|
TIMOLOL MALEATE 0.5 % EYE DROPS [11562]
|
Facility
IP
|
$2.33
|
|
|
Service Code
|
NDC 64980-514-05
|
| Hospital Charge Code |
1740181
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: Blue Shield of California Commercial |
$1.75
|
| Rate for Payer: Blue Shield of California EPN |
$1.24
|
| Rate for Payer: Cash Price |
$1.05
|
| Rate for Payer: Central Health Plan Commercial |
$1.86
|
| Rate for Payer: Cigna of CA HMO |
$1.63
|
| Rate for Payer: Cigna of CA PPO |
$1.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.93
|
| Rate for Payer: Galaxy Health WC |
$1.98
|
| Rate for Payer: Global Benefits Group Commercial |
$1.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.47
|
| Rate for Payer: Multiplan Commercial |
$1.75
|
| Rate for Payer: Networks By Design Commercial |
$1.51
|
| Rate for Payer: Prime Health Services Commercial |
$1.98
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS [11562]
|
Facility
OP
|
$2.32
|
|
|
Service Code
|
NDC 61314-227-05
|
| Hospital Charge Code |
1740181
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$2.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.37
|
| Rate for Payer: BCBS Transplant Transplant |
$1.39
|
| Rate for Payer: Blue Shield of California Commercial |
$1.46
|
| Rate for Payer: Blue Shield of California EPN |
$1.13
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: Central Health Plan Commercial |
$1.86
|
| Rate for Payer: Cigna of CA HMO |
$1.62
|
| Rate for Payer: Cigna of CA PPO |
$1.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.93
|
| Rate for Payer: Galaxy Health WC |
$1.97
|
| Rate for Payer: Global Benefits Group Commercial |
$1.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.09
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.74
|
| Rate for Payer: IEHP medi-cal |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.46
|
| Rate for Payer: Multiplan Commercial |
$1.74
|
| Rate for Payer: Networks By Design Commercial |
$1.51
|
| Rate for Payer: Prime Health Services Commercial |
$1.97
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.39
|
| Rate for Payer: Riverside University Health MISP |
$0.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.16
|
| Rate for Payer: United Healthcare All Other HMO |
$1.16
|
| Rate for Payer: United Healthcare HMO Rider |
$1.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.97
|
| Rate for Payer: Vantage Medical Group Senior |
$1.97
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS [11562]
|
Facility
IP
|
$1.31
|
|
|
Service Code
|
NDC 60758-801-05
|
| Hospital Charge Code |
1740181
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.18 |
| Rate for Payer: Blue Shield of California Commercial |
$0.98
|
| Rate for Payer: Blue Shield of California EPN |
$0.70
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Central Health Plan Commercial |
$1.05
|
| Rate for Payer: Cigna of CA HMO |
$0.92
|
| Rate for Payer: Cigna of CA PPO |
$0.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.98
|
| Rate for Payer: Networks By Design Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.11
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS [11562]
|
Facility
OP
|
$1.31
|
|
|
Service Code
|
NDC 60758-801-05
|
| Hospital Charge Code |
1740181
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.77
|
| Rate for Payer: BCBS Transplant Transplant |
$0.79
|
| Rate for Payer: Blue Shield of California Commercial |
$0.82
|
| Rate for Payer: Blue Shield of California EPN |
$0.64
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Central Health Plan Commercial |
$1.05
|
| Rate for Payer: Cigna of CA HMO |
$0.92
|
| Rate for Payer: Cigna of CA PPO |
$0.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.18
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.98
|
| Rate for Payer: IEHP medi-cal |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.98
|
| Rate for Payer: Networks By Design Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.11
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.79
|
| Rate for Payer: Riverside University Health MISP |
$0.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.66
|
| Rate for Payer: United Healthcare All Other HMO |
$0.66
|
| Rate for Payer: United Healthcare HMO Rider |
$0.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.11
|
| Rate for Payer: Vantage Medical Group Senior |
$1.11
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS [11562]
|
Facility
IP
|
$2.32
|
|
|
Service Code
|
NDC 61314-227-05
|
| Hospital Charge Code |
1740181
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$2.09 |
| Rate for Payer: Blue Shield of California Commercial |
$1.74
|
| Rate for Payer: Blue Shield of California EPN |
$1.24
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: Central Health Plan Commercial |
$1.86
|
| Rate for Payer: Cigna of CA HMO |
$1.62
|
| Rate for Payer: Cigna of CA PPO |
$1.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.93
|
| Rate for Payer: Galaxy Health WC |
$1.97
|
| Rate for Payer: Global Benefits Group Commercial |
$1.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.46
|
| Rate for Payer: Multiplan Commercial |
$1.74
|
| Rate for Payer: Networks By Design Commercial |
$1.51
|
| Rate for Payer: Prime Health Services Commercial |
$1.97
|
|
|
TIOTROPIUM BROMIDE 18 MCG CAPSULE WITH INHALATION DEVICE [38315]
|
Facility
IP
|
$24.34
|
|
|
Service Code
|
NDC 0597-0075-75
|
| Hospital Charge Code |
1744109
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$21.91 |
| Rate for Payer: Blue Shield of California Commercial |
$18.26
|
| Rate for Payer: Blue Shield of California EPN |
$13.00
|
| Rate for Payer: Cash Price |
$10.95
|
| Rate for Payer: Central Health Plan Commercial |
$19.47
|
| Rate for Payer: Cigna of CA HMO |
$17.04
|
| Rate for Payer: Cigna of CA PPO |
$17.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.74
|
| Rate for Payer: Galaxy Health WC |
$20.69
|
| Rate for Payer: Global Benefits Group Commercial |
$14.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.87
|
| Rate for Payer: Multiplan Commercial |
$18.26
|
| Rate for Payer: Networks By Design Commercial |
$15.82
|
| Rate for Payer: Prime Health Services Commercial |
$20.69
|
|
|
TIOTROPIUM BROMIDE 18 MCG CAPSULE WITH INHALATION DEVICE [38315]
|
Facility
OP
|
$24.34
|
|
|
Service Code
|
NDC 0597-0075-75
|
| Hospital Charge Code |
1744109
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$21.91 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.69
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.38
|
| Rate for Payer: BCBS Transplant Transplant |
$14.60
|
| Rate for Payer: Blue Shield of California Commercial |
$15.31
|
| Rate for Payer: Blue Shield of California EPN |
$11.90
|
| Rate for Payer: Cash Price |
$10.95
|
| Rate for Payer: Central Health Plan Commercial |
$19.47
|
| Rate for Payer: Cigna of CA HMO |
$17.04
|
| Rate for Payer: Cigna of CA PPO |
$17.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.74
|
| Rate for Payer: Galaxy Health WC |
$20.69
|
| Rate for Payer: Global Benefits Group Commercial |
$14.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.91
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$18.26
|
| Rate for Payer: IEHP medi-cal |
$8.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.87
|
| Rate for Payer: Multiplan Commercial |
$18.26
|
| Rate for Payer: Networks By Design Commercial |
$15.82
|
| Rate for Payer: Prime Health Services Commercial |
$20.69
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$14.60
|
| Rate for Payer: Riverside University Health MISP |
$9.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.17
|
| Rate for Payer: United Healthcare All Other HMO |
$12.17
|
| Rate for Payer: United Healthcare HMO Rider |
$12.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.69
|
| Rate for Payer: Vantage Medical Group Senior |
$20.69
|
|
|
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION MIST FOR INHALATION [207738]
|
Facility
IP
|
$22.50
|
|
|
Service Code
|
NDC 0597-0100-51
|
| Hospital Charge Code |
ERX207738
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$20.25 |
| Rate for Payer: Blue Shield of California Commercial |
$16.88
|
| Rate for Payer: Blue Shield of California EPN |
$12.02
|
| Rate for Payer: Cash Price |
$10.13
|
| Rate for Payer: Central Health Plan Commercial |
$18.00
|
| Rate for Payer: Cigna of CA HMO |
$15.75
|
| Rate for Payer: Cigna of CA PPO |
$15.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.00
|
| Rate for Payer: Galaxy Health WC |
$19.12
|
| Rate for Payer: Global Benefits Group Commercial |
$13.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$16.88
|
| Rate for Payer: Networks By Design Commercial |
$14.62
|
| Rate for Payer: Prime Health Services Commercial |
$19.12
|
|
|
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION MIST FOR INHALATION [207738]
|
Facility
OP
|
$22.50
|
|
|
Service Code
|
NDC 0597-0100-51
|
| Hospital Charge Code |
ERX207738
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$20.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.29
|
| Rate for Payer: BCBS Transplant Transplant |
$13.50
|
| Rate for Payer: Blue Shield of California Commercial |
$14.15
|
| Rate for Payer: Blue Shield of California EPN |
$11.00
|
| Rate for Payer: Cash Price |
$10.13
|
| Rate for Payer: Central Health Plan Commercial |
$18.00
|
| Rate for Payer: Cigna of CA HMO |
$15.75
|
| Rate for Payer: Cigna of CA PPO |
$15.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.00
|
| Rate for Payer: Galaxy Health WC |
$19.12
|
| Rate for Payer: Global Benefits Group Commercial |
$13.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.25
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$16.88
|
| Rate for Payer: IEHP medi-cal |
$7.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$16.88
|
| Rate for Payer: Networks By Design Commercial |
$14.62
|
| Rate for Payer: Prime Health Services Commercial |
$19.12
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$13.50
|
| Rate for Payer: Riverside University Health MISP |
$9.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.25
|
| Rate for Payer: United Healthcare All Other HMO |
$11.25
|
| Rate for Payer: United Healthcare HMO Rider |
$11.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.12
|
| Rate for Payer: Vantage Medical Group Senior |
$19.12
|
|
|
TIROFIBAN 12.5 MG/250 ML (50 MCG/ML)-0.9 % SODIUM CHLORIDE INTRAVENOUS [120194]
|
Facility
IP
|
$1.15
|
|
|
Service Code
|
CPT J3246
|
| Hospital Charge Code |
NDG120194
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Blue Shield of California Commercial |
$0.86
|
| Rate for Payer: Blue Shield of California EPN |
$0.61
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Central Health Plan Commercial |
$0.92
|
| Rate for Payer: Cigna of CA HMO |
$0.81
|
| Rate for Payer: Cigna of CA PPO |
$0.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.46
|
| Rate for Payer: Galaxy Health WC |
$0.98
|
| Rate for Payer: Global Benefits Group Commercial |
$0.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.86
|
| Rate for Payer: Networks By Design Commercial |
$0.58
|
| Rate for Payer: Prime Health Services Commercial |
$0.98
|
|
|
TIROFIBAN 12.5 MG/250 ML (50 MCG/ML)-0.9 % SODIUM CHLORIDE INTRAVENOUS [120194]
|
Facility
OP
|
$1.15
|
|
|
Service Code
|
CPT J3246
|
| Hospital Charge Code |
NDG120194
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$26.75 |
| Rate for Payer: Adventist Health Medi-Cal |
$4.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.83
|
| Rate for Payer: BCBS Transplant Transplant |
$0.69
|
| Rate for Payer: Blue Shield of California Commercial |
$4.93
|
| Rate for Payer: Blue Shield of California EPN |
$4.48
|
| Rate for Payer: Caremore Medicare Advantage |
$4.32
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Central Health Plan Commercial |
$0.92
|
| Rate for Payer: Cigna of CA HMO |
$0.81
|
| Rate for Payer: Cigna of CA PPO |
$0.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.32
|
| Rate for Payer: Galaxy Health WC |
$0.98
|
| Rate for Payer: Global Benefits Group Commercial |
$0.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.86
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.08
|
| Rate for Payer: IEHP medi-cal |
$7.13
|
| Rate for Payer: IEHP Medicare Advantage |
$4.32
|
| Rate for Payer: Innovage PACE Commercial |
$6.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.79
|
| Rate for Payer: Multiplan Commercial |
$0.86
|
| Rate for Payer: Networks By Design Commercial |
$0.58
|
| Rate for Payer: Prime Health Services Commercial |
$0.98
|
| Rate for Payer: Prime Health Services Medicare |
$4.58
|
| Rate for Payer: Riverside University Health MISP |
$4.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.58
|
| Rate for Payer: United Healthcare All Other HMO |
$0.58
|
| Rate for Payer: United Healthcare HMO Rider |
$0.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4.32
|
|
|
TIROFIBAN 5 MG/100 ML (50 MCG/ML)-0.9 % SODIUM CHLORIDE INTRAVENOUS [23050]
|
Facility
OP
|
$1.10
|
|
|
Service Code
|
CPT J3246
|
| Hospital Charge Code |
NDG23050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$26.75 |
| Rate for Payer: Adventist Health Medi-Cal |
$4.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.83
|
| Rate for Payer: BCBS Transplant Transplant |
$0.66
|
| Rate for Payer: Blue Shield of California Commercial |
$4.93
|
| Rate for Payer: Blue Shield of California EPN |
$4.48
|
| Rate for Payer: Caremore Medicare Advantage |
$4.32
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Central Health Plan Commercial |
$0.88
|
| Rate for Payer: Cigna of CA HMO |
$0.77
|
| Rate for Payer: Cigna of CA PPO |
$0.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.32
|
| Rate for Payer: Galaxy Health WC |
$0.94
|
| Rate for Payer: Global Benefits Group Commercial |
$0.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.99
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.83
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.08
|
| Rate for Payer: IEHP medi-cal |
$7.13
|
| Rate for Payer: IEHP Medicare Advantage |
$4.32
|
| Rate for Payer: Innovage PACE Commercial |
$6.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.79
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: Networks By Design Commercial |
$0.55
|
| Rate for Payer: Prime Health Services Commercial |
$0.94
|
| Rate for Payer: Prime Health Services Medicare |
$4.58
|
| Rate for Payer: Riverside University Health MISP |
$4.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.55
|
| Rate for Payer: United Healthcare All Other HMO |
$0.55
|
| Rate for Payer: United Healthcare HMO Rider |
$0.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4.32
|
|
|
TIROFIBAN 5 MG/100 ML (50 MCG/ML)-0.9 % SODIUM CHLORIDE INTRAVENOUS [23050]
|
Facility
IP
|
$1.10
|
|
|
Service Code
|
CPT J3246
|
| Hospital Charge Code |
NDG23050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Blue Shield of California Commercial |
$0.83
|
| Rate for Payer: Blue Shield of California EPN |
$0.59
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Central Health Plan Commercial |
$0.88
|
| Rate for Payer: Cigna of CA HMO |
$0.77
|
| Rate for Payer: Cigna of CA PPO |
$0.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.94
|
| Rate for Payer: Global Benefits Group Commercial |
$0.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.99
|
| 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: Multiplan Commercial |
$0.83
|
| Rate for Payer: Networks By Design Commercial |
$0.55
|
| Rate for Payer: Prime Health Services Commercial |
$0.94
|
|
|
TISOTUMAB VEDOTIN-TFTV 40 MG INTRAVENOUS SOLUTION [232793]
|
Facility
OP
|
$7,622.40
|
|
|
Service Code
|
NDC 51144-003-01
|
| Hospital Charge Code |
ERX232793
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,524.48 |
| Max. Negotiated Rate |
$6,860.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4,629.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,479.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,192.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,192.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,690.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,503.31
|
| Rate for Payer: BCBS Transplant Transplant |
$4,573.44
|
| Rate for Payer: Blue Shield of California Commercial |
$4,794.49
|
| Rate for Payer: Blue Shield of California EPN |
$3,727.35
|
| Rate for Payer: Cash Price |
$3,430.08
|
| Rate for Payer: Cash Price |
$3,430.08
|
| Rate for Payer: Central Health Plan Commercial |
$6,097.92
|
| Rate for Payer: Cigna of CA HMO |
$5,335.68
|
| Rate for Payer: Cigna of CA PPO |
$5,335.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,479.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,048.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,048.96
|
| Rate for Payer: Galaxy Health WC |
$6,479.04
|
| Rate for Payer: Global Benefits Group Commercial |
$4,573.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,860.16
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,716.80
|
| Rate for Payer: IEHP medi-cal |
$2,667.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,084.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,524.48
|
| Rate for Payer: Multiplan Commercial |
$5,716.80
|
| Rate for Payer: Networks By Design Commercial |
$3,811.20
|
| Rate for Payer: Prime Health Services Commercial |
$6,479.04
|
| Rate for Payer: Riverside University Health MISP |
$3,048.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,573.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,573.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,811.20
|
| Rate for Payer: United Healthcare All Other HMO |
$3,811.20
|
| Rate for Payer: United Healthcare HMO Rider |
$3,811.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,811.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,479.04
|
| Rate for Payer: Vantage Medical Group Senior |
$6,479.04
|
|
|
TISOTUMAB VEDOTIN-TFTV 40 MG INTRAVENOUS SOLUTION [232793]
|
Facility
IP
|
$7,622.40
|
|
|
Service Code
|
NDC 51144-003-01
|
| Hospital Charge Code |
ERX232793
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,524.48 |
| Max. Negotiated Rate |
$6,860.16 |
| Rate for Payer: Blue Shield of California Commercial |
$5,716.80
|
| Rate for Payer: Blue Shield of California EPN |
$4,070.36
|
| Rate for Payer: Cash Price |
$3,430.08
|
| Rate for Payer: Central Health Plan Commercial |
$6,097.92
|
| Rate for Payer: Cigna of CA HMO |
$5,335.68
|
| Rate for Payer: Cigna of CA PPO |
$5,335.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,048.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,048.96
|
| Rate for Payer: Galaxy Health WC |
$6,479.04
|
| Rate for Payer: Global Benefits Group Commercial |
$4,573.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,860.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,084.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,524.48
|
| Rate for Payer: Multiplan Commercial |
$5,716.80
|
| Rate for Payer: Networks By Design Commercial |
$3,811.20
|
| Rate for Payer: Prime Health Services Commercial |
$6,479.04
|
|
|
Tissue expander placement in breast reconstruction, including subsequent expansion(s)
|
Facility
OP
|
$36,328.73
|
|
|
Service Code
|
CPT 19357
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,755.97 |
| Max. Negotiated Rate |
$36,328.73 |
| Rate for Payer: Adventist Health Medi-Cal |
$22,017.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$33,026.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24,219.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22,017.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$30,100.95
|
| Rate for Payer: Blue Shield of California Commercial |
$6,621.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,755.97
|
| Rate for Payer: Caremore Medicare Advantage |
$22,017.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33,026.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,723.50
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22,017.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$22,017.41
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36,108.55
|
| Rate for Payer: IEHP medi-cal |
$36,328.73
|
| Rate for Payer: IEHP Medicare Advantage |
$22,017.41
|
| Rate for Payer: Innovage PACE Commercial |
$33,026.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,017.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,503.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,503.33
|
| Rate for Payer: Multiplan WC |
$30,100.95
|
| Rate for Payer: Preferred Health Network WC |
$30,715.26
|
| Rate for Payer: Prime Health Services Medicare |
$23,338.45
|
| Rate for Payer: Prime Health Services WC |
$29,793.80
|
| Rate for Payer: Riverside University Health MISP |
$24,219.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33,026.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,219.15
|
| Rate for Payer: Vantage Medical Group Senior |
$22,017.41
|
|
|
TIZANIDINE 2 MG TABLET [14792]
|
Facility
OP
|
$1.29
|
|
|
Service Code
|
NDC 68084-775-25
|
| Hospital Charge Code |
1712365
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.76
|
| Rate for Payer: BCBS Transplant Transplant |
$0.77
|
| Rate for Payer: Blue Shield of California Commercial |
$0.81
|
| Rate for Payer: Blue Shield of California EPN |
$0.63
|
| Rate for Payer: Cash Price |
$0.58
|
| Rate for Payer: Central Health Plan Commercial |
$1.03
|
| Rate for Payer: Cigna of CA HMO |
$0.90
|
| Rate for Payer: Cigna of CA PPO |
$0.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.16
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.97
|
| Rate for Payer: IEHP medi-cal |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.97
|
| Rate for Payer: Networks By Design Commercial |
$0.84
|
| Rate for Payer: Prime Health Services Commercial |
$1.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.77
|
| Rate for Payer: Riverside University Health MISP |
$0.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.65
|
| Rate for Payer: United Healthcare All Other HMO |
$0.65
|
| Rate for Payer: United Healthcare HMO Rider |
$0.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1.10
|
|
|
TIZANIDINE 2 MG TABLET [14792]
|
Facility
IP
|
$1.29
|
|
|
Service Code
|
NDC 68084-775-95
|
| Hospital Charge Code |
1712365
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Blue Shield of California Commercial |
$0.97
|
| Rate for Payer: Blue Shield of California EPN |
$0.69
|
| Rate for Payer: Cash Price |
$0.58
|
| Rate for Payer: Central Health Plan Commercial |
$1.03
|
| Rate for Payer: Cigna of CA HMO |
$0.90
|
| Rate for Payer: Cigna of CA PPO |
$0.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.97
|
| Rate for Payer: Networks By Design Commercial |
$0.84
|
| Rate for Payer: Prime Health Services Commercial |
$1.10
|
|
|
TIZANIDINE 2 MG TABLET [14792]
|
Facility
IP
|
$1.29
|
|
|
Service Code
|
NDC 68084-775-25
|
| Hospital Charge Code |
1712365
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Blue Shield of California Commercial |
$0.97
|
| Rate for Payer: Blue Shield of California EPN |
$0.69
|
| Rate for Payer: Cash Price |
$0.58
|
| Rate for Payer: Central Health Plan Commercial |
$1.03
|
| Rate for Payer: Cigna of CA HMO |
$0.90
|
| Rate for Payer: Cigna of CA PPO |
$0.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.97
|
| Rate for Payer: Networks By Design Commercial |
$0.84
|
| Rate for Payer: Prime Health Services Commercial |
$1.10
|
|
|
TIZANIDINE 2 MG TABLET [14792]
|
Facility
OP
|
$1.29
|
|
|
Service Code
|
NDC 68084-775-95
|
| Hospital Charge Code |
1712365
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.76
|
| Rate for Payer: BCBS Transplant Transplant |
$0.77
|
| Rate for Payer: Blue Shield of California Commercial |
$0.81
|
| Rate for Payer: Blue Shield of California EPN |
$0.63
|
| Rate for Payer: Cash Price |
$0.58
|
| Rate for Payer: Central Health Plan Commercial |
$1.03
|
| Rate for Payer: Cigna of CA HMO |
$0.90
|
| Rate for Payer: Cigna of CA PPO |
$0.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.16
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.97
|
| Rate for Payer: IEHP medi-cal |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.97
|
| Rate for Payer: Networks By Design Commercial |
$0.84
|
| Rate for Payer: Prime Health Services Commercial |
$1.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.77
|
| Rate for Payer: Riverside University Health MISP |
$0.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.65
|
| Rate for Payer: United Healthcare All Other HMO |
$0.65
|
| Rate for Payer: United Healthcare HMO Rider |
$0.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1.10
|
|
|
TIZANIDINE 2 MG TABLET [14792]
|
Facility
OP
|
$0.20
|
|
|
Service Code
|
NDC 60505-0251-3
|
| Hospital Charge Code |
1712365
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.12
|
| Rate for Payer: BCBS Transplant Transplant |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.14
|
| Rate for Payer: Cigna of CA PPO |
$0.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.17
|
| Rate for Payer: Global Benefits Group Commercial |
$0.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.18
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.15
|
| Rate for Payer: IEHP medi-cal |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Networks By Design Commercial |
$0.13
|
| Rate for Payer: Prime Health Services Commercial |
$0.17
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.12
|
| Rate for Payer: Riverside University Health MISP |
$0.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Vantage Medical Group Senior |
$0.17
|
|
|
TIZANIDINE 2 MG TABLET [14792]
|
Facility
IP
|
$0.20
|
|
|
Service Code
|
NDC 60505-0251-3
|
| Hospital Charge Code |
1712365
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.14
|
| Rate for Payer: Cigna of CA PPO |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.17
|
| Rate for Payer: Global Benefits Group Commercial |
$0.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Networks By Design Commercial |
$0.13
|
| Rate for Payer: Prime Health Services Commercial |
$0.17
|
|
|
TIZANIDINE 4 MG TABLET [14793]
|
Facility
OP
|
$0.79
|
|
|
Service Code
|
NDC 50268-760-11
|
| Hospital Charge Code |
1710900
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.67
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.47
|
| Rate for Payer: BCBS Transplant Transplant |
$0.47
|
| Rate for Payer: Blue Shield of California Commercial |
$0.50
|
| Rate for Payer: Blue Shield of California EPN |
$0.39
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Central Health Plan Commercial |
$0.63
|
| Rate for Payer: Cigna of CA HMO |
$0.55
|
| Rate for Payer: Cigna of CA PPO |
$0.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.67
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.71
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.59
|
| Rate for Payer: IEHP medi-cal |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: Networks By Design Commercial |
$0.51
|
| Rate for Payer: Prime Health Services Commercial |
$0.67
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.47
|
| Rate for Payer: Riverside University Health MISP |
$0.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO |
$0.40
|
| Rate for Payer: United Healthcare HMO Rider |
$0.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.67
|
| Rate for Payer: Vantage Medical Group Senior |
$0.67
|
|
|
TIZANIDINE 4 MG TABLET [14793]
|
Facility
OP
|
$0.63
|
|
|
Service Code
|
NDC 0904-6418-61
|
| Hospital Charge Code |
1710900
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.37
|
| Rate for Payer: BCBS Transplant Transplant |
$0.38
|
| Rate for Payer: Blue Shield of California Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Central Health Plan Commercial |
$0.50
|
| Rate for Payer: Cigna of CA HMO |
$0.44
|
| Rate for Payer: Cigna of CA PPO |
$0.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.25
|
| Rate for Payer: Galaxy Health WC |
$0.54
|
| Rate for Payer: Global Benefits Group Commercial |
$0.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.57
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.47
|
| Rate for Payer: IEHP medi-cal |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.47
|
| Rate for Payer: Networks By Design Commercial |
$0.41
|
| Rate for Payer: Prime Health Services Commercial |
$0.54
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.38
|
| Rate for Payer: Riverside University Health MISP |
$0.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.32
|
| Rate for Payer: United Healthcare All Other HMO |
$0.32
|
| Rate for Payer: United Healthcare HMO Rider |
$0.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.54
|
| Rate for Payer: Vantage Medical Group Senior |
$0.54
|
|
|
TIZANIDINE 4 MG TABLET [14793]
|
Facility
OP
|
$0.12
|
|
|
Service Code
|
NDC 29300-169-15
|
| Hospital Charge Code |
1710900
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.07
|
| Rate for Payer: BCBS Transplant Transplant |
$0.07
|
| 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 |
$0.10
|
| 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 |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.11
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.09
|
| Rate for Payer: IEHP medi-cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: Riverside University Health MISP |
$0.05
|
| 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 |
$0.10
|
| Rate for Payer: Vantage Medical Group Senior |
$0.10
|
|
