|
TAPENTADOL 50 MG TABLET [98253]
|
Facility
IP
|
$11.56
|
|
|
Service Code
|
NDC 24510-050-10
|
| Hospital Charge Code |
1730175
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.31 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: Blue Shield of California Commercial |
$8.67
|
| Rate for Payer: Blue Shield of California EPN |
$6.17
|
| Rate for Payer: Cash Price |
$5.20
|
| Rate for Payer: Central Health Plan Commercial |
$9.25
|
| Rate for Payer: Cigna of CA HMO |
$8.09
|
| Rate for Payer: Cigna of CA PPO |
$8.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.62
|
| Rate for Payer: Galaxy Health WC |
$9.83
|
| Rate for Payer: Global Benefits Group Commercial |
$6.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.31
|
| Rate for Payer: Multiplan Commercial |
$8.67
|
| Rate for Payer: Networks By Design Commercial |
$7.51
|
| Rate for Payer: Prime Health Services Commercial |
$9.83
|
|
|
Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.0 sq cm or less
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 11920
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$784.71 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$784.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$784.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$784.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.71
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,286.92
|
| Rate for Payer: IEHP medi-cal |
$1,294.77
|
| Rate for Payer: IEHP Medicare Advantage |
$784.71
|
| Rate for Payer: Innovage PACE Commercial |
$1,177.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,051.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.51
|
| Rate for Payer: Prime Health Services Medicare |
$831.79
|
| Rate for Payer: Riverside University Health MISP |
$863.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Vantage Medical Group Senior |
$784.71
|
|
|
TAZEMETOSTAT 200 MG TABLET [226994]
|
Facility
OP
|
$88.73
|
|
|
Service Code
|
NDC 72607-100-00
|
| Hospital Charge Code |
ERX226994
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.75 |
| Max. Negotiated Rate |
$79.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$53.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$75.42
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$48.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$48.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$42.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.42
|
| Rate for Payer: BCBS Transplant Transplant |
$53.24
|
| Rate for Payer: Blue Shield of California Commercial |
$55.81
|
| Rate for Payer: Blue Shield of California EPN |
$43.39
|
| Rate for Payer: Cash Price |
$39.93
|
| Rate for Payer: Central Health Plan Commercial |
$70.98
|
| Rate for Payer: Cigna of CA HMO |
$62.11
|
| Rate for Payer: Cigna of CA PPO |
$62.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$35.49
|
| Rate for Payer: Galaxy Health WC |
$75.42
|
| Rate for Payer: Global Benefits Group Commercial |
$53.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.86
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$66.55
|
| Rate for Payer: IEHP medi-cal |
$31.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.75
|
| Rate for Payer: Multiplan Commercial |
$66.55
|
| Rate for Payer: Networks By Design Commercial |
$57.67
|
| Rate for Payer: Prime Health Services Commercial |
$75.42
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$53.24
|
| Rate for Payer: Riverside University Health MISP |
$35.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$53.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$44.36
|
| Rate for Payer: United Healthcare All Other HMO |
$44.36
|
| Rate for Payer: United Healthcare HMO Rider |
$44.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$75.42
|
| Rate for Payer: Vantage Medical Group Senior |
$75.42
|
|
|
TAZEMETOSTAT 200 MG TABLET [226994]
|
Facility
IP
|
$88.73
|
|
|
Service Code
|
NDC 72607-100-00
|
| Hospital Charge Code |
ERX226994
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.75 |
| Max. Negotiated Rate |
$79.86 |
| Rate for Payer: Blue Shield of California Commercial |
$66.55
|
| Rate for Payer: Blue Shield of California EPN |
$47.38
|
| Rate for Payer: Cash Price |
$39.93
|
| Rate for Payer: Central Health Plan Commercial |
$70.98
|
| Rate for Payer: Cigna of CA HMO |
$62.11
|
| Rate for Payer: Cigna of CA PPO |
$62.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.49
|
| Rate for Payer: Galaxy Health WC |
$75.42
|
| Rate for Payer: Global Benefits Group Commercial |
$53.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.75
|
| Rate for Payer: Multiplan Commercial |
$66.55
|
| Rate for Payer: Networks By Design Commercial |
$57.67
|
| Rate for Payer: Prime Health Services Commercial |
$75.42
|
|
|
TEBENTAFUSP-TEBN 100 MCG/0.5 ML INTRAVENOUS SOLUTION [233477]
|
Facility
OP
|
$47,304.00
|
|
|
Service Code
|
CPT J9274
|
| Hospital Charge Code |
NDG233477
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$208.93 |
| Max. Negotiated Rate |
$42,573.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$208.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,294.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$261.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$229.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$229.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$371.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$406.46
|
| Rate for Payer: BCBS Transplant Transplant |
$28,382.40
|
| Rate for Payer: Blue Shield of California Commercial |
$29,754.22
|
| Rate for Payer: Blue Shield of California EPN |
$23,131.66
|
| Rate for Payer: Caremore Medicare Advantage |
$208.93
|
| Rate for Payer: Cash Price |
$21,286.80
|
| Rate for Payer: Cash Price |
$21,286.80
|
| Rate for Payer: Central Health Plan Commercial |
$37,843.20
|
| Rate for Payer: Cigna of CA HMO |
$33,112.80
|
| Rate for Payer: Cigna of CA PPO |
$33,112.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$261.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$208.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$208.93
|
| Rate for Payer: Galaxy Health WC |
$40,208.40
|
| Rate for Payer: Global Benefits Group Commercial |
$28,382.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$42,573.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$35,478.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$342.64
|
| Rate for Payer: IEHP medi-cal |
$344.73
|
| Rate for Payer: IEHP Medicare Advantage |
$208.93
|
| Rate for Payer: Innovage PACE Commercial |
$313.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31,551.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$208.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,460.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$279.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$279.96
|
| Rate for Payer: Multiplan Commercial |
$35,478.00
|
| Rate for Payer: Networks By Design Commercial |
$23,652.00
|
| Rate for Payer: Prime Health Services Commercial |
$40,208.40
|
| Rate for Payer: Prime Health Services Medicare |
$221.46
|
| Rate for Payer: Riverside University Health MISP |
$229.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28,382.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28,382.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$23,652.00
|
| Rate for Payer: United Healthcare All Other HMO |
$23,652.00
|
| Rate for Payer: United Healthcare HMO Rider |
$23,652.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23,652.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$261.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.82
|
| Rate for Payer: Vantage Medical Group Senior |
$229.82
|
|
|
TEBENTAFUSP-TEBN 100 MCG/0.5 ML INTRAVENOUS SOLUTION [233477]
|
Facility
IP
|
$47,304.00
|
|
|
Service Code
|
CPT J9274
|
| Hospital Charge Code |
NDG233477
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,460.80 |
| Max. Negotiated Rate |
$42,573.60 |
| Rate for Payer: Blue Shield of California Commercial |
$35,478.00
|
| Rate for Payer: Blue Shield of California EPN |
$25,260.34
|
| Rate for Payer: Cash Price |
$21,286.80
|
| Rate for Payer: Central Health Plan Commercial |
$37,843.20
|
| Rate for Payer: Cigna of CA HMO |
$33,112.80
|
| Rate for Payer: Cigna of CA PPO |
$33,112.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,921.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$18,921.60
|
| Rate for Payer: Galaxy Health WC |
$40,208.40
|
| Rate for Payer: Global Benefits Group Commercial |
$28,382.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$42,573.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31,551.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,460.80
|
| Rate for Payer: Multiplan Commercial |
$35,478.00
|
| Rate for Payer: Networks By Design Commercial |
$23,652.00
|
| Rate for Payer: Prime Health Services Commercial |
$40,208.40
|
|
|
TECLISTAMAB-CQYV 10 MG/ML SUBCUTANEOUS SOLUTION [236039]
|
Facility
OP
|
$708.00
|
|
|
Service Code
|
CPT J9380
|
| Hospital Charge Code |
NDG236039
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.85 |
| Max. Negotiated Rate |
$637.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$30.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$191.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$38.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$33.93
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$33.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$342.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$418.29
|
| Rate for Payer: BCBS Transplant Transplant |
$424.80
|
| Rate for Payer: Blue Shield of California Commercial |
$445.33
|
| Rate for Payer: Blue Shield of California EPN |
$346.21
|
| Rate for Payer: Caremore Medicare Advantage |
$30.85
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Central Health Plan Commercial |
$566.40
|
| Rate for Payer: Cigna of CA HMO |
$495.60
|
| Rate for Payer: Cigna of CA PPO |
$495.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.64
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$30.85
|
| Rate for Payer: EPIC Health Plan Transplant |
$30.85
|
| Rate for Payer: Galaxy Health WC |
$601.80
|
| Rate for Payer: Global Benefits Group Commercial |
$424.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$637.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$531.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$50.59
|
| Rate for Payer: IEHP medi-cal |
$50.90
|
| Rate for Payer: IEHP Medicare Advantage |
$30.85
|
| Rate for Payer: Innovage PACE Commercial |
$46.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$472.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.33
|
| Rate for Payer: Multiplan Commercial |
$531.00
|
| Rate for Payer: Networks By Design Commercial |
$354.00
|
| Rate for Payer: Prime Health Services Commercial |
$601.80
|
| Rate for Payer: Prime Health Services Medicare |
$32.70
|
| Rate for Payer: Riverside University Health MISP |
$33.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$424.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$424.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$354.00
|
| Rate for Payer: United Healthcare All Other HMO |
$354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$354.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$354.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.93
|
| Rate for Payer: Vantage Medical Group Senior |
$33.93
|
|
|
TECLISTAMAB-CQYV 10 MG/ML SUBCUTANEOUS SOLUTION [236039]
|
Facility
IP
|
$708.00
|
|
|
Service Code
|
CPT J9380
|
| Hospital Charge Code |
NDG236039
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$141.60 |
| Max. Negotiated Rate |
$637.20 |
| Rate for Payer: Blue Shield of California Commercial |
$531.00
|
| Rate for Payer: Blue Shield of California EPN |
$378.07
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Central Health Plan Commercial |
$566.40
|
| Rate for Payer: Cigna of CA HMO |
$495.60
|
| Rate for Payer: Cigna of CA PPO |
$495.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$283.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$283.20
|
| Rate for Payer: Galaxy Health WC |
$601.80
|
| Rate for Payer: Global Benefits Group Commercial |
$424.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$637.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$472.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.60
|
| Rate for Payer: Multiplan Commercial |
$531.00
|
| Rate for Payer: Networks By Design Commercial |
$354.00
|
| Rate for Payer: Prime Health Services Commercial |
$601.80
|
|
|
TECLISTAMAB-CQYV 90 MG/ML SUBCUTANEOUS SOLUTION [236038]
|
Facility
IP
|
$6,372.00
|
|
|
Service Code
|
CPT J9380
|
| Hospital Charge Code |
NDG236038
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,274.40 |
| Max. Negotiated Rate |
$5,734.80 |
| Rate for Payer: Blue Shield of California Commercial |
$4,779.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,402.65
|
| Rate for Payer: Cash Price |
$2,867.40
|
| Rate for Payer: Central Health Plan Commercial |
$5,097.60
|
| Rate for Payer: Cigna of CA HMO |
$4,460.40
|
| Rate for Payer: Cigna of CA PPO |
$4,460.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,548.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,548.80
|
| Rate for Payer: Galaxy Health WC |
$5,416.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,823.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,734.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,250.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,274.40
|
| Rate for Payer: Multiplan Commercial |
$4,779.00
|
| Rate for Payer: Networks By Design Commercial |
$3,186.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,416.20
|
|
|
TECLISTAMAB-CQYV 90 MG/ML SUBCUTANEOUS SOLUTION [236038]
|
Facility
OP
|
$6,372.00
|
|
|
Service Code
|
CPT J9380
|
| Hospital Charge Code |
NDG236038
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.85 |
| Max. Negotiated Rate |
$5,734.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$30.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$191.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$38.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$33.93
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$33.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,085.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,764.58
|
| Rate for Payer: BCBS Transplant Transplant |
$3,823.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,007.99
|
| Rate for Payer: Blue Shield of California EPN |
$3,115.91
|
| Rate for Payer: Caremore Medicare Advantage |
$30.85
|
| Rate for Payer: Cash Price |
$2,867.40
|
| Rate for Payer: Cash Price |
$2,867.40
|
| Rate for Payer: Central Health Plan Commercial |
$5,097.60
|
| Rate for Payer: Cigna of CA HMO |
$4,460.40
|
| Rate for Payer: Cigna of CA PPO |
$4,460.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.64
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$30.85
|
| Rate for Payer: EPIC Health Plan Transplant |
$30.85
|
| Rate for Payer: Galaxy Health WC |
$5,416.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,823.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,734.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,779.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$50.59
|
| Rate for Payer: IEHP medi-cal |
$50.90
|
| Rate for Payer: IEHP Medicare Advantage |
$30.85
|
| Rate for Payer: Innovage PACE Commercial |
$46.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,250.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,274.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.33
|
| Rate for Payer: Multiplan Commercial |
$4,779.00
|
| Rate for Payer: Networks By Design Commercial |
$3,186.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,416.20
|
| Rate for Payer: Prime Health Services Medicare |
$32.70
|
| Rate for Payer: Riverside University Health MISP |
$33.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,823.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,823.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,186.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,186.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,186.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,186.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.93
|
| Rate for Payer: Vantage Medical Group Senior |
$33.93
|
|
|
TEDIZOLID 200 MG INTRAVENOUS SOLUTION [206225]
|
Facility
IP
|
$369.29
|
|
|
Service Code
|
CPT J3090
|
| Hospital Charge Code |
ERX206225
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.86 |
| Max. Negotiated Rate |
$332.36 |
| Rate for Payer: Blue Shield of California Commercial |
$276.97
|
| Rate for Payer: Blue Shield of California EPN |
$197.20
|
| Rate for Payer: Cash Price |
$166.18
|
| Rate for Payer: Central Health Plan Commercial |
$295.43
|
| Rate for Payer: Cigna of CA HMO |
$258.50
|
| Rate for Payer: Cigna of CA PPO |
$258.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$147.72
|
| Rate for Payer: Galaxy Health WC |
$313.90
|
| Rate for Payer: Global Benefits Group Commercial |
$221.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$332.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$246.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.86
|
| Rate for Payer: Multiplan Commercial |
$276.97
|
| Rate for Payer: Networks By Design Commercial |
$184.64
|
| Rate for Payer: Prime Health Services Commercial |
$313.90
|
|
|
TEDIZOLID 200 MG INTRAVENOUS SOLUTION [206225]
|
Facility
OP
|
$369.29
|
|
|
Service Code
|
CPT J3090
|
| Hospital Charge Code |
ERX206225
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$332.36 |
| Rate for Payer: Adventist Health Medi-Cal |
$1.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.53
|
| Rate for Payer: BCBS Transplant Transplant |
$221.57
|
| Rate for Payer: Blue Shield of California Commercial |
$2.04
|
| Rate for Payer: Blue Shield of California EPN |
$1.85
|
| Rate for Payer: Caremore Medicare Advantage |
$1.78
|
| Rate for Payer: Cash Price |
$166.18
|
| Rate for Payer: Cash Price |
$166.18
|
| Rate for Payer: Central Health Plan Commercial |
$295.43
|
| Rate for Payer: Cigna of CA HMO |
$258.50
|
| Rate for Payer: Cigna of CA PPO |
$258.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.78
|
| Rate for Payer: Galaxy Health WC |
$313.90
|
| Rate for Payer: Global Benefits Group Commercial |
$221.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$332.36
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$276.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2.92
|
| Rate for Payer: IEHP medi-cal |
$2.94
|
| Rate for Payer: IEHP Medicare Advantage |
$1.78
|
| Rate for Payer: Innovage PACE Commercial |
$2.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$246.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.39
|
| Rate for Payer: Multiplan Commercial |
$276.97
|
| Rate for Payer: Networks By Design Commercial |
$184.64
|
| Rate for Payer: Prime Health Services Commercial |
$313.90
|
| Rate for Payer: Prime Health Services Medicare |
$1.89
|
| Rate for Payer: Riverside University Health MISP |
$1.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$221.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$221.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$184.64
|
| Rate for Payer: United Healthcare All Other HMO |
$184.64
|
| Rate for Payer: United Healthcare HMO Rider |
$184.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$184.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.96
|
| Rate for Payer: Vantage Medical Group Senior |
$1.78
|
|
|
TELMISARTAN 40 MG TABLET [24335]
|
Facility
IP
|
$5.61
|
|
|
Service Code
|
NDC 0597-0040-37
|
| Hospital Charge Code |
1710970
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$5.05 |
| Rate for Payer: Blue Shield of California Commercial |
$4.21
|
| Rate for Payer: Blue Shield of California EPN |
$3.00
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Central Health Plan Commercial |
$4.49
|
| Rate for Payer: Cigna of CA HMO |
$3.93
|
| Rate for Payer: Cigna of CA PPO |
$3.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.24
|
| Rate for Payer: Galaxy Health WC |
$4.77
|
| Rate for Payer: Global Benefits Group Commercial |
$3.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: Multiplan Commercial |
$4.21
|
| Rate for Payer: Networks By Design Commercial |
$3.65
|
| Rate for Payer: Prime Health Services Commercial |
$4.77
|
|
|
TELMISARTAN 40 MG TABLET [24335]
|
Facility
OP
|
$5.61
|
|
|
Service Code
|
NDC 0597-0040-37
|
| Hospital Charge Code |
1710970
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$5.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.31
|
| Rate for Payer: BCBS Transplant Transplant |
$3.37
|
| Rate for Payer: Blue Shield of California Commercial |
$3.53
|
| Rate for Payer: Blue Shield of California EPN |
$2.74
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Central Health Plan Commercial |
$4.49
|
| Rate for Payer: Cigna of CA HMO |
$3.93
|
| Rate for Payer: Cigna of CA PPO |
$3.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.24
|
| Rate for Payer: Galaxy Health WC |
$4.77
|
| Rate for Payer: Global Benefits Group Commercial |
$3.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.05
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.21
|
| Rate for Payer: IEHP medi-cal |
$1.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: Multiplan Commercial |
$4.21
|
| Rate for Payer: Networks By Design Commercial |
$3.65
|
| Rate for Payer: Prime Health Services Commercial |
$4.77
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.37
|
| Rate for Payer: Riverside University Health MISP |
$2.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.80
|
| Rate for Payer: United Healthcare All Other HMO |
$2.80
|
| Rate for Payer: United Healthcare HMO Rider |
$2.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.77
|
| Rate for Payer: Vantage Medical Group Senior |
$4.77
|
|
|
TELMISARTAN 80 MG TABLET [24336]
|
Facility
OP
|
$5.61
|
|
|
Service Code
|
NDC 0597-0041-37
|
| Hospital Charge Code |
1710961
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$5.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.31
|
| Rate for Payer: BCBS Transplant Transplant |
$3.37
|
| Rate for Payer: Blue Shield of California Commercial |
$3.53
|
| Rate for Payer: Blue Shield of California EPN |
$2.74
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Central Health Plan Commercial |
$4.49
|
| Rate for Payer: Cigna of CA HMO |
$3.93
|
| Rate for Payer: Cigna of CA PPO |
$3.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.24
|
| Rate for Payer: Galaxy Health WC |
$4.77
|
| Rate for Payer: Global Benefits Group Commercial |
$3.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.05
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.21
|
| Rate for Payer: IEHP medi-cal |
$1.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: Multiplan Commercial |
$4.21
|
| Rate for Payer: Networks By Design Commercial |
$3.65
|
| Rate for Payer: Prime Health Services Commercial |
$4.77
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.37
|
| Rate for Payer: Riverside University Health MISP |
$2.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.80
|
| Rate for Payer: United Healthcare All Other HMO |
$2.80
|
| Rate for Payer: United Healthcare HMO Rider |
$2.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.77
|
| Rate for Payer: Vantage Medical Group Senior |
$4.77
|
|
|
TELMISARTAN 80 MG TABLET [24336]
|
Facility
IP
|
$5.61
|
|
|
Service Code
|
NDC 0597-0041-37
|
| Hospital Charge Code |
1710961
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$5.05 |
| Rate for Payer: Blue Shield of California Commercial |
$4.21
|
| Rate for Payer: Blue Shield of California EPN |
$3.00
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Central Health Plan Commercial |
$4.49
|
| Rate for Payer: Cigna of CA HMO |
$3.93
|
| Rate for Payer: Cigna of CA PPO |
$3.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.24
|
| Rate for Payer: Galaxy Health WC |
$4.77
|
| Rate for Payer: Global Benefits Group Commercial |
$3.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: Multiplan Commercial |
$4.21
|
| Rate for Payer: Networks By Design Commercial |
$3.65
|
| Rate for Payer: Prime Health Services Commercial |
$4.77
|
|
|
TEMAZEPAM 15 MG CAPSULE [7753]
|
Facility
OP
|
$0.11
|
|
|
Service Code
|
NDC 67877-146-05
|
| Hospital Charge Code |
1730140
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: BCBS Transplant Transplant |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.08
|
| Rate for Payer: IEHP medi-cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: Riverside University Health MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
TEMAZEPAM 15 MG CAPSULE [7753]
|
Facility
OP
|
$0.11
|
|
|
Service Code
|
NDC 67877-146-01
|
| Hospital Charge Code |
1730140
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: BCBS Transplant Transplant |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.08
|
| Rate for Payer: IEHP medi-cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: Riverside University Health MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
TEMAZEPAM 15 MG CAPSULE [7753]
|
Facility
IP
|
$0.11
|
|
|
Service Code
|
NDC 0228-2076-10
|
| Hospital Charge Code |
1730140
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
TEMAZEPAM 15 MG CAPSULE [7753]
|
Facility
IP
|
$0.14
|
|
|
Service Code
|
NDC 65162-556-10
|
| Hospital Charge Code |
1730140
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
|
|
TEMAZEPAM 15 MG CAPSULE [7753]
|
Facility
IP
|
$0.11
|
|
|
Service Code
|
NDC 67877-146-05
|
| Hospital Charge Code |
1730140
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
TEMAZEPAM 15 MG CAPSULE [7753]
|
Facility
OP
|
$0.11
|
|
|
Service Code
|
NDC 0228-2076-10
|
| Hospital Charge Code |
1730140
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: BCBS Transplant Transplant |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.08
|
| Rate for Payer: IEHP medi-cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: Riverside University Health MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
TEMAZEPAM 15 MG CAPSULE [7753]
|
Facility
OP
|
$0.14
|
|
|
Service Code
|
NDC 65162-556-10
|
| Hospital Charge Code |
1730140
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: BCBS Transplant Transplant |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.13
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.11
|
| Rate for Payer: IEHP medi-cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: Riverside University Health MISP |
$0.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.12
|
|
|
TEMAZEPAM 15 MG CAPSULE [7753]
|
Facility
IP
|
$0.11
|
|
|
Service Code
|
NDC 67877-146-01
|
| Hospital Charge Code |
1730140
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
TEMAZEPAM 30 MG CAPSULE [7754]
|
Facility
IP
|
$0.14
|
|
|
Service Code
|
NDC 0378-5050-01
|
| Hospital Charge Code |
1730141
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
|
