|
TREPROSTINIL DIOLAMINE ER 0.125 MG TABLET,EXTENDED RELEASE [205150]
|
Facility
|
IP
|
$9.17
|
|
|
Service Code
|
NDC 6630230002
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$6.88 |
| Rate for Payer: Adventist Health Commercial |
$1.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.91
|
| Rate for Payer: Cash Price |
$4.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.21
|
| Rate for Payer: Heritage Provider Network Senior |
$6.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.29
|
| Rate for Payer: Multiplan Commercial |
$6.88
|
|
|
TREPROSTINIL DIOLAMINE ER 0.125 MG TABLET,EXTENDED RELEASE [205150]
|
Facility
|
OP
|
$9.17
|
|
|
Service Code
|
NDC 6630230001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$7.79 |
| Rate for Payer: Adventist Health Commercial |
$1.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.59
|
| Rate for Payer: Blue Shield of California Commercial |
$5.59
|
| Rate for Payer: Blue Shield of California EPN |
$4.47
|
| Rate for Payer: Cash Price |
$4.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.68
|
| Rate for Payer: Heritage Provider Network Senior |
$5.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.42
|
| Rate for Payer: Multiplan Commercial |
$6.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.67
|
| Rate for Payer: TriValley Medical Group Senior |
$3.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.79
|
| Rate for Payer: Vantage Medical Group Senior |
$7.79
|
|
|
TREPROSTINIL DIOLAMINE ER 1 MG TABLET,EXTENDED RELEASE [205151]
|
Facility
|
OP
|
$73.33
|
|
|
Service Code
|
NDC 6630231001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.27 |
| Max. Negotiated Rate |
$62.33 |
| Rate for Payer: Adventist Health Commercial |
$14.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$45.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$62.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$55.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.68
|
| Rate for Payer: Blue Shield of California Commercial |
$44.73
|
| Rate for Payer: Blue Shield of California EPN |
$35.79
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$47.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.39
|
| Rate for Payer: Heritage Provider Network Senior |
$45.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$34.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$51.33
|
| Rate for Payer: Multiplan Commercial |
$55.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$29.33
|
| Rate for Payer: TriValley Medical Group Senior |
$29.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$62.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.33
|
| Rate for Payer: Vantage Medical Group Senior |
$62.33
|
|
|
TREPROSTINIL DIOLAMINE ER 1 MG TABLET,EXTENDED RELEASE [205151]
|
Facility
|
OP
|
$73.33
|
|
|
Service Code
|
NDC 6630231002
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.27 |
| Max. Negotiated Rate |
$62.33 |
| Rate for Payer: Adventist Health Commercial |
$14.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$45.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$62.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$55.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.68
|
| Rate for Payer: Blue Shield of California Commercial |
$44.73
|
| Rate for Payer: Blue Shield of California EPN |
$35.79
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$47.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.39
|
| Rate for Payer: Heritage Provider Network Senior |
$45.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$34.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$51.33
|
| Rate for Payer: Multiplan Commercial |
$55.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$29.33
|
| Rate for Payer: TriValley Medical Group Senior |
$29.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$62.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.33
|
| Rate for Payer: Vantage Medical Group Senior |
$62.33
|
|
|
TREPROSTINIL DIOLAMINE ER 1 MG TABLET,EXTENDED RELEASE [205151]
|
Facility
|
IP
|
$73.33
|
|
|
Service Code
|
NDC 6630231002
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.27 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: Adventist Health Commercial |
$14.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$47.22
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$49.64
|
| Rate for Payer: Heritage Provider Network Senior |
$49.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.33
|
| Rate for Payer: Multiplan Commercial |
$55.00
|
|
|
TREPROSTINIL DIOLAMINE ER 1 MG TABLET,EXTENDED RELEASE [205151]
|
Facility
|
IP
|
$73.33
|
|
|
Service Code
|
NDC 6630231001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.27 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: Adventist Health Commercial |
$14.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$47.22
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$49.64
|
| Rate for Payer: Heritage Provider Network Senior |
$49.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.33
|
| Rate for Payer: Multiplan Commercial |
$55.00
|
|
|
TREPROSTINIL DIOLAMINE ER 2.5 MG TABLET,EXTENDED RELEASE [205152]
|
Facility
|
OP
|
$183.33
|
|
|
Service Code
|
NDC 6630232502
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$33.18 |
| Max. Negotiated Rate |
$155.83 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$155.83
|
| Rate for Payer: Adventist Health Commercial |
$36.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$113.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$155.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$100.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.70
|
| Rate for Payer: Blue Shield of California Commercial |
$111.83
|
| Rate for Payer: Blue Shield of California EPN |
$89.47
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$119.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$155.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$155.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$155.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$113.48
|
| Rate for Payer: Heritage Provider Network Senior |
$113.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$87.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$128.33
|
| Rate for Payer: Multiplan Commercial |
$137.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$73.33
|
| Rate for Payer: TriValley Medical Group Senior |
$73.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$91.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$91.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$155.83
|
| Rate for Payer: Vantage Medical Group Senior |
$155.83
|
|
|
TREPROSTINIL DIOLAMINE ER 2.5 MG TABLET,EXTENDED RELEASE [205152]
|
Facility
|
IP
|
$183.33
|
|
|
Service Code
|
NDC 6630232502
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$33.18 |
| Max. Negotiated Rate |
$137.50 |
| Rate for Payer: Adventist Health Commercial |
$36.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$118.06
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$124.11
|
| Rate for Payer: Heritage Provider Network Senior |
$124.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.83
|
| Rate for Payer: Multiplan Commercial |
$137.50
|
|
|
TREPROSTINIL DIOLAMINE ER 2.5 MG TABLET,EXTENDED RELEASE [205152]
|
Facility
|
IP
|
$183.33
|
|
|
Service Code
|
NDC 6630232501
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$33.18 |
| Max. Negotiated Rate |
$137.50 |
| Rate for Payer: Adventist Health Commercial |
$36.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$118.06
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$124.11
|
| Rate for Payer: Heritage Provider Network Senior |
$124.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.83
|
| Rate for Payer: Multiplan Commercial |
$137.50
|
|
|
TREPROSTINIL DIOLAMINE ER 2.5 MG TABLET,EXTENDED RELEASE [205152]
|
Facility
|
OP
|
$183.33
|
|
|
Service Code
|
NDC 6630232501
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$33.18 |
| Max. Negotiated Rate |
$155.83 |
| Rate for Payer: Adventist Health Commercial |
$36.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$113.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$155.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$100.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.70
|
| Rate for Payer: Blue Shield of California Commercial |
$111.83
|
| Rate for Payer: Blue Shield of California EPN |
$89.47
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$119.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$155.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$155.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$155.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$113.48
|
| Rate for Payer: Heritage Provider Network Senior |
$113.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$87.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$128.33
|
| Rate for Payer: Multiplan Commercial |
$137.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$73.33
|
| Rate for Payer: TriValley Medical Group Senior |
$73.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$91.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$91.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$155.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$155.83
|
| Rate for Payer: Vantage Medical Group Senior |
$155.83
|
|
|
TREPROSTINIL DIOLAMINE ER 5 MG TABLET, EXTENDED RELEASE [218793]
|
Facility
|
OP
|
$366.66
|
|
|
Service Code
|
NDC 6630235002
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$66.37 |
| Max. Negotiated Rate |
$311.66 |
| Rate for Payer: Adventist Health Commercial |
$73.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$226.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$311.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$201.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$275.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$183.40
|
| Rate for Payer: Blue Shield of California Commercial |
$223.66
|
| Rate for Payer: Blue Shield of California EPN |
$178.93
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$238.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$311.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$311.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$311.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$226.96
|
| Rate for Payer: Heritage Provider Network Senior |
$226.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$174.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$256.66
|
| Rate for Payer: Multiplan Commercial |
$275.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$146.66
|
| Rate for Payer: TriValley Medical Group Senior |
$146.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$183.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$183.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$311.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$311.66
|
| Rate for Payer: Vantage Medical Group Senior |
$311.66
|
|
|
TREPROSTINIL DIOLAMINE ER 5 MG TABLET, EXTENDED RELEASE [218793]
|
Facility
|
IP
|
$366.66
|
|
|
Service Code
|
NDC 6630235002
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$66.37 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Adventist Health Commercial |
$73.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$236.13
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$198.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$248.23
|
| Rate for Payer: Heritage Provider Network Senior |
$248.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.67
|
| Rate for Payer: Multiplan Commercial |
$275.00
|
|
|
TREPROSTINIL DIOLAMINE ER 5 MG TABLET, EXTENDED RELEASE [218793]
|
Facility
|
IP
|
$366.66
|
|
|
Service Code
|
NDC 6630235001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$66.37 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Adventist Health Commercial |
$73.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$236.13
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$198.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$248.23
|
| Rate for Payer: Heritage Provider Network Senior |
$248.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.67
|
| Rate for Payer: Multiplan Commercial |
$275.00
|
|
|
TREPROSTINIL DIOLAMINE ER 5 MG TABLET, EXTENDED RELEASE [218793]
|
Facility
|
OP
|
$366.66
|
|
|
Service Code
|
NDC 6630235001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$66.37 |
| Max. Negotiated Rate |
$311.66 |
| Rate for Payer: Adventist Health Commercial |
$73.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$226.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$311.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$201.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$275.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$183.40
|
| Rate for Payer: Blue Shield of California Commercial |
$223.66
|
| Rate for Payer: Blue Shield of California EPN |
$178.93
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$238.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$311.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$311.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$311.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$226.96
|
| Rate for Payer: Heritage Provider Network Senior |
$226.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$174.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$256.66
|
| Rate for Payer: Multiplan Commercial |
$275.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$146.66
|
| Rate for Payer: TriValley Medical Group Senior |
$146.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$183.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$183.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$311.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$311.66
|
| Rate for Payer: Vantage Medical Group Senior |
$311.66
|
|
|
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: Aetna of CA Non-Gatekeeper |
$467.41
|
| Rate for Payer: Cash Price |
$326.61
|
| 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 Foundation Hospitals 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 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 |
$54.74 |
| Max. Negotiated Rate |
$544.34 |
| Rate for Payer: Adventist Health Commercial |
$145.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$448.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.35
|
| 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 |
$326.61
|
| Rate for Payer: Cash Price |
$326.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$333.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$464.51
|
| Rate for Payer: EPIC Health Plan Medicare |
$54.74
|
| 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) Medicare Advantage |
$54.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$346.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$131.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$73.35
|
| 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 |
$68.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.21
|
| Rate for Payer: Vantage Medical Group Senior |
$60.21
|
|
|
TREPROSTINIL SODIUM 1 MG/ML INJECTION SOLUTION [32931]
|
Facility
|
OP
|
$76.40
|
|
|
Service Code
|
HCPCS J3285
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.83 |
| Max. Negotiated Rate |
$131.35 |
| Rate for Payer: Adventist Health Commercial |
$15.28
|
| Rate for Payer: Adventist Health Commercial |
$13.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$47.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.35
|
| 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 |
$34.38
|
| Rate for Payer: Cash Price |
$34.38
|
| Rate for Payer: Cash Price |
$30.94
|
| Rate for Payer: Cash Price |
$30.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.01
|
| Rate for Payer: EPIC Health Plan Medicare |
$54.74
|
| Rate for Payer: EPIC Health Plan Medicare |
$54.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.84
|
| Rate for Payer: Heritage Provider Network Senior |
$35.37
|
| Rate for Payer: Heritage Provider Network Senior |
$31.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$54.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$54.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$36.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$32.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.95
|
| 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: Molina Healthcare of CA Medi-Cal/Medicare |
$73.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$73.35
|
| Rate for Payer: Multiplan Commercial |
$57.30
|
| Rate for Payer: Multiplan Commercial |
$51.57
|
| Rate for Payer: TriValley Medical Group Commercial |
$27.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$30.56
|
| 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+ |
$25.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.21
|
| Rate for Payer: Vantage Medical Group Senior |
$60.21
|
| Rate for Payer: Vantage Medical Group Senior |
$60.21
|
|
|
TREPROSTINIL SODIUM 1 MG/ML INJECTION SOLUTION [32931]
|
Facility
|
IP
|
$68.76
|
|
|
Service Code
|
HCPCS J3285
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.45 |
| Max. Negotiated Rate |
$51.57 |
| Rate for Payer: Adventist Health Commercial |
$13.75
|
| Rate for Payer: Adventist Health Commercial |
$15.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$44.28
|
| Rate for Payer: Cash Price |
$34.38
|
| Rate for Payer: Cash Price |
$30.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.26
|
| 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 Foundation Hospitals Medi-Cal |
$13.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.45
|
| 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: Multiplan Commercial |
$57.30
|
| Rate for Payer: Multiplan Commercial |
$51.57
|
| 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
|
IP
|
$181.45
|
|
|
Service Code
|
HCPCS J3285
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.84 |
| Max. Negotiated Rate |
$136.09 |
| Rate for Payer: Adventist Health Commercial |
$36.29
|
| Rate for Payer: Adventist Health Commercial |
$38.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$123.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$116.85
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Cash Price |
$81.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$83.47
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.14
|
| 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 Foundation Hospitals Medi-Cal |
$34.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.84
|
| 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: Multiplan Commercial |
$143.25
|
| Rate for Payer: Multiplan Commercial |
$136.09
|
| 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 2.5 MG/ML INJECTION SOLUTION [32932]
|
Facility
|
OP
|
$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: Aetna of CA Non-Gatekeeper |
$112.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$118.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.35
|
| 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 |
$85.95
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Cash Price |
$81.65
|
| Rate for Payer: Cash Price |
$81.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$83.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.13
|
| Rate for Payer: EPIC Health Plan Medicare |
$54.74
|
| Rate for Payer: EPIC Health Plan Medicare |
$54.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$88.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$84.01
|
| Rate for Payer: Heritage Provider Network Senior |
$88.43
|
| Rate for Payer: Heritage Provider Network Senior |
$84.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$54.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$54.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$91.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$86.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.95
|
| 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: Molina Healthcare of CA Medi-Cal/Medicare |
$73.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$73.35
|
| Rate for Payer: Multiplan Commercial |
$143.25
|
| Rate for Payer: Multiplan Commercial |
$136.09
|
| Rate for Payer: TriValley Medical Group Commercial |
$72.58
|
| Rate for Payer: TriValley Medical Group Commercial |
$76.40
|
| 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+ |
$63.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$60.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.21
|
| Rate for Payer: Vantage Medical Group Senior |
$60.21
|
| Rate for Payer: Vantage Medical Group Senior |
$60.21
|
|
|
TREPROSTINIL SODIUM 5 MG/ML INJECTION SOLUTION [32933]
|
Facility
|
OP
|
$362.90
|
|
|
Service Code
|
HCPCS J3285
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.74 |
| Max. Negotiated Rate |
$272.18 |
| Rate for Payer: Adventist Health Commercial |
$72.58
|
| Rate for Payer: Adventist Health Commercial |
$68.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$212.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$224.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.35
|
| 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 |
$163.30
|
| Rate for Payer: Cash Price |
$163.30
|
| Rate for Payer: Cash Price |
$154.71
|
| Rate for Payer: Cash Price |
$154.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$166.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$158.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.03
|
| Rate for Payer: EPIC Health Plan Medicare |
$54.74
|
| Rate for Payer: EPIC Health Plan Medicare |
$54.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$168.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$159.18
|
| Rate for Payer: Heritage Provider Network Senior |
$168.02
|
| Rate for Payer: Heritage Provider Network Senior |
$159.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$54.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$54.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$173.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$163.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$62.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.95
|
| 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: Molina Healthcare of CA Medi-Cal/Medicare |
$73.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$73.35
|
| Rate for Payer: Multiplan Commercial |
$272.18
|
| Rate for Payer: Multiplan Commercial |
$257.85
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$145.16
|
| 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+ |
$120.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$113.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.21
|
| Rate for Payer: Vantage Medical Group Senior |
$60.21
|
| Rate for Payer: Vantage Medical Group Senior |
$60.21
|
|
|
TREPROSTINIL SODIUM 5 MG/ML INJECTION SOLUTION [32933]
|
Facility
|
IP
|
$343.80
|
|
|
Service Code
|
HCPCS J3285
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.23 |
| 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 Non-Gatekeeper |
$233.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$221.41
|
| Rate for Payer: Cash Price |
$163.30
|
| Rate for Payer: Cash Price |
$154.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$158.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$166.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.97
|
| 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 Foundation Hospitals Medi-Cal |
$65.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$62.23
|
| 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: Multiplan Commercial |
$272.18
|
| Rate for Payer: Multiplan Commercial |
$257.85
|
| 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
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE [16005]
|
Facility
|
OP
|
$35.34
|
|
|
Service Code
|
NDC 6846279201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$30.04 |
| Rate for Payer: Adventist Health Commercial |
$7.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.68
|
| Rate for Payer: Blue Shield of California Commercial |
$21.56
|
| Rate for Payer: Blue Shield of California EPN |
$17.25
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.88
|
| Rate for Payer: Heritage Provider Network Senior |
$21.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.74
|
| Rate for Payer: Multiplan Commercial |
$26.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.14
|
| Rate for Payer: TriValley Medical Group Senior |
$14.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.04
|
| Rate for Payer: Vantage Medical Group Senior |
$30.04
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE [16005]
|
Facility
|
OP
|
$33.03
|
|
|
Service Code
|
NDC 6808407521
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$28.08 |
| Rate for Payer: Adventist Health Commercial |
$6.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.52
|
| Rate for Payer: Blue Shield of California Commercial |
$20.15
|
| Rate for Payer: Blue Shield of California EPN |
$16.12
|
| Rate for Payer: Cash Price |
$14.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$21.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.45
|
| Rate for Payer: Heritage Provider Network Senior |
$20.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$15.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.12
|
| Rate for Payer: Multiplan Commercial |
$24.77
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.21
|
| Rate for Payer: TriValley Medical Group Senior |
$13.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.08
|
| Rate for Payer: Vantage Medical Group Senior |
$28.08
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE [16005]
|
Facility
|
OP
|
$33.03
|
|
|
Service Code
|
NDC 6808407511
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$28.08 |
| Rate for Payer: Adventist Health Commercial |
$6.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.52
|
| Rate for Payer: Blue Shield of California Commercial |
$20.15
|
| Rate for Payer: Blue Shield of California EPN |
$16.12
|
| Rate for Payer: Cash Price |
$14.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$21.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.45
|
| Rate for Payer: Heritage Provider Network Senior |
$20.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$15.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.12
|
| Rate for Payer: Multiplan Commercial |
$24.77
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.21
|
| Rate for Payer: TriValley Medical Group Senior |
$13.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.08
|
| Rate for Payer: Vantage Medical Group Senior |
$28.08
|
|
