PAROXETINE 10 MG TABLET [16632]
|
Facility
|
IP
|
$0.14
|
|
Service Code
|
NDC 68382-097-06
|
Hospital Charge Code |
1713121
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.03 |
Max. Negotiated Rate |
$0.12 |
Rate for Payer: Blue Shield of California Commercial |
$0.10
|
Rate for Payer: Blue Shield of California EPN |
$0.07
|
Rate for Payer: Cash Price |
$0.06
|
Rate for Payer: Cigna of CA HMO |
$0.10
|
Rate for Payer: Cigna of CA PPO |
$0.10
|
Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
Rate for Payer: Galaxy Health WC |
$0.12
|
Rate for Payer: Global Benefits Group Commercial |
$0.08
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
Rate for Payer: Multiplan Commercial |
$0.11
|
Rate for Payer: Networks By Design Commercial |
$0.09
|
Rate for Payer: Prime Health Services Commercial |
$0.12
|
|
PAROXETINE 20 MG TABLET [10855]
|
Facility
|
IP
|
$0.30
|
|
Service Code
|
NDC 0904-5677-61
|
Hospital Charge Code |
1711583
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.07 |
Max. Negotiated Rate |
$0.26 |
Rate for Payer: Blue Shield of California Commercial |
$0.21
|
Rate for Payer: Blue Shield of California EPN |
$0.15
|
Rate for Payer: Cash Price |
$0.14
|
Rate for Payer: Cigna of CA HMO |
$0.21
|
Rate for Payer: Cigna of CA PPO |
$0.21
|
Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
Rate for Payer: Galaxy Health WC |
$0.26
|
Rate for Payer: Global Benefits Group Commercial |
$0.18
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.20
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
Rate for Payer: Multiplan Commercial |
$0.24
|
Rate for Payer: Networks By Design Commercial |
$0.20
|
Rate for Payer: Prime Health Services Commercial |
$0.26
|
|
PAROXETINE 20 MG TABLET [10855]
|
Facility
|
OP
|
$0.17
|
|
Service Code
|
NDC 68382-098-06
|
Hospital Charge Code |
1711583
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.04 |
Max. Negotiated Rate |
$0.14 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.11
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.14
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.09
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.09
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
Rate for Payer: Blue Distinction Transplant |
$0.10
|
Rate for Payer: Blue Shield of California Commercial |
$0.13
|
Rate for Payer: Blue Shield of California EPN |
$0.10
|
Rate for Payer: Cash Price |
$0.08
|
Rate for Payer: Cigna of CA HMO |
$0.12
|
Rate for Payer: Cigna of CA PPO |
$0.12
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
Rate for Payer: Dignity Health Media |
$0.14
|
Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
Rate for Payer: EPIC Health Plan Transplant |
$0.07
|
Rate for Payer: Galaxy Health WC |
$0.14
|
Rate for Payer: Global Benefits Group Commercial |
$0.10
|
Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.13
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
Rate for Payer: Multiplan Commercial |
$0.14
|
Rate for Payer: Networks By Design Commercial |
$0.11
|
Rate for Payer: Prime Health Services Commercial |
$0.14
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
Rate for Payer: United Healthcare All Other HMO |
$0.09
|
Rate for Payer: United Healthcare HMO Rider |
$0.09
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
PAROXETINE 20 MG TABLET [10855]
|
Facility
|
IP
|
$0.17
|
|
Service Code
|
NDC 60505-0083-1
|
Hospital Charge Code |
1711583
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.04 |
Max. Negotiated Rate |
$0.14 |
Rate for Payer: Blue Shield of California Commercial |
$0.12
|
Rate for Payer: Blue Shield of California EPN |
$0.09
|
Rate for Payer: Cash Price |
$0.08
|
Rate for Payer: Cigna of CA HMO |
$0.12
|
Rate for Payer: Cigna of CA PPO |
$0.12
|
Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
Rate for Payer: Galaxy Health WC |
$0.14
|
Rate for Payer: Global Benefits Group Commercial |
$0.10
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
Rate for Payer: Multiplan Commercial |
$0.14
|
Rate for Payer: Networks By Design Commercial |
$0.11
|
Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
PAROXETINE 20 MG TABLET [10855]
|
Facility
|
IP
|
$0.17
|
|
Service Code
|
NDC 68382-098-06
|
Hospital Charge Code |
1711583
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.04 |
Max. Negotiated Rate |
$0.14 |
Rate for Payer: Blue Shield of California Commercial |
$0.12
|
Rate for Payer: Blue Shield of California EPN |
$0.09
|
Rate for Payer: Cash Price |
$0.08
|
Rate for Payer: Cigna of CA HMO |
$0.12
|
Rate for Payer: Cigna of CA PPO |
$0.12
|
Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
Rate for Payer: Galaxy Health WC |
$0.14
|
Rate for Payer: Global Benefits Group Commercial |
$0.10
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
Rate for Payer: Multiplan Commercial |
$0.14
|
Rate for Payer: Networks By Design Commercial |
$0.11
|
Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
PAROXETINE 20 MG TABLET [10855]
|
Facility
|
IP
|
$0.39
|
|
Service Code
|
NDC 68084-045-11
|
Hospital Charge Code |
1711583
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.09 |
Max. Negotiated Rate |
$0.33 |
Rate for Payer: Blue Shield of California Commercial |
$0.28
|
Rate for Payer: Blue Shield of California EPN |
$0.20
|
Rate for Payer: Cash Price |
$0.18
|
Rate for Payer: Cigna of CA HMO |
$0.27
|
Rate for Payer: Cigna of CA PPO |
$0.27
|
Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
Rate for Payer: Galaxy Health WC |
$0.33
|
Rate for Payer: Global Benefits Group Commercial |
$0.23
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.26
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
Rate for Payer: Multiplan Commercial |
$0.31
|
Rate for Payer: Networks By Design Commercial |
$0.25
|
Rate for Payer: Prime Health Services Commercial |
$0.33
|
|
PAROXETINE 20 MG TABLET [10855]
|
Facility
|
IP
|
$0.39
|
|
Service Code
|
NDC 68084-045-01
|
Hospital Charge Code |
1711583
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.09 |
Max. Negotiated Rate |
$0.33 |
Rate for Payer: Blue Shield of California Commercial |
$0.28
|
Rate for Payer: Blue Shield of California EPN |
$0.20
|
Rate for Payer: Cash Price |
$0.18
|
Rate for Payer: Cigna of CA HMO |
$0.27
|
Rate for Payer: Cigna of CA PPO |
$0.27
|
Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
Rate for Payer: Galaxy Health WC |
$0.33
|
Rate for Payer: Global Benefits Group Commercial |
$0.23
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.26
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
Rate for Payer: Multiplan Commercial |
$0.31
|
Rate for Payer: Networks By Design Commercial |
$0.25
|
Rate for Payer: Prime Health Services Commercial |
$0.33
|
|
PAROXETINE 20 MG TABLET [10855]
|
Facility
|
OP
|
$0.39
|
|
Service Code
|
NDC 68084-045-11
|
Hospital Charge Code |
1711583
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.09 |
Max. Negotiated Rate |
$0.33 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.26
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.33
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.21
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.21
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.23
|
Rate for Payer: Blue Distinction Transplant |
$0.23
|
Rate for Payer: Blue Shield of California Commercial |
$0.29
|
Rate for Payer: Blue Shield of California EPN |
$0.23
|
Rate for Payer: Cash Price |
$0.18
|
Rate for Payer: Cigna of CA HMO |
$0.27
|
Rate for Payer: Cigna of CA PPO |
$0.27
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.33
|
Rate for Payer: Dignity Health Media |
$0.33
|
Rate for Payer: Dignity Health Medi-Cal |
$0.33
|
Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
Rate for Payer: EPIC Health Plan Transplant |
$0.16
|
Rate for Payer: Galaxy Health WC |
$0.33
|
Rate for Payer: Global Benefits Group Commercial |
$0.23
|
Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.29
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.26
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
Rate for Payer: Multiplan Commercial |
$0.31
|
Rate for Payer: Networks By Design Commercial |
$0.25
|
Rate for Payer: Prime Health Services Commercial |
$0.33
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.23
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.23
|
Rate for Payer: United Healthcare All Other Commercial |
$0.20
|
Rate for Payer: United Healthcare All Other HMO |
$0.20
|
Rate for Payer: United Healthcare HMO Rider |
$0.20
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.20
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.33
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.33
|
Rate for Payer: Vantage Medical Group Senior |
$0.33
|
|
PAROXETINE 20 MG TABLET [10855]
|
Facility
|
OP
|
$0.39
|
|
Service Code
|
NDC 68084-045-01
|
Hospital Charge Code |
1711583
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.09 |
Max. Negotiated Rate |
$0.33 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.26
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.33
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.21
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.21
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.23
|
Rate for Payer: Blue Distinction Transplant |
$0.23
|
Rate for Payer: Blue Shield of California Commercial |
$0.29
|
Rate for Payer: Blue Shield of California EPN |
$0.23
|
Rate for Payer: Cash Price |
$0.18
|
Rate for Payer: Cigna of CA HMO |
$0.27
|
Rate for Payer: Cigna of CA PPO |
$0.27
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.33
|
Rate for Payer: Dignity Health Media |
$0.33
|
Rate for Payer: Dignity Health Medi-Cal |
$0.33
|
Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
Rate for Payer: EPIC Health Plan Transplant |
$0.16
|
Rate for Payer: Galaxy Health WC |
$0.33
|
Rate for Payer: Global Benefits Group Commercial |
$0.23
|
Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.29
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.26
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
Rate for Payer: Multiplan Commercial |
$0.31
|
Rate for Payer: Networks By Design Commercial |
$0.25
|
Rate for Payer: Prime Health Services Commercial |
$0.33
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.23
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.23
|
Rate for Payer: United Healthcare All Other Commercial |
$0.20
|
Rate for Payer: United Healthcare All Other HMO |
$0.20
|
Rate for Payer: United Healthcare HMO Rider |
$0.20
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.20
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.33
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.33
|
Rate for Payer: Vantage Medical Group Senior |
$0.33
|
|
PAROXETINE 20 MG TABLET [10855]
|
Facility
|
OP
|
$0.17
|
|
Service Code
|
NDC 60505-0083-1
|
Hospital Charge Code |
1711583
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.04 |
Max. Negotiated Rate |
$0.14 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.11
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.14
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.09
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.09
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
Rate for Payer: Blue Distinction Transplant |
$0.10
|
Rate for Payer: Blue Shield of California Commercial |
$0.13
|
Rate for Payer: Blue Shield of California EPN |
$0.10
|
Rate for Payer: Cash Price |
$0.08
|
Rate for Payer: Cigna of CA HMO |
$0.12
|
Rate for Payer: Cigna of CA PPO |
$0.12
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
Rate for Payer: Dignity Health Media |
$0.14
|
Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
Rate for Payer: EPIC Health Plan Transplant |
$0.07
|
Rate for Payer: Galaxy Health WC |
$0.14
|
Rate for Payer: Global Benefits Group Commercial |
$0.10
|
Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.13
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
Rate for Payer: Multiplan Commercial |
$0.14
|
Rate for Payer: Networks By Design Commercial |
$0.11
|
Rate for Payer: Prime Health Services Commercial |
$0.14
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
Rate for Payer: United Healthcare All Other HMO |
$0.09
|
Rate for Payer: United Healthcare HMO Rider |
$0.09
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
PAROXETINE 20 MG TABLET [10855]
|
Facility
|
OP
|
$0.30
|
|
Service Code
|
NDC 0904-5677-61
|
Hospital Charge Code |
1711583
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.07 |
Max. Negotiated Rate |
$0.26 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.20
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.26
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.17
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.18
|
Rate for Payer: Blue Distinction Transplant |
$0.18
|
Rate for Payer: Blue Shield of California Commercial |
$0.22
|
Rate for Payer: Blue Shield of California EPN |
$0.18
|
Rate for Payer: Cash Price |
$0.14
|
Rate for Payer: Cigna of CA HMO |
$0.21
|
Rate for Payer: Cigna of CA PPO |
$0.21
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
Rate for Payer: Dignity Health Media |
$0.26
|
Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
Rate for Payer: EPIC Health Plan Transplant |
$0.12
|
Rate for Payer: Galaxy Health WC |
$0.26
|
Rate for Payer: Global Benefits Group Commercial |
$0.18
|
Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.23
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.20
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
Rate for Payer: Multiplan Commercial |
$0.24
|
Rate for Payer: Networks By Design Commercial |
$0.20
|
Rate for Payer: Prime Health Services Commercial |
$0.26
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.18
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.18
|
Rate for Payer: United Healthcare All Other Commercial |
$0.15
|
Rate for Payer: United Healthcare All Other HMO |
$0.15
|
Rate for Payer: United Healthcare HMO Rider |
$0.15
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.15
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.26
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
PAROXETINE 30 MG TABLET [10856]
|
Facility
|
IP
|
$0.32
|
|
Service Code
|
NDC 43547-349-03
|
Hospital Charge Code |
1713111
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.08 |
Max. Negotiated Rate |
$0.27 |
Rate for Payer: Blue Shield of California Commercial |
$0.23
|
Rate for Payer: Blue Shield of California EPN |
$0.16
|
Rate for Payer: Cash Price |
$0.14
|
Rate for Payer: Cigna of CA HMO |
$0.22
|
Rate for Payer: Cigna of CA PPO |
$0.22
|
Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
Rate for Payer: Galaxy Health WC |
$0.27
|
Rate for Payer: Global Benefits Group Commercial |
$0.19
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
Rate for Payer: Multiplan Commercial |
$0.26
|
Rate for Payer: Networks By Design Commercial |
$0.21
|
Rate for Payer: Prime Health Services Commercial |
$0.27
|
|
PAROXETINE 30 MG TABLET [10856]
|
Facility
|
IP
|
$1.14
|
|
Service Code
|
NDC 68084-046-11
|
Hospital Charge Code |
1713111
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.27 |
Max. Negotiated Rate |
$0.97 |
Rate for Payer: Blue Shield of California Commercial |
$0.81
|
Rate for Payer: Blue Shield of California EPN |
$0.58
|
Rate for Payer: Cash Price |
$0.51
|
Rate for Payer: Cigna of CA HMO |
$0.80
|
Rate for Payer: Cigna of CA PPO |
$0.80
|
Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
Rate for Payer: Galaxy Health WC |
$0.97
|
Rate for Payer: Global Benefits Group Commercial |
$0.68
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.76
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.43
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
Rate for Payer: Multiplan Commercial |
$0.91
|
Rate for Payer: Networks By Design Commercial |
$0.74
|
Rate for Payer: Prime Health Services Commercial |
$0.97
|
|
PAROXETINE 30 MG TABLET [10856]
|
Facility
|
IP
|
$0.55
|
|
Service Code
|
NDC 50268-642-15
|
Hospital Charge Code |
1713111
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.13 |
Max. Negotiated Rate |
$0.47 |
Rate for Payer: Blue Shield of California Commercial |
$0.39
|
Rate for Payer: Blue Shield of California EPN |
$0.28
|
Rate for Payer: Cash Price |
$0.25
|
Rate for Payer: Cigna of CA HMO |
$0.39
|
Rate for Payer: Cigna of CA PPO |
$0.39
|
Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
Rate for Payer: Galaxy Health WC |
$0.47
|
Rate for Payer: Global Benefits Group Commercial |
$0.33
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.37
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
Rate for Payer: Multiplan Commercial |
$0.44
|
Rate for Payer: Networks By Design Commercial |
$0.36
|
Rate for Payer: Prime Health Services Commercial |
$0.47
|
|
PAROXETINE 30 MG TABLET [10856]
|
Facility
|
OP
|
$1.14
|
|
Service Code
|
NDC 68084-046-11
|
Hospital Charge Code |
1713111
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.27 |
Max. Negotiated Rate |
$0.97 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.75
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.97
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.63
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.63
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.68
|
Rate for Payer: Blue Distinction Transplant |
$0.68
|
Rate for Payer: Blue Shield of California Commercial |
$0.84
|
Rate for Payer: Blue Shield of California EPN |
$0.67
|
Rate for Payer: Cash Price |
$0.51
|
Rate for Payer: Cigna of CA HMO |
$0.80
|
Rate for Payer: Cigna of CA PPO |
$0.80
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.97
|
Rate for Payer: Dignity Health Media |
$0.97
|
Rate for Payer: Dignity Health Medi-Cal |
$0.97
|
Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
Rate for Payer: EPIC Health Plan Transplant |
$0.46
|
Rate for Payer: Galaxy Health WC |
$0.97
|
Rate for Payer: Global Benefits Group Commercial |
$0.68
|
Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.86
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.76
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.43
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
Rate for Payer: Multiplan Commercial |
$0.91
|
Rate for Payer: Networks By Design Commercial |
$0.74
|
Rate for Payer: Prime Health Services Commercial |
$0.97
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.68
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.68
|
Rate for Payer: United Healthcare All Other Commercial |
$0.57
|
Rate for Payer: United Healthcare All Other HMO |
$0.57
|
Rate for Payer: United Healthcare HMO Rider |
$0.57
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.57
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.97
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.97
|
Rate for Payer: Vantage Medical Group Senior |
$0.97
|
|
PAROXETINE 30 MG TABLET [10856]
|
Facility
|
OP
|
$0.32
|
|
Service Code
|
NDC 43547-349-03
|
Hospital Charge Code |
1713111
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.08 |
Max. Negotiated Rate |
$0.27 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.21
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.27
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.18
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.18
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.19
|
Rate for Payer: Blue Distinction Transplant |
$0.19
|
Rate for Payer: Blue Shield of California Commercial |
$0.24
|
Rate for Payer: Blue Shield of California EPN |
$0.19
|
Rate for Payer: Cash Price |
$0.14
|
Rate for Payer: Cigna of CA HMO |
$0.22
|
Rate for Payer: Cigna of CA PPO |
$0.22
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.27
|
Rate for Payer: Dignity Health Media |
$0.27
|
Rate for Payer: Dignity Health Medi-Cal |
$0.27
|
Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
Rate for Payer: EPIC Health Plan Transplant |
$0.13
|
Rate for Payer: Galaxy Health WC |
$0.27
|
Rate for Payer: Global Benefits Group Commercial |
$0.19
|
Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.24
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
Rate for Payer: Multiplan Commercial |
$0.26
|
Rate for Payer: Networks By Design Commercial |
$0.21
|
Rate for Payer: Prime Health Services Commercial |
$0.27
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.19
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.19
|
Rate for Payer: United Healthcare All Other Commercial |
$0.16
|
Rate for Payer: United Healthcare All Other HMO |
$0.16
|
Rate for Payer: United Healthcare HMO Rider |
$0.16
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.27
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.27
|
Rate for Payer: Vantage Medical Group Senior |
$0.27
|
|
PAROXETINE 30 MG TABLET [10856]
|
Facility
|
IP
|
$0.23
|
|
Service Code
|
NDC 68382-099-06
|
Hospital Charge Code |
1713111
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.06 |
Max. Negotiated Rate |
$0.20 |
Rate for Payer: Blue Shield of California Commercial |
$0.16
|
Rate for Payer: Blue Shield of California EPN |
$0.12
|
Rate for Payer: Cash Price |
$0.10
|
Rate for Payer: Cigna of CA HMO |
$0.16
|
Rate for Payer: Cigna of CA PPO |
$0.16
|
Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
Rate for Payer: Galaxy Health WC |
$0.20
|
Rate for Payer: Global Benefits Group Commercial |
$0.14
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
Rate for Payer: Multiplan Commercial |
$0.18
|
Rate for Payer: Networks By Design Commercial |
$0.15
|
Rate for Payer: Prime Health Services Commercial |
$0.20
|
|
PAROXETINE 30 MG TABLET [10856]
|
Facility
|
OP
|
$0.23
|
|
Service Code
|
NDC 68382-099-06
|
Hospital Charge Code |
1713111
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.06 |
Max. Negotiated Rate |
$0.20 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.15
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.20
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.13
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.13
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
Rate for Payer: Blue Distinction Transplant |
$0.14
|
Rate for Payer: Blue Shield of California Commercial |
$0.17
|
Rate for Payer: Blue Shield of California EPN |
$0.13
|
Rate for Payer: Cash Price |
$0.10
|
Rate for Payer: Cigna of CA HMO |
$0.16
|
Rate for Payer: Cigna of CA PPO |
$0.16
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
Rate for Payer: Dignity Health Media |
$0.20
|
Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
Rate for Payer: EPIC Health Plan Transplant |
$0.09
|
Rate for Payer: Galaxy Health WC |
$0.20
|
Rate for Payer: Global Benefits Group Commercial |
$0.14
|
Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.17
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
Rate for Payer: Multiplan Commercial |
$0.18
|
Rate for Payer: Networks By Design Commercial |
$0.15
|
Rate for Payer: Prime Health Services Commercial |
$0.20
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
Rate for Payer: United Healthcare All Other HMO |
$0.12
|
Rate for Payer: United Healthcare HMO Rider |
$0.12
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
PAROXETINE 30 MG TABLET [10856]
|
Facility
|
IP
|
$0.55
|
|
Service Code
|
NDC 50268-642-11
|
Hospital Charge Code |
1713111
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.13 |
Max. Negotiated Rate |
$0.47 |
Rate for Payer: Blue Shield of California Commercial |
$0.39
|
Rate for Payer: Blue Shield of California EPN |
$0.28
|
Rate for Payer: Cash Price |
$0.25
|
Rate for Payer: Cigna of CA HMO |
$0.39
|
Rate for Payer: Cigna of CA PPO |
$0.39
|
Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
Rate for Payer: Galaxy Health WC |
$0.47
|
Rate for Payer: Global Benefits Group Commercial |
$0.33
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.37
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
Rate for Payer: Multiplan Commercial |
$0.44
|
Rate for Payer: Networks By Design Commercial |
$0.36
|
Rate for Payer: Prime Health Services Commercial |
$0.47
|
|
PAROXETINE 30 MG TABLET [10856]
|
Facility
|
OP
|
$0.55
|
|
Service Code
|
NDC 50268-642-15
|
Hospital Charge Code |
1713111
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.13 |
Max. Negotiated Rate |
$0.47 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.36
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.47
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.30
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.30
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.33
|
Rate for Payer: Blue Distinction Transplant |
$0.33
|
Rate for Payer: Blue Shield of California Commercial |
$0.41
|
Rate for Payer: Blue Shield of California EPN |
$0.32
|
Rate for Payer: Cash Price |
$0.25
|
Rate for Payer: Cigna of CA HMO |
$0.39
|
Rate for Payer: Cigna of CA PPO |
$0.39
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.47
|
Rate for Payer: Dignity Health Media |
$0.47
|
Rate for Payer: Dignity Health Medi-Cal |
$0.47
|
Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
Rate for Payer: EPIC Health Plan Transplant |
$0.22
|
Rate for Payer: Galaxy Health WC |
$0.47
|
Rate for Payer: Global Benefits Group Commercial |
$0.33
|
Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.41
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.37
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
Rate for Payer: Multiplan Commercial |
$0.44
|
Rate for Payer: Networks By Design Commercial |
$0.36
|
Rate for Payer: Prime Health Services Commercial |
$0.47
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.33
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.33
|
Rate for Payer: United Healthcare All Other Commercial |
$0.28
|
Rate for Payer: United Healthcare All Other HMO |
$0.28
|
Rate for Payer: United Healthcare HMO Rider |
$0.28
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.28
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.47
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.47
|
Rate for Payer: Vantage Medical Group Senior |
$0.47
|
|
PAROXETINE 30 MG TABLET [10856]
|
Facility
|
OP
|
$0.55
|
|
Service Code
|
NDC 50268-642-11
|
Hospital Charge Code |
1713111
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.13 |
Max. Negotiated Rate |
$0.47 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.36
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.47
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.30
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.30
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.33
|
Rate for Payer: Blue Distinction Transplant |
$0.33
|
Rate for Payer: Blue Shield of California Commercial |
$0.41
|
Rate for Payer: Blue Shield of California EPN |
$0.32
|
Rate for Payer: Cash Price |
$0.25
|
Rate for Payer: Cigna of CA HMO |
$0.39
|
Rate for Payer: Cigna of CA PPO |
$0.39
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.47
|
Rate for Payer: Dignity Health Media |
$0.47
|
Rate for Payer: Dignity Health Medi-Cal |
$0.47
|
Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
Rate for Payer: EPIC Health Plan Transplant |
$0.22
|
Rate for Payer: Galaxy Health WC |
$0.47
|
Rate for Payer: Global Benefits Group Commercial |
$0.33
|
Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.41
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.37
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
Rate for Payer: Multiplan Commercial |
$0.44
|
Rate for Payer: Networks By Design Commercial |
$0.36
|
Rate for Payer: Prime Health Services Commercial |
$0.47
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.33
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.33
|
Rate for Payer: United Healthcare All Other Commercial |
$0.28
|
Rate for Payer: United Healthcare All Other HMO |
$0.28
|
Rate for Payer: United Healthcare HMO Rider |
$0.28
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.28
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.47
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.47
|
Rate for Payer: Vantage Medical Group Senior |
$0.47
|
|
PARTIAL THICKNESS BURNS WITHOUT SKIN GRAFT
|
Facility
|
IP
|
$15,886.66
|
|
Service Code
|
APR-DRG 8443
|
Min. Negotiated Rate |
$12,186.74 |
Max. Negotiated Rate |
$15,886.66 |
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12,186.74
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15,886.66
|
|
PARTIAL THICKNESS BURNS WITHOUT SKIN GRAFT
|
Facility
|
IP
|
$9,243.27
|
|
Service Code
|
APR-DRG 8442
|
Min. Negotiated Rate |
$7,090.56 |
Max. Negotiated Rate |
$9,243.27 |
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,090.56
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,243.27
|
|
PARTIAL THICKNESS BURNS WITHOUT SKIN GRAFT
|
Facility
|
IP
|
$5,705.22
|
|
Service Code
|
APR-DRG 8441
|
Min. Negotiated Rate |
$4,376.51 |
Max. Negotiated Rate |
$5,705.22 |
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,376.51
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,705.22
|
|
PARTIAL THICKNESS BURNS WITHOUT SKIN GRAFT
|
Facility
|
IP
|
$36,689.34
|
|
Service Code
|
APR-DRG 8444
|
Min. Negotiated Rate |
$28,144.59 |
Max. Negotiated Rate |
$36,689.34 |
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28,144.59
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36,689.34
|
|