TRIFLURIDINE 1 % EYE DROPS [11595]
|
Facility
|
OP
|
$31.36
|
|
Service Code
|
NDC 61314-044-75
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$5.68 |
Max. Negotiated Rate |
$26.66 |
Rate for Payer: Adventist Health Commercial |
$6.27
|
Rate for Payer: Aetna of CA Gatekeeper |
$16.76
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.54
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.66
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.25
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.52
|
Rate for Payer: Blue Shield of California Commercial |
$19.13
|
Rate for Payer: Blue Shield of California EPN |
$15.30
|
Rate for Payer: Cash Price |
$17.25
|
Rate for Payer: Cigna of CA HMO/PPO |
$20.38
|
Rate for Payer: Dignity Health Commercial/Exchange |
$26.66
|
Rate for Payer: Dignity Health Medi-Cal |
$26.66
|
Rate for Payer: Dignity Health Senior |
$26.66
|
Rate for Payer: EPIC Health Plan Commercial |
$20.07
|
Rate for Payer: Heritage Provider Network Commercial |
$19.41
|
Rate for Payer: Heritage Provider Network Senior |
$19.41
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$14.96
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.68
|
Rate for Payer: LLUH Dept of Risk Management WC |
$7.84
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.95
|
Rate for Payer: Molina Healthcare of CA Medicare |
$21.95
|
Rate for Payer: Multiplan Commercial |
$23.52
|
Rate for Payer: TriValley Medical Group Commercial |
$12.54
|
Rate for Payer: TriValley Medical Group Senior |
$12.54
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.68
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.68
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.66
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$26.66
|
Rate for Payer: Vantage Medical Group Senior |
$26.66
|
|
TRIFLURIDINE 1 % EYE DROPS [11595]
|
Facility
|
IP
|
$31.36
|
|
Service Code
|
NDC 61314-044-75
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$5.68 |
Max. Negotiated Rate |
$23.52 |
Rate for Payer: Adventist Health Commercial |
$6.27
|
Rate for Payer: Cash Price |
$17.25
|
Rate for Payer: EPIC Health Plan Commercial |
$16.93
|
Rate for Payer: Heritage Provider Network Commercial |
$21.23
|
Rate for Payer: Heritage Provider Network Senior |
$21.23
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.68
|
Rate for Payer: LLUH Dept of Risk Management WC |
$7.84
|
Rate for Payer: Multiplan Commercial |
$23.52
|
|
TRIHEXYPHENIDYL 2 MG TABLET [8166]
|
Facility
|
OP
|
$0.18
|
|
Service Code
|
NDC 70954-212-10
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.03 |
Max. Negotiated Rate |
$0.15 |
Rate for Payer: Adventist Health Commercial |
$0.04
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.10
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.12
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.15
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.10
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.14
|
Rate for Payer: Blue Shield of California Commercial |
$0.11
|
Rate for Payer: Blue Shield of California EPN |
$0.09
|
Rate for Payer: Cash Price |
$0.10
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.12
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.15
|
Rate for Payer: Dignity Health Medi-Cal |
$0.15
|
Rate for Payer: Dignity Health Senior |
$0.15
|
Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
Rate for Payer: Heritage Provider Network Commercial |
$0.11
|
Rate for Payer: Heritage Provider Network Senior |
$0.11
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.09
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.13
|
Rate for Payer: Molina Healthcare of CA Medicare |
$0.13
|
Rate for Payer: Multiplan Commercial |
$0.14
|
Rate for Payer: TriValley Medical Group Commercial |
$0.07
|
Rate for Payer: TriValley Medical Group Senior |
$0.07
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.09
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.09
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.15
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.15
|
Rate for Payer: Vantage Medical Group Senior |
$0.15
|
|
TRIHEXYPHENIDYL 2 MG TABLET [8166]
|
Facility
|
OP
|
$0.18
|
|
Service Code
|
NDC 0591-5335-01
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.03 |
Max. Negotiated Rate |
$0.15 |
Rate for Payer: Adventist Health Commercial |
$0.04
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.10
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.12
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.15
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.10
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.14
|
Rate for Payer: Blue Shield of California Commercial |
$0.11
|
Rate for Payer: Blue Shield of California EPN |
$0.09
|
Rate for Payer: Cash Price |
$0.10
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.12
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.15
|
Rate for Payer: Dignity Health Medi-Cal |
$0.15
|
Rate for Payer: Dignity Health Senior |
$0.15
|
Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
Rate for Payer: Heritage Provider Network Commercial |
$0.11
|
Rate for Payer: Heritage Provider Network Senior |
$0.11
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.09
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.13
|
Rate for Payer: Molina Healthcare of CA Medicare |
$0.13
|
Rate for Payer: Multiplan Commercial |
$0.14
|
Rate for Payer: TriValley Medical Group Commercial |
$0.07
|
Rate for Payer: TriValley Medical Group Senior |
$0.07
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.09
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.09
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.15
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.15
|
Rate for Payer: Vantage Medical Group Senior |
$0.15
|
|
TRIHEXYPHENIDYL 2 MG TABLET [8166]
|
Facility
|
IP
|
$0.18
|
|
Service Code
|
NDC 70954-212-10
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.03 |
Max. Negotiated Rate |
$0.14 |
Rate for Payer: Adventist Health Commercial |
$0.04
|
Rate for Payer: Cash Price |
$0.10
|
Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
Rate for Payer: Heritage Provider Network Commercial |
$0.12
|
Rate for Payer: Heritage Provider Network Senior |
$0.12
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
Rate for Payer: Multiplan Commercial |
$0.14
|
|
TRIHEXYPHENIDYL 2 MG TABLET [8166]
|
Facility
|
IP
|
$0.18
|
|
Service Code
|
NDC 0591-5335-01
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.03 |
Max. Negotiated Rate |
$0.14 |
Rate for Payer: Adventist Health Commercial |
$0.04
|
Rate for Payer: Cash Price |
$0.10
|
Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
Rate for Payer: Heritage Provider Network Commercial |
$0.12
|
Rate for Payer: Heritage Provider Network Senior |
$0.12
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
Rate for Payer: Multiplan Commercial |
$0.14
|
|
TRIHEXYPHENIDYL 5 MG TABLET [8167]
|
Facility
|
IP
|
$0.27
|
|
Service Code
|
NDC 70954-211-10
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.05 |
Max. Negotiated Rate |
$0.20 |
Rate for Payer: Adventist Health Commercial |
$0.05
|
Rate for Payer: Cash Price |
$0.15
|
Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
Rate for Payer: Heritage Provider Network Commercial |
$0.18
|
Rate for Payer: Heritage Provider Network Senior |
$0.18
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
Rate for Payer: Multiplan Commercial |
$0.20
|
|
TRIHEXYPHENIDYL 5 MG TABLET [8167]
|
Facility
|
IP
|
$0.36
|
|
Service Code
|
NDC 0591-5337-01
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.07 |
Max. Negotiated Rate |
$0.27 |
Rate for Payer: Adventist Health Commercial |
$0.07
|
Rate for Payer: Cash Price |
$0.20
|
Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
Rate for Payer: Heritage Provider Network Commercial |
$0.24
|
Rate for Payer: Heritage Provider Network Senior |
$0.24
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
Rate for Payer: Multiplan Commercial |
$0.27
|
|
TRIHEXYPHENIDYL 5 MG TABLET [8167]
|
Facility
|
OP
|
$0.36
|
|
Service Code
|
NDC 0591-5337-01
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.07 |
Max. Negotiated Rate |
$0.31 |
Rate for Payer: Adventist Health Commercial |
$0.07
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.19
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.25
|
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: Blue Shield of California Commercial |
$0.22
|
Rate for Payer: Blue Shield of California EPN |
$0.18
|
Rate for Payer: Cash Price |
$0.20
|
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 Senior |
$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 Permanente of CA Commercial |
$0.17
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.25
|
Rate for Payer: Molina Healthcare of CA 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 Medi-Cal |
$0.31
|
Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
TRIHEXYPHENIDYL 5 MG TABLET [8167]
|
Facility
|
OP
|
$0.27
|
|
Service Code
|
NDC 70954-211-10
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.05 |
Max. Negotiated Rate |
$0.23 |
Rate for Payer: Adventist Health Commercial |
$0.05
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.14
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.19
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.23
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
Rate for Payer: Blue Shield of California Commercial |
$0.16
|
Rate for Payer: Blue Shield of California EPN |
$0.13
|
Rate for Payer: Cash Price |
$0.15
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.18
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.23
|
Rate for Payer: Dignity Health Medi-Cal |
$0.23
|
Rate for Payer: Dignity Health Senior |
$0.23
|
Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
Rate for Payer: Heritage Provider Network Commercial |
$0.17
|
Rate for Payer: Heritage Provider Network Senior |
$0.17
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.13
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.19
|
Rate for Payer: Molina Healthcare of CA Medicare |
$0.19
|
Rate for Payer: Multiplan Commercial |
$0.20
|
Rate for Payer: TriValley Medical Group Commercial |
$0.11
|
Rate for Payer: TriValley Medical Group Senior |
$0.11
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.14
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.14
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.23
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.23
|
Rate for Payer: Vantage Medical Group Senior |
$0.23
|
|
TRIMETHOBENZAMIDE 100 MG/ML INTRAMUSCULAR SOLUTION [110953]
|
Facility
|
OP
|
$36.38
|
|
Service Code
|
HCPCS J3250
|
Hospital Charge Code |
901700025
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$6.58 |
Max. Negotiated Rate |
$157.02 |
Rate for Payer: Adventist Health Commercial |
$7.28
|
Rate for Payer: Aetna of CA Gatekeeper |
$19.45
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.99
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.92
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.01
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.29
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.02
|
Rate for Payer: Blue Shield of California Commercial |
$53.77
|
Rate for Payer: Blue Shield of California EPN |
$53.77
|
Rate for Payer: Cash Price |
$20.01
|
Rate for Payer: Cash Price |
$20.01
|
Rate for Payer: Cigna of CA HMO/PPO |
$16.73
|
Rate for Payer: Dignity Health Commercial/Exchange |
$30.92
|
Rate for Payer: Dignity Health Medi-Cal |
$30.92
|
Rate for Payer: Dignity Health Senior |
$30.92
|
Rate for Payer: EPIC Health Plan Commercial |
$23.28
|
Rate for Payer: Heritage Provider Network Commercial |
$16.84
|
Rate for Payer: Heritage Provider Network Senior |
$16.84
|
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.04
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$17.35
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.58
|
Rate for Payer: LLUH Dept of Risk Management WC |
$9.10
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.47
|
Rate for Payer: Molina Healthcare of CA Medicare |
$25.47
|
Rate for Payer: Multiplan Commercial |
$27.29
|
Rate for Payer: TriValley Medical Group Commercial |
$14.55
|
Rate for Payer: TriValley Medical Group Senior |
$14.55
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.14
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.05
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.92
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$30.92
|
Rate for Payer: Vantage Medical Group Senior |
$30.92
|
|
TRIMETHOBENZAMIDE 100 MG/ML INTRAMUSCULAR SOLUTION [110953]
|
Facility
|
IP
|
$36.38
|
|
Service Code
|
HCPCS J3250
|
Hospital Charge Code |
901700025
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$6.58 |
Max. Negotiated Rate |
$27.29 |
Rate for Payer: Adventist Health Commercial |
$7.28
|
Rate for Payer: Cash Price |
$20.01
|
Rate for Payer: Cigna of CA HMO/PPO |
$16.73
|
Rate for Payer: EPIC Health Plan Commercial |
$19.65
|
Rate for Payer: Heritage Provider Network Commercial |
$16.84
|
Rate for Payer: Heritage Provider Network Senior |
$16.84
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.58
|
Rate for Payer: LLUH Dept of Risk Management WC |
$9.10
|
Rate for Payer: Multiplan Commercial |
$27.29
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.14
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.05
|
|
TROMETHAMINE 36 MG/ML (0.3 M) INTRAVENOUS SOLUTION [11608]
|
Facility
|
OP
|
$0.94
|
|
Service Code
|
NDC 0409-1593-14
|
Hospital Charge Code |
901700004
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.17 |
Max. Negotiated Rate |
$0.80 |
Rate for Payer: Adventist Health Commercial |
$0.19
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.50
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.65
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.80
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.52
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.71
|
Rate for Payer: Blue Shield of California Commercial |
$0.57
|
Rate for Payer: Blue Shield of California EPN |
$0.46
|
Rate for Payer: Cash Price |
$0.52
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.61
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.80
|
Rate for Payer: Dignity Health Medi-Cal |
$0.80
|
Rate for Payer: Dignity Health Senior |
$0.80
|
Rate for Payer: EPIC Health Plan Commercial |
$0.60
|
Rate for Payer: Heritage Provider Network Commercial |
$0.58
|
Rate for Payer: Heritage Provider Network Senior |
$0.58
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.45
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.17
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.66
|
Rate for Payer: Molina Healthcare of CA Medicare |
$0.66
|
Rate for Payer: Multiplan Commercial |
$0.71
|
Rate for Payer: TriValley Medical Group Commercial |
$0.38
|
Rate for Payer: TriValley Medical Group Senior |
$0.38
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.47
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.47
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.80
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.80
|
Rate for Payer: Vantage Medical Group Senior |
$0.80
|
|
TROMETHAMINE 36 MG/ML (0.3 M) INTRAVENOUS SOLUTION [11608]
|
Facility
|
OP
|
$0.94
|
|
Service Code
|
NDC 0409-1593-04
|
Hospital Charge Code |
901700004
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.17 |
Max. Negotiated Rate |
$0.80 |
Rate for Payer: Adventist Health Commercial |
$0.19
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.50
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.65
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.80
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.52
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.71
|
Rate for Payer: Blue Shield of California Commercial |
$0.57
|
Rate for Payer: Blue Shield of California EPN |
$0.46
|
Rate for Payer: Cash Price |
$0.52
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.61
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.80
|
Rate for Payer: Dignity Health Medi-Cal |
$0.80
|
Rate for Payer: Dignity Health Senior |
$0.80
|
Rate for Payer: EPIC Health Plan Commercial |
$0.60
|
Rate for Payer: Heritage Provider Network Commercial |
$0.58
|
Rate for Payer: Heritage Provider Network Senior |
$0.58
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.45
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.17
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.66
|
Rate for Payer: Molina Healthcare of CA Medicare |
$0.66
|
Rate for Payer: Multiplan Commercial |
$0.71
|
Rate for Payer: TriValley Medical Group Commercial |
$0.38
|
Rate for Payer: TriValley Medical Group Senior |
$0.38
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.47
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.47
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.80
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.80
|
Rate for Payer: Vantage Medical Group Senior |
$0.80
|
|
TROMETHAMINE 36 MG/ML (0.3 M) INTRAVENOUS SOLUTION [11608]
|
Facility
|
IP
|
$0.94
|
|
Service Code
|
NDC 0409-1593-14
|
Hospital Charge Code |
901700004
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.17 |
Max. Negotiated Rate |
$0.71 |
Rate for Payer: Adventist Health Commercial |
$0.19
|
Rate for Payer: Cash Price |
$0.52
|
Rate for Payer: EPIC Health Plan Commercial |
$0.51
|
Rate for Payer: Heritage Provider Network Commercial |
$0.64
|
Rate for Payer: Heritage Provider Network Senior |
$0.64
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.17
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
Rate for Payer: Multiplan Commercial |
$0.71
|
|
TROMETHAMINE 36 MG/ML (0.3 M) INTRAVENOUS SOLUTION [11608]
|
Facility
|
IP
|
$0.94
|
|
Service Code
|
NDC 0409-1593-04
|
Hospital Charge Code |
901700004
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.17 |
Max. Negotiated Rate |
$0.71 |
Rate for Payer: Adventist Health Commercial |
$0.19
|
Rate for Payer: Cash Price |
$0.52
|
Rate for Payer: EPIC Health Plan Commercial |
$0.51
|
Rate for Payer: Heritage Provider Network Commercial |
$0.64
|
Rate for Payer: Heritage Provider Network Senior |
$0.64
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.17
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
Rate for Payer: Multiplan Commercial |
$0.71
|
|
TROPICAMIDE 0.5 % EYE DROPS [8249]
|
Facility
|
IP
|
$1.71
|
|
Service Code
|
NDC 61314-354-01
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.31 |
Max. Negotiated Rate |
$1.28 |
Rate for Payer: Adventist Health Commercial |
$0.34
|
Rate for Payer: Cash Price |
$0.94
|
Rate for Payer: EPIC Health Plan Commercial |
$0.92
|
Rate for Payer: Heritage Provider Network Commercial |
$1.16
|
Rate for Payer: Heritage Provider Network Senior |
$1.16
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.31
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
Rate for Payer: Multiplan Commercial |
$1.28
|
|
TROPICAMIDE 0.5 % EYE DROPS [8249]
|
Facility
|
OP
|
$1.71
|
|
Service Code
|
NDC 61314-354-01
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.31 |
Max. Negotiated Rate |
$1.45 |
Rate for Payer: Adventist Health Commercial |
$0.34
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.91
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.17
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.45
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.94
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.28
|
Rate for Payer: Blue Shield of California Commercial |
$1.04
|
Rate for Payer: Blue Shield of California EPN |
$0.83
|
Rate for Payer: Cash Price |
$0.94
|
Rate for Payer: Cigna of CA HMO/PPO |
$1.11
|
Rate for Payer: Dignity Health Commercial/Exchange |
$1.45
|
Rate for Payer: Dignity Health Medi-Cal |
$1.45
|
Rate for Payer: Dignity Health Senior |
$1.45
|
Rate for Payer: EPIC Health Plan Commercial |
$1.09
|
Rate for Payer: Heritage Provider Network Commercial |
$1.06
|
Rate for Payer: Heritage Provider Network Senior |
$1.06
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.82
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.31
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.20
|
Rate for Payer: Molina Healthcare of CA Medicare |
$1.20
|
Rate for Payer: Multiplan Commercial |
$1.28
|
Rate for Payer: TriValley Medical Group Commercial |
$0.68
|
Rate for Payer: TriValley Medical Group Senior |
$0.68
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.86
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.86
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.45
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$1.45
|
Rate for Payer: Vantage Medical Group Senior |
$1.45
|
|
TROPICAMIDE 1 % EYE DROPS [8250]
|
Facility
|
IP
|
$2.45
|
|
Service Code
|
NDC 61314-355-02
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.44 |
Max. Negotiated Rate |
$1.84 |
Rate for Payer: Adventist Health Commercial |
$0.49
|
Rate for Payer: Cash Price |
$1.35
|
Rate for Payer: EPIC Health Plan Commercial |
$1.32
|
Rate for Payer: Heritage Provider Network Commercial |
$1.66
|
Rate for Payer: Heritage Provider Network Senior |
$1.66
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.44
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.61
|
Rate for Payer: Multiplan Commercial |
$1.84
|
|
TROPICAMIDE 1 % EYE DROPS [8250]
|
Facility
|
IP
|
$0.68
|
|
Service Code
|
NDC 70069-121-01
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.12 |
Max. Negotiated Rate |
$0.51 |
Rate for Payer: Adventist Health Commercial |
$0.14
|
Rate for Payer: Cash Price |
$0.37
|
Rate for Payer: EPIC Health Plan Commercial |
$0.37
|
Rate for Payer: Heritage Provider Network Commercial |
$0.46
|
Rate for Payer: Heritage Provider Network Senior |
$0.46
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
Rate for Payer: Multiplan Commercial |
$0.51
|
|
TROPICAMIDE 1 % EYE DROPS [8250]
|
Facility
|
OP
|
$0.68
|
|
Service Code
|
NDC 70069-121-01
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.12 |
Max. Negotiated Rate |
$0.58 |
Rate for Payer: Adventist Health Commercial |
$0.14
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.36
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.47
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.58
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.37
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.51
|
Rate for Payer: Blue Shield of California Commercial |
$0.41
|
Rate for Payer: Blue Shield of California EPN |
$0.33
|
Rate for Payer: Cash Price |
$0.37
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.44
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.58
|
Rate for Payer: Dignity Health Medi-Cal |
$0.58
|
Rate for Payer: Dignity Health Senior |
$0.58
|
Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
Rate for Payer: Heritage Provider Network Commercial |
$0.42
|
Rate for Payer: Heritage Provider Network Senior |
$0.42
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.32
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.48
|
Rate for Payer: Molina Healthcare of CA Medicare |
$0.48
|
Rate for Payer: Multiplan Commercial |
$0.51
|
Rate for Payer: TriValley Medical Group Commercial |
$0.27
|
Rate for Payer: TriValley Medical Group Senior |
$0.27
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.34
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.34
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.58
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.58
|
Rate for Payer: Vantage Medical Group Senior |
$0.58
|
|
TROPICAMIDE 1 % EYE DROPS [8250]
|
Facility
|
OP
|
$2.45
|
|
Service Code
|
NDC 61314-355-02
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.44 |
Max. Negotiated Rate |
$2.08 |
Rate for Payer: Adventist Health Commercial |
$0.49
|
Rate for Payer: Aetna of CA Gatekeeper |
$1.31
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.68
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.08
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.35
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.84
|
Rate for Payer: Blue Shield of California Commercial |
$1.49
|
Rate for Payer: Blue Shield of California EPN |
$1.20
|
Rate for Payer: Cash Price |
$1.35
|
Rate for Payer: Cigna of CA HMO/PPO |
$1.59
|
Rate for Payer: Dignity Health Commercial/Exchange |
$2.08
|
Rate for Payer: Dignity Health Medi-Cal |
$2.08
|
Rate for Payer: Dignity Health Senior |
$2.08
|
Rate for Payer: EPIC Health Plan Commercial |
$1.57
|
Rate for Payer: Heritage Provider Network Commercial |
$1.52
|
Rate for Payer: Heritage Provider Network Senior |
$1.52
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$1.17
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.44
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.61
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.72
|
Rate for Payer: Molina Healthcare of CA Medicare |
$1.72
|
Rate for Payer: Multiplan Commercial |
$1.84
|
Rate for Payer: TriValley Medical Group Commercial |
$0.98
|
Rate for Payer: TriValley Medical Group Senior |
$0.98
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.23
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.23
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.08
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$2.08
|
Rate for Payer: Vantage Medical Group Senior |
$2.08
|
|
TROPICAMIDE 1 %-PROPARACAINE 0.5 %-PE 2.5 %-KETOROLAC 0.5 % EYE DROPS [223020]
|
Facility
|
IP
|
$16.80
|
|
Service Code
|
HCPCS J3490
|
Hospital Charge Code |
901700025
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$3.04 |
Max. Negotiated Rate |
$12.60 |
Rate for Payer: Adventist Health Commercial |
$3.36
|
Rate for Payer: Cash Price |
$9.24
|
Rate for Payer: Cigna of CA HMO/PPO |
$7.73
|
Rate for Payer: EPIC Health Plan Commercial |
$9.07
|
Rate for Payer: Heritage Provider Network Commercial |
$7.78
|
Rate for Payer: Heritage Provider Network Senior |
$7.78
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.04
|
Rate for Payer: LLUH Dept of Risk Management WC |
$4.20
|
Rate for Payer: Multiplan Commercial |
$12.60
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.07
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.56
|
|
TROPICAMIDE 1 %-PROPARACAINE 0.5 %-PE 2.5 %-KETOROLAC 0.5 % EYE DROPS [223020]
|
Facility
|
OP
|
$16.80
|
|
Service Code
|
HCPCS J3490
|
Hospital Charge Code |
901700025
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$3.04 |
Max. Negotiated Rate |
$14.28 |
Rate for Payer: Adventist Health Commercial |
$3.36
|
Rate for Payer: Aetna of CA Gatekeeper |
$8.98
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.54
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.28
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.24
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.60
|
Rate for Payer: Blue Shield of California Commercial |
$10.25
|
Rate for Payer: Blue Shield of California EPN |
$8.20
|
Rate for Payer: Cash Price |
$9.24
|
Rate for Payer: Cigna of CA HMO/PPO |
$7.73
|
Rate for Payer: Dignity Health Commercial/Exchange |
$14.28
|
Rate for Payer: Dignity Health Medi-Cal |
$14.28
|
Rate for Payer: Dignity Health Senior |
$14.28
|
Rate for Payer: EPIC Health Plan Commercial |
$10.75
|
Rate for Payer: Heritage Provider Network Commercial |
$7.78
|
Rate for Payer: Heritage Provider Network Senior |
$7.78
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$8.01
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.04
|
Rate for Payer: LLUH Dept of Risk Management WC |
$4.20
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.76
|
Rate for Payer: Molina Healthcare of CA Medicare |
$11.76
|
Rate for Payer: Multiplan Commercial |
$12.60
|
Rate for Payer: TriValley Medical Group Commercial |
$6.72
|
Rate for Payer: TriValley Medical Group Senior |
$6.72
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.07
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.56
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.28
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$14.28
|
Rate for Payer: Vantage Medical Group Senior |
$14.28
|
|
TRYPAN BLUE 0.06 % INTRAOCULAR SYRINGE [88317]
|
Facility
|
IP
|
$198.96
|
|
Service Code
|
HCPCS Q9968
|
Hospital Charge Code |
901700025
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$36.01 |
Max. Negotiated Rate |
$149.22 |
Rate for Payer: Adventist Health Commercial |
$39.79
|
Rate for Payer: Cash Price |
$109.43
|
Rate for Payer: Cigna of CA HMO/PPO |
$91.52
|
Rate for Payer: EPIC Health Plan Commercial |
$107.44
|
Rate for Payer: Heritage Provider Network Commercial |
$92.12
|
Rate for Payer: Heritage Provider Network Senior |
$92.12
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.01
|
Rate for Payer: LLUH Dept of Risk Management WC |
$49.74
|
Rate for Payer: Multiplan Commercial |
$149.22
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.88
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$65.88
|
|