|
TRAZODONE 50 MG TABLET [8085]
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
NDC 70010-231-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$0.04
|
| 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 |
$0.06
|
|
|
TRAZODONE 50 MG TABLET [8085]
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 68382-805-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
|
TRAZODONE ORAL SUSPENSION COMPOUND 10 MG/ML [4080353]
|
Facility
|
OP
|
$0.15
|
|
|
Service Code
|
NDC 9994-0803-53
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| 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 |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| 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 Medi-Cal |
$0.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.11
|
| 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 |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.08
|
| 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: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$0.09
|
| 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
|
|
|
TREPROSTINIL 1.74 MG/2.9 ML (0.6 MG/ML) SOLUTION FOR NEBULIZATION [120688]
|
Facility
|
IP
|
$353.43
|
|
|
Service Code
|
NDC 66302-206-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$70.69 |
| Max. Negotiated Rate |
$300.42 |
| Rate for Payer: Adventist Health Commercial |
$70.69
|
| Rate for Payer: Blue Shield of California Commercial |
$260.83
|
| Rate for Payer: Blue Shield of California EPN |
$171.77
|
| Rate for Payer: Cash Price |
$194.39
|
| 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 Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$218.77
|
| 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 |
$229.73
|
| Rate for Payer: Prime Health Services Commercial |
$300.42
|
|
|
TREPROSTINIL 1.74 MG/2.9 ML (0.6 MG/ML) SOLUTION FOR NEBULIZATION [120688]
|
Facility
|
OP
|
$353.43
|
|
|
Service Code
|
NDC 66302-206-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$70.69 |
| Max. Negotiated Rate |
$300.42 |
| Rate for Payer: Adventist Health Commercial |
$70.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$231.81
|
| 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 |
$265.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$217.04
|
| Rate for Payer: Cash Price |
$194.39
|
| 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 Medi-Cal |
$300.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$300.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.37
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$218.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$247.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$247.40
|
| Rate for Payer: Multiplan Commercial |
$282.74
|
| Rate for Payer: Networks By Design Commercial |
$229.73
|
| 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
|
$8.91
|
|
|
Service Code
|
NDC 66302-300-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$7.57 |
| Rate for Payer: Adventist Health Commercial |
$1.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.47
|
| Rate for Payer: Cash Price |
$4.90
|
| Rate for Payer: Cigna of CA HMO |
$6.24
|
| Rate for Payer: Cigna of CA PPO |
$6.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.56
|
| Rate for Payer: EPIC Health Plan Senior |
$3.56
|
| Rate for Payer: Galaxy Health WC |
$7.57
|
| Rate for Payer: Global Benefits Group Commercial |
$5.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.24
|
| Rate for Payer: Multiplan Commercial |
$7.13
|
| Rate for Payer: Networks By Design Commercial |
$5.79
|
| Rate for Payer: Prime Health Services Commercial |
$7.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.46
|
| Rate for Payer: United Healthcare All Other HMO |
$4.46
|
| Rate for Payer: United Healthcare HMO Rider |
$4.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.57
|
| Rate for Payer: Vantage Medical Group Senior |
$7.57
|
|
|
TREPROSTINIL DIOLAMINE ER 0.125 MG TABLET,EXTENDED RELEASE [205150]
|
Facility
|
IP
|
$8.91
|
|
|
Service Code
|
NDC 66302-300-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$7.57 |
| Rate for Payer: Adventist Health Commercial |
$1.78
|
| Rate for Payer: Blue Shield of California Commercial |
$6.58
|
| Rate for Payer: Blue Shield of California EPN |
$4.33
|
| Rate for Payer: Cash Price |
$4.90
|
| Rate for Payer: Cigna of CA HMO |
$6.24
|
| Rate for Payer: Cigna of CA PPO |
$6.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.56
|
| Rate for Payer: EPIC Health Plan Senior |
$3.56
|
| Rate for Payer: Galaxy Health WC |
$7.57
|
| Rate for Payer: Global Benefits Group Commercial |
$5.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.14
|
| Rate for Payer: Multiplan Commercial |
$7.13
|
| Rate for Payer: Networks By Design Commercial |
$5.79
|
| Rate for Payer: Prime Health Services Commercial |
$7.57
|
|
|
TREPROSTINIL DIOLAMINE ER 0.125 MG TABLET,EXTENDED RELEASE [205150]
|
Facility
|
OP
|
$8.91
|
|
|
Service Code
|
NDC 66302-300-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$7.57 |
| Rate for Payer: Adventist Health Commercial |
$1.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.47
|
| Rate for Payer: Cash Price |
$4.90
|
| Rate for Payer: Cigna of CA HMO |
$6.24
|
| Rate for Payer: Cigna of CA PPO |
$6.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.56
|
| Rate for Payer: EPIC Health Plan Senior |
$3.56
|
| Rate for Payer: Galaxy Health WC |
$7.57
|
| Rate for Payer: Global Benefits Group Commercial |
$5.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.24
|
| Rate for Payer: Multiplan Commercial |
$7.13
|
| Rate for Payer: Networks By Design Commercial |
$5.79
|
| Rate for Payer: Prime Health Services Commercial |
$7.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.46
|
| Rate for Payer: United Healthcare All Other HMO |
$4.46
|
| Rate for Payer: United Healthcare HMO Rider |
$4.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.57
|
| Rate for Payer: Vantage Medical Group Senior |
$7.57
|
|
|
TREPROSTINIL DIOLAMINE ER 0.125 MG TABLET,EXTENDED RELEASE [205150]
|
Facility
|
IP
|
$8.91
|
|
|
Service Code
|
NDC 66302-300-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$7.57 |
| Rate for Payer: Adventist Health Commercial |
$1.78
|
| Rate for Payer: Blue Shield of California Commercial |
$6.58
|
| Rate for Payer: Blue Shield of California EPN |
$4.33
|
| Rate for Payer: Cash Price |
$4.90
|
| Rate for Payer: Cigna of CA HMO |
$6.24
|
| Rate for Payer: Cigna of CA PPO |
$6.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.56
|
| Rate for Payer: EPIC Health Plan Senior |
$3.56
|
| Rate for Payer: Galaxy Health WC |
$7.57
|
| Rate for Payer: Global Benefits Group Commercial |
$5.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.14
|
| Rate for Payer: Multiplan Commercial |
$7.13
|
| Rate for Payer: Networks By Design Commercial |
$5.79
|
| Rate for Payer: Prime Health Services Commercial |
$7.57
|
|
|
TREPROSTINIL DIOLAMINE ER 1 MG TABLET,EXTENDED RELEASE [205151]
|
Facility
|
IP
|
$71.26
|
|
|
Service Code
|
NDC 66302-310-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.25 |
| Max. Negotiated Rate |
$60.57 |
| Rate for Payer: Adventist Health Commercial |
$14.25
|
| Rate for Payer: Blue Shield of California Commercial |
$52.59
|
| Rate for Payer: Blue Shield of California EPN |
$34.63
|
| Rate for Payer: Cash Price |
$39.19
|
| Rate for Payer: Cigna of CA HMO |
$49.88
|
| Rate for Payer: Cigna of CA PPO |
$49.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.50
|
| Rate for Payer: EPIC Health Plan Senior |
$28.50
|
| Rate for Payer: Galaxy Health WC |
$60.57
|
| Rate for Payer: Global Benefits Group Commercial |
$42.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.10
|
| Rate for Payer: Multiplan Commercial |
$57.01
|
| Rate for Payer: Networks By Design Commercial |
$46.32
|
| Rate for Payer: Prime Health Services Commercial |
$60.57
|
|
|
TREPROSTINIL DIOLAMINE ER 1 MG TABLET,EXTENDED RELEASE [205151]
|
Facility
|
OP
|
$71.26
|
|
|
Service Code
|
NDC 66302-310-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.25 |
| Max. Negotiated Rate |
$60.57 |
| Rate for Payer: Adventist Health Commercial |
$14.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.76
|
| Rate for Payer: Cash Price |
$39.19
|
| Rate for Payer: Cigna of CA HMO |
$49.88
|
| Rate for Payer: Cigna of CA PPO |
$49.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.50
|
| Rate for Payer: EPIC Health Plan Senior |
$28.50
|
| Rate for Payer: Galaxy Health WC |
$60.57
|
| Rate for Payer: Global Benefits Group Commercial |
$42.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.88
|
| Rate for Payer: Multiplan Commercial |
$57.01
|
| Rate for Payer: Networks By Design Commercial |
$46.32
|
| Rate for Payer: Prime Health Services Commercial |
$60.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.63
|
| Rate for Payer: United Healthcare All Other HMO |
$35.63
|
| Rate for Payer: United Healthcare HMO Rider |
$35.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$60.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.57
|
| Rate for Payer: Vantage Medical Group Senior |
$60.57
|
|
|
TREPROSTINIL DIOLAMINE ER 1 MG TABLET,EXTENDED RELEASE [205151]
|
Facility
|
OP
|
$71.26
|
|
|
Service Code
|
NDC 66302-310-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.25 |
| Max. Negotiated Rate |
$60.57 |
| Rate for Payer: Adventist Health Commercial |
$14.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.76
|
| Rate for Payer: Cash Price |
$39.19
|
| Rate for Payer: Cigna of CA HMO |
$49.88
|
| Rate for Payer: Cigna of CA PPO |
$49.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.50
|
| Rate for Payer: EPIC Health Plan Senior |
$28.50
|
| Rate for Payer: Galaxy Health WC |
$60.57
|
| Rate for Payer: Global Benefits Group Commercial |
$42.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.88
|
| Rate for Payer: Multiplan Commercial |
$57.01
|
| Rate for Payer: Networks By Design Commercial |
$46.32
|
| Rate for Payer: Prime Health Services Commercial |
$60.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.63
|
| Rate for Payer: United Healthcare All Other HMO |
$35.63
|
| Rate for Payer: United Healthcare HMO Rider |
$35.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$60.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.57
|
| Rate for Payer: Vantage Medical Group Senior |
$60.57
|
|
|
TREPROSTINIL DIOLAMINE ER 1 MG TABLET,EXTENDED RELEASE [205151]
|
Facility
|
IP
|
$71.26
|
|
|
Service Code
|
NDC 66302-310-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.25 |
| Max. Negotiated Rate |
$60.57 |
| Rate for Payer: Adventist Health Commercial |
$14.25
|
| Rate for Payer: Blue Shield of California Commercial |
$52.59
|
| Rate for Payer: Blue Shield of California EPN |
$34.63
|
| Rate for Payer: Cash Price |
$39.19
|
| Rate for Payer: Cigna of CA HMO |
$49.88
|
| Rate for Payer: Cigna of CA PPO |
$49.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.50
|
| Rate for Payer: EPIC Health Plan Senior |
$28.50
|
| Rate for Payer: Galaxy Health WC |
$60.57
|
| Rate for Payer: Global Benefits Group Commercial |
$42.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.10
|
| Rate for Payer: Multiplan Commercial |
$57.01
|
| Rate for Payer: Networks By Design Commercial |
$46.32
|
| Rate for Payer: Prime Health Services Commercial |
$60.57
|
|
|
TREPROSTINIL DIOLAMINE ER 2.5 MG TABLET,EXTENDED RELEASE [205152]
|
Facility
|
IP
|
$178.15
|
|
|
Service Code
|
NDC 66302-325-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.63 |
| Max. Negotiated Rate |
$151.43 |
| Rate for Payer: Adventist Health Commercial |
$35.63
|
| Rate for Payer: Blue Shield of California Commercial |
$131.47
|
| Rate for Payer: Blue Shield of California EPN |
$86.58
|
| Rate for Payer: Cash Price |
$97.98
|
| Rate for Payer: Cigna of CA HMO |
$124.70
|
| Rate for Payer: Cigna of CA PPO |
$124.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.26
|
| Rate for Payer: EPIC Health Plan Senior |
$71.26
|
| Rate for Payer: Galaxy Health WC |
$151.43
|
| Rate for Payer: Global Benefits Group Commercial |
$106.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.76
|
| Rate for Payer: Multiplan Commercial |
$142.52
|
| Rate for Payer: Networks By Design Commercial |
$115.80
|
| Rate for Payer: Prime Health Services Commercial |
$151.43
|
|
|
TREPROSTINIL DIOLAMINE ER 2.5 MG TABLET,EXTENDED RELEASE [205152]
|
Facility
|
OP
|
$178.15
|
|
|
Service Code
|
NDC 66302-325-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.63 |
| Max. Negotiated Rate |
$151.43 |
| Rate for Payer: Adventist Health Commercial |
$35.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$116.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$151.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$97.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$133.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$109.40
|
| Rate for Payer: Cash Price |
$97.98
|
| Rate for Payer: Cigna of CA HMO |
$124.70
|
| Rate for Payer: Cigna of CA PPO |
$124.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$151.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$151.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.26
|
| Rate for Payer: EPIC Health Plan Senior |
$71.26
|
| Rate for Payer: Galaxy Health WC |
$151.43
|
| Rate for Payer: Global Benefits Group Commercial |
$106.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$124.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$124.70
|
| Rate for Payer: Multiplan Commercial |
$142.52
|
| Rate for Payer: Networks By Design Commercial |
$115.80
|
| Rate for Payer: Prime Health Services Commercial |
$151.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$89.08
|
| Rate for Payer: United Healthcare All Other HMO |
$89.08
|
| Rate for Payer: United Healthcare HMO Rider |
$89.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$151.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.43
|
| Rate for Payer: Vantage Medical Group Senior |
$151.43
|
|
|
TREPROSTINIL DIOLAMINE ER 2.5 MG TABLET,EXTENDED RELEASE [205152]
|
Facility
|
IP
|
$178.15
|
|
|
Service Code
|
NDC 66302-325-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.63 |
| Max. Negotiated Rate |
$151.43 |
| Rate for Payer: Adventist Health Commercial |
$35.63
|
| Rate for Payer: Blue Shield of California Commercial |
$131.47
|
| Rate for Payer: Blue Shield of California EPN |
$86.58
|
| Rate for Payer: Cash Price |
$97.98
|
| Rate for Payer: Cigna of CA HMO |
$124.70
|
| Rate for Payer: Cigna of CA PPO |
$124.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.26
|
| Rate for Payer: EPIC Health Plan Senior |
$71.26
|
| Rate for Payer: Galaxy Health WC |
$151.43
|
| Rate for Payer: Global Benefits Group Commercial |
$106.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.76
|
| Rate for Payer: Multiplan Commercial |
$142.52
|
| Rate for Payer: Networks By Design Commercial |
$115.80
|
| Rate for Payer: Prime Health Services Commercial |
$151.43
|
|
|
TREPROSTINIL DIOLAMINE ER 2.5 MG TABLET,EXTENDED RELEASE [205152]
|
Facility
|
OP
|
$178.15
|
|
|
Service Code
|
NDC 66302-325-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.63 |
| Max. Negotiated Rate |
$151.43 |
| Rate for Payer: Adventist Health Commercial |
$35.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$116.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$151.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$97.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$133.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$109.40
|
| Rate for Payer: Cash Price |
$97.98
|
| Rate for Payer: Cigna of CA HMO |
$124.70
|
| Rate for Payer: Cigna of CA PPO |
$124.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$151.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$151.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.26
|
| Rate for Payer: EPIC Health Plan Senior |
$71.26
|
| Rate for Payer: Galaxy Health WC |
$151.43
|
| Rate for Payer: Global Benefits Group Commercial |
$106.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$124.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$124.70
|
| Rate for Payer: Multiplan Commercial |
$142.52
|
| Rate for Payer: Networks By Design Commercial |
$115.80
|
| Rate for Payer: Prime Health Services Commercial |
$151.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$89.08
|
| Rate for Payer: United Healthcare All Other HMO |
$89.08
|
| Rate for Payer: United Healthcare HMO Rider |
$89.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$151.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.43
|
| Rate for Payer: Vantage Medical Group Senior |
$151.43
|
|
|
TREPROSTINIL DIOLAMINE ER 5 MG TABLET, EXTENDED RELEASE [218793]
|
Facility
|
IP
|
$356.31
|
|
|
Service Code
|
NDC 66302-350-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$71.26 |
| Max. Negotiated Rate |
$302.86 |
| Rate for Payer: Adventist Health Commercial |
$71.26
|
| Rate for Payer: Blue Shield of California Commercial |
$262.96
|
| Rate for Payer: Blue Shield of California EPN |
$173.17
|
| Rate for Payer: Cash Price |
$195.97
|
| Rate for Payer: Cigna of CA HMO |
$249.42
|
| Rate for Payer: Cigna of CA PPO |
$249.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$142.52
|
| Rate for Payer: EPIC Health Plan Senior |
$142.52
|
| Rate for Payer: Galaxy Health WC |
$302.86
|
| Rate for Payer: Global Benefits Group Commercial |
$213.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$237.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$220.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.51
|
| Rate for Payer: Multiplan Commercial |
$285.05
|
| Rate for Payer: Networks By Design Commercial |
$231.60
|
| Rate for Payer: Prime Health Services Commercial |
$302.86
|
|
|
TREPROSTINIL DIOLAMINE ER 5 MG TABLET, EXTENDED RELEASE [218793]
|
Facility
|
IP
|
$356.31
|
|
|
Service Code
|
NDC 66302-350-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$71.26 |
| Max. Negotiated Rate |
$302.86 |
| Rate for Payer: Adventist Health Commercial |
$71.26
|
| Rate for Payer: Blue Shield of California Commercial |
$262.96
|
| Rate for Payer: Blue Shield of California EPN |
$173.17
|
| Rate for Payer: Cash Price |
$195.97
|
| Rate for Payer: Cigna of CA HMO |
$249.42
|
| Rate for Payer: Cigna of CA PPO |
$249.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$142.52
|
| Rate for Payer: EPIC Health Plan Senior |
$142.52
|
| Rate for Payer: Galaxy Health WC |
$302.86
|
| Rate for Payer: Global Benefits Group Commercial |
$213.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$237.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$220.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.51
|
| Rate for Payer: Multiplan Commercial |
$285.05
|
| Rate for Payer: Networks By Design Commercial |
$231.60
|
| Rate for Payer: Prime Health Services Commercial |
$302.86
|
|
|
TREPROSTINIL DIOLAMINE ER 5 MG TABLET, EXTENDED RELEASE [218793]
|
Facility
|
OP
|
$356.31
|
|
|
Service Code
|
NDC 66302-350-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$71.26 |
| Max. Negotiated Rate |
$302.86 |
| Rate for Payer: Adventist Health Commercial |
$71.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$233.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$302.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$195.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$218.81
|
| Rate for Payer: Cash Price |
$195.97
|
| Rate for Payer: Cigna of CA HMO |
$249.42
|
| Rate for Payer: Cigna of CA PPO |
$249.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$302.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$302.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$302.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$142.52
|
| Rate for Payer: EPIC Health Plan Senior |
$142.52
|
| Rate for Payer: Galaxy Health WC |
$302.86
|
| Rate for Payer: Global Benefits Group Commercial |
$213.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$237.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$220.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$249.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$249.42
|
| Rate for Payer: Multiplan Commercial |
$285.05
|
| Rate for Payer: Networks By Design Commercial |
$231.60
|
| Rate for Payer: Prime Health Services Commercial |
$302.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$213.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$213.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$178.16
|
| Rate for Payer: United Healthcare All Other HMO |
$178.16
|
| Rate for Payer: United Healthcare HMO Rider |
$178.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$178.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$302.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$302.86
|
| Rate for Payer: Vantage Medical Group Senior |
$302.86
|
|
|
TREPROSTINIL DIOLAMINE ER 5 MG TABLET, EXTENDED RELEASE [218793]
|
Facility
|
OP
|
$356.31
|
|
|
Service Code
|
NDC 66302-350-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$71.26 |
| Max. Negotiated Rate |
$302.86 |
| Rate for Payer: Adventist Health Commercial |
$71.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$233.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$302.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$195.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$218.81
|
| Rate for Payer: Cash Price |
$195.97
|
| Rate for Payer: Cigna of CA HMO |
$249.42
|
| Rate for Payer: Cigna of CA PPO |
$249.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$302.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$302.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$302.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$142.52
|
| Rate for Payer: EPIC Health Plan Senior |
$142.52
|
| Rate for Payer: Galaxy Health WC |
$302.86
|
| Rate for Payer: Global Benefits Group Commercial |
$213.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$237.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$220.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$249.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$249.42
|
| Rate for Payer: Multiplan Commercial |
$285.05
|
| Rate for Payer: Networks By Design Commercial |
$231.60
|
| Rate for Payer: Prime Health Services Commercial |
$302.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$213.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$213.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$178.16
|
| Rate for Payer: United Healthcare All Other HMO |
$178.16
|
| Rate for Payer: United Healthcare HMO Rider |
$178.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$178.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$302.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$302.86
|
| Rate for Payer: Vantage Medical Group Senior |
$302.86
|
|
|
TREPROSTINIL SODIUM 10 MG/ML INJECTION SOLUTION [32934]
|
Facility
|
IP
|
$725.79
|
|
|
Service Code
|
HCPCS J3285
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$145.16 |
| Max. Negotiated Rate |
$616.92 |
| Rate for Payer: Adventist Health Commercial |
$145.16
|
| Rate for Payer: Blue Shield of California Commercial |
$535.63
|
| Rate for Payer: Blue Shield of California EPN |
$352.73
|
| Rate for Payer: Cash Price |
$399.19
|
| 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 Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$449.26
|
| 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 |
$362.89
|
| Rate for Payer: Prime Health Services Commercial |
$616.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$272.39
|
| Rate for Payer: United Healthcare All Other HMO |
$265.13
|
| Rate for Payer: United Healthcare HMO Rider |
$259.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$237.70
|
|
|
TREPROSTINIL SODIUM 10 MG/ML INJECTION SOLUTION [32934]
|
Facility
|
OP
|
$725.79
|
|
|
Service Code
|
HCPCS J3285
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.48 |
| Max. Negotiated Rate |
$616.92 |
| Rate for Payer: Adventist Health Commercial |
$145.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$476.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$61.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.65
|
| Rate for Payer: Blue Shield of California Commercial |
$71.39
|
| Rate for Payer: Blue Shield of California EPN |
$71.39
|
| Rate for Payer: Cash Price |
$399.19
|
| Rate for Payer: Cash Price |
$399.19
|
| 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 |
$69.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$61.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$61.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.90
|
| Rate for Payer: EPIC Health Plan Senior |
$55.48
|
| Rate for Payer: Galaxy Health WC |
$616.92
|
| Rate for Payer: Global Benefits Group Commercial |
$435.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$55.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$484.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$69.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74.34
|
| Rate for Payer: Multiplan Commercial |
$580.63
|
| Rate for Payer: Networks By Design Commercial |
$362.89
|
| 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 |
$272.39
|
| Rate for Payer: United Healthcare All Other HMO |
$265.13
|
| Rate for Payer: United Healthcare HMO Rider |
$259.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$237.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$55.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61.03
|
| Rate for Payer: Vantage Medical Group Senior |
$61.03
|
|
|
TREPROSTINIL SODIUM 1 MG/ML INJECTION SOLUTION [32931]
|
Facility
|
OP
|
$68.76
|
|
|
Service Code
|
HCPCS J3285
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.75 |
| Max. Negotiated Rate |
$155.65 |
| Rate for Payer: Adventist Health Commercial |
$13.75
|
| Rate for Payer: Adventist Health Commercial |
$15.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$61.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$61.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.65
|
| Rate for Payer: Blue Shield of California Commercial |
$71.39
|
| Rate for Payer: Blue Shield of California Commercial |
$71.39
|
| Rate for Payer: Blue Shield of California EPN |
$71.39
|
| Rate for Payer: Blue Shield of California EPN |
$71.39
|
| Rate for Payer: Cash Price |
$42.02
|
| Rate for Payer: Cash Price |
$42.02
|
| Rate for Payer: Cash Price |
$37.82
|
| Rate for Payer: Cash Price |
$37.82
|
| Rate for Payer: Cigna of CA HMO |
$53.48
|
| Rate for Payer: Cigna of CA HMO |
$48.13
|
| Rate for Payer: Cigna of CA PPO |
$48.13
|
| Rate for Payer: Cigna of CA PPO |
$53.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$61.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$61.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$61.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$61.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.90
|
| Rate for Payer: EPIC Health Plan Senior |
$55.48
|
| Rate for Payer: EPIC Health Plan Senior |
$55.48
|
| Rate for Payer: Galaxy Health WC |
$58.45
|
| Rate for Payer: Galaxy Health WC |
$64.94
|
| Rate for Payer: Global Benefits Group Commercial |
$45.84
|
| Rate for Payer: Global Benefits Group Commercial |
$41.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$55.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$55.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$69.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$69.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74.34
|
| Rate for Payer: Multiplan Commercial |
$55.01
|
| Rate for Payer: Multiplan Commercial |
$61.12
|
| Rate for Payer: Networks By Design Commercial |
$38.20
|
| Rate for Payer: Networks By Design Commercial |
$34.38
|
| Rate for Payer: Prime Health Services Commercial |
$58.45
|
| Rate for Payer: Prime Health Services Commercial |
$64.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$41.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$41.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.81
|
| Rate for Payer: United Healthcare All Other HMO |
$25.12
|
| Rate for Payer: United Healthcare All Other HMO |
$27.91
|
| Rate for Payer: United Healthcare HMO Rider |
$24.57
|
| Rate for Payer: United Healthcare HMO Rider |
$27.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.52
|
| Rate for Payer: Upland Medical Group Pediatric |
$55.48
|
| Rate for Payer: Upland Medical Group Pediatric |
$55.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61.03
|
| Rate for Payer: Vantage Medical Group Senior |
$61.03
|
| Rate for Payer: Vantage Medical Group Senior |
$61.03
|
|
