|
Tendon transplantation or transfer, flexor or extensor, forearm and/or wrist, single; each tendon
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 25310
|
| Min. Negotiated Rate |
$624.92 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: Dignity Health Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,044.21
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: IEHP Medi-Cal |
$624.92
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,684.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,095.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,448.63
|
| Rate for Payer: TriValley Medical Group Senior |
$4,044.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
TENECTEPLASE 50 MG INTRAVENOUS SOLUTION [220772]
|
Facility
OP
|
$8,853.91
|
|
|
Service Code
|
CPT J3101
|
| Hospital Charge Code |
ERX220772
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$107.07 |
| Max. Negotiated Rate |
$6,640.43 |
| Rate for Payer: Adventist Health Commercial |
$1,770.78
|
| Rate for Payer: Adventist Health Commercial |
$1,492.53
|
| Rate for Payer: Aetna of CA Gatekeeper |
$376.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$376.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,126.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,082.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$191.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$191.39
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$168.43
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$168.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$168.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$168.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.07
|
| Rate for Payer: Blue Shield of California Commercial |
$141.33
|
| Rate for Payer: Blue Shield of California Commercial |
$141.33
|
| Rate for Payer: Blue Shield of California EPN |
$141.33
|
| Rate for Payer: Blue Shield of California EPN |
$141.33
|
| Rate for Payer: Cash Price |
$3,358.18
|
| Rate for Payer: Cash Price |
$3,358.18
|
| Rate for Payer: Cash Price |
$3,984.26
|
| Rate for Payer: Cash Price |
$3,984.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,072.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,432.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$229.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$229.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$168.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$168.43
|
| Rate for Payer: Dignity Health Senior |
$168.43
|
| Rate for Payer: Dignity Health Senior |
$168.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,666.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,776.08
|
| Rate for Payer: EPIC Health Plan Medicare |
$153.11
|
| Rate for Payer: EPIC Health Plan Medicare |
$153.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,455.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,099.36
|
| Rate for Payer: Heritage Provider Network Senior |
$4,099.36
|
| Rate for Payer: Heritage Provider Network Senior |
$3,455.20
|
| Rate for Payer: Humana Medicare |
$153.11
|
| Rate for Payer: Humana Medicare |
$153.11
|
| Rate for Payer: IEHP Medicare Advantage |
$153.11
|
| Rate for Payer: IEHP Medicare Advantage |
$153.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$290.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$290.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,350.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,602.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$180.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$180.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,213.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,865.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$192.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$192.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$192.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$192.92
|
| Rate for Payer: Multiplan Commercial |
$6,640.43
|
| Rate for Payer: Multiplan Commercial |
$5,596.97
|
| Rate for Payer: TriValley Medical Group Commercial |
$168.43
|
| Rate for Payer: TriValley Medical Group Commercial |
$168.43
|
| Rate for Payer: TriValley Medical Group Senior |
$153.11
|
| Rate for Payer: TriValley Medical Group Senior |
$153.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,720.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,228.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,493.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,958.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$229.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$229.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$168.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$168.43
|
| Rate for Payer: Vantage Medical Group Senior |
$153.11
|
| Rate for Payer: Vantage Medical Group Senior |
$153.11
|
|
|
TENECTEPLASE 50 MG INTRAVENOUS SOLUTION [220772]
|
Facility
IP
|
$8,853.91
|
|
|
Service Code
|
CPT J3101
|
| Hospital Charge Code |
ERX220772
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,602.56 |
| Max. Negotiated Rate |
$6,640.43 |
| Rate for Payer: Adventist Health Commercial |
$1,770.78
|
| Rate for Payer: Adventist Health Commercial |
$1,492.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,126.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,082.64
|
| Rate for Payer: Cash Price |
$3,358.18
|
| Rate for Payer: Cash Price |
$3,984.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,072.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,432.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,029.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,781.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,052.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,994.10
|
| Rate for Payer: Heritage Provider Network Senior |
$5,994.10
|
| Rate for Payer: Heritage Provider Network Senior |
$5,052.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,602.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,350.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,865.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,213.48
|
| Rate for Payer: Multiplan Commercial |
$5,596.97
|
| Rate for Payer: Multiplan Commercial |
$6,640.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,720.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,228.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,493.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,958.09
|
|
|
Tenodesis of long tendon of biceps
|
Facility
OP
|
$16,983.21
|
|
|
Service Code
|
CPT 23430
|
| Min. Negotiated Rate |
$157.98 |
| Max. Negotiated Rate |
$16,983.21 |
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: Dignity Health Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,938.53
|
| Rate for Payer: Humana Medicare |
$8,938.53
|
| Rate for Payer: IEHP Medi-Cal |
$157.98
|
| Rate for Payer: IEHP Medicare Advantage |
$8,938.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16,983.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,547.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,262.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,262.55
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,832.38
|
| Rate for Payer: TriValley Medical Group Senior |
$8,938.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
TENOFOVIR ALAFENAMIDE 25 MG TABLET [216415]
|
Facility
IP
|
$54.97
|
|
|
Service Code
|
NDC 61958-2301-1
|
| Hospital Charge Code |
ERX216415
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.95 |
| Max. Negotiated Rate |
$41.23 |
| Rate for Payer: Adventist Health Commercial |
$10.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.76
|
| Rate for Payer: Cash Price |
$24.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.21
|
| Rate for Payer: Heritage Provider Network Senior |
$37.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.74
|
| Rate for Payer: Multiplan Commercial |
$41.23
|
|
|
TENOFOVIR ALAFENAMIDE 25 MG TABLET [216415]
|
Facility
OP
|
$54.97
|
|
|
Service Code
|
NDC 61958-2301-1
|
| Hospital Charge Code |
ERX216415
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.95 |
| Max. Negotiated Rate |
$46.72 |
| Rate for Payer: Adventist Health Commercial |
$10.99
|
| Rate for Payer: Aetna of CA Gatekeeper |
$29.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$46.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$30.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$41.23
|
| Rate for Payer: Blue Shield of California Commercial |
$34.14
|
| Rate for Payer: Blue Shield of California EPN |
$32.27
|
| Rate for Payer: Cash Price |
$24.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.72
|
| Rate for Payer: Dignity Health Senior |
$46.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.03
|
| Rate for Payer: Heritage Provider Network Senior |
$34.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.74
|
| Rate for Payer: Multiplan Commercial |
$41.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.72
|
| Rate for Payer: Vantage Medical Group Senior |
$46.72
|
|
|
TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [31684]
|
Facility
IP
|
$1.15
|
|
|
Service Code
|
NDC 69097-533-02
|
| Hospital Charge Code |
1710955
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.86 |
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.79
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.78
|
| Rate for Payer: Heritage Provider Network Senior |
$0.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.86
|
|
|
TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [31684]
|
Facility
OP
|
$4.21
|
|
|
Service Code
|
NDC 50268-758-11
|
| Hospital Charge Code |
1710955
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.58 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.16
|
| Rate for Payer: Blue Shield of California Commercial |
$2.61
|
| Rate for Payer: Blue Shield of California EPN |
$2.47
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.58
|
| Rate for Payer: Dignity Health Senior |
$3.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.61
|
| Rate for Payer: Heritage Provider Network Senior |
$2.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.05
|
| Rate for Payer: Multiplan Commercial |
$3.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.58
|
| Rate for Payer: Vantage Medical Group Senior |
$3.58
|
|
|
TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [31684]
|
Facility
OP
|
$4.21
|
|
|
Service Code
|
NDC 50268-758-12
|
| Hospital Charge Code |
1710955
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.58 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.16
|
| Rate for Payer: Blue Shield of California Commercial |
$2.61
|
| Rate for Payer: Blue Shield of California EPN |
$2.47
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.58
|
| Rate for Payer: Dignity Health Senior |
$3.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.61
|
| Rate for Payer: Heritage Provider Network Senior |
$2.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.05
|
| Rate for Payer: Multiplan Commercial |
$3.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.58
|
| Rate for Payer: Vantage Medical Group Senior |
$3.58
|
|
|
TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [31684]
|
Facility
OP
|
$1.15
|
|
|
Service Code
|
NDC 69097-533-02
|
| Hospital Charge Code |
1710955
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.86
|
| Rate for Payer: Blue Shield of California Commercial |
$0.71
|
| Rate for Payer: Blue Shield of California EPN |
$0.68
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.98
|
| Rate for Payer: Dignity Health Senior |
$0.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.71
|
| Rate for Payer: Heritage Provider Network Senior |
$0.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.98
|
| Rate for Payer: Vantage Medical Group Senior |
$0.98
|
|
|
TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [31684]
|
Facility
IP
|
$4.21
|
|
|
Service Code
|
NDC 50268-758-11
|
| Hospital Charge Code |
1710955
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.16 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.89
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.85
|
| Rate for Payer: Heritage Provider Network Senior |
$2.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.05
|
| Rate for Payer: Multiplan Commercial |
$3.16
|
|
|
TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [31684]
|
Facility
IP
|
$4.21
|
|
|
Service Code
|
NDC 50268-758-12
|
| Hospital Charge Code |
1710955
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.16 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.89
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.85
|
| Rate for Payer: Heritage Provider Network Senior |
$2.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.05
|
| Rate for Payer: Multiplan Commercial |
$3.16
|
|
|
Tenolysis, extensor tendon, hand OR finger, each tendon
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 26445
|
| Min. Negotiated Rate |
$505.28 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: Dignity Health Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,044.21
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: IEHP Medi-Cal |
$505.28
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,684.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,095.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,448.63
|
| Rate for Payer: TriValley Medical Group Senior |
$4,044.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
Tenolysis, flexor or extensor tendon, forearm and/or wrist, single, each tendon
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 25295
|
| Min. Negotiated Rate |
$103.96 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: Dignity Health Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,044.21
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: IEHP Medi-Cal |
$103.96
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,684.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,095.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,448.63
|
| Rate for Payer: TriValley Medical Group Senior |
$4,044.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
Tenolysis, flexor tendon; palm AND finger, each tendon
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 26442
|
| Min. Negotiated Rate |
$132.41 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: Dignity Health Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,044.21
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: IEHP Medi-Cal |
$132.41
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,684.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,095.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,448.63
|
| Rate for Payer: TriValley Medical Group Senior |
$4,044.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
Tenolysis, flexor tendon; palm OR finger, each tendon
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 26440
|
| Min. Negotiated Rate |
$530.84 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,208.90
|
| Rate for Payer: Dignity Health Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,008.09
|
| Rate for Payer: Humana Medicare |
$2,008.09
|
| Rate for Payer: IEHP Medi-Cal |
$530.84
|
| Rate for Payer: IEHP Medicare Advantage |
$2,008.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,815.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,369.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,530.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,208.90
|
| Rate for Payer: TriValley Medical Group Senior |
$2,008.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.09
|
|
|
Tenotomy, elbow, lateral or medial (eg, epicondylitis, tennis elbow, golfer's elbow); debridement, soft tissue and/or bone, open
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 24358
|
| Min. Negotiated Rate |
$580.21 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: Dignity Health Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,044.21
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: IEHP Medi-Cal |
$580.21
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,684.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,095.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,448.63
|
| Rate for Payer: TriValley Medical Group Senior |
$4,044.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
Tenotomy, elbow, lateral or medial (eg, epicondylitis, tennis elbow, golfer's elbow); debridement, soft tissue and/or bone, open with tendon repair or reattachment
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 24359
|
| Min. Negotiated Rate |
$152.16 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: Dignity Health Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,044.21
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: IEHP Medi-Cal |
$152.16
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,684.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,095.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,448.63
|
| Rate for Payer: TriValley Medical Group Senior |
$4,044.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
Tenotomy, extensor, hand or finger, open, each tendon
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 26460
|
| Min. Negotiated Rate |
$268.32 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,208.90
|
| Rate for Payer: Dignity Health Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,008.09
|
| Rate for Payer: Humana Medicare |
$2,008.09
|
| Rate for Payer: IEHP Medi-Cal |
$268.32
|
| Rate for Payer: IEHP Medicare Advantage |
$2,008.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,815.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,369.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,530.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,208.90
|
| Rate for Payer: TriValley Medical Group Senior |
$2,008.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.09
|
|
|
Tenotomy, flexor, finger, open, each tendon
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 26455
|
| Min. Negotiated Rate |
$65.63 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,208.90
|
| Rate for Payer: Dignity Health Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,008.09
|
| Rate for Payer: Humana Medicare |
$2,008.09
|
| Rate for Payer: IEHP Medi-Cal |
$65.63
|
| Rate for Payer: IEHP Medicare Advantage |
$2,008.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,815.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,369.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,530.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,208.90
|
| Rate for Payer: TriValley Medical Group Senior |
$2,008.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.09
|
|
|
Tenotomy, open, flexor or extensor tendon, forearm and/or wrist, single, each tendon
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 25290
|
| Min. Negotiated Rate |
$530.84 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: Dignity Health Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,044.21
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: IEHP Medi-Cal |
$530.84
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,684.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,095.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,448.63
|
| Rate for Payer: TriValley Medical Group Senior |
$4,044.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
TERAZOSIN 1 MG CAPSULE [14550]
|
Facility
OP
|
$0.28
|
|
|
Service Code
|
NDC 51079-936-20
|
| Hospital Charge Code |
1711490
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.21
|
| Rate for Payer: Blue Shield of California Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.24
|
| Rate for Payer: Dignity Health Senior |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Senior |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: Vantage Medical Group Senior |
$0.24
|
|
|
TERAZOSIN 1 MG CAPSULE [14550]
|
Facility
IP
|
$0.28
|
|
|
Service Code
|
NDC 51079-936-20
|
| Hospital Charge Code |
1711490
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.19
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Senior |
$0.19
|
| 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 |
$0.21
|
|
|
TERAZOSIN 1 MG CAPSULE [14550]
|
Facility
OP
|
$0.22
|
|
|
Service Code
|
NDC 59746-383-06
|
| Hospital Charge Code |
1711490
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
| Rate for Payer: Dignity Health Senior |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Senior |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
|
|
TERAZOSIN 1 MG CAPSULE [14550]
|
Facility
IP
|
$0.28
|
|
|
Service Code
|
NDC 51079-936-01
|
| Hospital Charge Code |
1711490
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.19
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Senior |
$0.19
|
| 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 |
$0.21
|
|
