|
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 |
$2.97 |
| Max. Negotiated Rate |
$13.37 |
| Rate for Payer: Blue Shield of California Commercial |
$11.14
|
| Rate for Payer: Blue Shield of California EPN |
$7.94
|
| Rate for Payer: Cash Price |
$6.69
|
| Rate for Payer: Central Health Plan Commercial |
$11.89
|
| 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: Health Management Network EPO/PPO |
$13.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.97
|
| Rate for Payer: Multiplan Commercial |
$11.14
|
| Rate for Payer: Networks By Design Commercial |
$9.66
|
| Rate for Payer: Prime Health Services Commercial |
$12.63
|
|
|
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 |
$11.89 |
| Max. Negotiated Rate |
$53.50 |
| Rate for Payer: Blue Shield of California Commercial |
$44.59
|
| Rate for Payer: Blue Shield of California EPN |
$31.75
|
| Rate for Payer: Cash Price |
$26.75
|
| Rate for Payer: Central Health Plan Commercial |
$47.56
|
| 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: Health Management Network EPO/PPO |
$53.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.89
|
| Rate for Payer: Multiplan Commercial |
$44.59
|
| Rate for Payer: Networks By Design Commercial |
$38.64
|
| Rate for Payer: Prime Health Services Commercial |
$50.53
|
|
|
TREPROSTINIL DIOLAMINE ER 1 MG TABLET,EXTENDED RELEASE [205151]
|
Facility
OP
|
$59.45
|
|
|
Service Code
|
NDC 66302-310-10
|
| Hospital Charge Code |
ERX205151
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.89 |
| Max. Negotiated Rate |
$53.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$36.10
|
| 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 Exchange |
$28.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.12
|
| Rate for Payer: BCBS Transplant Transplant |
$35.67
|
| Rate for Payer: Blue Shield of California Commercial |
$37.39
|
| Rate for Payer: Blue Shield of California EPN |
$29.07
|
| Rate for Payer: Cash Price |
$26.75
|
| Rate for Payer: Central Health Plan Commercial |
$47.56
|
| 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: 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 Management Network EPO/PPO |
$53.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$44.59
|
| Rate for Payer: IEHP medi-cal |
$20.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.89
|
| Rate for Payer: Multiplan Commercial |
$44.59
|
| 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: Riverside University Health MISP |
$23.78
|
| 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 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 |
$11.89 |
| Max. Negotiated Rate |
$53.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$36.10
|
| 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 Exchange |
$28.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.12
|
| Rate for Payer: BCBS Transplant Transplant |
$35.67
|
| Rate for Payer: Blue Shield of California Commercial |
$37.39
|
| Rate for Payer: Blue Shield of California EPN |
$29.07
|
| Rate for Payer: Cash Price |
$26.75
|
| Rate for Payer: Central Health Plan Commercial |
$47.56
|
| 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: 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 Management Network EPO/PPO |
$53.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$44.59
|
| Rate for Payer: IEHP medi-cal |
$20.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.89
|
| Rate for Payer: Multiplan Commercial |
$44.59
|
| 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: Riverside University Health MISP |
$23.78
|
| 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 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 |
$11.89 |
| Max. Negotiated Rate |
$53.50 |
| Rate for Payer: Blue Shield of California Commercial |
$44.59
|
| Rate for Payer: Blue Shield of California EPN |
$31.75
|
| Rate for Payer: Cash Price |
$26.75
|
| Rate for Payer: Central Health Plan Commercial |
$47.56
|
| 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: Health Management Network EPO/PPO |
$53.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.89
|
| Rate for Payer: Multiplan Commercial |
$44.59
|
| 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 |
$29.72 |
| Max. Negotiated Rate |
$133.76 |
| Rate for Payer: Blue Shield of California Commercial |
$111.46
|
| Rate for Payer: Blue Shield of California EPN |
$79.36
|
| Rate for Payer: Cash Price |
$66.88
|
| Rate for Payer: Central Health Plan Commercial |
$118.90
|
| 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: Health Management Network EPO/PPO |
$133.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.72
|
| Rate for Payer: Multiplan Commercial |
$111.46
|
| 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 |
$29.72 |
| Max. Negotiated Rate |
$133.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$90.26
|
| 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 Exchange |
$71.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.80
|
| Rate for Payer: BCBS Transplant Transplant |
$89.17
|
| Rate for Payer: Blue Shield of California Commercial |
$93.48
|
| Rate for Payer: Blue Shield of California EPN |
$72.68
|
| Rate for Payer: Cash Price |
$66.88
|
| Rate for Payer: Central Health Plan Commercial |
$118.90
|
| 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: 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 Management Network EPO/PPO |
$133.76
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$111.46
|
| Rate for Payer: IEHP medi-cal |
$52.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.72
|
| Rate for Payer: Multiplan Commercial |
$111.46
|
| 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: Riverside University Health MISP |
$59.45
|
| 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 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 |
$59.45 |
| Max. Negotiated Rate |
$267.51 |
| Rate for Payer: Blue Shield of California Commercial |
$222.92
|
| Rate for Payer: Blue Shield of California EPN |
$158.72
|
| Rate for Payer: Cash Price |
$133.75
|
| Rate for Payer: Central Health Plan Commercial |
$237.78
|
| 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: Health Management Network EPO/PPO |
$267.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.45
|
| Rate for Payer: Multiplan Commercial |
$222.92
|
| 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 |
$59.45 |
| Max. Negotiated Rate |
$267.51 |
| Rate for Payer: Blue Shield of California Commercial |
$222.92
|
| Rate for Payer: Blue Shield of California EPN |
$158.72
|
| Rate for Payer: Cash Price |
$133.75
|
| Rate for Payer: Central Health Plan Commercial |
$237.78
|
| 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: Health Management Network EPO/PPO |
$267.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.45
|
| Rate for Payer: Multiplan Commercial |
$222.92
|
| 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 66302-350-01
|
| Hospital Charge Code |
ERX218793
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$59.45 |
| Max. Negotiated Rate |
$267.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$180.51
|
| 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 Exchange |
$143.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.60
|
| Rate for Payer: BCBS Transplant Transplant |
$178.34
|
| Rate for Payer: Blue Shield of California Commercial |
$186.96
|
| Rate for Payer: Blue Shield of California EPN |
$145.35
|
| Rate for Payer: Cash Price |
$133.75
|
| Rate for Payer: Central Health Plan Commercial |
$237.78
|
| 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: 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 Management Network EPO/PPO |
$267.51
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$222.92
|
| Rate for Payer: IEHP medi-cal |
$104.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.45
|
| Rate for Payer: Multiplan Commercial |
$222.92
|
| 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: Riverside University Health MISP |
$118.89
|
| 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 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 66302-350-10
|
| Hospital Charge Code |
ERX218793
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$59.45 |
| Max. Negotiated Rate |
$267.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$180.51
|
| 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 Exchange |
$143.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.60
|
| Rate for Payer: BCBS Transplant Transplant |
$178.34
|
| Rate for Payer: Blue Shield of California Commercial |
$186.96
|
| Rate for Payer: Blue Shield of California EPN |
$145.35
|
| Rate for Payer: Cash Price |
$133.75
|
| Rate for Payer: Central Health Plan Commercial |
$237.78
|
| 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: 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 Management Network EPO/PPO |
$267.51
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$222.92
|
| Rate for Payer: IEHP medi-cal |
$104.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.45
|
| Rate for Payer: Multiplan Commercial |
$222.92
|
| 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: Riverside University Health MISP |
$118.89
|
| 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 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 |
$653.21 |
| Rate for Payer: Adventist Health Medi-Cal |
$56.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$349.43
|
| 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 Exchange |
$107.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.41
|
| Rate for Payer: BCBS Transplant Transplant |
$435.47
|
| Rate for Payer: Blue Shield of California Commercial |
$79.84
|
| Rate for Payer: Blue Shield of California EPN |
$72.58
|
| Rate for Payer: Caremore Medicare Advantage |
$56.38
|
| Rate for Payer: Cash Price |
$326.61
|
| Rate for Payer: Cash Price |
$326.61
|
| Rate for Payer: Central Health Plan Commercial |
$580.63
|
| 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: 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 Management Network EPO/PPO |
$653.21
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$544.34
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$92.47
|
| Rate for Payer: IEHP medi-cal |
$93.03
|
| Rate for Payer: IEHP Medicare Advantage |
$56.38
|
| Rate for Payer: Innovage PACE Commercial |
$84.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$484.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$75.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$75.55
|
| Rate for Payer: Multiplan Commercial |
$544.34
|
| Rate for Payer: Networks By Design Commercial |
$362.90
|
| Rate for Payer: Prime Health Services Commercial |
$616.92
|
| Rate for Payer: Prime Health Services Medicare |
$59.77
|
| Rate for Payer: Riverside University Health MISP |
$62.02
|
| 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 |
$145.16 |
| Max. Negotiated Rate |
$653.21 |
| Rate for Payer: Blue Shield of California Commercial |
$544.34
|
| Rate for Payer: Blue Shield of California EPN |
$387.57
|
| Rate for Payer: Cash Price |
$326.61
|
| Rate for Payer: Central Health Plan Commercial |
$580.63
|
| 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: Health Management Network EPO/PPO |
$653.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$484.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.16
|
| Rate for Payer: Multiplan Commercial |
$544.34
|
| 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 |
$36.29 |
| Max. Negotiated Rate |
$349.43 |
| Rate for Payer: Adventist Health Medi-Cal |
$56.38
|
| Rate for Payer: Adventist Health Medi-Cal |
$56.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$349.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$349.43
|
| 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 Exchange |
$107.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$107.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.41
|
| Rate for Payer: BCBS Transplant Transplant |
$108.87
|
| Rate for Payer: BCBS Transplant Transplant |
$114.60
|
| Rate for Payer: Blue Shield of California Commercial |
$114.13
|
| Rate for Payer: Blue Shield of California Commercial |
$120.14
|
| Rate for Payer: Blue Shield of California EPN |
$88.73
|
| Rate for Payer: Blue Shield of California EPN |
$93.40
|
| Rate for Payer: Caremore Medicare Advantage |
$56.38
|
| Rate for Payer: Caremore Medicare Advantage |
$56.38
|
| Rate for Payer: Cash Price |
$81.65
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Cash Price |
$81.65
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Central Health Plan Commercial |
$145.16
|
| Rate for Payer: Central Health Plan Commercial |
$152.80
|
| Rate for Payer: Cigna of CA HMO |
$122.24
|
| Rate for Payer: Cigna of CA HMO |
$116.13
|
| Rate for Payer: Cigna of CA PPO |
$141.34
|
| Rate for Payer: Cigna of CA PPO |
$134.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$84.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$84.57
|
| 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 |
$108.87
|
| Rate for Payer: Global Benefits Group Commercial |
$114.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$171.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$163.30
|
| 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/Senior |
$92.47
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$92.47
|
| Rate for Payer: IEHP medi-cal |
$93.03
|
| Rate for Payer: IEHP medi-cal |
$93.03
|
| Rate for Payer: IEHP Medicare Advantage |
$56.38
|
| Rate for Payer: IEHP Medicare Advantage |
$56.38
|
| Rate for Payer: Innovage PACE Commercial |
$84.57
|
| Rate for Payer: Innovage PACE Commercial |
$84.57
|
| 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 Medicare Advantage |
$56.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$75.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$75.55
|
| 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 |
$136.09
|
| Rate for Payer: Multiplan Commercial |
$143.25
|
| 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 |
$162.35
|
| Rate for Payer: Prime Health Services Commercial |
$154.23
|
| Rate for Payer: Prime Health Services Medicare |
$59.77
|
| Rate for Payer: Prime Health Services Medicare |
$59.77
|
| Rate for Payer: Riverside University Health MISP |
$62.02
|
| Rate for Payer: Riverside University Health MISP |
$62.02
|
| 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 |
$114.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$108.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$90.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$95.50
|
| 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 |
$95.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$90.72
|
| 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
|
$191.00
|
|
|
Service Code
|
CPT J3285
|
| Hospital Charge Code |
NDG32932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.20 |
| Max. Negotiated Rate |
$171.90 |
| Rate for Payer: Blue Shield of California Commercial |
$143.25
|
| Rate for Payer: Blue Shield of California Commercial |
$136.09
|
| Rate for Payer: Blue Shield of California EPN |
$101.99
|
| Rate for Payer: Blue Shield of California EPN |
$96.89
|
| Rate for Payer: Cash Price |
$81.65
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Central Health Plan Commercial |
$145.16
|
| Rate for Payer: Central Health Plan Commercial |
$152.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.40
|
| Rate for Payer: Galaxy Health WC |
$162.35
|
| Rate for Payer: Galaxy Health WC |
$154.23
|
| Rate for Payer: Global Benefits Group Commercial |
$108.87
|
| Rate for Payer: Global Benefits Group Commercial |
$114.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$171.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$163.30
|
| 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: LLUH Dept of Risk Management WC |
$38.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.29
|
| Rate for Payer: Multiplan Commercial |
$143.25
|
| Rate for Payer: Multiplan Commercial |
$136.09
|
| Rate for Payer: Networks By Design Commercial |
$117.94
|
| Rate for Payer: Networks By Design Commercial |
$124.15
|
| 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
IP
|
$362.90
|
|
|
Service Code
|
CPT J3285
|
| Hospital Charge Code |
NDG32933
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$72.58 |
| Max. Negotiated Rate |
$326.61 |
| Rate for Payer: Blue Shield of California Commercial |
$272.18
|
| Rate for Payer: Blue Shield of California EPN |
$193.79
|
| Rate for Payer: Cash Price |
$163.31
|
| Rate for Payer: Central Health Plan Commercial |
$290.32
|
| 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: Health Management Network EPO/PPO |
$326.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$242.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.58
|
| Rate for Payer: Multiplan Commercial |
$272.18
|
| Rate for Payer: Networks By Design Commercial |
$181.45
|
| Rate for Payer: Prime Health Services Commercial |
$308.46
|
|
|
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 |
$349.43 |
| Rate for Payer: Adventist Health Medi-Cal |
$56.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$349.43
|
| 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 Exchange |
$107.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.41
|
| Rate for Payer: BCBS Transplant Transplant |
$217.74
|
| Rate for Payer: Blue Shield of California Commercial |
$79.84
|
| Rate for Payer: Blue Shield of California EPN |
$72.58
|
| Rate for Payer: Caremore Medicare Advantage |
$56.38
|
| Rate for Payer: Cash Price |
$163.31
|
| Rate for Payer: Cash Price |
$163.31
|
| Rate for Payer: Central Health Plan Commercial |
$290.32
|
| 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: 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 Management Network EPO/PPO |
$326.61
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$272.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$92.47
|
| Rate for Payer: IEHP medi-cal |
$93.03
|
| Rate for Payer: IEHP Medicare Advantage |
$56.38
|
| Rate for Payer: Innovage PACE Commercial |
$84.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$242.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$75.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$75.55
|
| Rate for Payer: Multiplan Commercial |
$272.18
|
| Rate for Payer: Networks By Design Commercial |
$181.45
|
| Rate for Payer: Prime Health Services Commercial |
$308.46
|
| Rate for Payer: Prime Health Services Medicare |
$59.77
|
| Rate for Payer: Riverside University Health MISP |
$62.02
|
| 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
|
|
|
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 |
$7.07 |
| Max. Negotiated Rate |
$31.81 |
| Rate for Payer: Aetna of CA HMO/PPO |
$21.46
|
| 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 Exchange |
$17.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.88
|
| Rate for Payer: BCBS Transplant Transplant |
$21.20
|
| Rate for Payer: Blue Shield of California Commercial |
$22.23
|
| Rate for Payer: Blue Shield of California EPN |
$17.28
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Central Health Plan Commercial |
$28.27
|
| 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: 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 Management Network EPO/PPO |
$31.81
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$26.50
|
| Rate for Payer: IEHP medi-cal |
$12.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.07
|
| Rate for Payer: Multiplan Commercial |
$26.50
|
| 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: Riverside University Health MISP |
$14.14
|
| 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 Medi-Cal |
$30.04
|
| Rate for Payer: Vantage Medical Group Senior |
$30.04
|
|
|
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 |
$6.61 |
| Max. Negotiated Rate |
$29.73 |
| Rate for Payer: Blue Shield of California Commercial |
$24.77
|
| Rate for Payer: Blue Shield of California EPN |
$17.64
|
| Rate for Payer: Cash Price |
$14.86
|
| Rate for Payer: Central Health Plan Commercial |
$26.42
|
| 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: Health Management Network EPO/PPO |
$29.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.61
|
| Rate for Payer: Multiplan Commercial |
$24.77
|
| 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 68084-075-11
|
| Hospital Charge Code |
1711646
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.61 |
| Max. Negotiated Rate |
$29.73 |
| Rate for Payer: Aetna of CA HMO/PPO |
$20.06
|
| 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 Exchange |
$15.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.51
|
| Rate for Payer: BCBS Transplant Transplant |
$19.82
|
| Rate for Payer: Blue Shield of California Commercial |
$20.78
|
| Rate for Payer: Blue Shield of California EPN |
$16.15
|
| Rate for Payer: Cash Price |
$14.86
|
| Rate for Payer: Central Health Plan Commercial |
$26.42
|
| 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: 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 Management Network EPO/PPO |
$29.73
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$24.77
|
| Rate for Payer: IEHP medi-cal |
$11.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.61
|
| Rate for Payer: Multiplan Commercial |
$24.77
|
| 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: Riverside University Health MISP |
$13.21
|
| 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 Medi-Cal |
$28.08
|
| Rate for Payer: Vantage Medical Group Senior |
$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 |
$6.61 |
| Max. Negotiated Rate |
$29.73 |
| Rate for Payer: Blue Shield of California Commercial |
$24.77
|
| Rate for Payer: Blue Shield of California EPN |
$17.64
|
| Rate for Payer: Cash Price |
$14.86
|
| Rate for Payer: Central Health Plan Commercial |
$26.42
|
| 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: Health Management Network EPO/PPO |
$29.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.61
|
| Rate for Payer: Multiplan Commercial |
$24.77
|
| 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
|
$35.34
|
|
|
Service Code
|
NDC 68462-792-01
|
| Hospital Charge Code |
1711646
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$31.81 |
| Rate for Payer: Blue Shield of California Commercial |
$26.50
|
| Rate for Payer: Blue Shield of California EPN |
$18.87
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Central Health Plan Commercial |
$28.27
|
| 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: Health Management Network EPO/PPO |
$31.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.07
|
| Rate for Payer: Multiplan Commercial |
$26.50
|
| Rate for Payer: Networks By Design Commercial |
$22.97
|
| Rate for Payer: Prime Health Services Commercial |
$30.04
|
|
|
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 |
$6.61 |
| Max. Negotiated Rate |
$29.73 |
| Rate for Payer: Aetna of CA HMO/PPO |
$20.06
|
| 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 Exchange |
$15.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.51
|
| Rate for Payer: BCBS Transplant Transplant |
$19.82
|
| Rate for Payer: Blue Shield of California Commercial |
$20.78
|
| Rate for Payer: Blue Shield of California EPN |
$16.15
|
| Rate for Payer: Cash Price |
$14.86
|
| Rate for Payer: Central Health Plan Commercial |
$26.42
|
| 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: 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 Management Network EPO/PPO |
$29.73
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$24.77
|
| Rate for Payer: IEHP medi-cal |
$11.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.61
|
| Rate for Payer: Multiplan Commercial |
$24.77
|
| 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: Riverside University Health MISP |
$13.21
|
| 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 Medi-Cal |
$28.08
|
| Rate for Payer: Vantage Medical Group Senior |
$28.08
|
|
|
TRIAMCINOLONE 9 MG-MOXIFLOX 0.6 MG/0.6 ML IN WATER(PF)INTRAOCULAR SUSP [221760]
|
Facility
OP
|
$30.60
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
NDG221760
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$27.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$18.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$26.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.83
|
| Rate for Payer: BCBS Transplant Transplant |
$18.36
|
| Rate for Payer: Blue Shield of California Commercial |
$19.25
|
| Rate for Payer: Blue Shield of California EPN |
$14.96
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Central Health Plan Commercial |
$24.48
|
| Rate for Payer: Cigna of CA HMO |
$21.42
|
| Rate for Payer: Cigna of CA PPO |
$21.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.24
|
| Rate for Payer: Galaxy Health WC |
$26.01
|
| Rate for Payer: Global Benefits Group Commercial |
$18.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.54
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$22.95
|
| Rate for Payer: IEHP medi-cal |
$10.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.12
|
| Rate for Payer: Multiplan Commercial |
$22.95
|
| Rate for Payer: Networks By Design Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Commercial |
$26.01
|
| Rate for Payer: Riverside University Health MISP |
$12.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.30
|
| Rate for Payer: United Healthcare All Other HMO |
$15.30
|
| Rate for Payer: United Healthcare HMO Rider |
$15.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.01
|
| Rate for Payer: Vantage Medical Group Senior |
$26.01
|
|
|
TRIAMCINOLONE 9 MG-MOXIFLOX 0.6 MG/0.6 ML IN WATER(PF)INTRAOCULAR SUSP [221760]
|
Facility
IP
|
$30.60
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
NDG221760
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$27.54 |
| Rate for Payer: Blue Shield of California Commercial |
$22.95
|
| Rate for Payer: Blue Shield of California EPN |
$16.34
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Central Health Plan Commercial |
$24.48
|
| Rate for Payer: Cigna of CA HMO |
$21.42
|
| Rate for Payer: Cigna of CA PPO |
$21.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.24
|
| Rate for Payer: Galaxy Health WC |
$26.01
|
| Rate for Payer: Global Benefits Group Commercial |
$18.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.12
|
| Rate for Payer: Multiplan Commercial |
$22.95
|
| Rate for Payer: Networks By Design Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Commercial |
$26.01
|
|
