|
TAPENTADOL 50 MG TABLET [98253]
|
Facility
|
IP
|
$16.05
|
|
|
Service Code
|
NDC 2451005010
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$12.04 |
| Rate for Payer: Adventist Health Commercial |
$3.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.34
|
| Rate for Payer: Cash Price |
$7.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.87
|
| Rate for Payer: Heritage Provider Network Senior |
$10.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.01
|
| Rate for Payer: Multiplan Commercial |
$12.04
|
|
|
TAPENTADOL 50 MG TABLET [98253]
|
Facility
|
OP
|
$16.05
|
|
|
Service Code
|
NDC 2451005010
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$13.64 |
| Rate for Payer: Adventist Health Commercial |
$3.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.03
|
| Rate for Payer: Blue Shield of California Commercial |
$9.79
|
| Rate for Payer: Blue Shield of California EPN |
$7.83
|
| Rate for Payer: Cash Price |
$7.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.93
|
| Rate for Payer: Heritage Provider Network Senior |
$9.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.23
|
| Rate for Payer: Multiplan Commercial |
$12.04
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.42
|
| Rate for Payer: TriValley Medical Group Senior |
$6.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.64
|
| Rate for Payer: Vantage Medical Group Senior |
$13.64
|
|
|
TARLATAMAB-DLLE 10 MG INTRAVENOUS SOLUTION [241611]
|
Facility
|
OP
|
$18,540.00
|
|
|
Service Code
|
HCPCS J9026
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,530.00 |
| Max. Negotiated Rate |
$13,905.00 |
| Rate for Payer: Adventist Health Commercial |
$3,708.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,457.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,015.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,773.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,773.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,636.27
|
| Rate for Payer: Blue Shield of California Commercial |
$1,530.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,530.00
|
| Rate for Payer: Cash Price |
$8,343.00
|
| Rate for Payer: Cash Price |
$8,343.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,528.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,015.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,773.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,773.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,865.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,612.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,584.02
|
| Rate for Payer: Heritage Provider Network Senior |
$8,584.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,612.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8,843.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,355.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,854.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,635.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,160.64
|
| Rate for Payer: Multiplan Commercial |
$13,905.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,416.00
|
| Rate for Payer: TriValley Medical Group Senior |
$7,416.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,698.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,138.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,015.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,773.66
|
| Rate for Payer: Vantage Medical Group Senior |
$1,773.66
|
|
|
TARLATAMAB-DLLE 10 MG INTRAVENOUS SOLUTION [241611]
|
Facility
|
IP
|
$18,540.00
|
|
|
Service Code
|
HCPCS J9026
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,355.74 |
| Max. Negotiated Rate |
$13,905.00 |
| Rate for Payer: Adventist Health Commercial |
$3,708.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,939.76
|
| Rate for Payer: Cash Price |
$8,343.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,528.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,011.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,584.02
|
| Rate for Payer: Heritage Provider Network Senior |
$8,584.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,355.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,635.00
|
| Rate for Payer: Multiplan Commercial |
$13,905.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,698.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,138.59
|
|
|
TARLATAMAB-DLLE 1 MG INTRAVENOUS SOLUTION [241612]
|
Facility
|
OP
|
$1,854.00
|
|
|
Service Code
|
HCPCS J9026
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$335.57 |
| Max. Negotiated Rate |
$3,636.27 |
| Rate for Payer: Adventist Health Commercial |
$370.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,145.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,015.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,773.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,773.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,636.27
|
| Rate for Payer: Blue Shield of California Commercial |
$1,530.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,530.00
|
| Rate for Payer: Cash Price |
$834.30
|
| Rate for Payer: Cash Price |
$834.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$852.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,015.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,773.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,773.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.56
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,612.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$858.40
|
| Rate for Payer: Heritage Provider Network Senior |
$858.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,612.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$884.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$335.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,854.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$463.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,160.64
|
| Rate for Payer: Multiplan Commercial |
$1,390.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$741.60
|
| Rate for Payer: TriValley Medical Group Senior |
$741.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$669.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$613.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,015.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,773.66
|
| Rate for Payer: Vantage Medical Group Senior |
$1,773.66
|
|
|
TARLATAMAB-DLLE 1 MG INTRAVENOUS SOLUTION [241612]
|
Facility
|
IP
|
$1,854.00
|
|
|
Service Code
|
HCPCS J9026
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$335.57 |
| Max. Negotiated Rate |
$1,390.50 |
| Rate for Payer: Adventist Health Commercial |
$370.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,193.98
|
| Rate for Payer: Cash Price |
$834.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$852.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,001.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$858.40
|
| Rate for Payer: Heritage Provider Network Senior |
$858.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$335.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$463.50
|
| Rate for Payer: Multiplan Commercial |
$1,390.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$669.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$613.86
|
|
|
TAZEMETOSTAT 200 MG TABLET [226994]
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
NDC 7260710000
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.37 |
| Max. Negotiated Rate |
$80.25 |
| Rate for Payer: Adventist Health Commercial |
$21.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.91
|
| Rate for Payer: Cash Price |
$48.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$72.44
|
| Rate for Payer: Heritage Provider Network Senior |
$72.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.75
|
| Rate for Payer: Multiplan Commercial |
$80.25
|
|
|
TAZEMETOSTAT 200 MG TABLET [226994]
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
NDC 7260710000
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.37 |
| Max. Negotiated Rate |
$90.95 |
| Rate for Payer: Adventist Health Commercial |
$21.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$66.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$80.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.52
|
| Rate for Payer: Blue Shield of California Commercial |
$65.27
|
| Rate for Payer: Blue Shield of California EPN |
$52.22
|
| Rate for Payer: Cash Price |
$48.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$69.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.23
|
| Rate for Payer: Heritage Provider Network Senior |
$66.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$51.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$74.90
|
| Rate for Payer: Multiplan Commercial |
$80.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$42.80
|
| Rate for Payer: TriValley Medical Group Senior |
$42.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$53.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$53.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.95
|
| Rate for Payer: Vantage Medical Group Senior |
$90.95
|
|
|
TEBENTAFUSP-TEBN 100 MCG/0.5 ML INTRAVENOUS SOLUTION [233477]
|
Facility
|
IP
|
$51,624.00
|
|
|
Service Code
|
HCPCS J9274
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,343.94 |
| Max. Negotiated Rate |
$38,718.00 |
| Rate for Payer: Adventist Health Commercial |
$10,324.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33,245.86
|
| Rate for Payer: Cash Price |
$23,230.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23,747.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$27,876.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,901.91
|
| Rate for Payer: Heritage Provider Network Senior |
$23,901.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,343.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,906.00
|
| Rate for Payer: Multiplan Commercial |
$38,718.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18,651.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17,092.71
|
|
|
TEBENTAFUSP-TEBN 100 MCG/0.5 ML INTRAVENOUS SOLUTION [233477]
|
Facility
|
OP
|
$51,624.00
|
|
|
Service Code
|
HCPCS J9274
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$206.65 |
| Max. Negotiated Rate |
$38,718.00 |
| Rate for Payer: Adventist Health Commercial |
$10,324.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31,903.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$285.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$250.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$454.71
|
| Rate for Payer: Blue Shield of California Commercial |
$206.65
|
| Rate for Payer: Blue Shield of California EPN |
$206.65
|
| Rate for Payer: Cash Price |
$23,230.80
|
| Rate for Payer: Cash Price |
$23,230.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23,747.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$285.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$250.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$250.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$33,039.36
|
| Rate for Payer: EPIC Health Plan Medicare |
$228.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,901.91
|
| Rate for Payer: Heritage Provider Network Senior |
$23,901.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$228.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$24,624.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,343.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$262.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,906.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$305.53
|
| Rate for Payer: Multiplan Commercial |
$38,718.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$20,649.60
|
| Rate for Payer: TriValley Medical Group Senior |
$20,649.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18,651.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17,092.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$285.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$250.81
|
| Rate for Payer: Vantage Medical Group Senior |
$250.81
|
|
|
TECLISTAMAB-CQYV 10 MG/ML SUBCUTANEOUS SOLUTION [236039]
|
Facility
|
OP
|
$849.73
|
|
|
Service Code
|
HCPCS J9380
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.38 |
| Max. Negotiated Rate |
$637.30 |
| Rate for Payer: Adventist Health Commercial |
$169.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$525.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$425.03
|
| Rate for Payer: Blue Shield of California Commercial |
$32.38
|
| Rate for Payer: Blue Shield of California EPN |
$32.38
|
| Rate for Payer: Cash Price |
$382.38
|
| Rate for Payer: Cash Price |
$382.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$390.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$543.83
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$393.42
|
| Rate for Payer: Heritage Provider Network Senior |
$393.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$405.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$153.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.33
|
| Rate for Payer: Multiplan Commercial |
$637.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$339.89
|
| Rate for Payer: TriValley Medical Group Senior |
$339.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$307.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$281.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.85
|
| Rate for Payer: Vantage Medical Group Senior |
$38.85
|
|
|
TECLISTAMAB-CQYV 10 MG/ML SUBCUTANEOUS SOLUTION [236039]
|
Facility
|
IP
|
$849.73
|
|
|
Service Code
|
HCPCS J9380
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$153.80 |
| Max. Negotiated Rate |
$637.30 |
| Rate for Payer: Adventist Health Commercial |
$169.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$547.23
|
| Rate for Payer: Cash Price |
$382.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$390.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$458.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$393.42
|
| Rate for Payer: Heritage Provider Network Senior |
$393.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$153.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.43
|
| Rate for Payer: Multiplan Commercial |
$637.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$307.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$281.35
|
|
|
TECLISTAMAB-CQYV 90 MG/ML SUBCUTANEOUS SOLUTION [236038]
|
Facility
|
IP
|
$7,647.61
|
|
|
Service Code
|
HCPCS J9380
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,384.22 |
| Max. Negotiated Rate |
$5,735.71 |
| Rate for Payer: Adventist Health Commercial |
$1,529.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,925.06
|
| Rate for Payer: Cash Price |
$3,441.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,517.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,129.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,540.84
|
| Rate for Payer: Heritage Provider Network Senior |
$3,540.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,384.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,911.90
|
| Rate for Payer: Multiplan Commercial |
$5,735.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,763.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,532.12
|
|
|
TECLISTAMAB-CQYV 90 MG/ML SUBCUTANEOUS SOLUTION [236038]
|
Facility
|
OP
|
$7,647.61
|
|
|
Service Code
|
HCPCS J9380
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.38 |
| Max. Negotiated Rate |
$5,735.71 |
| Rate for Payer: Adventist Health Commercial |
$1,529.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,726.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,825.33
|
| Rate for Payer: Blue Shield of California Commercial |
$32.38
|
| Rate for Payer: Blue Shield of California EPN |
$32.38
|
| Rate for Payer: Cash Price |
$3,441.42
|
| Rate for Payer: Cash Price |
$3,441.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,517.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,894.47
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,540.84
|
| Rate for Payer: Heritage Provider Network Senior |
$3,540.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,647.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,384.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,911.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.33
|
| Rate for Payer: Multiplan Commercial |
$5,735.71
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,059.04
|
| Rate for Payer: TriValley Medical Group Senior |
$3,059.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,763.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,532.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.85
|
| Rate for Payer: Vantage Medical Group Senior |
$38.85
|
|
|
TELISOTUZUMAB VEDOTIN-TLLV 100 MG INTRAVENOUS SOLUTION [246066]
|
Facility
|
IP
|
$16,776.00
|
|
|
Service Code
|
HCPCS J9326
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,036.46 |
| Max. Negotiated Rate |
$12,582.00 |
| Rate for Payer: Adventist Health Commercial |
$3,355.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,803.74
|
| Rate for Payer: Cash Price |
$7,549.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,716.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,059.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,767.29
|
| Rate for Payer: Heritage Provider Network Senior |
$7,767.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,036.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,194.00
|
| Rate for Payer: Multiplan Commercial |
$12,582.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,061.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,554.53
|
|
|
TELISOTUZUMAB VEDOTIN-TLLV 100 MG INTRAVENOUS SOLUTION [246066]
|
Facility
|
OP
|
$16,776.00
|
|
|
Service Code
|
HCPCS J9326
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$146.06 |
| Max. Negotiated Rate |
$12,582.00 |
| Rate for Payer: Adventist Health Commercial |
$3,355.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,367.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$219.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$160.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$146.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$338.91
|
| Rate for Payer: Blue Shield of California Commercial |
$10,233.36
|
| Rate for Payer: Blue Shield of California EPN |
$8,186.69
|
| Rate for Payer: Cash Price |
$7,549.20
|
| Rate for Payer: Cash Price |
$7,549.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,716.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$219.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$160.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$146.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,736.64
|
| Rate for Payer: EPIC Health Plan Medicare |
$146.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,767.29
|
| Rate for Payer: Heritage Provider Network Senior |
$7,767.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$146.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8,002.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,036.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$167.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,194.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$195.72
|
| Rate for Payer: Multiplan Commercial |
$12,582.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$6,710.40
|
| Rate for Payer: TriValley Medical Group Senior |
$6,710.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,061.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,554.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$219.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$160.67
|
| Rate for Payer: Vantage Medical Group Senior |
$146.06
|
|
|
TELISOTUZUMAB VEDOTIN-TLLV 20 MG INTRAVENOUS SOLUTION [246067]
|
Facility
|
IP
|
$3,355.20
|
|
|
Service Code
|
HCPCS J9326
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$607.29 |
| Max. Negotiated Rate |
$2,516.40 |
| Rate for Payer: Adventist Health Commercial |
$671.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,160.75
|
| Rate for Payer: Cash Price |
$1,509.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,543.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,811.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,553.46
|
| Rate for Payer: Heritage Provider Network Senior |
$1,553.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$607.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$838.80
|
| Rate for Payer: Multiplan Commercial |
$2,516.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,212.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,110.91
|
|
|
TELISOTUZUMAB VEDOTIN-TLLV 20 MG INTRAVENOUS SOLUTION [246067]
|
Facility
|
OP
|
$3,355.20
|
|
|
Service Code
|
HCPCS J9326
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$146.06 |
| Max. Negotiated Rate |
$2,516.40 |
| Rate for Payer: Adventist Health Commercial |
$671.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,073.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$219.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$160.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$146.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$338.91
|
| Rate for Payer: Blue Shield of California Commercial |
$2,046.67
|
| Rate for Payer: Blue Shield of California EPN |
$1,637.34
|
| Rate for Payer: Cash Price |
$1,509.84
|
| Rate for Payer: Cash Price |
$1,509.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,543.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$219.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$160.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$146.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,147.33
|
| Rate for Payer: EPIC Health Plan Medicare |
$146.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,553.46
|
| Rate for Payer: Heritage Provider Network Senior |
$1,553.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$146.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,600.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$607.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$167.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$838.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$195.72
|
| Rate for Payer: Multiplan Commercial |
$2,516.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,342.08
|
| Rate for Payer: TriValley Medical Group Senior |
$1,342.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,212.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,110.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$219.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$160.67
|
| Rate for Payer: Vantage Medical Group Senior |
$146.06
|
|
|
TELMISARTAN 40 MG TABLET [24335]
|
Facility
|
IP
|
$5.61
|
|
|
Service Code
|
NDC 0597004037
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Adventist Health Commercial |
$1.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.61
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.80
|
| Rate for Payer: Heritage Provider Network Senior |
$3.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.40
|
| Rate for Payer: Multiplan Commercial |
$4.21
|
|
|
TELMISARTAN 40 MG TABLET [24335]
|
Facility
|
OP
|
$5.61
|
|
|
Service Code
|
NDC 0597004037
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$4.77 |
| Rate for Payer: Adventist Health Commercial |
$1.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.81
|
| Rate for Payer: Blue Shield of California Commercial |
$3.42
|
| Rate for Payer: Blue Shield of California EPN |
$2.74
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.47
|
| Rate for Payer: Heritage Provider Network Senior |
$3.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.93
|
| Rate for Payer: Multiplan Commercial |
$4.21
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.24
|
| Rate for Payer: TriValley Medical Group Senior |
$2.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.77
|
| Rate for Payer: Vantage Medical Group Senior |
$4.77
|
|
|
TELMISARTAN 80 MG TABLET [24336]
|
Facility
|
OP
|
$5.61
|
|
|
Service Code
|
NDC 0597004137
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$4.77 |
| Rate for Payer: Adventist Health Commercial |
$1.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.81
|
| Rate for Payer: Blue Shield of California Commercial |
$3.42
|
| Rate for Payer: Blue Shield of California EPN |
$2.74
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.47
|
| Rate for Payer: Heritage Provider Network Senior |
$3.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.93
|
| Rate for Payer: Multiplan Commercial |
$4.21
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.24
|
| Rate for Payer: TriValley Medical Group Senior |
$2.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.77
|
| Rate for Payer: Vantage Medical Group Senior |
$4.77
|
|
|
TELMISARTAN 80 MG TABLET [24336]
|
Facility
|
IP
|
$5.61
|
|
|
Service Code
|
NDC 0597004137
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Adventist Health Commercial |
$1.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.61
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.80
|
| Rate for Payer: Heritage Provider Network Senior |
$3.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.40
|
| Rate for Payer: Multiplan Commercial |
$4.21
|
|
|
TEMAZEPAM 15 MG CAPSULE [7753]
|
Facility
|
OP
|
$0.11
|
|
|
Service Code
|
NDC 0228207610
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
TEMAZEPAM 15 MG CAPSULE [7753]
|
Facility
|
OP
|
$0.11
|
|
|
Service Code
|
NDC 6787714601
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
TEMAZEPAM 15 MG CAPSULE [7753]
|
Facility
|
IP
|
$0.11
|
|
|
Service Code
|
NDC 6787714601
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.07
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
|
