|
TOBRAMYCIN 300 MG/5 ML IN 0.225 % SODIUM CHLORIDE FOR NEBULIZATION [22240]
|
Facility
|
OP
|
$1.71
|
|
|
Service Code
|
NDC 4257140809
|
| 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 Non-Gatekeeper |
$1.06
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$0.86
|
| 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 |
$0.77
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$0.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
|
|
TOBRAMYCIN 300 MG/5 ML IN 0.225 % SODIUM CHLORIDE FOR NEBULIZATION [22240]
|
Facility
|
IP
|
$2.82
|
|
|
Service Code
|
NDC 4359860556
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Adventist Health Commercial |
$0.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.82
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.91
|
| Rate for Payer: Heritage Provider Network Senior |
$1.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.71
|
| Rate for Payer: Multiplan Commercial |
$2.12
|
|
|
TOBRAMYCIN 300 MG/5 ML IN 0.225 % SODIUM CHLORIDE FOR NEBULIZATION [22240]
|
Facility
|
OP
|
$2.82
|
|
|
Service Code
|
NDC 4359860556
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: Adventist Health Commercial |
$0.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.41
|
| Rate for Payer: Blue Shield of California Commercial |
$1.72
|
| Rate for Payer: Blue Shield of California EPN |
$1.38
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.75
|
| Rate for Payer: Heritage Provider Network Senior |
$1.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.97
|
| Rate for Payer: Multiplan Commercial |
$2.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.13
|
| Rate for Payer: TriValley Medical Group Senior |
$1.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.40
|
| Rate for Payer: Vantage Medical Group Senior |
$2.40
|
|
|
TOBRAMYCIN 300 MG/5 ML IN 0.225 % SODIUM CHLORIDE FOR NEBULIZATION [22240]
|
Facility
|
IP
|
$1.71
|
|
|
Service Code
|
NDC 7075660444
|
| 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: Aetna of CA Non-Gatekeeper |
$1.10
|
| Rate for Payer: Cash Price |
$0.77
|
| 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 Foundation Hospitals Medi-Cal |
$0.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$1.28
|
|
|
TOBRAMYCIN 300 MG/5 ML IN 0.225 % SODIUM CHLORIDE FOR NEBULIZATION [22240]
|
Facility
|
OP
|
$1.71
|
|
|
Service Code
|
NDC 7075660456
|
| 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 Non-Gatekeeper |
$1.06
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$0.86
|
| 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 |
$0.77
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$0.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
|
|
TOBRAMYCIN 300 MG/5 ML IN 0.225 % SODIUM CHLORIDE FOR NEBULIZATION [22240]
|
Facility
|
IP
|
$2.82
|
|
|
Service Code
|
NDC 4359860504
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Adventist Health Commercial |
$0.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.82
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.91
|
| Rate for Payer: Heritage Provider Network Senior |
$1.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.71
|
| Rate for Payer: Multiplan Commercial |
$2.12
|
|
|
TOBRAMYCIN 40 MG/ML INJECTION SOLUTION [7994]
|
Facility
|
IP
|
$1.19
|
|
|
Service Code
|
HCPCS J3260
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.89 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Adventist Health Commercial |
$0.25
|
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.81
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.58
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.55
|
| Rate for Payer: Heritage Provider Network Senior |
$0.55
|
| Rate for Payer: Heritage Provider Network Senior |
$0.40
|
| Rate for Payer: Heritage Provider Network Senior |
$0.41
|
| Rate for Payer: Heritage Provider Network Senior |
$0.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.23
|
| 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 |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.65
|
| Rate for Payer: Multiplan Commercial |
$0.89
|
| Rate for Payer: Multiplan Commercial |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$0.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.42
|
|
|
TOBRAMYCIN 40 MG/ML INJECTION SOLUTION [7994]
|
Facility
|
OP
|
$1.19
|
|
|
Service Code
|
HCPCS J3260
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$16.34 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Adventist Health Commercial |
$0.25
|
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.34
|
| Rate for Payer: Blue Shield of California Commercial |
$2.08
|
| Rate for Payer: Blue Shield of California Commercial |
$2.08
|
| Rate for Payer: Blue Shield of California Commercial |
$2.08
|
| Rate for Payer: Blue Shield of California Commercial |
$2.08
|
| Rate for Payer: Blue Shield of California EPN |
$2.08
|
| Rate for Payer: Blue Shield of California EPN |
$2.08
|
| Rate for Payer: Blue Shield of California EPN |
$2.08
|
| Rate for Payer: Blue Shield of California EPN |
$2.08
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.58
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.40
|
| Rate for Payer: Heritage Provider Network Senior |
$0.55
|
| Rate for Payer: Heritage Provider Network Senior |
$0.41
|
| Rate for Payer: Heritage Provider Network Senior |
$0.58
|
| Rate for Payer: Heritage Provider Network Senior |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.88
|
| Rate for Payer: Multiplan Commercial |
$0.95
|
| Rate for Payer: Multiplan Commercial |
$0.89
|
| Rate for Payer: Multiplan Commercial |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$0.65
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.48
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.35
|
| Rate for Payer: TriValley Medical Group Senior |
$0.35
|
| Rate for Payer: TriValley Medical Group Senior |
$0.50
|
| Rate for Payer: TriValley Medical Group Senior |
$0.48
|
| Rate for Payer: TriValley Medical Group Senior |
$0.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.73
|
| Rate for Payer: Vantage Medical Group Senior |
$1.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.73
|
|
|
TOBRAMYCIN-DEXAMETHASONE 0.3 %-0.1 % EYE OINTMENT [11566]
|
Facility
|
IP
|
$112.32
|
|
|
Service Code
|
NDC 0078087601
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$20.33 |
| Max. Negotiated Rate |
$84.24 |
| Rate for Payer: Adventist Health Commercial |
$22.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.33
|
| Rate for Payer: Cash Price |
$50.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$76.04
|
| Rate for Payer: Heritage Provider Network Senior |
$76.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.08
|
| Rate for Payer: Multiplan Commercial |
$84.24
|
|
|
TOBRAMYCIN-DEXAMETHASONE 0.3 %-0.1 % EYE OINTMENT [11566]
|
Facility
|
OP
|
$112.32
|
|
|
Service Code
|
NDC 0078087601
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$20.33 |
| Max. Negotiated Rate |
$95.47 |
| Rate for Payer: Adventist Health Commercial |
$22.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$69.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$95.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$61.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$84.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.18
|
| Rate for Payer: Blue Shield of California Commercial |
$68.52
|
| Rate for Payer: Blue Shield of California EPN |
$54.81
|
| Rate for Payer: Cash Price |
$50.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$73.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$95.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$95.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$95.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$69.53
|
| Rate for Payer: Heritage Provider Network Senior |
$69.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$53.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$78.62
|
| Rate for Payer: Multiplan Commercial |
$84.24
|
| Rate for Payer: TriValley Medical Group Commercial |
$44.93
|
| Rate for Payer: TriValley Medical Group Senior |
$44.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$56.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$56.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$95.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$95.47
|
| Rate for Payer: Vantage Medical Group Senior |
$95.47
|
|
|
TOCILIZUMAB 200 MG/10 ML (20 MG/ML) INTRAVENOUS SOLUTION [108062]
|
Facility
|
IP
|
$159.35
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.84 |
| Max. Negotiated Rate |
$119.51 |
| Rate for Payer: Adventist Health Commercial |
$31.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$102.62
|
| Rate for Payer: Cash Price |
$71.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$73.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.78
|
| Rate for Payer: Heritage Provider Network Senior |
$73.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.84
|
| Rate for Payer: Multiplan Commercial |
$119.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$57.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$52.76
|
|
|
TOCILIZUMAB 200 MG/10 ML (20 MG/ML) INTRAVENOUS SOLUTION [108062]
|
Facility
|
OP
|
$159.35
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.41 |
| Max. Negotiated Rate |
$119.51 |
| Rate for Payer: Adventist Health Commercial |
$31.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$98.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.01
|
| Rate for Payer: Blue Shield of California Commercial |
$6.77
|
| Rate for Payer: Blue Shield of California EPN |
$6.77
|
| Rate for Payer: Cash Price |
$71.71
|
| Rate for Payer: Cash Price |
$71.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$73.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.98
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.78
|
| Rate for Payer: Heritage Provider Network Senior |
$73.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$76.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.25
|
| Rate for Payer: Multiplan Commercial |
$119.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$63.74
|
| Rate for Payer: TriValley Medical Group Senior |
$63.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$57.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$52.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.95
|
| Rate for Payer: Vantage Medical Group Senior |
$5.95
|
|
|
TOCILIZUMAB 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION [108061]
|
Facility
|
IP
|
$159.35
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.84 |
| Max. Negotiated Rate |
$119.51 |
| Rate for Payer: Adventist Health Commercial |
$31.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$102.62
|
| Rate for Payer: Cash Price |
$71.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$73.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.78
|
| Rate for Payer: Heritage Provider Network Senior |
$73.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.84
|
| Rate for Payer: Multiplan Commercial |
$119.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$57.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$52.76
|
|
|
TOCILIZUMAB 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION [108061]
|
Facility
|
OP
|
$159.35
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.41 |
| Max. Negotiated Rate |
$119.51 |
| Rate for Payer: Adventist Health Commercial |
$31.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$98.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.01
|
| Rate for Payer: Blue Shield of California Commercial |
$6.77
|
| Rate for Payer: Blue Shield of California EPN |
$6.77
|
| Rate for Payer: Cash Price |
$71.71
|
| Rate for Payer: Cash Price |
$71.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$73.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.98
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.78
|
| Rate for Payer: Heritage Provider Network Senior |
$73.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$76.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.25
|
| Rate for Payer: Multiplan Commercial |
$119.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$63.74
|
| Rate for Payer: TriValley Medical Group Senior |
$63.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$57.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$52.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.95
|
| Rate for Payer: Vantage Medical Group Senior |
$5.95
|
|
|
TOCILIZUMAB-AAZG 200 MG/10 ML (20 MG/ML) INTRAVENOUS SOLUTION [241038]
|
Facility
|
IP
|
$117.50
|
|
|
Service Code
|
HCPCS Q5135
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.27 |
| Max. Negotiated Rate |
$88.12 |
| Rate for Payer: Adventist Health Commercial |
$23.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$75.67
|
| Rate for Payer: Cash Price |
$52.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$54.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.40
|
| Rate for Payer: Heritage Provider Network Senior |
$54.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.38
|
| Rate for Payer: Multiplan Commercial |
$88.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$42.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$38.90
|
|
|
TOCILIZUMAB-AAZG 200 MG/10 ML (20 MG/ML) INTRAVENOUS SOLUTION [241038]
|
Facility
|
OP
|
$117.50
|
|
|
Service Code
|
HCPCS Q5135
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$88.12 |
| Rate for Payer: Adventist Health Commercial |
$23.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.94
|
| Rate for Payer: Blue Shield of California Commercial |
$4.92
|
| Rate for Payer: Blue Shield of California EPN |
$4.92
|
| Rate for Payer: Cash Price |
$52.88
|
| Rate for Payer: Cash Price |
$52.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$54.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.40
|
| Rate for Payer: Heritage Provider Network Senior |
$54.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$56.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.44
|
| Rate for Payer: Multiplan Commercial |
$88.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$47.00
|
| Rate for Payer: TriValley Medical Group Senior |
$47.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$42.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$38.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.47
|
| Rate for Payer: Vantage Medical Group Senior |
$4.47
|
|
|
TOCILIZUMAB-AAZG 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION [241039]
|
Facility
|
OP
|
$117.50
|
|
|
Service Code
|
HCPCS Q5135
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$88.12 |
| Rate for Payer: Adventist Health Commercial |
$23.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.94
|
| Rate for Payer: Blue Shield of California Commercial |
$4.92
|
| Rate for Payer: Blue Shield of California EPN |
$4.92
|
| Rate for Payer: Cash Price |
$52.88
|
| Rate for Payer: Cash Price |
$52.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$54.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.40
|
| Rate for Payer: Heritage Provider Network Senior |
$54.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$56.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.44
|
| Rate for Payer: Multiplan Commercial |
$88.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$47.00
|
| Rate for Payer: TriValley Medical Group Senior |
$47.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$42.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$38.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.47
|
| Rate for Payer: Vantage Medical Group Senior |
$4.47
|
|
|
TOCILIZUMAB-AAZG 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION [241039]
|
Facility
|
IP
|
$117.50
|
|
|
Service Code
|
HCPCS Q5135
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.27 |
| Max. Negotiated Rate |
$88.12 |
| Rate for Payer: Adventist Health Commercial |
$23.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$75.67
|
| Rate for Payer: Cash Price |
$52.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$54.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.40
|
| Rate for Payer: Heritage Provider Network Senior |
$54.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.38
|
| Rate for Payer: Multiplan Commercial |
$88.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$42.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$38.90
|
|
|
TOCILIZUMAB-AAZG 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION [241037]
|
Facility
|
IP
|
$117.50
|
|
|
Service Code
|
HCPCS Q5135
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.27 |
| Max. Negotiated Rate |
$88.12 |
| Rate for Payer: Adventist Health Commercial |
$23.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$75.67
|
| Rate for Payer: Cash Price |
$52.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$54.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.40
|
| Rate for Payer: Heritage Provider Network Senior |
$54.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.38
|
| Rate for Payer: Multiplan Commercial |
$88.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$42.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$38.90
|
|
|
TOCILIZUMAB-AAZG 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION [241037]
|
Facility
|
OP
|
$117.50
|
|
|
Service Code
|
HCPCS Q5135
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$88.12 |
| Rate for Payer: Adventist Health Commercial |
$23.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.94
|
| Rate for Payer: Blue Shield of California Commercial |
$4.92
|
| Rate for Payer: Blue Shield of California EPN |
$4.92
|
| Rate for Payer: Cash Price |
$52.88
|
| Rate for Payer: Cash Price |
$52.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$54.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.40
|
| Rate for Payer: Heritage Provider Network Senior |
$54.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$56.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.44
|
| Rate for Payer: Multiplan Commercial |
$88.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$47.00
|
| Rate for Payer: TriValley Medical Group Senior |
$47.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$42.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$38.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.47
|
| Rate for Payer: Vantage Medical Group Senior |
$4.47
|
|
|
TOFERSEN 100 MG/15 ML (6.7 MG/ML) INTRATHECAL SOLUTION [237803]
|
Facility
|
OP
|
$1,243.96
|
|
|
Service Code
|
HCPCS J1304
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$149.50 |
| Max. Negotiated Rate |
$932.97 |
| Rate for Payer: Adventist Health Commercial |
$248.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$768.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$181.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$181.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$344.88
|
| Rate for Payer: Blue Shield of California Commercial |
$149.50
|
| Rate for Payer: Blue Shield of California EPN |
$149.50
|
| Rate for Payer: Cash Price |
$559.78
|
| Rate for Payer: Cash Price |
$559.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$572.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$181.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$181.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$796.13
|
| Rate for Payer: EPIC Health Plan Medicare |
$164.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$575.95
|
| Rate for Payer: Heritage Provider Network Senior |
$575.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$164.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$593.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$225.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$189.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$310.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$220.86
|
| Rate for Payer: Multiplan Commercial |
$932.97
|
| Rate for Payer: TriValley Medical Group Commercial |
$497.58
|
| Rate for Payer: TriValley Medical Group Senior |
$497.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$449.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$411.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$181.30
|
| Rate for Payer: Vantage Medical Group Senior |
$181.30
|
|
|
TOFERSEN 100 MG/15 ML (6.7 MG/ML) INTRATHECAL SOLUTION [237803]
|
Facility
|
IP
|
$1,243.96
|
|
|
Service Code
|
HCPCS J1304
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$225.16 |
| Max. Negotiated Rate |
$932.97 |
| Rate for Payer: Adventist Health Commercial |
$248.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$801.11
|
| Rate for Payer: Cash Price |
$559.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$572.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$671.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$575.95
|
| Rate for Payer: Heritage Provider Network Senior |
$575.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$225.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$310.99
|
| Rate for Payer: Multiplan Commercial |
$932.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$449.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$411.88
|
|
|
TOLNAFTATE 1 % TOPICAL CREAM [8020]
|
Facility
|
OP
|
$0.18
|
|
|
Service Code
|
NDC 2438503203
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.11
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
| 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 |
$0.08
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 Senior |
$0.15
|
|
|
TOLNAFTATE 1 % TOPICAL CREAM [8020]
|
Facility
|
IP
|
$0.21
|
|
|
Service Code
|
NDC 5167220202
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.14
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Senior |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.16
|
|
|
TOLNAFTATE 1 % TOPICAL CREAM [8020]
|
Facility
|
IP
|
$0.18
|
|
|
Service Code
|
NDC 2438503203
|
| 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: Aetna of CA Non-Gatekeeper |
$0.12
|
| Rate for Payer: Cash Price |
$0.08
|
| 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 Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
|
