|
TADALAFIL 20 MG TABLET (PULMONARY HYPERTENSION) [214774]
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
NDC 27241-123-02
|
| Hospital Charge Code |
ERX214774
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.69
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.68
|
| Rate for Payer: Heritage Provider Network Senior |
$0.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
|
|
TADALAFIL 20 MG TABLET (PULMONARY HYPERTENSION) [214774]
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
NDC 33342-278-09
|
| Hospital Charge Code |
ERX214774
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.75
|
| Rate for Payer: Blue Shield of California Commercial |
$0.62
|
| Rate for Payer: Blue Shield of California EPN |
$0.59
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: Dignity Health Senior |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.62
|
| Rate for Payer: Heritage Provider Network Senior |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
TADALAFIL 20 MG TABLET (PULMONARY HYPERTENSION) [214774]
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
NDC 69097-526-03
|
| Hospital Charge Code |
ERX214774
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.75
|
| Rate for Payer: Blue Shield of California Commercial |
$0.62
|
| Rate for Payer: Blue Shield of California EPN |
$0.59
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: Dignity Health Senior |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.62
|
| Rate for Payer: Heritage Provider Network Senior |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
TADALAFIL 20 MG TABLET (PULMONARY HYPERTENSION) [214774]
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
NDC 69097-526-03
|
| Hospital Charge Code |
ERX214774
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.69
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.68
|
| Rate for Payer: Heritage Provider Network Senior |
$0.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
|
|
TADALAFIL 5 MG TABLET [37400]
|
Facility
IP
|
$0.36
|
|
|
Service Code
|
NDC 43598-575-30
|
| Hospital Charge Code |
ERX37400
|
|
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 |
$0.25
|
| 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 Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
|
|
TADALAFIL 5 MG TABLET [37400]
|
Facility
OP
|
$0.36
|
|
|
Service Code
|
NDC 43598-575-30
|
| Hospital Charge Code |
ERX37400
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.27
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| 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 Senior |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Senior |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
|
TADALAFIL ORAL SUSPENSION COMPOUND 5 MG/ML [4081077]
|
Facility
OP
|
$0.25
|
|
|
Service Code
|
NDC 99994-0810-77
|
| Hospital Charge Code |
NDC4081077
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.21
|
| Rate for Payer: Dignity Health Senior |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Senior |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Vantage Medical Group Senior |
$0.21
|
|
|
TADALAFIL ORAL SUSPENSION COMPOUND 5 MG/ML [4081077]
|
Facility
IP
|
$0.25
|
|
|
Service Code
|
NDC 99994-0810-77
|
| Hospital Charge Code |
NDC4081077
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.17
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Senior |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
|
|
TAFASITAMAB-CXIX 200 MG INTRAVENOUS SOLUTION [228997]
|
Facility
OP
|
$1,570.38
|
|
|
Service Code
|
CPT J9349
|
| Hospital Charge Code |
ERX228997
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$1,177.78 |
| Rate for Payer: Adventist Health Commercial |
$314.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$26.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,078.85
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.65
|
| Rate for Payer: Blue Shield of California Commercial |
$12.80
|
| Rate for Payer: Blue Shield of California EPN |
$12.80
|
| Rate for Payer: Cash Price |
$706.67
|
| Rate for Payer: Cash Price |
$706.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$722.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.96
|
| Rate for Payer: Dignity Health Senior |
$14.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,005.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$727.09
|
| Rate for Payer: Heritage Provider Network Senior |
$727.09
|
| Rate for Payer: Humana Medicare |
$13.60
|
| Rate for Payer: IEHP Medi-Cal |
$28.17
|
| Rate for Payer: IEHP Medicare Advantage |
$13.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$284.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.13
|
| Rate for Payer: Multiplan Commercial |
$1,177.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.96
|
| Rate for Payer: TriValley Medical Group Senior |
$13.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$572.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$524.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.96
|
| Rate for Payer: Vantage Medical Group Senior |
$14.96
|
|
|
TAFASITAMAB-CXIX 200 MG INTRAVENOUS SOLUTION [228997]
|
Facility
IP
|
$1,570.38
|
|
|
Service Code
|
CPT J9349
|
| Hospital Charge Code |
ERX228997
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$284.24 |
| Max. Negotiated Rate |
$1,177.78 |
| Rate for Payer: Adventist Health Commercial |
$314.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,078.85
|
| Rate for Payer: Cash Price |
$706.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$722.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,063.15
|
| Rate for Payer: Heritage Provider Network Senior |
$1,063.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$284.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.60
|
| Rate for Payer: Multiplan Commercial |
$1,177.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$572.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$524.66
|
|
|
TALIMOGENE LAHERPAREPVEC 10EXP6 (1 MILLION) PFU/ML SUSP FOR INJECTION [211748]
|
Facility
IP
|
$76.04
|
|
|
Service Code
|
CPT J9325
|
| Hospital Charge Code |
NDG211748
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$57.03 |
| Rate for Payer: Adventist Health Commercial |
$15.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.24
|
| Rate for Payer: Cash Price |
$34.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$51.48
|
| Rate for Payer: Heritage Provider Network Senior |
$51.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.01
|
| Rate for Payer: Multiplan Commercial |
$57.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.40
|
|
|
TALIMOGENE LAHERPAREPVEC 10EXP6 (1 MILLION) PFU/ML SUSP FOR INJECTION [211748]
|
Facility
OP
|
$76.04
|
|
|
Service Code
|
CPT J9325
|
| Hospital Charge Code |
NDG211748
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$131.14 |
| Rate for Payer: Adventist Health Commercial |
$15.21
|
| Rate for Payer: Aetna of CA Gatekeeper |
$131.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$83.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$73.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$73.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.05
|
| Rate for Payer: Blue Shield of California Commercial |
$61.03
|
| Rate for Payer: Blue Shield of California EPN |
$61.03
|
| Rate for Payer: Cash Price |
$34.22
|
| Rate for Payer: Cash Price |
$34.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$99.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.25
|
| Rate for Payer: Dignity Health Senior |
$73.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.67
|
| Rate for Payer: EPIC Health Plan Medicare |
$66.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.21
|
| Rate for Payer: Heritage Provider Network Senior |
$35.21
|
| Rate for Payer: Humana Medicare |
$66.59
|
| Rate for Payer: IEHP Medi-Cal |
$110.84
|
| Rate for Payer: IEHP Medicare Advantage |
$66.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$126.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$78.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$83.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.90
|
| Rate for Payer: Multiplan Commercial |
$57.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$73.25
|
| Rate for Payer: TriValley Medical Group Senior |
$66.59
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$99.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.25
|
| Rate for Payer: Vantage Medical Group Senior |
$66.59
|
|
|
TALIMOGENE LAHERPAREPVEC 10EXP8 (100 MILLION)PFU/ML SUSP FOR INJECTION [211749]
|
Facility
IP
|
$7,603.57
|
|
|
Service Code
|
CPT J9325
|
| Hospital Charge Code |
NDG211749
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,376.25 |
| Max. Negotiated Rate |
$5,702.68 |
| Rate for Payer: Adventist Health Commercial |
$1,520.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,223.65
|
| Rate for Payer: Cash Price |
$3,421.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,497.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,105.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,147.62
|
| Rate for Payer: Heritage Provider Network Senior |
$5,147.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,376.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,900.89
|
| Rate for Payer: Multiplan Commercial |
$5,702.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,772.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,540.35
|
|
|
TALIMOGENE LAHERPAREPVEC 10EXP8 (100 MILLION)PFU/ML SUSP FOR INJECTION [211749]
|
Facility
OP
|
$7,603.57
|
|
|
Service Code
|
CPT J9325
|
| Hospital Charge Code |
NDG211749
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.03 |
| Max. Negotiated Rate |
$5,702.68 |
| Rate for Payer: Adventist Health Commercial |
$1,520.71
|
| Rate for Payer: Aetna of CA Gatekeeper |
$131.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,223.65
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$83.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$73.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$73.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.05
|
| Rate for Payer: Blue Shield of California Commercial |
$61.03
|
| Rate for Payer: Blue Shield of California EPN |
$61.03
|
| Rate for Payer: Cash Price |
$3,421.61
|
| Rate for Payer: Cash Price |
$3,421.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,497.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$99.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.25
|
| Rate for Payer: Dignity Health Senior |
$73.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,866.28
|
| Rate for Payer: EPIC Health Plan Medicare |
$66.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,520.45
|
| Rate for Payer: Heritage Provider Network Senior |
$3,520.45
|
| Rate for Payer: Humana Medicare |
$66.59
|
| Rate for Payer: IEHP Medi-Cal |
$110.84
|
| Rate for Payer: IEHP Medicare Advantage |
$66.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$126.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,376.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$78.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,900.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$83.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.90
|
| Rate for Payer: Multiplan Commercial |
$5,702.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$73.25
|
| Rate for Payer: TriValley Medical Group Senior |
$66.59
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,772.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,540.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$99.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.25
|
| Rate for Payer: Vantage Medical Group Senior |
$66.59
|
|
|
TAMOXIFEN 10 MG TABLET [7711]
|
Facility
IP
|
$0.46
|
|
|
Service Code
|
CPT S0187
|
| Hospital Charge Code |
1710109
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.39
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.31
|
| Rate for Payer: Heritage Provider Network Senior |
$0.39
|
| Rate for Payer: Heritage Provider Network Senior |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
|
|
TAMOXIFEN 10 MG TABLET [7711]
|
Facility
OP
|
$0.46
|
|
|
Service Code
|
CPT S0187
|
| Hospital Charge Code |
1710109
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$6.06 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.55
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California EPN |
$0.33
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.39
|
| Rate for Payer: Dignity Health Senior |
$0.48
|
| Rate for Payer: Dignity Health Senior |
$0.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.28
|
| Rate for Payer: Heritage Provider Network Senior |
$0.28
|
| Rate for Payer: Heritage Provider Network Senior |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$0.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.39
|
| Rate for Payer: Vantage Medical Group Senior |
$0.39
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
|
|
TAMOXIFEN 20 MG TABLET [11498]
|
Facility
OP
|
$0.46
|
|
|
Service Code
|
NDC 59651-300-30
|
| Hospital Charge Code |
1710943
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.39
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.35
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.39
|
| Rate for Payer: Dignity Health Senior |
$0.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.28
|
| Rate for Payer: Heritage Provider Network Senior |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.39
|
| Rate for Payer: Vantage Medical Group Senior |
$0.39
|
|
|
TAMOXIFEN 20 MG TABLET [11498]
|
Facility
OP
|
$0.46
|
|
|
Service Code
|
NDC 51862-446-30
|
| Hospital Charge Code |
1710943
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.39
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.35
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.39
|
| Rate for Payer: Dignity Health Senior |
$0.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.28
|
| Rate for Payer: Heritage Provider Network Senior |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.39
|
| Rate for Payer: Vantage Medical Group Senior |
$0.39
|
|
|
TAMOXIFEN 20 MG TABLET [11498]
|
Facility
IP
|
$0.46
|
|
|
Service Code
|
NDC 59651-300-30
|
| Hospital Charge Code |
1710943
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.32
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.31
|
| Rate for Payer: Heritage Provider Network Senior |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
|
|
TAMOXIFEN 20 MG TABLET [11498]
|
Facility
IP
|
$0.46
|
|
|
Service Code
|
NDC 51862-446-30
|
| Hospital Charge Code |
1710943
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.32
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.31
|
| Rate for Payer: Heritage Provider Network Senior |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
|
|
TAMSULOSIN 0.4 MG CAPSULE [103890]
|
Facility
IP
|
$0.07
|
|
|
Service Code
|
NDC 0904-6401-89
|
| Hospital Charge Code |
1711755
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.05
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Senior |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
|
|
TAMSULOSIN 0.4 MG CAPSULE [103890]
|
Facility
OP
|
$0.09
|
|
|
Service Code
|
NDC 65862-598-01
|
| Hospital Charge Code |
1711755
|
|
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 Gatekeeper |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.08
|
| Rate for Payer: Dignity Health Senior |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Senior |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
|
TAMSULOSIN 0.4 MG CAPSULE [103890]
|
Facility
OP
|
$0.29
|
|
|
Service Code
|
NDC 62756-160-88
|
| Hospital Charge Code |
1711755
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.25
|
| Rate for Payer: Dignity Health Senior |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Senior |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: Vantage Medical Group Senior |
$0.25
|
|
|
TAMSULOSIN 0.4 MG CAPSULE [103890]
|
Facility
IP
|
$0.29
|
|
|
Service Code
|
NDC 62756-160-88
|
| Hospital Charge Code |
1711755
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.20
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.20
|
| Rate for Payer: Heritage Provider Network Senior |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
|
|
TAMSULOSIN 0.4 MG CAPSULE [103890]
|
Facility
OP
|
$0.07
|
|
|
Service Code
|
NDC 0904-6401-89
|
| Hospital Charge Code |
1711755
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.06
|
| Rate for Payer: Dignity Health Senior |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Senior |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Vantage Medical Group Senior |
$0.06
|
|
