|
TRIHEXYPHENIDYL 2 MG TABLET [8166]
|
Facility
|
IP
|
$0.18
|
|
|
Service Code
|
NDC 7095421210
|
| 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
|
|
|
TRIHEXYPHENIDYL 2 MG TABLET [8166]
|
Facility
|
OP
|
$0.18
|
|
|
Service Code
|
NDC 0591533501
|
| 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 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 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 7095421210
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.11
|
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| 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 Medi-Cal |
$0.15
|
| Rate for Payer: Vantage Medical Group Senior |
$0.15
|
|
|
TRIHEXYPHENIDYL 5 MG TABLET [8167]
|
Facility
|
IP
|
$0.36
|
|
|
Service Code
|
NDC 0591533701
|
| 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: Aetna of CA Non-Gatekeeper |
$0.23
|
| Rate for Payer: Cash Price |
$0.16
|
| 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 Foundation Hospitals 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
|
$0.27
|
|
|
Service Code
|
NDC 7095421110
|
| 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 Non-Gatekeeper |
$0.17
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
| 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 |
$0.12
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
|
|
TRIHEXYPHENIDYL 5 MG TABLET [8167]
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
NDC 7095421110
|
| 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: Aetna of CA Non-Gatekeeper |
$0.17
|
| Rate for Payer: Cash Price |
$0.12
|
| 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 Foundation Hospitals 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
|
OP
|
$0.36
|
|
|
Service Code
|
NDC 0591533701
|
| 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 Non-Gatekeeper |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Senior |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
|
TRIMETHOBENZAMIDE 100 MG/ML INTRAMUSCULAR SOLUTION [110953]
|
Facility
|
IP
|
$39.65
|
|
|
Service Code
|
HCPCS J3250
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.18 |
| Max. Negotiated Rate |
$29.74 |
| Rate for Payer: Adventist Health Commercial |
$7.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.53
|
| Rate for Payer: Cash Price |
$17.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.36
|
| Rate for Payer: Heritage Provider Network Senior |
$18.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.91
|
| Rate for Payer: Multiplan Commercial |
$29.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.13
|
|
|
TRIMETHOBENZAMIDE 100 MG/ML INTRAMUSCULAR SOLUTION [110953]
|
Facility
|
OP
|
$39.65
|
|
|
Service Code
|
HCPCS J3250
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.18 |
| Max. Negotiated Rate |
$53.77 |
| Rate for Payer: Adventist Health Commercial |
$7.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.16
|
| 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 |
$17.84
|
| Rate for Payer: Cash Price |
$17.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.36
|
| Rate for Payer: Heritage Provider Network Senior |
$18.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$18.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27.75
|
| Rate for Payer: Multiplan Commercial |
$29.74
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.86
|
| Rate for Payer: TriValley Medical Group Senior |
$15.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.70
|
| Rate for Payer: Vantage Medical Group Senior |
$33.70
|
|
|
TROMETHAMINE 36 MG/ML (0.3 M) INTRAVENOUS SOLUTION [11608]
|
Facility
|
IP
|
$0.94
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.71 |
| Rate for Payer: Adventist Health Commercial |
$0.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.61
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.44
|
| Rate for Payer: Heritage Provider Network Senior |
$0.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.31
|
|
|
TROMETHAMINE 36 MG/ML (0.3 M) INTRAVENOUS SOLUTION [11608]
|
Facility
|
OP
|
$0.94
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Adventist Health Commercial |
$0.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.58
|
| 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 |
$0.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.44
|
| Rate for Payer: Heritage Provider Network Senior |
$0.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 |
$0.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.31
|
| 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
|
|
|
TROPICAMIDE 0.5 % EYE DROPS [8249]
|
Facility
|
IP
|
$1.71
|
|
|
Service Code
|
NDC 6131435401
|
| 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
|
|
|
TROPICAMIDE 0.5 % EYE DROPS [8249]
|
Facility
|
OP
|
$1.71
|
|
|
Service Code
|
NDC 6131435401
|
| 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
|
|
|
TROPICAMIDE 1 % EYE DROPS [8250]
|
Facility
|
OP
|
$2.45
|
|
|
Service Code
|
NDC 6131435502
|
| 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 Non-Gatekeeper |
$1.51
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$1.23
|
| 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 |
$1.10
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$1.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 % EYE DROPS [8250]
|
Facility
|
IP
|
$2.45
|
|
|
Service Code
|
NDC 6131435502
|
| 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: Aetna of CA Non-Gatekeeper |
$1.58
|
| Rate for Payer: Cash Price |
$1.10
|
| 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 Foundation Hospitals 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
|
OP
|
$0.68
|
|
|
Service Code
|
NDC 7006912101
|
| 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 Non-Gatekeeper |
$0.42
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$0.34
|
| 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 |
$0.31
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$0.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
IP
|
$0.68
|
|
|
Service Code
|
NDC 7006912101
|
| 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: Aetna of CA Non-Gatekeeper |
$0.44
|
| Rate for Payer: Cash Price |
$0.31
|
| 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 Foundation Hospitals Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.51
|
|
|
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: Aetna of CA Non-Gatekeeper |
$10.82
|
| Rate for Payer: Cash Price |
$7.56
|
| 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 Foundation Hospitals 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 Non-Gatekeeper |
$10.38
|
| 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 |
$7.56
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$8.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
$207.91
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.63 |
| Max. Negotiated Rate |
$155.93 |
| Rate for Payer: Adventist Health Commercial |
$41.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$133.89
|
| Rate for Payer: Cash Price |
$93.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$95.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$96.26
|
| Rate for Payer: Heritage Provider Network Senior |
$96.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.98
|
| Rate for Payer: Multiplan Commercial |
$155.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$75.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$68.84
|
|
|
TRYPAN BLUE 0.06 % INTRAOCULAR SYRINGE [88317]
|
Facility
|
OP
|
$207.91
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$155.93 |
| Rate for Payer: Adventist Health Commercial |
$41.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$128.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.63
|
| Rate for Payer: Blue Shield of California Commercial |
$126.83
|
| Rate for Payer: Blue Shield of California EPN |
$101.46
|
| Rate for Payer: Cash Price |
$93.56
|
| Rate for Payer: Cash Price |
$93.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$95.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$133.06
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$96.26
|
| Rate for Payer: Heritage Provider Network Senior |
$96.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$99.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.57
|
| Rate for Payer: Multiplan Commercial |
$155.93
|
| Rate for Payer: TriValley Medical Group Commercial |
$83.16
|
| Rate for Payer: TriValley Medical Group Senior |
$83.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$75.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$68.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.96
|
| Rate for Payer: Vantage Medical Group Senior |
$11.96
|
|
|
TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION [8259]
|
Facility
|
IP
|
$151.39
|
|
|
Service Code
|
HCPCS 86580
|
| Hospital Charge Code |
901700020
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.40 |
| Max. Negotiated Rate |
$113.54 |
| Rate for Payer: Adventist Health Commercial |
$30.28
|
| Rate for Payer: Adventist Health Commercial |
$23.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$75.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$97.50
|
| Rate for Payer: Cash Price |
$53.09
|
| Rate for Payer: Cash Price |
$68.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$79.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$102.49
|
| Rate for Payer: Heritage Provider Network Senior |
$79.87
|
| Rate for Payer: Heritage Provider Network Senior |
$102.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.85
|
| Rate for Payer: Multiplan Commercial |
$88.48
|
| Rate for Payer: Multiplan Commercial |
$113.54
|
|
|
TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION [8259]
|
Facility
|
OP
|
$151.39
|
|
|
Service Code
|
HCPCS 86580
|
| Hospital Charge Code |
901700020
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.25 |
| Max. Negotiated Rate |
$113.54 |
| Rate for Payer: Adventist Health Commercial |
$30.28
|
| Rate for Payer: Adventist Health Commercial |
$23.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$93.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.57
|
| Rate for Payer: Blue Shield of California Commercial |
$55.39
|
| Rate for Payer: Blue Shield of California Commercial |
$55.39
|
| Rate for Payer: Blue Shield of California EPN |
$44.54
|
| Rate for Payer: Blue Shield of California EPN |
$44.54
|
| Rate for Payer: Cash Price |
$53.09
|
| Rate for Payer: Cash Price |
$68.13
|
| Rate for Payer: Cash Price |
$68.13
|
| Rate for Payer: Cash Price |
$53.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$76.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$98.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.61
|
| Rate for Payer: EPIC Health Plan Medicare |
$37.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$37.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$93.71
|
| Rate for Payer: Heritage Provider Network Senior |
$73.03
|
| Rate for Payer: Heritage Provider Network Senior |
$93.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$72.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$56.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.85
|
| Rate for Payer: Multiplan Commercial |
$88.48
|
| Rate for Payer: Multiplan Commercial |
$113.54
|
| Rate for Payer: TriValley Medical Group Commercial |
$37.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$37.20
|
| Rate for Payer: TriValley Medical Group Senior |
$37.20
|
| Rate for Payer: TriValley Medical Group Senior |
$37.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
|
|
TUCATINIB 150 MG TABLET [227737]
|
Facility
|
OP
|
$271.90
|
|
|
Service Code
|
NDC 5114400212
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$49.21 |
| Max. Negotiated Rate |
$231.12 |
| Rate for Payer: Adventist Health Commercial |
$54.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$168.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$231.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$149.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$203.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.00
|
| Rate for Payer: Blue Shield of California Commercial |
$165.86
|
| Rate for Payer: Blue Shield of California EPN |
$132.69
|
| Rate for Payer: Cash Price |
$122.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$176.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$231.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$231.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$231.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$168.31
|
| Rate for Payer: Heritage Provider Network Senior |
$168.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$129.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$190.33
|
| Rate for Payer: Multiplan Commercial |
$203.93
|
| Rate for Payer: TriValley Medical Group Commercial |
$108.76
|
| Rate for Payer: TriValley Medical Group Senior |
$108.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$135.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$135.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$231.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$231.12
|
| Rate for Payer: Vantage Medical Group Senior |
$231.12
|
|
|
TUCATINIB 150 MG TABLET [227737]
|
Facility
|
IP
|
$271.90
|
|
|
Service Code
|
NDC 5114400212
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$49.21 |
| Max. Negotiated Rate |
$203.93 |
| Rate for Payer: Adventist Health Commercial |
$54.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$175.10
|
| Rate for Payer: Cash Price |
$122.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$184.08
|
| Rate for Payer: Heritage Provider Network Senior |
$184.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.97
|
| Rate for Payer: Multiplan Commercial |
$203.93
|
|
