|
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 |
$63.97 |
| Max. Negotiated Rate |
$300.42 |
| Rate for Payer: Adventist Health Commercial |
$70.69
|
| Rate for Payer: Aetna of CA Gatekeeper |
$188.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$242.81
|
| 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: Blue Shield of California Commercial |
$215.59
|
| Rate for Payer: Blue Shield of California EPN |
$172.47
|
| Rate for Payer: Cash Price |
$194.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$229.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$300.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$300.42
|
| Rate for Payer: Dignity Health Senior |
$300.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$218.77
|
| Rate for Payer: Heritage Provider Network Senior |
$218.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$168.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.36
|
| 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 |
$265.07
|
| Rate for Payer: TriValley Medical Group Commercial |
$141.37
|
| Rate for Payer: TriValley Medical Group Senior |
$141.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$176.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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
|
IP
|
$8.91
|
|
|
Service Code
|
NDC 66302-300-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$6.68 |
| Rate for Payer: Adventist Health Commercial |
$1.78
|
| Rate for Payer: Cash Price |
$4.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.03
|
| Rate for Payer: Heritage Provider Network Senior |
$6.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.23
|
| Rate for Payer: Multiplan Commercial |
$6.68
|
|
|
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 |
$1.61 |
| Max. Negotiated Rate |
$6.68 |
| Rate for Payer: Adventist Health Commercial |
$1.78
|
| Rate for Payer: Cash Price |
$4.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.03
|
| Rate for Payer: Heritage Provider Network Senior |
$6.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.23
|
| Rate for Payer: Multiplan Commercial |
$6.68
|
|
|
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 |
$1.61 |
| Max. Negotiated Rate |
$7.57 |
| Rate for Payer: Adventist Health Commercial |
$1.78
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.12
|
| 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: Blue Shield of California Commercial |
$5.44
|
| Rate for Payer: Blue Shield of California EPN |
$4.35
|
| Rate for Payer: Cash Price |
$4.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.57
|
| Rate for Payer: Dignity Health Senior |
$7.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.52
|
| Rate for Payer: Heritage Provider Network Senior |
$5.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.23
|
| 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 |
$6.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.56
|
| Rate for Payer: TriValley Medical Group Senior |
$3.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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
|
OP
|
$8.91
|
|
|
Service Code
|
NDC 66302-300-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$7.57 |
| Rate for Payer: Adventist Health Commercial |
$1.78
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.12
|
| 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: Blue Shield of California Commercial |
$5.44
|
| Rate for Payer: Blue Shield of California EPN |
$4.35
|
| Rate for Payer: Cash Price |
$4.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.57
|
| Rate for Payer: Dignity Health Senior |
$7.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.52
|
| Rate for Payer: Heritage Provider Network Senior |
$5.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.23
|
| 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 |
$6.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.56
|
| Rate for Payer: TriValley Medical Group Senior |
$3.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 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 |
$12.90 |
| Max. Negotiated Rate |
$53.45 |
| Rate for Payer: Adventist Health Commercial |
$14.25
|
| Rate for Payer: Cash Price |
$39.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.24
|
| Rate for Payer: Heritage Provider Network Senior |
$48.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.82
|
| Rate for Payer: Multiplan Commercial |
$53.45
|
|
|
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 |
$12.90 |
| Max. Negotiated Rate |
$53.45 |
| Rate for Payer: Adventist Health Commercial |
$14.25
|
| Rate for Payer: Cash Price |
$39.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.24
|
| Rate for Payer: Heritage Provider Network Senior |
$48.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.82
|
| Rate for Payer: Multiplan Commercial |
$53.45
|
|
|
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 |
$12.90 |
| Max. Negotiated Rate |
$60.57 |
| Rate for Payer: Adventist Health Commercial |
$14.25
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.96
|
| 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: Blue Shield of California Commercial |
$43.47
|
| Rate for Payer: Blue Shield of California EPN |
$34.77
|
| Rate for Payer: Cash Price |
$39.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$46.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.57
|
| Rate for Payer: Dignity Health Senior |
$60.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.11
|
| Rate for Payer: Heritage Provider Network Senior |
$44.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$33.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.82
|
| 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 |
$53.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$28.50
|
| Rate for Payer: TriValley Medical Group Senior |
$28.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$35.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 66302-310-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$60.57 |
| Rate for Payer: Adventist Health Commercial |
$14.25
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.96
|
| 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: Blue Shield of California Commercial |
$43.47
|
| Rate for Payer: Blue Shield of California EPN |
$34.77
|
| Rate for Payer: Cash Price |
$39.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$46.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.57
|
| Rate for Payer: Dignity Health Senior |
$60.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.11
|
| Rate for Payer: Heritage Provider Network Senior |
$44.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$33.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.82
|
| 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 |
$53.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$28.50
|
| Rate for Payer: TriValley Medical Group Senior |
$28.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$35.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 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 |
$32.25 |
| Max. Negotiated Rate |
$133.61 |
| Rate for Payer: Adventist Health Commercial |
$35.63
|
| Rate for Payer: Cash Price |
$97.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$120.61
|
| Rate for Payer: Heritage Provider Network Senior |
$120.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.54
|
| Rate for Payer: Multiplan Commercial |
$133.61
|
|
|
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 |
$32.25 |
| Max. Negotiated Rate |
$133.61 |
| Rate for Payer: Adventist Health Commercial |
$35.63
|
| Rate for Payer: Cash Price |
$97.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$120.61
|
| Rate for Payer: Heritage Provider Network Senior |
$120.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.54
|
| Rate for Payer: Multiplan Commercial |
$133.61
|
|
|
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 |
$32.25 |
| Max. Negotiated Rate |
$151.43 |
| Rate for Payer: Adventist Health Commercial |
$35.63
|
| Rate for Payer: Aetna of CA Gatekeeper |
$95.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$122.39
|
| 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: Blue Shield of California Commercial |
$108.67
|
| Rate for Payer: Blue Shield of California EPN |
$86.94
|
| Rate for Payer: Cash Price |
$97.98
|
| Rate for Payer: Cigna of CA HMO/PPO |
$115.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$151.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.43
|
| Rate for Payer: Dignity Health Senior |
$151.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$110.27
|
| Rate for Payer: Heritage Provider Network Senior |
$110.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$84.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.54
|
| 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 |
$133.61
|
| Rate for Payer: TriValley Medical Group Commercial |
$71.26
|
| Rate for Payer: TriValley Medical Group Senior |
$71.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$89.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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
|
OP
|
$178.15
|
|
|
Service Code
|
NDC 66302-325-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$32.25 |
| Max. Negotiated Rate |
$151.43 |
| Rate for Payer: Adventist Health Commercial |
$35.63
|
| Rate for Payer: Aetna of CA Gatekeeper |
$95.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$122.39
|
| 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: Blue Shield of California Commercial |
$108.67
|
| Rate for Payer: Blue Shield of California EPN |
$86.94
|
| Rate for Payer: Cash Price |
$97.98
|
| Rate for Payer: Cigna of CA HMO/PPO |
$115.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$151.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.43
|
| Rate for Payer: Dignity Health Senior |
$151.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$110.27
|
| Rate for Payer: Heritage Provider Network Senior |
$110.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$84.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.54
|
| 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 |
$133.61
|
| Rate for Payer: TriValley Medical Group Commercial |
$71.26
|
| Rate for Payer: TriValley Medical Group Senior |
$71.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$89.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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
|
OP
|
$356.31
|
|
|
Service Code
|
NDC 66302-350-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$64.49 |
| Max. Negotiated Rate |
$302.86 |
| Rate for Payer: Adventist Health Commercial |
$71.26
|
| Rate for Payer: Aetna of CA Gatekeeper |
$190.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$244.78
|
| 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: Blue Shield of California Commercial |
$217.35
|
| Rate for Payer: Blue Shield of California EPN |
$173.88
|
| Rate for Payer: Cash Price |
$195.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$231.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$302.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$302.86
|
| Rate for Payer: Dignity Health Senior |
$302.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$220.56
|
| Rate for Payer: Heritage Provider Network Senior |
$220.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$169.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.08
|
| 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 |
$267.23
|
| Rate for Payer: TriValley Medical Group Commercial |
$142.52
|
| Rate for Payer: TriValley Medical Group Senior |
$142.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$178.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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
|
IP
|
$356.31
|
|
|
Service Code
|
NDC 66302-350-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$64.49 |
| Max. Negotiated Rate |
$267.23 |
| Rate for Payer: Adventist Health Commercial |
$71.26
|
| Rate for Payer: Cash Price |
$195.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$241.22
|
| Rate for Payer: Heritage Provider Network Senior |
$241.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.08
|
| Rate for Payer: Multiplan Commercial |
$267.23
|
|
|
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 |
$64.49 |
| Max. Negotiated Rate |
$267.23 |
| Rate for Payer: Adventist Health Commercial |
$71.26
|
| Rate for Payer: Cash Price |
$195.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$241.22
|
| Rate for Payer: Heritage Provider Network Senior |
$241.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.08
|
| Rate for Payer: Multiplan Commercial |
$267.23
|
|
|
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 |
$64.49 |
| Max. Negotiated Rate |
$302.86 |
| Rate for Payer: Adventist Health Commercial |
$71.26
|
| Rate for Payer: Aetna of CA Gatekeeper |
$190.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$244.78
|
| 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: Blue Shield of California Commercial |
$217.35
|
| Rate for Payer: Blue Shield of California EPN |
$173.88
|
| Rate for Payer: Cash Price |
$195.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$231.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$302.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$302.86
|
| Rate for Payer: Dignity Health Senior |
$302.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$220.56
|
| Rate for Payer: Heritage Provider Network Senior |
$220.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$169.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.08
|
| 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 |
$267.23
|
| Rate for Payer: TriValley Medical Group Commercial |
$142.52
|
| Rate for Payer: TriValley Medical Group Senior |
$142.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$178.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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
|
OP
|
$725.79
|
|
|
Service Code
|
HCPCS J3285
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.48 |
| Max. Negotiated Rate |
$544.34 |
| Rate for Payer: Adventist Health Commercial |
$145.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$387.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$498.62
|
| 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 |
$148.40
|
| Rate for Payer: Blue Shield of California Commercial |
$60.68
|
| Rate for Payer: Blue Shield of California EPN |
$60.68
|
| Rate for Payer: Cash Price |
$399.19
|
| Rate for Payer: Cash Price |
$399.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$333.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$61.03
|
| Rate for Payer: Dignity Health Senior |
$61.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$464.51
|
| Rate for Payer: EPIC Health Plan Medicare |
$55.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$336.04
|
| Rate for Payer: Heritage Provider Network Senior |
$336.04
|
| 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 |
$346.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$63.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$69.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$69.91
|
| Rate for Payer: Multiplan Commercial |
$544.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$290.32
|
| Rate for Payer: TriValley Medical Group Senior |
$290.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$262.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$240.31
|
| 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 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 |
$131.37 |
| Max. Negotiated Rate |
$544.34 |
| Rate for Payer: Adventist Health Commercial |
$145.16
|
| Rate for Payer: Cash Price |
$399.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$333.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$391.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$336.04
|
| Rate for Payer: Heritage Provider Network Senior |
$336.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.45
|
| Rate for Payer: Multiplan Commercial |
$544.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$262.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$240.31
|
|
|
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 |
$12.45 |
| Max. Negotiated Rate |
$148.40 |
| Rate for Payer: Adventist Health Commercial |
$13.75
|
| Rate for Payer: Adventist Health Commercial |
$15.28
|
| Rate for Payer: Aetna of CA Gatekeeper |
$36.75
|
| Rate for Payer: Aetna of CA Gatekeeper |
$40.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$47.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.49
|
| 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 |
$148.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.40
|
| Rate for Payer: Blue Shield of California Commercial |
$60.68
|
| Rate for Payer: Blue Shield of California Commercial |
$60.68
|
| Rate for Payer: Blue Shield of California EPN |
$60.68
|
| Rate for Payer: Blue Shield of California EPN |
$60.68
|
| Rate for Payer: Cash Price |
$42.02
|
| Rate for Payer: Cash Price |
$37.82
|
| Rate for Payer: Cash Price |
$42.02
|
| Rate for Payer: Cash Price |
$37.82
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.14
|
| 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 Senior |
$61.03
|
| Rate for Payer: Dignity Health Senior |
$61.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$55.48
|
| Rate for Payer: EPIC Health Plan Medicare |
$55.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.37
|
| Rate for Payer: Heritage Provider Network Senior |
$31.84
|
| Rate for Payer: Heritage Provider Network Senior |
$35.37
|
| 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 |
$36.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$32.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$63.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$63.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$69.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$69.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$69.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$69.91
|
| Rate for Payer: Multiplan Commercial |
$51.57
|
| Rate for Payer: Multiplan Commercial |
$57.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$30.56
|
| Rate for Payer: TriValley Medical Group Commercial |
$27.50
|
| Rate for Payer: TriValley Medical Group Senior |
$27.50
|
| Rate for Payer: TriValley Medical Group Senior |
$30.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.30
|
| 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
|
|
|
TREPROSTINIL SODIUM 1 MG/ML INJECTION SOLUTION [32931]
|
Facility
|
IP
|
$76.40
|
|
|
Service Code
|
HCPCS J3285
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.83 |
| Max. Negotiated Rate |
$57.30 |
| Rate for Payer: Adventist Health Commercial |
$15.28
|
| Rate for Payer: Adventist Health Commercial |
$13.75
|
| Rate for Payer: Cash Price |
$42.02
|
| Rate for Payer: Cash Price |
$37.82
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.37
|
| Rate for Payer: Heritage Provider Network Senior |
$35.37
|
| Rate for Payer: Heritage Provider Network Senior |
$31.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.19
|
| Rate for Payer: Multiplan Commercial |
$51.57
|
| Rate for Payer: Multiplan Commercial |
$57.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.77
|
|
|
TREPROSTINIL SODIUM 2.5 MG/ML INJECTION SOLUTION [32932]
|
Facility
|
OP
|
$181.45
|
|
|
Service Code
|
HCPCS J3285
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.84 |
| Max. Negotiated Rate |
$148.40 |
| Rate for Payer: Adventist Health Commercial |
$36.29
|
| Rate for Payer: Adventist Health Commercial |
$38.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$96.99
|
| Rate for Payer: Aetna of CA Gatekeeper |
$102.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$124.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$131.22
|
| 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 |
$148.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.40
|
| Rate for Payer: Blue Shield of California Commercial |
$60.68
|
| Rate for Payer: Blue Shield of California Commercial |
$60.68
|
| Rate for Payer: Blue Shield of California EPN |
$60.68
|
| Rate for Payer: Blue Shield of California EPN |
$60.68
|
| Rate for Payer: Cash Price |
$105.05
|
| Rate for Payer: Cash Price |
$99.80
|
| Rate for Payer: Cash Price |
$105.05
|
| Rate for Payer: Cash Price |
$99.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$83.47
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.86
|
| 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 Senior |
$61.03
|
| Rate for Payer: Dignity Health Senior |
$61.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.24
|
| Rate for Payer: EPIC Health Plan Medicare |
$55.48
|
| Rate for Payer: EPIC Health Plan Medicare |
$55.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$84.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$88.43
|
| Rate for Payer: Heritage Provider Network Senior |
$84.01
|
| Rate for Payer: Heritage Provider Network Senior |
$88.43
|
| 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 |
$91.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$86.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$63.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$63.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$69.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$69.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$69.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$69.91
|
| Rate for Payer: Multiplan Commercial |
$136.09
|
| Rate for Payer: Multiplan Commercial |
$143.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$76.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$72.58
|
| Rate for Payer: TriValley Medical Group Senior |
$72.58
|
| Rate for Payer: TriValley Medical Group Senior |
$76.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$69.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$65.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$60.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$63.24
|
| 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
|
|
|
TREPROSTINIL SODIUM 2.5 MG/ML INJECTION SOLUTION [32932]
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
HCPCS J3285
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.57 |
| Max. Negotiated Rate |
$143.25 |
| Rate for Payer: Adventist Health Commercial |
$38.20
|
| Rate for Payer: Adventist Health Commercial |
$36.29
|
| Rate for Payer: Cash Price |
$105.05
|
| Rate for Payer: Cash Price |
$99.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$83.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$84.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$88.43
|
| Rate for Payer: Heritage Provider Network Senior |
$88.43
|
| Rate for Payer: Heritage Provider Network Senior |
$84.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.36
|
| Rate for Payer: Multiplan Commercial |
$136.09
|
| Rate for Payer: Multiplan Commercial |
$143.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$65.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$69.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$63.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$60.08
|
|
|
TREPROSTINIL SODIUM 5 MG/ML INJECTION SOLUTION [32933]
|
Facility
|
IP
|
$362.90
|
|
|
Service Code
|
HCPCS J3285
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.68 |
| Max. Negotiated Rate |
$272.18 |
| Rate for Payer: Adventist Health Commercial |
$72.58
|
| Rate for Payer: Adventist Health Commercial |
$68.76
|
| Rate for Payer: Cash Price |
$199.59
|
| Rate for Payer: Cash Price |
$189.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$166.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$158.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$159.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$168.02
|
| Rate for Payer: Heritage Provider Network Senior |
$168.02
|
| Rate for Payer: Heritage Provider Network Senior |
$159.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.95
|
| Rate for Payer: Multiplan Commercial |
$257.85
|
| Rate for Payer: Multiplan Commercial |
$272.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$124.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$131.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$120.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$113.83
|
|
|
TREPROSTINIL SODIUM 5 MG/ML INJECTION SOLUTION [32933]
|
Facility
|
OP
|
$343.80
|
|
|
Service Code
|
HCPCS J3285
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.48 |
| Max. Negotiated Rate |
$257.85 |
| Rate for Payer: Adventist Health Commercial |
$68.76
|
| Rate for Payer: Adventist Health Commercial |
$72.58
|
| Rate for Payer: Aetna of CA Gatekeeper |
$183.76
|
| Rate for Payer: Aetna of CA Gatekeeper |
$193.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$236.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$249.31
|
| 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 |
$148.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.40
|
| Rate for Payer: Blue Shield of California Commercial |
$60.68
|
| Rate for Payer: Blue Shield of California Commercial |
$60.68
|
| Rate for Payer: Blue Shield of California EPN |
$60.68
|
| Rate for Payer: Blue Shield of California EPN |
$60.68
|
| Rate for Payer: Cash Price |
$199.59
|
| Rate for Payer: Cash Price |
$189.09
|
| Rate for Payer: Cash Price |
$199.59
|
| Rate for Payer: Cash Price |
$189.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$158.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$166.93
|
| 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 Senior |
$61.03
|
| Rate for Payer: Dignity Health Senior |
$61.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.26
|
| Rate for Payer: EPIC Health Plan Medicare |
$55.48
|
| Rate for Payer: EPIC Health Plan Medicare |
$55.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$159.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$168.02
|
| Rate for Payer: Heritage Provider Network Senior |
$159.18
|
| Rate for Payer: Heritage Provider Network Senior |
$168.02
|
| 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 |
$173.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$163.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$63.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$63.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$69.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$69.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$69.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$69.91
|
| Rate for Payer: Multiplan Commercial |
$257.85
|
| Rate for Payer: Multiplan Commercial |
$272.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$145.16
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.52
|
| Rate for Payer: TriValley Medical Group Senior |
$137.52
|
| Rate for Payer: TriValley Medical Group Senior |
$145.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$131.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$124.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$113.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$120.16
|
| 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
|
|
