility
IP
|
$31.52
|
|
|
Service Code
|
CPT J7503
|
| Hospital Charge Code |
ERX211106
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$28.37 |
| Rate for Payer: Blue Shield of California Commercial |
$23.64
|
| Rate for Payer: Blue Shield of California EPN |
$16.83
|
| Rate for Payer: Cash Price |
$14.18
|
| Rate for Payer: Central Health Plan Commercial |
$25.22
|
| Rate for Payer: Cigna of CA HMO |
$22.06
|
| Rate for Payer: Cigna of CA PPO |
$22.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.61
|
| Rate for Payer: Galaxy Health WC |
$26.79
|
| Rate for Payer: Global Benefits Group Commercial |
$18.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$23.64
|
| Rate for Payer: Networks By Design Commercial |
$15.76
|
| Rate for Payer: Prime Health Services Commercial |
$26.79
|
|
|
TADALAFIL 20 MG TABLET (PULMONARY HYPERTENSION) [214774]
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
NDC 27241-123-02
|
| Hospital Charge Code |
ERX214774
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.59
|
| Rate for Payer: BCBS Transplant Transplant |
$0.60
|
| Rate for Payer: Blue Shield of California Commercial |
$0.63
|
| Rate for Payer: Blue Shield of California EPN |
$0.49
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Central Health Plan Commercial |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.75
|
| Rate for Payer: IEHP medi-cal |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: Riverside University Health MISP |
$0.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
TADALAFIL 20 MG TABLET (PULMONARY HYPERTENSION) [214774]
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
NDC 33342-278-09
|
| Hospital Charge Code |
ERX214774
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.59
|
| Rate for Payer: BCBS Transplant Transplant |
$0.60
|
| Rate for Payer: Blue Shield of California Commercial |
$0.63
|
| Rate for Payer: Blue Shield of California EPN |
$0.49
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Central Health Plan Commercial |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.75
|
| Rate for Payer: IEHP medi-cal |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: Riverside University Health MISP |
$0.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
TADALAFIL 20 MG TABLET (PULMONARY HYPERTENSION) [214774]
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
NDC 33342-278-09
|
| Hospital Charge Code |
ERX214774
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Blue Shield of California Commercial |
$0.75
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Central Health Plan Commercial |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
|
|
TADALAFIL 20 MG TABLET (PULMONARY HYPERTENSION) [214774]
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
NDC 69097-526-03
|
| Hospital Charge Code |
ERX214774
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Blue Shield of California Commercial |
$0.75
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Central Health Plan Commercial |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
|
|
TADALAFIL 20 MG TABLET (PULMONARY HYPERTENSION) [214774]
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
NDC 27241-123-02
|
| Hospital Charge Code |
ERX214774
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Blue Shield of California Commercial |
$0.75
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Central Health Plan Commercial |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
|
|
TADALAFIL 20 MG TABLET (PULMONARY HYPERTENSION) [214774]
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
NDC 69097-526-03
|
| Hospital Charge Code |
ERX214774
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.59
|
| Rate for Payer: BCBS Transplant Transplant |
$0.60
|
| Rate for Payer: Blue Shield of California Commercial |
$0.63
|
| Rate for Payer: Blue Shield of California EPN |
$0.49
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Central Health Plan Commercial |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.75
|
| Rate for Payer: IEHP medi-cal |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: Riverside University Health MISP |
$0.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
TADALAFIL 5 MG TABLET [37400]
|
Facility
IP
|
$0.36
|
|
|
Service Code
|
NDC 43598-575-30
|
| Hospital Charge Code |
ERX37400
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.19
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Central Health Plan Commercial |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
|
|
TADALAFIL 5 MG TABLET [37400]
|
Facility
OP
|
$0.36
|
|
|
Service Code
|
NDC 43598-575-30
|
| Hospital Charge Code |
ERX37400
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.21
|
| Rate for Payer: BCBS Transplant Transplant |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Central Health Plan Commercial |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.32
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.27
|
| Rate for Payer: IEHP medi-cal |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.22
|
| Rate for Payer: Riverside University Health MISP |
$0.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
|
TADALAFIL ORAL SUSPENSION COMPOUND 5 MG/ML [4081077]
|
Facility
OP
|
$0.25
|
|
|
Service Code
|
NDC 99994-0810-77
|
| Hospital Charge Code |
NDC4081077
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: BCBS Transplant Transplant |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Central Health Plan Commercial |
$0.20
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.23
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.19
|
| Rate for Payer: IEHP medi-cal |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.15
|
| Rate for Payer: Riverside University Health MISP |
$0.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Vantage Medical Group Senior |
$0.21
|
|
|
TADALAFIL ORAL SUSPENSION COMPOUND 5 MG/ML [4081077]
|
Facility
IP
|
$0.25
|
|
|
Service Code
|
NDC 99994-0810-77
|
| Hospital Charge Code |
NDC4081077
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Central Health Plan Commercial |
$0.20
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
|
|
TAFASITAMAB-CXIX 200 MG INTRAVENOUS SOLUTION [228997]
|
Facility
OP
|
$1,570.38
|
|
|
Service Code
|
CPT J9349
|
| Hospital Charge Code |
ERX228997
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$1,413.34 |
| Rate for Payer: Adventist Health Medi-Cal |
$13.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.00
|
| Rate for Payer: BCBS Transplant Transplant |
$942.23
|
| Rate for Payer: Blue Shield of California Commercial |
$987.77
|
| Rate for Payer: Blue Shield of California EPN |
$767.92
|
| Rate for Payer: Caremore Medicare Advantage |
$13.60
|
| Rate for Payer: Cash Price |
$706.67
|
| Rate for Payer: Cash Price |
$706.67
|
| Rate for Payer: Central Health Plan Commercial |
$1,256.30
|
| Rate for Payer: Cigna of CA HMO |
$1,099.27
|
| Rate for Payer: Cigna of CA PPO |
$1,099.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.35
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.60
|
| Rate for Payer: Galaxy Health WC |
$1,334.82
|
| Rate for Payer: Global Benefits Group Commercial |
$942.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,413.34
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,177.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.30
|
| Rate for Payer: IEHP medi-cal |
$22.43
|
| Rate for Payer: IEHP Medicare Advantage |
$13.60
|
| Rate for Payer: Innovage PACE Commercial |
$20.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,047.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$314.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.22
|
| Rate for Payer: Multiplan Commercial |
$1,177.78
|
| Rate for Payer: Networks By Design Commercial |
$785.19
|
| Rate for Payer: Prime Health Services Commercial |
$1,334.82
|
| Rate for Payer: Prime Health Services Medicare |
$14.41
|
| Rate for Payer: Riverside University Health MISP |
$14.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$942.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$942.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$785.19
|
| Rate for Payer: United Healthcare All Other HMO |
$785.19
|
| Rate for Payer: United Healthcare HMO Rider |
$785.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$785.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.96
|
| Rate for Payer: Vantage Medical Group Senior |
$14.96
|
|
|
TAFASITAMAB-CXIX 200 MG INTRAVENOUS SOLUTION [228997]
|
Facility
IP
|
$1,570.38
|
|
|
Service Code
|
CPT J9349
|
| Hospital Charge Code |
ERX228997
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$314.08 |
| Max. Negotiated Rate |
$1,413.34 |
| Rate for Payer: Blue Shield of California Commercial |
$1,177.78
|
| Rate for Payer: Blue Shield of California EPN |
$838.58
|
| Rate for Payer: Cash Price |
$706.67
|
| Rate for Payer: Central Health Plan Commercial |
$1,256.30
|
| Rate for Payer: Cigna of CA HMO |
$1,099.27
|
| Rate for Payer: Cigna of CA PPO |
$1,099.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$628.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$628.15
|
| Rate for Payer: Galaxy Health WC |
$1,334.82
|
| Rate for Payer: Global Benefits Group Commercial |
$942.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,413.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,047.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$314.08
|
| Rate for Payer: Multiplan Commercial |
$1,177.78
|
| Rate for Payer: Networks By Design Commercial |
$785.19
|
| Rate for Payer: Prime Health Services Commercial |
$1,334.82
|
|
|
TALIMOGENE LAHERPAREPVEC 10EXP6 (1 MILLION) PFU/ML SUSP FOR INJECTION [211748]
|
Facility
IP
|
$76.04
|
|
|
Service Code
|
CPT J9325
|
| Hospital Charge Code |
NDG211748
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.21 |
| Max. Negotiated Rate |
$68.44 |
| Rate for Payer: Blue Shield of California Commercial |
$57.03
|
| Rate for Payer: Blue Shield of California EPN |
$40.61
|
| Rate for Payer: Cash Price |
$34.22
|
| Rate for Payer: Central Health Plan Commercial |
$60.83
|
| Rate for Payer: Cigna of CA HMO |
$53.23
|
| Rate for Payer: Cigna of CA PPO |
$53.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$30.42
|
| Rate for Payer: Galaxy Health WC |
$64.63
|
| Rate for Payer: Global Benefits Group Commercial |
$45.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.21
|
| Rate for Payer: Multiplan Commercial |
$57.03
|
| Rate for Payer: Networks By Design Commercial |
$38.02
|
| Rate for Payer: Prime Health Services Commercial |
$64.63
|
|
|
TALIMOGENE LAHERPAREPVEC 10EXP6 (1 MILLION) PFU/ML SUSP FOR INJECTION [211748]
|
Facility
OP
|
$76.04
|
|
|
Service Code
|
CPT J9325
|
| Hospital Charge Code |
NDG211748
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.21 |
| Max. Negotiated Rate |
$131.14 |
| Rate for Payer: Adventist Health Medi-Cal |
$66.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$83.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$73.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$73.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95.36
|
| Rate for Payer: BCBS Transplant Transplant |
$45.62
|
| Rate for Payer: Blue Shield of California Commercial |
$68.38
|
| Rate for Payer: Blue Shield of California EPN |
$62.16
|
| Rate for Payer: Caremore Medicare Advantage |
$66.59
|
| Rate for Payer: Cash Price |
$34.22
|
| Rate for Payer: Cash Price |
$34.22
|
| Rate for Payer: Central Health Plan Commercial |
$60.83
|
| Rate for Payer: Cigna of CA HMO |
$53.23
|
| Rate for Payer: Cigna of CA PPO |
$53.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$99.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$66.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$66.59
|
| Rate for Payer: Galaxy Health WC |
$64.63
|
| Rate for Payer: Global Benefits Group Commercial |
$45.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.44
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$57.03
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$109.20
|
| Rate for Payer: IEHP medi-cal |
$109.87
|
| Rate for Payer: IEHP Medicare Advantage |
$66.59
|
| Rate for Payer: Innovage PACE Commercial |
$99.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$66.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$89.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$89.23
|
| Rate for Payer: Multiplan Commercial |
$57.03
|
| Rate for Payer: Networks By Design Commercial |
$38.02
|
| Rate for Payer: Prime Health Services Commercial |
$64.63
|
| Rate for Payer: Prime Health Services Medicare |
$70.58
|
| Rate for Payer: Riverside University Health MISP |
$73.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.02
|
| Rate for Payer: United Healthcare All Other HMO |
$38.02
|
| Rate for Payer: United Healthcare HMO Rider |
$38.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$99.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.25
|
| Rate for Payer: Vantage Medical Group Senior |
$66.59
|
|
