|
TACROLIMUS 5 MG CAPSULE, IMMEDIATE-RELEASE [12934]
|
Facility
|
IP
|
$45.73
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.28 |
| Max. Negotiated Rate |
$34.30 |
| Rate for Payer: Adventist Health Commercial |
$9.15
|
| Rate for Payer: Adventist Health Commercial |
$0.70
|
| Rate for Payer: Adventist Health Commercial |
$1.08
|
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.48
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Cash Price |
$20.58
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$21.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.17
|
| Rate for Payer: Heritage Provider Network Senior |
$21.17
|
| Rate for Payer: Heritage Provider Network Senior |
$0.56
|
| Rate for Payer: Heritage Provider Network Senior |
$1.62
|
| Rate for Payer: Heritage Provider Network Senior |
$2.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$34.30
|
| Rate for Payer: Multiplan Commercial |
$2.62
|
| Rate for Payer: Multiplan Commercial |
$4.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.79
|
|
|
TACROLIMUS 5 MG CAPSULE, IMMEDIATE-RELEASE [12934]
|
Facility
|
OP
|
$45.73
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$38.87 |
| Rate for Payer: Adventist Health Commercial |
$9.15
|
| Rate for Payer: Adventist Health Commercial |
$0.70
|
| Rate for Payer: Adventist Health Commercial |
$1.08
|
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.27
|
| Rate for Payer: Blue Shield of California Commercial |
$0.74
|
| Rate for Payer: Blue Shield of California Commercial |
$0.74
|
| Rate for Payer: Blue Shield of California Commercial |
$0.74
|
| Rate for Payer: Blue Shield of California Commercial |
$0.74
|
| Rate for Payer: Blue Shield of California EPN |
$0.74
|
| Rate for Payer: Blue Shield of California EPN |
$0.74
|
| Rate for Payer: Blue Shield of California EPN |
$0.74
|
| Rate for Payer: Blue Shield of California EPN |
$0.74
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$20.58
|
| Rate for Payer: Cash Price |
$20.58
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$21.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.56
|
| Rate for Payer: Heritage Provider Network Senior |
$21.17
|
| Rate for Payer: Heritage Provider Network Senior |
$1.62
|
| Rate for Payer: Heritage Provider Network Senior |
$2.50
|
| Rate for Payer: Heritage Provider Network Senior |
$0.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$21.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.78
|
| Rate for Payer: Multiplan Commercial |
$4.05
|
| Rate for Payer: Multiplan Commercial |
$34.30
|
| Rate for Payer: Multiplan Commercial |
$2.62
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.48
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.29
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.16
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.40
|
| Rate for Payer: TriValley Medical Group Senior |
$1.40
|
| Rate for Payer: TriValley Medical Group Senior |
$2.16
|
| Rate for Payer: TriValley Medical Group Senior |
$18.29
|
| Rate for Payer: TriValley Medical Group Senior |
$0.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: Vantage Medical Group Senior |
$38.87
|
| Rate for Payer: Vantage Medical Group Senior |
$2.98
|
| Rate for Payer: Vantage Medical Group Senior |
$4.59
|
| Rate for Payer: Vantage Medical Group Senior |
$1.02
|
|
|
TACROLIMUS 5 MG/ML INTRAVENOUS SOLUTION [12935]
|
Facility
|
IP
|
$315.21
|
|
|
Service Code
|
HCPCS J7525
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.05 |
| Max. Negotiated Rate |
$236.41 |
| Rate for Payer: Adventist Health Commercial |
$63.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$203.00
|
| Rate for Payer: Cash Price |
$141.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$145.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$145.94
|
| Rate for Payer: Heritage Provider Network Senior |
$145.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.80
|
| Rate for Payer: Multiplan Commercial |
$236.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$113.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$104.37
|
|
|
TACROLIMUS 5 MG/ML INTRAVENOUS SOLUTION [12935]
|
Facility
|
OP
|
$315.21
|
|
|
Service Code
|
HCPCS J7525
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.05 |
| Max. Negotiated Rate |
$402.27 |
| Rate for Payer: Adventist Health Commercial |
$63.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$194.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$402.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$295.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$268.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$267.42
|
| Rate for Payer: Blue Shield of California Commercial |
$252.55
|
| Rate for Payer: Blue Shield of California EPN |
$252.55
|
| Rate for Payer: Cash Price |
$141.84
|
| Rate for Payer: Cash Price |
$141.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$145.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$335.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$295.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$295.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.73
|
| Rate for Payer: EPIC Health Plan Medicare |
$268.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$145.94
|
| Rate for Payer: Heritage Provider Network Senior |
$145.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$268.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$150.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$308.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$359.36
|
| Rate for Payer: Multiplan Commercial |
$236.41
|
| Rate for Payer: TriValley Medical Group Commercial |
$126.08
|
| Rate for Payer: TriValley Medical Group Senior |
$126.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$113.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$104.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$335.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$295.00
|
| Rate for Payer: Vantage Medical Group Senior |
$295.00
|
|
|
TACROLIMUS ORAL SUSPENSION COMPOUND 0.5 MG/ML [4080345]
|
Facility
|
OP
|
$2.61
|
|
|
Service Code
|
NDC 9994080345
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.31
|
| Rate for Payer: Blue Shield of California Commercial |
$1.59
|
| Rate for Payer: Blue Shield of California EPN |
$1.27
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.83
|
| Rate for Payer: Multiplan Commercial |
$1.96
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.04
|
| Rate for Payer: TriValley Medical Group Senior |
$1.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.22
|
| Rate for Payer: Vantage Medical Group Senior |
$2.22
|
|
|
TACROLIMUS ORAL SUSPENSION COMPOUND 0.5 MG/ML [4080345]
|
Facility
|
IP
|
$2.61
|
|
|
Service Code
|
NDC 9994080345
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$1.96 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.68
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.77
|
| Rate for Payer: Heritage Provider Network Senior |
$1.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.65
|
| Rate for Payer: Multiplan Commercial |
$1.96
|
|
|
TACROLIMUS XR 0.75 MG TABLET,EXTENDED RELEASE 24 HR [211104]
|
Facility
|
IP
|
$6.54
|
|
|
Service Code
|
HCPCS J7508
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$4.91 |
| Rate for Payer: Adventist Health Commercial |
$1.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.21
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.03
|
| Rate for Payer: Heritage Provider Network Senior |
$3.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.64
|
| Rate for Payer: Multiplan Commercial |
$4.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.17
|
|
|
TACROLIMUS XR 0.75 MG TABLET,EXTENDED RELEASE 24 HR [211104]
|
Facility
|
OP
|
$6.54
|
|
|
Service Code
|
HCPCS J7508
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$5.56 |
| Rate for Payer: Adventist Health Commercial |
$1.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.94
|
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California EPN |
$0.57
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.03
|
| Rate for Payer: Heritage Provider Network Senior |
$3.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.58
|
| Rate for Payer: Multiplan Commercial |
$4.91
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.62
|
| Rate for Payer: TriValley Medical Group Senior |
$2.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.56
|
| Rate for Payer: Vantage Medical Group Senior |
$5.56
|
|
|
TACROLIMUS XR 1 MG TABLET,EXTENDED RELEASE 24 HR [211105]
|
Facility
|
IP
|
$8.72
|
|
|
Service Code
|
HCPCS J7508
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$6.54 |
| Rate for Payer: Adventist Health Commercial |
$1.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.62
|
| Rate for Payer: Cash Price |
$3.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.04
|
| Rate for Payer: Heritage Provider Network Senior |
$4.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.18
|
| Rate for Payer: Multiplan Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.89
|
|
|
TACROLIMUS XR 1 MG TABLET,EXTENDED RELEASE 24 HR [211105]
|
Facility
|
OP
|
$8.72
|
|
|
Service Code
|
HCPCS J7508
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$7.41 |
| Rate for Payer: Adventist Health Commercial |
$1.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.94
|
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California EPN |
$0.57
|
| Rate for Payer: Cash Price |
$3.92
|
| Rate for Payer: Cash Price |
$3.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.04
|
| Rate for Payer: Heritage Provider Network Senior |
$4.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.10
|
| Rate for Payer: Multiplan Commercial |
$6.54
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.49
|
| Rate for Payer: TriValley Medical Group Senior |
$3.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.41
|
| Rate for Payer: Vantage Medical Group Senior |
$7.41
|
|
|
TACROLIMUS XR 4 MG TABLET,EXTENDED RELEASE 24 HR [211106]
|
Facility
|
OP
|
$34.89
|
|
|
Service Code
|
HCPCS J7508
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$29.66 |
| Rate for Payer: Adventist Health Commercial |
$6.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.94
|
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California EPN |
$0.57
|
| Rate for Payer: Cash Price |
$15.70
|
| Rate for Payer: Cash Price |
$15.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.15
|
| Rate for Payer: Heritage Provider Network Senior |
$16.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.42
|
| Rate for Payer: Multiplan Commercial |
$26.17
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.96
|
| Rate for Payer: TriValley Medical Group Senior |
$13.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.66
|
| Rate for Payer: Vantage Medical Group Senior |
$29.66
|
|
|
TACROLIMUS XR 4 MG TABLET,EXTENDED RELEASE 24 HR [211106]
|
Facility
|
IP
|
$34.89
|
|
|
Service Code
|
HCPCS J7508
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.32 |
| Max. Negotiated Rate |
$26.17 |
| Rate for Payer: Adventist Health Commercial |
$6.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22.47
|
| Rate for Payer: Cash Price |
$15.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.15
|
| Rate for Payer: Heritage Provider Network Senior |
$16.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.72
|
| Rate for Payer: Multiplan Commercial |
$26.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.55
|
|
|
TADALAFIL 20 MG TABLET [36986]
|
Facility
|
IP
|
$0.44
|
|
|
Service Code
|
NDC 4354705103
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.33 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.28
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.30
|
| Rate for Payer: Heritage Provider Network Senior |
$0.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.33
|
|
|
TADALAFIL 20 MG TABLET [36986]
|
Facility
|
IP
|
$3.88
|
|
|
Service Code
|
NDC 5026873913
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Adventist Health Commercial |
$0.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.50
|
| Rate for Payer: Cash Price |
$1.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.63
|
| Rate for Payer: Heritage Provider Network Senior |
$2.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.97
|
| Rate for Payer: Multiplan Commercial |
$2.91
|
|
|
TADALAFIL 20 MG TABLET [36986]
|
Facility
|
OP
|
$3.88
|
|
|
Service Code
|
NDC 5026873913
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$3.30 |
| Rate for Payer: Adventist Health Commercial |
$0.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.94
|
| Rate for Payer: Blue Shield of California Commercial |
$2.37
|
| Rate for Payer: Blue Shield of California EPN |
$1.89
|
| Rate for Payer: Cash Price |
$1.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.40
|
| Rate for Payer: Heritage Provider Network Senior |
$2.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.72
|
| Rate for Payer: Multiplan Commercial |
$2.91
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.55
|
| Rate for Payer: TriValley Medical Group Senior |
$1.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3.30
|
|
|
TADALAFIL 20 MG TABLET [36986]
|
Facility
|
OP
|
$0.44
|
|
|
Service Code
|
NDC 4354705103
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.27
|
| Rate for Payer: Heritage Provider Network Senior |
$0.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$0.33
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.18
|
| Rate for Payer: TriValley Medical Group Senior |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Vantage Medical Group Senior |
$0.37
|
|
|
TADALAFIL 20 MG TABLET [36986]
|
Facility
|
OP
|
$3.88
|
|
|
Service Code
|
NDC 5026873911
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$3.30 |
| Rate for Payer: Adventist Health Commercial |
$0.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.94
|
| Rate for Payer: Blue Shield of California Commercial |
$2.37
|
| Rate for Payer: Blue Shield of California EPN |
$1.89
|
| Rate for Payer: Cash Price |
$1.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.40
|
| Rate for Payer: Heritage Provider Network Senior |
$2.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.72
|
| Rate for Payer: Multiplan Commercial |
$2.91
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.55
|
| Rate for Payer: TriValley Medical Group Senior |
$1.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3.30
|
|
|
TADALAFIL 20 MG TABLET [36986]
|
Facility
|
IP
|
$3.88
|
|
|
Service Code
|
NDC 5026873911
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Adventist Health Commercial |
$0.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.50
|
| Rate for Payer: Cash Price |
$1.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.63
|
| Rate for Payer: Heritage Provider Network Senior |
$2.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.97
|
| Rate for Payer: Multiplan Commercial |
$2.91
|
|
|
TADALAFIL 20 MG TABLET (PULMONARY HYPERTENSION) [214774]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 6909752603
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.64
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.68
|
| Rate for Payer: Heritage Provider Network Senior |
$0.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
|
|
TADALAFIL 20 MG TABLET (PULMONARY HYPERTENSION) [214774]
|
Facility
|
IP
|
$0.60
|
|
|
Service Code
|
NDC 2724112302
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.39
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.41
|
| Rate for Payer: Heritage Provider Network Senior |
$0.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
|
|
TADALAFIL 20 MG TABLET (PULMONARY HYPERTENSION) [214774]
|
Facility
|
OP
|
$0.60
|
|
|
Service Code
|
NDC 2724112302
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.30
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.37
|
| Rate for Payer: Heritage Provider Network Senior |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.24
|
| Rate for Payer: TriValley Medical Group Senior |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
|
TADALAFIL 20 MG TABLET (PULMONARY HYPERTENSION) [214774]
|
Facility
|
IP
|
$0.60
|
|
|
Service Code
|
NDC 3334227809
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.39
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.41
|
| Rate for Payer: Heritage Provider Network Senior |
$0.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
|
|
TADALAFIL 20 MG TABLET (PULMONARY HYPERTENSION) [214774]
|
Facility
|
OP
|
$0.60
|
|
|
Service Code
|
NDC 3334227809
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.30
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.37
|
| Rate for Payer: Heritage Provider Network Senior |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.24
|
| Rate for Payer: TriValley Medical Group Senior |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
|
TADALAFIL 20 MG TABLET (PULMONARY HYPERTENSION) [214774]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 6909752603
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.50
|
| Rate for Payer: Blue Shield of California Commercial |
$0.61
|
| Rate for Payer: Blue Shield of California EPN |
$0.49
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.62
|
| Rate for Payer: Heritage Provider Network Senior |
$0.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.40
|
| Rate for Payer: TriValley Medical Group Senior |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
TADALAFIL 5 MG TABLET [37400]
|
Facility
|
OP
|
$0.36
|
|
|
Service Code
|
NDC 4359857530
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Senior |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
