PAROXETINE 10 MG TABLET [16632]
|
Facility
|
IP
|
$0.96
|
|
Service Code
|
NDC 0904-5676-61
|
Hospital Charge Code |
1713121
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.53 |
Max. Negotiated Rate |
$0.77 |
Rate for Payer: Cash Price |
$0.43
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.77
|
Rate for Payer: Health Smart Auto/Commercial |
$0.58
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.72
|
|
PAROXETINE 10 MG TABLET [16632]
|
Facility
|
OP
|
$0.96
|
|
Service Code
|
NDC 0904-5676-61
|
Hospital Charge Code |
1713121
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.53 |
Max. Negotiated Rate |
$0.72 |
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.58
|
Rate for Payer: Aetna of CA Government/Medicare |
$0.58
|
Rate for Payer: Cash Price |
$0.43
|
Rate for Payer: Health Smart Auto/Commercial |
$0.58
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.58
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.72
|
|
PAROXETINE 10 MG TABLET [16632]
|
Facility
|
OP
|
$1.02
|
|
Service Code
|
NDC 68084-044-11
|
Hospital Charge Code |
1713121
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.56 |
Max. Negotiated Rate |
$0.77 |
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.61
|
Rate for Payer: Aetna of CA Government/Medicare |
$0.61
|
Rate for Payer: Cash Price |
$0.46
|
Rate for Payer: Health Smart Auto/Commercial |
$0.61
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.61
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.77
|
|
PAROXETINE 10 MG TABLET [16632]
|
Facility
|
OP
|
$0.24
|
|
Service Code
|
NDC 43547-347-03
|
Hospital Charge Code |
1713121
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.13 |
Max. Negotiated Rate |
$0.18 |
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.14
|
Rate for Payer: Aetna of CA Government/Medicare |
$0.14
|
Rate for Payer: Cash Price |
$0.11
|
Rate for Payer: Health Smart Auto/Commercial |
$0.14
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.14
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.18
|
|
PAROXETINE 10 MG TABLET [16632]
|
Facility
|
OP
|
$0.80
|
|
Service Code
|
NDC 50268-640-15
|
Hospital Charge Code |
1713121
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.44 |
Max. Negotiated Rate |
$0.60 |
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.48
|
Rate for Payer: Aetna of CA Government/Medicare |
$0.48
|
Rate for Payer: Cash Price |
$0.36
|
Rate for Payer: Health Smart Auto/Commercial |
$0.48
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.48
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.60
|
|
PAROXETINE 10 MG TABLET [16632]
|
Facility
|
IP
|
$0.80
|
|
Service Code
|
NDC 50268-640-11
|
Hospital Charge Code |
1713121
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.44 |
Max. Negotiated Rate |
$0.64 |
Rate for Payer: Cash Price |
$0.36
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.64
|
Rate for Payer: Health Smart Auto/Commercial |
$0.48
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.60
|
|
PAROXETINE 10 MG TABLET [16632]
|
Facility
|
IP
|
$0.80
|
|
Service Code
|
NDC 50268-640-15
|
Hospital Charge Code |
1713121
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.44 |
Max. Negotiated Rate |
$0.64 |
Rate for Payer: Cash Price |
$0.36
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.64
|
Rate for Payer: Health Smart Auto/Commercial |
$0.48
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.60
|
|
PAROXETINE 10 MG TABLET [16632]
|
Facility
|
OP
|
$1.02
|
|
Service Code
|
NDC 68084-044-01
|
Hospital Charge Code |
1713121
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.56 |
Max. Negotiated Rate |
$0.77 |
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.61
|
Rate for Payer: Aetna of CA Government/Medicare |
$0.61
|
Rate for Payer: Cash Price |
$0.46
|
Rate for Payer: Health Smart Auto/Commercial |
$0.61
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.61
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.77
|
|
PAROXETINE 10 MG TABLET [16632]
|
Facility
|
IP
|
$1.02
|
|
Service Code
|
NDC 68084-044-01
|
Hospital Charge Code |
1713121
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.56 |
Max. Negotiated Rate |
$0.82 |
Rate for Payer: Cash Price |
$0.46
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.82
|
Rate for Payer: Health Smart Auto/Commercial |
$0.61
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.77
|
|
PAROXETINE 10 MG TABLET [16632]
|
Facility
|
IP
|
$0.24
|
|
Service Code
|
NDC 43547-347-03
|
Hospital Charge Code |
1713121
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.13 |
Max. Negotiated Rate |
$0.19 |
Rate for Payer: Cash Price |
$0.11
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.19
|
Rate for Payer: Health Smart Auto/Commercial |
$0.14
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.18
|
|
PAROXETINE 10 MG TABLET [16632]
|
Facility
|
IP
|
$0.14
|
|
Service Code
|
NDC 68382-097-06
|
Hospital Charge Code |
1713121
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.08 |
Max. Negotiated Rate |
$0.11 |
Rate for Payer: Cash Price |
$0.06
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.11
|
Rate for Payer: Health Smart Auto/Commercial |
$0.08
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.11
|
|
PAROXETINE 10 MG TABLET [16632]
|
Facility
|
IP
|
$0.14
|
|
Service Code
|
NDC 0378-7001-93
|
Hospital Charge Code |
1713121
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.08 |
Max. Negotiated Rate |
$0.11 |
Rate for Payer: Cash Price |
$0.06
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.11
|
Rate for Payer: Health Smart Auto/Commercial |
$0.08
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.11
|
|
PAROXETINE 10 MG TABLET [16632]
|
Facility
|
OP
|
$0.14
|
|
Service Code
|
NDC 0378-7001-93
|
Hospital Charge Code |
1713121
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.08 |
Max. Negotiated Rate |
$0.11 |
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.08
|
Rate for Payer: Aetna of CA Government/Medicare |
$0.08
|
Rate for Payer: Cash Price |
$0.06
|
Rate for Payer: Health Smart Auto/Commercial |
$0.08
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.08
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.11
|
|
PAROXETINE 20 MG TABLET [10855]
|
Facility
|
OP
|
$0.30
|
|
Service Code
|
NDC 0904-5677-61
|
Hospital Charge Code |
1711583
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.17 |
Max. Negotiated Rate |
$0.23 |
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.18
|
Rate for Payer: Aetna of CA Government/Medicare |
$0.18
|
Rate for Payer: Cash Price |
$0.14
|
Rate for Payer: Health Smart Auto/Commercial |
$0.18
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.18
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.23
|
|
PAROXETINE 20 MG TABLET [10855]
|
Facility
|
OP
|
$0.39
|
|
Service Code
|
NDC 68084-045-11
|
Hospital Charge Code |
1711583
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.21 |
Max. Negotiated Rate |
$0.29 |
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.23
|
Rate for Payer: Aetna of CA Government/Medicare |
$0.23
|
Rate for Payer: Cash Price |
$0.18
|
Rate for Payer: Health Smart Auto/Commercial |
$0.23
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.23
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.29
|
|
PAROXETINE 20 MG TABLET [10855]
|
Facility
|
OP
|
$0.17
|
|
Service Code
|
NDC 60505-0083-1
|
Hospital Charge Code |
1711583
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.09 |
Max. Negotiated Rate |
$0.13 |
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.10
|
Rate for Payer: Aetna of CA Government/Medicare |
$0.10
|
Rate for Payer: Cash Price |
$0.08
|
Rate for Payer: Health Smart Auto/Commercial |
$0.10
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.10
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.13
|
|
PAROXETINE 20 MG TABLET [10855]
|
Facility
|
IP
|
$0.17
|
|
Service Code
|
NDC 60505-0083-1
|
Hospital Charge Code |
1711583
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.09 |
Max. Negotiated Rate |
$0.14 |
Rate for Payer: Cash Price |
$0.08
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.14
|
Rate for Payer: Health Smart Auto/Commercial |
$0.10
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.13
|
|
PAROXETINE 20 MG TABLET [10855]
|
Facility
|
OP
|
$0.17
|
|
Service Code
|
NDC 68382-098-06
|
Hospital Charge Code |
1711583
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.09 |
Max. Negotiated Rate |
$0.13 |
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.10
|
Rate for Payer: Aetna of CA Government/Medicare |
$0.10
|
Rate for Payer: Cash Price |
$0.08
|
Rate for Payer: Health Smart Auto/Commercial |
$0.10
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.10
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.13
|
|
PAROXETINE 20 MG TABLET [10855]
|
Facility
|
IP
|
$0.30
|
|
Service Code
|
NDC 0904-5677-61
|
Hospital Charge Code |
1711583
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.17 |
Max. Negotiated Rate |
$0.24 |
Rate for Payer: Cash Price |
$0.14
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.24
|
Rate for Payer: Health Smart Auto/Commercial |
$0.18
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.23
|
|
PAROXETINE 20 MG TABLET [10855]
|
Facility
|
OP
|
$0.39
|
|
Service Code
|
NDC 68084-045-01
|
Hospital Charge Code |
1711583
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.21 |
Max. Negotiated Rate |
$0.29 |
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.23
|
Rate for Payer: Aetna of CA Government/Medicare |
$0.23
|
Rate for Payer: Cash Price |
$0.18
|
Rate for Payer: Health Smart Auto/Commercial |
$0.23
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.23
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.29
|
|
PAROXETINE 20 MG TABLET [10855]
|
Facility
|
IP
|
$0.17
|
|
Service Code
|
NDC 68382-098-06
|
Hospital Charge Code |
1711583
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.09 |
Max. Negotiated Rate |
$0.14 |
Rate for Payer: Cash Price |
$0.08
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.14
|
Rate for Payer: Health Smart Auto/Commercial |
$0.10
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.13
|
|
PAROXETINE 20 MG TABLET [10855]
|
Facility
|
IP
|
$0.39
|
|
Service Code
|
NDC 68084-045-11
|
Hospital Charge Code |
1711583
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.21 |
Max. Negotiated Rate |
$0.31 |
Rate for Payer: Cash Price |
$0.18
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.31
|
Rate for Payer: Health Smart Auto/Commercial |
$0.23
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.29
|
|
PAROXETINE 20 MG TABLET [10855]
|
Facility
|
IP
|
$0.39
|
|
Service Code
|
NDC 68084-045-01
|
Hospital Charge Code |
1711583
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.21 |
Max. Negotiated Rate |
$0.31 |
Rate for Payer: Cash Price |
$0.18
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.31
|
Rate for Payer: Health Smart Auto/Commercial |
$0.23
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.29
|
|
PAROXETINE 30 MG TABLET [10856]
|
Facility
|
IP
|
$0.55
|
|
Service Code
|
NDC 50268-642-11
|
Hospital Charge Code |
1713111
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.30 |
Max. Negotiated Rate |
$0.44 |
Rate for Payer: Cash Price |
$0.25
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.44
|
Rate for Payer: Health Smart Auto/Commercial |
$0.33
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.41
|
|
PAROXETINE 30 MG TABLET [10856]
|
Facility
|
OP
|
$1.14
|
|
Service Code
|
NDC 68084-046-11
|
Hospital Charge Code |
1713111
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.63 |
Max. Negotiated Rate |
$0.86 |
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.68
|
Rate for Payer: Aetna of CA Government/Medicare |
$0.68
|
Rate for Payer: Cash Price |
$0.51
|
Rate for Payer: Health Smart Auto/Commercial |
$0.68
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.68
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.63
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.86
|
|