|
TRAZODONE 50 MG TABLET [8085]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 60505-2653-1
|
| Hospital Charge Code |
1710068
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: Blue Distinction Transplant |
$0.05
|
| 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 |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: Dignity Health Media |
$0.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
TRAZODONE 50 MG TABLET [8085]
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
NDC 42291-868-90
|
| Hospital Charge Code |
1710068
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
|
|
TRAZODONE 50 MG TABLET [8085]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 60505-2653-1
|
| Hospital Charge Code |
1710068
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
|
|
TRAZODONE ORAL SUSPENSION COMPOUND 10 MG/ML [4080353]
|
Facility
|
OP
|
$0.15
|
|
|
Service Code
|
NDC 9994-0803-53
|
| Hospital Charge Code |
1715307
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
| Rate for Payer: Blue Distinction Transplant |
$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 |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.13
|
| Rate for Payer: Dignity Health Media |
$0.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.09
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Vantage Medical Group Senior |
$0.13
|
|
|
TRAZODONE ORAL SUSPENSION COMPOUND 10 MG/ML [4080353]
|
Facility
|
IP
|
$0.15
|
|
|
Service Code
|
NDC 9994-0803-53
|
| Hospital Charge Code |
1715307
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.13
|
|
|
Treatment of incomplete abortion, any trimester, completed surgically
|
Facility
|
OP
|
$13,086.00
|
|
|
Service Code
|
CPT 59812
|
| Min. Negotiated Rate |
$320.44 |
| Max. Negotiated Rate |
$13,086.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Dignity Health Media |
$3,906.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,273.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,906.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,406.14
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,406.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,328.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,328.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,906.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,921.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,234.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
Treatment of missed abortion, completed surgically; first trimester
|
Facility
|
OP
|
$13,086.00
|
|
|
Service Code
|
CPT 59820
|
| Min. Negotiated Rate |
$752.70 |
| Max. Negotiated Rate |
$13,086.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Dignity Health Media |
$3,906.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,273.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,906.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,406.14
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,406.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,328.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,328.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,906.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$752.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,921.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,234.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
Treatment of slipped femoral epiphysis; by single or multiple pinning, in situ
|
Facility
|
OP
|
$13,086.00
|
|
|
Service Code
|
CPT 27176
|
| Min. Negotiated Rate |
$311.24 |
| Max. Negotiated Rate |
$13,086.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,241.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$311.24
|
|
|
TREMELIMUMAB-ACTL 20 MG/ML INTRAVENOUS SOLUTION [236035]
|
Facility
|
IP
|
$3,120.00
|
|
|
Service Code
|
CPT J9347
|
| Hospital Charge Code |
ERX236035
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$748.80 |
| Max. Negotiated Rate |
$2,652.00 |
| Rate for Payer: Blue Shield of California Commercial |
$2,221.44
|
| Rate for Payer: Blue Shield of California EPN |
$1,597.44
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Cigna of CA HMO |
$2,184.00
|
| Rate for Payer: Cigna of CA PPO |
$2,184.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,248.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,248.00
|
| Rate for Payer: Galaxy Health WC |
$2,652.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,872.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,081.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,188.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$748.80
|
| Rate for Payer: Multiplan Commercial |
$2,496.00
|
| Rate for Payer: Networks By Design Commercial |
$1,560.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,652.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,178.11
|
| Rate for Payer: United Healthcare All Other HMO |
$1,150.66
|
| Rate for Payer: United Healthcare HMO Rider |
$1,125.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,029.60
|
|
|
TREMELIMUMAB-ACTL 20 MG/ML INTRAVENOUS SOLUTION [236035]
|
Facility
|
OP
|
$3,120.00
|
|
|
Service Code
|
CPT J9347
|
| Hospital Charge Code |
ERX236035
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$136.09 |
| Max. Negotiated Rate |
$2,652.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$855.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$149.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$149.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,858.90
|
| Rate for Payer: Blue Distinction Transplant |
$1,872.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,299.44
|
| Rate for Payer: Blue Shield of California EPN |
$1,822.08
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Cigna of CA HMO |
$2,184.00
|
| Rate for Payer: Cigna of CA PPO |
$2,184.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.12
|
| Rate for Payer: Dignity Health Media |
$149.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$149.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$183.73
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$136.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$136.09
|
| Rate for Payer: Galaxy Health WC |
$2,652.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,872.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,340.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$223.19
|
| Rate for Payer: Heritage Provider Network Transplant |
$223.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$220.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$220.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$136.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,081.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$267.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$136.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$748.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$171.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$182.36
|
| Rate for Payer: Multiplan Commercial |
$2,496.00
|
| Rate for Payer: Networks By Design Commercial |
$1,560.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,652.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,872.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,872.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,560.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,560.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,560.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,560.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$149.70
|
| Rate for Payer: Vantage Medical Group Senior |
$149.70
|
|
|
TREPROSTINIL 1.74 MG/2.9 ML (0.6 MG/ML) SOLUTION FOR NEBULIZATION [120688]
|
Facility
|
IP
|
$353.43
|
|
|
Service Code
|
CPT J7686
|
| Hospital Charge Code |
NDG120688
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$84.82 |
| Max. Negotiated Rate |
$300.42 |
| Rate for Payer: Blue Shield of California Commercial |
$251.64
|
| Rate for Payer: Blue Shield of California EPN |
$180.96
|
| Rate for Payer: Cash Price |
$159.04
|
| Rate for Payer: Cigna of CA HMO |
$247.40
|
| Rate for Payer: Cigna of CA PPO |
$247.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$141.37
|
| Rate for Payer: Galaxy Health WC |
$300.42
|
| Rate for Payer: Global Benefits Group Commercial |
$212.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$235.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.82
|
| Rate for Payer: Multiplan Commercial |
$282.74
|
| Rate for Payer: Networks By Design Commercial |
$176.72
|
| Rate for Payer: Prime Health Services Commercial |
$300.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$133.46
|
| Rate for Payer: United Healthcare All Other HMO |
$130.34
|
| Rate for Payer: United Healthcare HMO Rider |
$127.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.63
|
|
|
TREPROSTINIL 1.74 MG/2.9 ML (0.6 MG/ML) SOLUTION FOR NEBULIZATION [120688]
|
Facility
|
OP
|
$353.43
|
|
|
Service Code
|
CPT J7686
|
| Hospital Charge Code |
NDG120688
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$84.82 |
| Max. Negotiated Rate |
$4,593.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4,593.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$300.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$194.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$194.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$906.14
|
| Rate for Payer: Blue Distinction Transplant |
$212.06
|
| Rate for Payer: Blue Shield of California Commercial |
$260.48
|
| Rate for Payer: Blue Shield of California EPN |
$776.19
|
| Rate for Payer: Cash Price |
$159.04
|
| Rate for Payer: Cash Price |
$159.04
|
| Rate for Payer: Cigna of CA HMO |
$247.40
|
| Rate for Payer: Cigna of CA PPO |
$247.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$300.42
|
| Rate for Payer: Dignity Health Media |
$300.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$300.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$141.37
|
| Rate for Payer: Galaxy Health WC |
$300.42
|
| Rate for Payer: Global Benefits Group Commercial |
$212.06
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$265.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$235.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.82
|
| Rate for Payer: Multiplan Commercial |
$282.74
|
| Rate for Payer: Networks By Design Commercial |
$176.72
|
| Rate for Payer: Prime Health Services Commercial |
$300.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$212.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$212.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$176.72
|
| Rate for Payer: United Healthcare All Other HMO |
$176.72
|
| Rate for Payer: United Healthcare HMO Rider |
$176.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$176.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$300.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$300.42
|
| Rate for Payer: Vantage Medical Group Senior |
$300.42
|
|
|
TREPROSTINIL DIOLAMINE ER 0.125 MG TABLET,EXTENDED RELEASE [205150]
|
Facility
|
OP
|
$7.43
|
|
|
Service Code
|
NDC 66302-300-01
|
| Hospital Charge Code |
ERX205150
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$6.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.43
|
| Rate for Payer: Blue Distinction Transplant |
$4.46
|
| Rate for Payer: Blue Shield of California Commercial |
$5.48
|
| Rate for Payer: Blue Shield of California EPN |
$4.34
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: Cigna of CA HMO |
$5.20
|
| Rate for Payer: Cigna of CA PPO |
$5.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.32
|
| Rate for Payer: Dignity Health Media |
$6.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.97
|
| Rate for Payer: Galaxy Health WC |
$6.32
|
| Rate for Payer: Global Benefits Group Commercial |
$4.46
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.78
|
| Rate for Payer: Multiplan Commercial |
$5.94
|
| Rate for Payer: Networks By Design Commercial |
$4.83
|
| Rate for Payer: Prime Health Services Commercial |
$6.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.72
|
| Rate for Payer: United Healthcare All Other HMO |
$3.72
|
| Rate for Payer: United Healthcare HMO Rider |
$3.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.32
|
| Rate for Payer: Vantage Medical Group Senior |
$6.32
|
|
|
TREPROSTINIL DIOLAMINE ER 0.125 MG TABLET,EXTENDED RELEASE [205150]
|
Facility
|
IP
|
$7.43
|
|
|
Service Code
|
NDC 66302-300-10
|
| Hospital Charge Code |
ERX205150
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$6.32 |
| Rate for Payer: Blue Shield of California Commercial |
$5.29
|
| Rate for Payer: Blue Shield of California EPN |
$3.80
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: Cigna of CA HMO |
$5.20
|
| Rate for Payer: Cigna of CA PPO |
$5.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.97
|
| Rate for Payer: Galaxy Health WC |
$6.32
|
| Rate for Payer: Global Benefits Group Commercial |
$4.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.78
|
| Rate for Payer: Multiplan Commercial |
$5.94
|
| Rate for Payer: Networks By Design Commercial |
$4.83
|
| Rate for Payer: Prime Health Services Commercial |
$6.32
|
|
|
TREPROSTINIL DIOLAMINE ER 0.125 MG TABLET,EXTENDED RELEASE [205150]
|
Facility
|
OP
|
$7.43
|
|
|
Service Code
|
NDC 66302-300-10
|
| Hospital Charge Code |
ERX205150
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$6.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.43
|
| Rate for Payer: Blue Distinction Transplant |
$4.46
|
| Rate for Payer: Blue Shield of California Commercial |
$5.48
|
| Rate for Payer: Blue Shield of California EPN |
$4.34
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: Cigna of CA HMO |
$5.20
|
| Rate for Payer: Cigna of CA PPO |
$5.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.32
|
| Rate for Payer: Dignity Health Media |
$6.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.97
|
| Rate for Payer: Galaxy Health WC |
$6.32
|
| Rate for Payer: Global Benefits Group Commercial |
$4.46
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.78
|
| Rate for Payer: Multiplan Commercial |
$5.94
|
| Rate for Payer: Networks By Design Commercial |
$4.83
|
| Rate for Payer: Prime Health Services Commercial |
$6.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.72
|
| Rate for Payer: United Healthcare All Other HMO |
$3.72
|
| Rate for Payer: United Healthcare HMO Rider |
$3.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.32
|
| Rate for Payer: Vantage Medical Group Senior |
$6.32
|
|
|
TREPROSTINIL DIOLAMINE ER 0.125 MG TABLET,EXTENDED RELEASE [205150]
|
Facility
|
IP
|
$7.43
|
|
|
Service Code
|
NDC 66302-300-01
|
| Hospital Charge Code |
ERX205150
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$6.32 |
| Rate for Payer: Blue Shield of California Commercial |
$5.29
|
| Rate for Payer: Blue Shield of California EPN |
$3.80
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: Cigna of CA HMO |
$5.20
|
| Rate for Payer: Cigna of CA PPO |
$5.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.97
|
| Rate for Payer: Galaxy Health WC |
$6.32
|
| Rate for Payer: Global Benefits Group Commercial |
$4.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.78
|
| Rate for Payer: Multiplan Commercial |
$5.94
|
| Rate for Payer: Networks By Design Commercial |
$4.83
|
| Rate for Payer: Prime Health Services Commercial |
$6.32
|
|
|
TREPROSTINIL DIOLAMINE ER 0.25 MG TABLET,EXTENDED RELEASE [205149]
|
Facility
|
IP
|
$14.86
|
|
|
Service Code
|
NDC 66302-302-10
|
| Hospital Charge Code |
ERX205149
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$12.63 |
| Rate for Payer: Blue Shield of California Commercial |
$10.58
|
| Rate for Payer: Blue Shield of California EPN |
$7.61
|
| Rate for Payer: Cash Price |
$6.69
|
| Rate for Payer: Cigna of CA HMO |
$10.40
|
| Rate for Payer: Cigna of CA PPO |
$10.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.94
|
| Rate for Payer: Galaxy Health WC |
$12.63
|
| Rate for Payer: Global Benefits Group Commercial |
$8.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.57
|
| Rate for Payer: Multiplan Commercial |
$11.89
|
| Rate for Payer: Networks By Design Commercial |
$9.66
|
| Rate for Payer: Prime Health Services Commercial |
$12.63
|
|
|
TREPROSTINIL DIOLAMINE ER 0.25 MG TABLET,EXTENDED RELEASE [205149]
|
Facility
|
OP
|
$14.86
|
|
|
Service Code
|
NDC 66302-302-10
|
| Hospital Charge Code |
ERX205149
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$12.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.85
|
| Rate for Payer: Blue Distinction Transplant |
$8.92
|
| Rate for Payer: Blue Shield of California Commercial |
$10.95
|
| Rate for Payer: Blue Shield of California EPN |
$8.68
|
| Rate for Payer: Cash Price |
$6.69
|
| Rate for Payer: Cigna of CA HMO |
$10.40
|
| Rate for Payer: Cigna of CA PPO |
$10.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.63
|
| Rate for Payer: Dignity Health Media |
$12.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.94
|
| Rate for Payer: Galaxy Health WC |
$12.63
|
| Rate for Payer: Global Benefits Group Commercial |
$8.92
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.57
|
| Rate for Payer: Multiplan Commercial |
$11.89
|
| Rate for Payer: Networks By Design Commercial |
$9.66
|
| Rate for Payer: Prime Health Services Commercial |
$12.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.43
|
| Rate for Payer: United Healthcare All Other HMO |
$7.43
|
| Rate for Payer: United Healthcare HMO Rider |
$7.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.63
|
| Rate for Payer: Vantage Medical Group Senior |
$12.63
|
|
|
TREPROSTINIL DIOLAMINE ER 1 MG TABLET,EXTENDED RELEASE [205151]
|
Facility
|
IP
|
$59.45
|
|
|
Service Code
|
NDC 66302-310-10
|
| Hospital Charge Code |
ERX205151
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.27 |
| Max. Negotiated Rate |
$50.53 |
| Rate for Payer: Blue Shield of California Commercial |
$42.33
|
| Rate for Payer: Blue Shield of California EPN |
$30.44
|
| Rate for Payer: Cash Price |
$26.75
|
| Rate for Payer: Cigna of CA HMO |
$41.62
|
| Rate for Payer: Cigna of CA PPO |
$41.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.78
|
| Rate for Payer: Galaxy Health WC |
$50.53
|
| Rate for Payer: Global Benefits Group Commercial |
$35.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.27
|
| Rate for Payer: Multiplan Commercial |
$47.56
|
| Rate for Payer: Networks By Design Commercial |
$38.64
|
| Rate for Payer: Prime Health Services Commercial |
$50.53
|
|
|
TREPROSTINIL DIOLAMINE ER 1 MG TABLET,EXTENDED RELEASE [205151]
|
Facility
|
OP
|
$59.45
|
|
|
Service Code
|
NDC 66302-310-10
|
| Hospital Charge Code |
ERX205151
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.27 |
| Max. Negotiated Rate |
$50.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$38.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.42
|
| Rate for Payer: Blue Distinction Transplant |
$35.67
|
| Rate for Payer: Blue Shield of California Commercial |
$43.81
|
| Rate for Payer: Blue Shield of California EPN |
$34.72
|
| Rate for Payer: Cash Price |
$26.75
|
| Rate for Payer: Cigna of CA HMO |
$41.62
|
| Rate for Payer: Cigna of CA PPO |
$41.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.53
|
| Rate for Payer: Dignity Health Media |
$50.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.78
|
| Rate for Payer: Galaxy Health WC |
$50.53
|
| Rate for Payer: Global Benefits Group Commercial |
$35.67
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$44.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.27
|
| Rate for Payer: Multiplan Commercial |
$47.56
|
| Rate for Payer: Networks By Design Commercial |
$38.64
|
| Rate for Payer: Prime Health Services Commercial |
$50.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.72
|
| Rate for Payer: United Healthcare All Other HMO |
$29.72
|
| Rate for Payer: United Healthcare HMO Rider |
$29.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.53
|
| Rate for Payer: Vantage Medical Group Senior |
$50.53
|
|
|
TREPROSTINIL DIOLAMINE ER 1 MG TABLET,EXTENDED RELEASE [205151]
|
Facility
|
OP
|
$59.45
|
|
|
Service Code
|
NDC 66302-310-01
|
| Hospital Charge Code |
ERX205151
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.27 |
| Max. Negotiated Rate |
$50.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$38.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.42
|
| Rate for Payer: Blue Distinction Transplant |
$35.67
|
| Rate for Payer: Blue Shield of California Commercial |
$43.81
|
| Rate for Payer: Blue Shield of California EPN |
$34.72
|
| Rate for Payer: Cash Price |
$26.75
|
| Rate for Payer: Cigna of CA HMO |
$41.62
|
| Rate for Payer: Cigna of CA PPO |
$41.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.53
|
| Rate for Payer: Dignity Health Media |
$50.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.78
|
| Rate for Payer: Galaxy Health WC |
$50.53
|
| Rate for Payer: Global Benefits Group Commercial |
$35.67
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$44.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.27
|
| Rate for Payer: Multiplan Commercial |
$47.56
|
| Rate for Payer: Networks By Design Commercial |
$38.64
|
| Rate for Payer: Prime Health Services Commercial |
$50.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.72
|
| Rate for Payer: United Healthcare All Other HMO |
$29.72
|
| Rate for Payer: United Healthcare HMO Rider |
$29.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.53
|
| Rate for Payer: Vantage Medical Group Senior |
$50.53
|
|
|
TREPROSTINIL DIOLAMINE ER 1 MG TABLET,EXTENDED RELEASE [205151]
|
Facility
|
IP
|
$59.45
|
|
|
Service Code
|
NDC 66302-310-01
|
| Hospital Charge Code |
ERX205151
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.27 |
| Max. Negotiated Rate |
$50.53 |
| Rate for Payer: Blue Shield of California Commercial |
$42.33
|
| Rate for Payer: Blue Shield of California EPN |
$30.44
|
| Rate for Payer: Cash Price |
$26.75
|
| Rate for Payer: Cigna of CA HMO |
$41.62
|
| Rate for Payer: Cigna of CA PPO |
$41.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.78
|
| Rate for Payer: Galaxy Health WC |
$50.53
|
| Rate for Payer: Global Benefits Group Commercial |
$35.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.27
|
| Rate for Payer: Multiplan Commercial |
$47.56
|
| Rate for Payer: Networks By Design Commercial |
$38.64
|
| Rate for Payer: Prime Health Services Commercial |
$50.53
|
|
|
TREPROSTINIL DIOLAMINE ER 2.5 MG TABLET,EXTENDED RELEASE [205152]
|
Facility
|
IP
|
$148.62
|
|
|
Service Code
|
NDC 66302-325-01
|
| Hospital Charge Code |
ERX205152
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.67 |
| Max. Negotiated Rate |
$126.33 |
| Rate for Payer: Blue Shield of California Commercial |
$105.82
|
| Rate for Payer: Blue Shield of California EPN |
$76.09
|
| Rate for Payer: Cash Price |
$66.88
|
| Rate for Payer: Cigna of CA HMO |
$104.03
|
| Rate for Payer: Cigna of CA PPO |
$104.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.45
|
| Rate for Payer: Galaxy Health WC |
$126.33
|
| Rate for Payer: Global Benefits Group Commercial |
$89.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.67
|
| Rate for Payer: Multiplan Commercial |
$118.90
|
| Rate for Payer: Networks By Design Commercial |
$96.60
|
| Rate for Payer: Prime Health Services Commercial |
$126.33
|
|
|
TREPROSTINIL DIOLAMINE ER 2.5 MG TABLET,EXTENDED RELEASE [205152]
|
Facility
|
OP
|
$148.62
|
|
|
Service Code
|
NDC 66302-325-01
|
| Hospital Charge Code |
ERX205152
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.67 |
| Max. Negotiated Rate |
$126.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$97.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$126.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$81.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$81.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.55
|
| Rate for Payer: Blue Distinction Transplant |
$89.17
|
| Rate for Payer: Blue Shield of California Commercial |
$109.53
|
| Rate for Payer: Blue Shield of California EPN |
$86.79
|
| Rate for Payer: Cash Price |
$66.88
|
| Rate for Payer: Cigna of CA HMO |
$104.03
|
| Rate for Payer: Cigna of CA PPO |
$104.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$126.33
|
| Rate for Payer: Dignity Health Media |
$126.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$126.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.45
|
| Rate for Payer: Galaxy Health WC |
$126.33
|
| Rate for Payer: Global Benefits Group Commercial |
$89.17
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$111.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.67
|
| Rate for Payer: Multiplan Commercial |
$118.90
|
| Rate for Payer: Networks By Design Commercial |
$96.60
|
| Rate for Payer: Prime Health Services Commercial |
$126.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$89.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$89.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.31
|
| Rate for Payer: United Healthcare All Other HMO |
$74.31
|
| Rate for Payer: United Healthcare HMO Rider |
$74.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$74.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$126.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$126.33
|
| Rate for Payer: Vantage Medical Group Senior |
$126.33
|
|
|
TREPROSTINIL DIOLAMINE ER 5 MG TABLET, EXTENDED RELEASE [218793]
|
Facility
|
OP
|
$297.23
|
|
|
Service Code
|
NDC 66302-350-01
|
| Hospital Charge Code |
ERX218793
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$71.34 |
| Max. Negotiated Rate |
$252.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$194.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$252.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$163.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.09
|
| Rate for Payer: Blue Distinction Transplant |
$178.34
|
| Rate for Payer: Blue Shield of California Commercial |
$219.06
|
| Rate for Payer: Blue Shield of California EPN |
$173.58
|
| Rate for Payer: Cash Price |
$133.75
|
| Rate for Payer: Cigna of CA HMO |
$208.06
|
| Rate for Payer: Cigna of CA PPO |
$208.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$252.65
|
| Rate for Payer: Dignity Health Media |
$252.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$118.89
|
| Rate for Payer: Galaxy Health WC |
$252.65
|
| Rate for Payer: Global Benefits Group Commercial |
$178.34
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$222.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.34
|
| Rate for Payer: Multiplan Commercial |
$237.78
|
| Rate for Payer: Networks By Design Commercial |
$193.20
|
| Rate for Payer: Prime Health Services Commercial |
$252.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$178.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$178.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$148.62
|
| Rate for Payer: United Healthcare All Other HMO |
$148.62
|
| Rate for Payer: United Healthcare HMO Rider |
$148.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$148.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$252.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.65
|
| Rate for Payer: Vantage Medical Group Senior |
$252.65
|
|
