|
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: AlphaCare Medical Group Commercial/Exchange |
$12.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.85
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$8.92
|
| 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
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: AlphaCare Medical Group Commercial/Exchange |
$50.53
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$32.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$32.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.42
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$35.67
|
| 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: AlphaCare Medical Group Commercial/Exchange |
$50.53
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$32.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$32.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.42
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$35.67
|
| 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 66302-310-10
|
| 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
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: AlphaCare Medical Group Commercial/Exchange |
$126.33
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$81.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$81.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.55
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$89.17
|
| 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
IP
|
$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: Blue Shield of California Commercial |
$211.63
|
| Rate for Payer: Blue Shield of California EPN |
$152.18
|
| 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: EPIC Health Plan Commercial |
$118.89
|
| Rate for Payer: Galaxy Health WC |
$252.65
|
| Rate for Payer: Global Benefits Group Commercial |
$178.34
|
| 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
|
|
|
TREPROSTINIL DIOLAMINE ER 5 MG TABLET, EXTENDED RELEASE [218793]
|
Facility
IP
|
$297.23
|
|
|
Service Code
|
NDC 66302-350-10
|
| Hospital Charge Code |
ERX218793
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$71.34 |
| Max. Negotiated Rate |
$252.65 |
| Rate for Payer: Blue Shield of California Commercial |
$211.63
|
| Rate for Payer: Blue Shield of California EPN |
$152.18
|
| 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: EPIC Health Plan Commercial |
$118.89
|
| Rate for Payer: Galaxy Health WC |
$252.65
|
| Rate for Payer: Global Benefits Group Commercial |
$178.34
|
| 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
|
|
|
TREPROSTINIL DIOLAMINE ER 5 MG TABLET, EXTENDED RELEASE [218793]
|
Facility
OP
|
$297.23
|
|
|
Service Code
|
NDC 66302-350-10
|
| 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: AlphaCare Medical Group Commercial/Exchange |
$252.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$163.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$163.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.09
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$178.34
|
| 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
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$252.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$163.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$163.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.09
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$178.34
|
| 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
|
|
|
TREPROSTINIL SODIUM 10 MG/ML INJECTION SOLUTION [32934]
|
Facility
OP
|
$725.79
|
|
|
Service Code
|
CPT J3285
|
| Hospital Charge Code |
NDG32934
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.38 |
| Max. Negotiated Rate |
$616.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$354.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$70.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$62.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$62.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.50
|
| Rate for Payer: BCBS Transplant Transplant |
$435.47
|
| Rate for Payer: Blue Shield of California Commercial |
$534.91
|
| Rate for Payer: Blue Shield of California EPN |
$72.58
|
| Rate for Payer: Cash Price |
$326.61
|
| Rate for Payer: Cash Price |
$326.61
|
| Rate for Payer: Cigna of CA HMO |
$508.05
|
| Rate for Payer: Cigna of CA PPO |
$508.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$84.57
|
| Rate for Payer: Dignity Health Media |
$56.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$56.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$56.38
|
| Rate for Payer: Galaxy Health WC |
$616.92
|
| Rate for Payer: Global Benefits Group Commercial |
$435.47
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$544.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.47
|
| Rate for Payer: Heritage Provider Network Transplant |
$92.47
|
| Rate for Payer: IEHP Medi-Cal |
$91.34
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$91.34
|
| Rate for Payer: IEHP Medicare Advantage |
$56.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$484.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$75.55
|
| Rate for Payer: Multiplan Commercial |
$580.63
|
| Rate for Payer: Networks By Design Commercial |
$362.90
|
| Rate for Payer: Prime Health Services Commercial |
$616.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$435.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$435.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$362.90
|
| Rate for Payer: United Healthcare All Other HMO |
$362.90
|
| Rate for Payer: United Healthcare HMO Rider |
$362.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$362.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$84.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.02
|
| Rate for Payer: Vantage Medical Group Senior |
$56.38
|
|
|
TREPROSTINIL SODIUM 10 MG/ML INJECTION SOLUTION [32934]
|
Facility
IP
|
$725.79
|
|
|
Service Code
|
CPT J3285
|
| Hospital Charge Code |
NDG32934
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$174.19 |
| Max. Negotiated Rate |
$616.92 |
| Rate for Payer: Blue Shield of California Commercial |
$516.76
|
| Rate for Payer: Blue Shield of California EPN |
$371.60
|
| Rate for Payer: Cash Price |
$326.61
|
| Rate for Payer: Cigna of CA HMO |
$508.05
|
| Rate for Payer: Cigna of CA PPO |
$508.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$290.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$290.32
|
| Rate for Payer: Galaxy Health WC |
$616.92
|
| Rate for Payer: Global Benefits Group Commercial |
$435.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$484.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$276.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.19
|
| Rate for Payer: Multiplan Commercial |
$580.63
|
| Rate for Payer: Networks By Design Commercial |
$362.90
|
| Rate for Payer: Prime Health Services Commercial |
$616.92
|
|
|
TREPROSTINIL SODIUM 2.5 MG/ML INJECTION SOLUTION [32932]
|
Facility
OP
|
$181.45
|
|
|
Service Code
|
CPT J3285
|
| Hospital Charge Code |
NDG32932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.55 |
| Max. Negotiated Rate |
$354.64 |
| Rate for Payer: Aetna of CA HMO/PPO |
$354.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$354.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$70.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$70.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$62.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$62.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$62.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$62.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.50
|
| Rate for Payer: BCBS Transplant Transplant |
$108.87
|
| Rate for Payer: BCBS Transplant Transplant |
$114.60
|
| Rate for Payer: Blue Shield of California Commercial |
$133.73
|
| Rate for Payer: Blue Shield of California Commercial |
$140.77
|
| Rate for Payer: Blue Shield of California EPN |
$111.54
|
| Rate for Payer: Blue Shield of California EPN |
$105.97
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Cash Price |
$81.65
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Cash Price |
$81.65
|
| Rate for Payer: Cigna of CA HMO |
$116.13
|
| Rate for Payer: Cigna of CA HMO |
$122.24
|
| Rate for Payer: Cigna of CA PPO |
$134.27
|
| Rate for Payer: Cigna of CA PPO |
$141.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$84.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$84.57
|
| Rate for Payer: Dignity Health Media |
$56.38
|
| Rate for Payer: Dignity Health Media |
$56.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$56.38
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$56.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$56.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$56.38
|
| Rate for Payer: Galaxy Health WC |
$154.23
|
| Rate for Payer: Galaxy Health WC |
$162.35
|
| Rate for Payer: Global Benefits Group Commercial |
$114.60
|
| Rate for Payer: Global Benefits Group Commercial |
$108.87
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$136.09
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$143.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.47
|
| Rate for Payer: Heritage Provider Network Transplant |
$92.47
|
| Rate for Payer: Heritage Provider Network Transplant |
$92.47
|
| Rate for Payer: IEHP Medi-Cal |
$91.34
|
| Rate for Payer: IEHP Medi-Cal |
$91.34
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$91.34
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$91.34
|
| Rate for Payer: IEHP Medicare Advantage |
$56.38
|
| Rate for Payer: IEHP Medicare Advantage |
$56.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$121.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$75.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$75.55
|
| Rate for Payer: Multiplan Commercial |
$145.16
|
| Rate for Payer: Multiplan Commercial |
$152.80
|
| Rate for Payer: Networks By Design Commercial |
$124.15
|
| Rate for Payer: Networks By Design Commercial |
$117.94
|
| Rate for Payer: Prime Health Services Commercial |
$154.23
|
| Rate for Payer: Prime Health Services Commercial |
$162.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$114.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$108.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$108.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$114.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$95.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$90.72
|
| Rate for Payer: United Healthcare All Other HMO |
$90.72
|
| Rate for Payer: United Healthcare All Other HMO |
$95.50
|
| Rate for Payer: United Healthcare HMO Rider |
$95.50
|
| Rate for Payer: United Healthcare HMO Rider |
$90.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$90.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$95.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$84.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$84.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.02
|
| Rate for Payer: Vantage Medical Group Senior |
$56.38
|
| Rate for Payer: Vantage Medical Group Senior |
$56.38
|
|
|
TREPROSTINIL SODIUM 2.5 MG/ML INJECTION SOLUTION [32932]
|
Facility
IP
|
$181.45
|
|
|
Service Code
|
CPT J3285
|
| Hospital Charge Code |
NDG32932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.55 |
| Max. Negotiated Rate |
$154.23 |
| Rate for Payer: Blue Shield of California Commercial |
$129.19
|
| Rate for Payer: Blue Shield of California Commercial |
$135.99
|
| Rate for Payer: Blue Shield of California EPN |
$97.79
|
| Rate for Payer: Blue Shield of California EPN |
$92.90
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Cash Price |
$81.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.58
|
| Rate for Payer: Galaxy Health WC |
$154.23
|
| Rate for Payer: Galaxy Health WC |
$162.35
|
| Rate for Payer: Global Benefits Group Commercial |
$108.87
|
| Rate for Payer: Global Benefits Group Commercial |
$114.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$121.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.84
|
| Rate for Payer: Multiplan Commercial |
$145.16
|
| Rate for Payer: Multiplan Commercial |
$152.80
|
| Rate for Payer: Networks By Design Commercial |
$124.15
|
| Rate for Payer: Networks By Design Commercial |
$117.94
|
| Rate for Payer: Prime Health Services Commercial |
$154.23
|
| Rate for Payer: Prime Health Services Commercial |
$162.35
|
|
|
TREPROSTINIL SODIUM 5 MG/ML INJECTION SOLUTION [32933]
|
Facility
OP
|
$362.90
|
|
|
Service Code
|
CPT J3285
|
| Hospital Charge Code |
NDG32933
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.38 |
| Max. Negotiated Rate |
$354.64 |
| Rate for Payer: Aetna of CA HMO/PPO |
$354.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$70.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$62.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$62.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.50
|
| Rate for Payer: BCBS Transplant Transplant |
$217.74
|
| Rate for Payer: Blue Shield of California Commercial |
$267.46
|
| Rate for Payer: Blue Shield of California EPN |
$72.58
|
| Rate for Payer: Cash Price |
$163.31
|
| Rate for Payer: Cash Price |
$163.31
|
| Rate for Payer: Cigna of CA HMO |
$254.03
|
| Rate for Payer: Cigna of CA PPO |
$254.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$84.57
|
| Rate for Payer: Dignity Health Media |
$56.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$56.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$56.38
|
| Rate for Payer: Galaxy Health WC |
$308.46
|
| Rate for Payer: Global Benefits Group Commercial |
$217.74
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$272.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.47
|
| Rate for Payer: Heritage Provider Network Transplant |
$92.47
|
| Rate for Payer: IEHP Medi-Cal |
$91.34
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$91.34
|
| Rate for Payer: IEHP Medicare Advantage |
$56.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$242.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$75.55
|
| Rate for Payer: Multiplan Commercial |
$290.32
|
| Rate for Payer: Networks By Design Commercial |
$181.45
|
| Rate for Payer: Prime Health Services Commercial |
$308.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$217.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$217.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$181.45
|
| Rate for Payer: United Healthcare All Other HMO |
$181.45
|
| Rate for Payer: United Healthcare HMO Rider |
$181.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$181.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$84.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.02
|
| Rate for Payer: Vantage Medical Group Senior |
$56.38
|
|
|
TREPROSTINIL SODIUM 5 MG/ML INJECTION SOLUTION [32933]
|
Facility
IP
|
$362.90
|
|
|
Service Code
|
CPT J3285
|
| Hospital Charge Code |
NDG32933
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$87.10 |
| Max. Negotiated Rate |
$308.46 |
| Rate for Payer: Blue Shield of California Commercial |
$258.38
|
| Rate for Payer: Blue Shield of California EPN |
$185.80
|
| Rate for Payer: Cash Price |
$163.31
|
| Rate for Payer: Cigna of CA HMO |
$254.03
|
| Rate for Payer: Cigna of CA PPO |
$254.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$145.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$145.16
|
| Rate for Payer: Galaxy Health WC |
$308.46
|
| Rate for Payer: Global Benefits Group Commercial |
$217.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$242.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$138.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.10
|
| Rate for Payer: Multiplan Commercial |
$290.32
|
| Rate for Payer: Networks By Design Commercial |
$181.45
|
| Rate for Payer: Prime Health Services Commercial |
$308.46
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE [16005]
|
Facility
IP
|
$33.03
|
|
|
Service Code
|
NDC 68084-075-21
|
| Hospital Charge Code |
1711646
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$28.08 |
| Rate for Payer: Blue Shield of California Commercial |
$23.52
|
| Rate for Payer: Blue Shield of California EPN |
$16.91
|
| Rate for Payer: Cash Price |
$14.86
|
| Rate for Payer: Cigna of CA HMO |
$23.12
|
| Rate for Payer: Cigna of CA PPO |
$23.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.21
|
| Rate for Payer: Galaxy Health WC |
$28.08
|
| Rate for Payer: Global Benefits Group Commercial |
$19.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.93
|
| Rate for Payer: Multiplan Commercial |
$26.42
|
| Rate for Payer: Networks By Design Commercial |
$21.47
|
| Rate for Payer: Prime Health Services Commercial |
$28.08
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE [16005]
|
Facility
IP
|
$33.03
|
|
|
Service Code
|
NDC 68084-075-11
|
| Hospital Charge Code |
1711646
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$28.08 |
| Rate for Payer: Blue Shield of California Commercial |
$23.52
|
| Rate for Payer: Blue Shield of California EPN |
$16.91
|
| Rate for Payer: Cash Price |
$14.86
|
| Rate for Payer: Cigna of CA HMO |
$23.12
|
| Rate for Payer: Cigna of CA PPO |
$23.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.21
|
| Rate for Payer: Galaxy Health WC |
$28.08
|
| Rate for Payer: Global Benefits Group Commercial |
$19.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.93
|
| Rate for Payer: Multiplan Commercial |
$26.42
|
| Rate for Payer: Networks By Design Commercial |
$21.47
|
| Rate for Payer: Prime Health Services Commercial |
$28.08
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE [16005]
|
Facility
OP
|
$33.03
|
|
|
Service Code
|
NDC 68084-075-21
|
| Hospital Charge Code |
1711646
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$28.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$21.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$28.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.68
|
| Rate for Payer: BCBS Transplant Transplant |
$19.82
|
| Rate for Payer: Blue Shield of California Commercial |
$24.34
|
| Rate for Payer: Blue Shield of California EPN |
$19.29
|
| Rate for Payer: Cash Price |
$14.86
|
| Rate for Payer: Cigna of CA HMO |
$23.12
|
| Rate for Payer: Cigna of CA PPO |
$23.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.08
|
| Rate for Payer: Dignity Health Media |
$28.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.21
|
| Rate for Payer: Galaxy Health WC |
$28.08
|
| Rate for Payer: Global Benefits Group Commercial |
$19.82
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$24.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.93
|
| Rate for Payer: Multiplan Commercial |
$26.42
|
| Rate for Payer: Networks By Design Commercial |
$21.47
|
| Rate for Payer: Prime Health Services Commercial |
$28.08
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$19.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.52
|
| Rate for Payer: United Healthcare All Other HMO |
$16.52
|
| Rate for Payer: United Healthcare HMO Rider |
$16.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.08
|
| Rate for Payer: Vantage Medical Group Senior |
$28.08
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE [16005]
|
Facility
OP
|
$35.34
|
|
|
Service Code
|
NDC 68462-792-01
|
| Hospital Charge Code |
1711646
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$30.04 |
| Rate for Payer: BCBS Transplant Transplant |
$21.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$30.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.06
|
| Rate for Payer: Blue Shield of California Commercial |
$26.05
|
| Rate for Payer: Blue Shield of California EPN |
$20.64
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna of CA HMO |
$24.74
|
| Rate for Payer: Cigna of CA PPO |
$24.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.04
|
| Rate for Payer: Dignity Health Media |
$30.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.14
|
| Rate for Payer: Galaxy Health WC |
$30.04
|
| Rate for Payer: Global Benefits Group Commercial |
$21.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$26.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.48
|
| Rate for Payer: Multiplan Commercial |
$28.27
|
| Rate for Payer: Networks By Design Commercial |
$22.97
|
| Rate for Payer: Prime Health Services Commercial |
$30.04
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$21.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.67
|
| Rate for Payer: United Healthcare All Other HMO |
$17.67
|
| Rate for Payer: United Healthcare HMO Rider |
$17.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.04
|
| Rate for Payer: Vantage Medical Group Senior |
$30.04
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE [16005]
|
Facility
OP
|
$33.03
|
|
|
Service Code
|
NDC 68084-075-11
|
| Hospital Charge Code |
1711646
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$28.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$21.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$28.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.68
|
| Rate for Payer: BCBS Transplant Transplant |
$19.82
|
| Rate for Payer: Blue Shield of California Commercial |
$24.34
|
| Rate for Payer: Blue Shield of California EPN |
$19.29
|
| Rate for Payer: Cash Price |
$14.86
|
| Rate for Payer: Cigna of CA HMO |
$23.12
|
| Rate for Payer: Cigna of CA PPO |
$23.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.08
|
| Rate for Payer: Dignity Health Media |
$28.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.21
|
| Rate for Payer: Galaxy Health WC |
$28.08
|
| Rate for Payer: Global Benefits Group Commercial |
$19.82
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$24.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.93
|
| Rate for Payer: Multiplan Commercial |
$26.42
|
| Rate for Payer: Networks By Design Commercial |
$21.47
|
| Rate for Payer: Prime Health Services Commercial |
$28.08
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$19.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.52
|
| Rate for Payer: United Healthcare All Other HMO |
$16.52
|
| Rate for Payer: United Healthcare HMO Rider |
$16.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.08
|
| Rate for Payer: Vantage Medical Group Senior |
$28.08
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE [16005]
|
Facility
IP
|
$35.34
|
|
|
Service Code
|
NDC 68462-792-01
|
| Hospital Charge Code |
1711646
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$30.04 |
| Rate for Payer: Blue Shield of California Commercial |
$25.16
|
| Rate for Payer: Blue Shield of California EPN |
$18.09
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna of CA HMO |
$24.74
|
| Rate for Payer: Cigna of CA PPO |
$24.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.14
|
| Rate for Payer: Galaxy Health WC |
$30.04
|
| Rate for Payer: Global Benefits Group Commercial |
$21.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.48
|
| Rate for Payer: Multiplan Commercial |
$28.27
|
| Rate for Payer: Networks By Design Commercial |
$22.97
|
| Rate for Payer: Prime Health Services Commercial |
$30.04
|
|
