|
Treatment of tibial shaft fracture (with or without fibular fracture) by intramedullary implant, with or without interlocking screws and/or cerclage
|
Facility
OP
|
$31,243.54
|
|
|
Service Code
|
CPT 27759
|
| Min. Negotiated Rate |
$1,126.73 |
| Max. Negotiated Rate |
$31,243.54 |
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$24,665.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18,088.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16,443.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,665.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,088.37
|
| Rate for Payer: Dignity Health Senior |
$16,443.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$16,443.97
|
| Rate for Payer: Humana Medicare |
$16,443.97
|
| Rate for Payer: IEHP Medi-Cal |
$1,126.73
|
| Rate for Payer: IEHP Medicare Advantage |
$16,443.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$31,243.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19,403.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,719.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20,719.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$18,088.37
|
| Rate for Payer: TriValley Medical Group Senior |
$16,443.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,665.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,088.37
|
| Rate for Payer: Vantage Medical Group Senior |
$16,443.97
|
|
|
TREMELIMUMAB-ACTL 20 MG/ML INTRAVENOUS SOLUTION [236035]
|
Facility
IP
|
$3,120.00
|
|
|
Service Code
|
CPT J9347
|
| Hospital Charge Code |
ERX236035
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$564.72 |
| Max. Negotiated Rate |
$2,340.00 |
| Rate for Payer: Adventist Health Commercial |
$624.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,143.44
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,435.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,684.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,112.24
|
| Rate for Payer: Heritage Provider Network Senior |
$2,112.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$564.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,340.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,137.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,042.39
|
|
|
TREMELIMUMAB-ACTL 20 MG/ML INTRAVENOUS SOLUTION [236035]
|
Facility
OP
|
$3,120.00
|
|
|
Service Code
|
CPT J9347
|
| Hospital Charge Code |
ERX236035
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$136.09 |
| Max. Negotiated Rate |
$2,340.00 |
| Rate for Payer: Adventist Health Commercial |
$624.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$334.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,143.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$149.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$149.70
|
| Rate for Payer: Blue Shield of California Commercial |
$1,937.52
|
| Rate for Payer: Blue Shield of California EPN |
$1,831.44
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,435.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$149.70
|
| Rate for Payer: Dignity Health Senior |
$149.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,996.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$136.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,444.56
|
| Rate for Payer: Heritage Provider Network Senior |
$1,444.56
|
| Rate for Payer: Humana Medicare |
$136.09
|
| Rate for Payer: IEHP Medi-Cal |
$219.26
|
| Rate for Payer: IEHP Medicare Advantage |
$136.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$258.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$564.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$160.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$171.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$171.48
|
| Rate for Payer: Multiplan Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$149.70
|
| Rate for Payer: TriValley Medical Group Senior |
$136.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,137.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,042.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$149.70
|
| Rate for Payer: Vantage Medical Group Senior |
$149.70
|
|
|
TREPROSTINIL 1.74 MG/2.9 ML (0.6 MG/ML) SOLUTION FOR NEBULIZATION [120688]
|
Facility
IP
|
$353.43
|
|
|
Service Code
|
CPT J7686
|
| Hospital Charge Code |
NDG120688
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.97 |
| Max. Negotiated Rate |
$265.07 |
| Rate for Payer: Adventist Health Commercial |
$70.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$242.81
|
| Rate for Payer: Cash Price |
$159.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$162.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$239.27
|
| Rate for Payer: Heritage Provider Network Senior |
$239.27
|
| 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: Multiplan Commercial |
$265.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$128.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$118.08
|
|
|
TREPROSTINIL 1.74 MG/2.9 ML (0.6 MG/ML) SOLUTION FOR NEBULIZATION [120688]
|
Facility
OP
|
$353.43
|
|
|
Service Code
|
CPT J7686
|
| Hospital Charge Code |
NDG120688
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.97 |
| Max. Negotiated Rate |
$1,794.11 |
| Rate for Payer: Adventist Health Commercial |
$70.69
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,794.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$242.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$300.42
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$194.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$265.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$908.53
|
| Rate for Payer: Blue Shield of California Commercial |
$726.00
|
| Rate for Payer: Blue Shield of California EPN |
$726.00
|
| Rate for Payer: Cash Price |
$159.04
|
| Rate for Payer: Cash Price |
$159.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$162.58
|
| 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 |
$163.64
|
| Rate for Payer: Heritage Provider Network Senior |
$163.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$170.35
|
| 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: Multiplan Commercial |
$265.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$128.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$118.08
|
| 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
|
$7.43
|
|
|
Service Code
|
NDC 66302-300-01
|
| Hospital Charge Code |
ERX205150
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$5.57 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.10
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.03
|
| Rate for Payer: Heritage Provider Network Senior |
$5.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.86
|
| Rate for Payer: Multiplan Commercial |
$5.57
|
|
|
TREPROSTINIL DIOLAMINE ER 0.125 MG TABLET,EXTENDED RELEASE [205150]
|
Facility
OP
|
$7.43
|
|
|
Service Code
|
NDC 66302-300-10
|
| Hospital Charge Code |
ERX205150
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$6.32 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.57
|
| Rate for Payer: Blue Shield of California Commercial |
$4.61
|
| Rate for Payer: Blue Shield of California EPN |
$4.36
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.32
|
| Rate for Payer: Dignity Health Senior |
$6.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.60
|
| Rate for Payer: Heritage Provider Network Senior |
$4.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.86
|
| Rate for Payer: Multiplan Commercial |
$5.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.32
|
| Rate for Payer: Vantage Medical Group Senior |
$6.32
|
|
|
TREPROSTINIL DIOLAMINE ER 0.125 MG TABLET,EXTENDED RELEASE [205150]
|
Facility
OP
|
$7.43
|
|
|
Service Code
|
NDC 66302-300-01
|
| Hospital Charge Code |
ERX205150
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$6.32 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.57
|
| Rate for Payer: Blue Shield of California Commercial |
$4.61
|
| Rate for Payer: Blue Shield of California EPN |
$4.36
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.32
|
| Rate for Payer: Dignity Health Senior |
$6.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.60
|
| Rate for Payer: Heritage Provider Network Senior |
$4.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.86
|
| Rate for Payer: Multiplan Commercial |
$5.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.32
|
| Rate for Payer: Vantage Medical Group Senior |
$6.32
|
|
|
TREPROSTINIL DIOLAMINE ER 0.125 MG TABLET,EXTENDED RELEASE [205150]
|
Facility
IP
|
$7.43
|
|
|
Service Code
|
NDC 66302-300-10
|
| Hospital Charge Code |
ERX205150
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$5.57 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.10
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.03
|
| Rate for Payer: Heritage Provider Network Senior |
$5.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.86
|
| Rate for Payer: Multiplan Commercial |
$5.57
|
|
|
TREPROSTINIL DIOLAMINE ER 0.25 MG TABLET,EXTENDED RELEASE [205149]
|
Facility
OP
|
$14.86
|
|
|
Service Code
|
NDC 66302-302-10
|
| Hospital Charge Code |
ERX205149
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.69 |
| Max. Negotiated Rate |
$12.63 |
| Rate for Payer: Adventist Health Commercial |
$2.97
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.14
|
| Rate for Payer: Blue Shield of California Commercial |
$9.23
|
| Rate for Payer: Blue Shield of California EPN |
$8.72
|
| Rate for Payer: Cash Price |
$6.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.63
|
| Rate for Payer: Dignity Health Senior |
$12.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.20
|
| Rate for Payer: Heritage Provider Network Senior |
$9.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.72
|
| Rate for Payer: Multiplan Commercial |
$11.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.63
|
| Rate for Payer: Vantage Medical Group Senior |
$12.63
|
|
|
TREPROSTINIL DIOLAMINE ER 0.25 MG TABLET,EXTENDED RELEASE [205149]
|
Facility
IP
|
$14.86
|
|
|
Service Code
|
NDC 66302-302-10
|
| Hospital Charge Code |
ERX205149
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.69 |
| Max. Negotiated Rate |
$11.14 |
| Rate for Payer: Adventist Health Commercial |
$2.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.21
|
| Rate for Payer: Cash Price |
$6.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.06
|
| Rate for Payer: Heritage Provider Network Senior |
$10.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.72
|
| Rate for Payer: Multiplan Commercial |
$11.14
|
|
|
TREPROSTINIL DIOLAMINE ER 1 MG TABLET,EXTENDED RELEASE [205151]
|
Facility
IP
|
$59.45
|
|
|
Service Code
|
NDC 66302-310-10
|
| Hospital Charge Code |
ERX205151
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.76 |
| Max. Negotiated Rate |
$44.59 |
| Rate for Payer: Adventist Health Commercial |
$11.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40.84
|
| Rate for Payer: Cash Price |
$26.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.25
|
| Rate for Payer: Heritage Provider Network Senior |
$40.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.86
|
| Rate for Payer: Multiplan Commercial |
$44.59
|
|
|
TREPROSTINIL DIOLAMINE ER 1 MG TABLET,EXTENDED RELEASE [205151]
|
Facility
IP
|
$59.45
|
|
|
Service Code
|
NDC 66302-310-01
|
| Hospital Charge Code |
ERX205151
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.76 |
| Max. Negotiated Rate |
$44.59 |
| Rate for Payer: Adventist Health Commercial |
$11.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40.84
|
| Rate for Payer: Cash Price |
$26.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.25
|
| Rate for Payer: Heritage Provider Network Senior |
$40.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.86
|
| Rate for Payer: Multiplan Commercial |
$44.59
|
|
|
TREPROSTINIL DIOLAMINE ER 1 MG TABLET,EXTENDED RELEASE [205151]
|
Facility
OP
|
$59.45
|
|
|
Service Code
|
NDC 66302-310-01
|
| Hospital Charge Code |
ERX205151
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.76 |
| Max. Negotiated Rate |
$50.53 |
| Rate for Payer: Adventist Health Commercial |
$11.89
|
| Rate for Payer: Aetna of CA Gatekeeper |
$31.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$50.53
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$32.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$44.59
|
| Rate for Payer: Blue Shield of California Commercial |
$36.92
|
| Rate for Payer: Blue Shield of California EPN |
$34.90
|
| Rate for Payer: Cash Price |
$26.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$38.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.53
|
| Rate for Payer: Dignity Health Senior |
$50.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.80
|
| Rate for Payer: Heritage Provider Network Senior |
$36.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$28.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.86
|
| Rate for Payer: Multiplan Commercial |
$44.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.53
|
| Rate for Payer: Vantage Medical Group Senior |
$50.53
|
|
|
TREPROSTINIL DIOLAMINE ER 1 MG TABLET,EXTENDED RELEASE [205151]
|
Facility
OP
|
$59.45
|
|
|
Service Code
|
NDC 66302-310-10
|
| Hospital Charge Code |
ERX205151
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.76 |
| Max. Negotiated Rate |
$50.53 |
| Rate for Payer: Adventist Health Commercial |
$11.89
|
| Rate for Payer: Aetna of CA Gatekeeper |
$31.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$50.53
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$32.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$44.59
|
| Rate for Payer: Blue Shield of California Commercial |
$36.92
|
| Rate for Payer: Blue Shield of California EPN |
$34.90
|
| Rate for Payer: Cash Price |
$26.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$38.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.53
|
| Rate for Payer: Dignity Health Senior |
$50.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.80
|
| Rate for Payer: Heritage Provider Network Senior |
$36.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$28.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.86
|
| Rate for Payer: Multiplan Commercial |
$44.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.53
|
| Rate for Payer: Vantage Medical Group Senior |
$50.53
|
|
|
TREPROSTINIL DIOLAMINE ER 2.5 MG TABLET,EXTENDED RELEASE [205152]
|
Facility
OP
|
$148.62
|
|
|
Service Code
|
NDC 66302-325-01
|
| Hospital Charge Code |
ERX205152
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$26.90 |
| Max. Negotiated Rate |
$126.33 |
| Rate for Payer: Adventist Health Commercial |
$29.72
|
| Rate for Payer: Aetna of CA Gatekeeper |
$79.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$102.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$126.33
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$81.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$111.46
|
| Rate for Payer: Blue Shield of California Commercial |
$92.29
|
| Rate for Payer: Blue Shield of California EPN |
$87.24
|
| Rate for Payer: Cash Price |
$66.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$96.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$126.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$126.33
|
| Rate for Payer: Dignity Health Senior |
$126.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.00
|
| Rate for Payer: Heritage Provider Network Senior |
$92.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$71.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.16
|
| Rate for Payer: Multiplan Commercial |
$111.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$126.33
|
| Rate for Payer: Vantage Medical Group Senior |
$126.33
|
|
|
TREPROSTINIL DIOLAMINE ER 2.5 MG TABLET,EXTENDED RELEASE [205152]
|
Facility
IP
|
$148.62
|
|
|
Service Code
|
NDC 66302-325-01
|
| Hospital Charge Code |
ERX205152
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$26.90 |
| Max. Negotiated Rate |
$111.46 |
| Rate for Payer: Adventist Health Commercial |
$29.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$102.10
|
| Rate for Payer: Cash Price |
$66.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$100.62
|
| Rate for Payer: Heritage Provider Network Senior |
$100.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.16
|
| Rate for Payer: Multiplan Commercial |
$111.46
|
|
|
TREPROSTINIL DIOLAMINE ER 5 MG TABLET, EXTENDED RELEASE [218793]
|
Facility
IP
|
$297.23
|
|
|
Service Code
|
NDC 66302-350-10
|
| Hospital Charge Code |
ERX218793
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$53.80 |
| Max. Negotiated Rate |
$222.92 |
| Rate for Payer: Adventist Health Commercial |
$59.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$204.20
|
| Rate for Payer: Cash Price |
$133.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$201.22
|
| Rate for Payer: Heritage Provider Network Senior |
$201.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.31
|
| Rate for Payer: Multiplan Commercial |
$222.92
|
|
|
TREPROSTINIL DIOLAMINE ER 5 MG TABLET, EXTENDED RELEASE [218793]
|
Facility
OP
|
$297.23
|
|
|
Service Code
|
NDC 66302-350-10
|
| Hospital Charge Code |
ERX218793
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$53.80 |
| Max. Negotiated Rate |
$252.65 |
| Rate for Payer: Adventist Health Commercial |
$59.45
|
| Rate for Payer: Aetna of CA Gatekeeper |
$158.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$204.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$252.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$163.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$222.92
|
| Rate for Payer: Blue Shield of California Commercial |
$184.58
|
| Rate for Payer: Blue Shield of California EPN |
$174.47
|
| Rate for Payer: Cash Price |
$133.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$193.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$252.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.65
|
| Rate for Payer: Dignity Health Senior |
$252.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.99
|
| Rate for Payer: Heritage Provider Network Senior |
$183.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$143.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.31
|
| Rate for Payer: Multiplan Commercial |
$222.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.65
|
| Rate for Payer: Vantage Medical Group Senior |
$252.65
|
|
|
TREPROSTINIL DIOLAMINE ER 5 MG TABLET, EXTENDED RELEASE [218793]
|
Facility
OP
|
$297.23
|
|
|
Service Code
|
NDC 66302-350-01
|
| Hospital Charge Code |
ERX218793
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$53.80 |
| Max. Negotiated Rate |
$252.65 |
| Rate for Payer: Adventist Health Commercial |
$59.45
|
| Rate for Payer: Aetna of CA Gatekeeper |
$158.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$204.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$252.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$163.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$222.92
|
| Rate for Payer: Blue Shield of California Commercial |
$184.58
|
| Rate for Payer: Blue Shield of California EPN |
$174.47
|
| Rate for Payer: Cash Price |
$133.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$193.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$252.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.65
|
| Rate for Payer: Dignity Health Senior |
$252.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.99
|
| Rate for Payer: Heritage Provider Network Senior |
$183.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$143.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.31
|
| Rate for Payer: Multiplan Commercial |
$222.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.65
|
| Rate for Payer: Vantage Medical Group Senior |
$252.65
|
|
|
TREPROSTINIL DIOLAMINE ER 5 MG TABLET, EXTENDED RELEASE [218793]
|
Facility
IP
|
$297.23
|
|
|
Service Code
|
NDC 66302-350-01
|
| Hospital Charge Code |
ERX218793
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$53.80 |
| Max. Negotiated Rate |
$222.92 |
| Rate for Payer: Adventist Health Commercial |
$59.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$204.20
|
| Rate for Payer: Cash Price |
$133.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$201.22
|
| Rate for Payer: Heritage Provider Network Senior |
$201.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.31
|
| Rate for Payer: Multiplan Commercial |
$222.92
|
|
|
TREPROSTINIL SODIUM 10 MG/ML INJECTION SOLUTION [32934]
|
Facility
IP
|
$725.79
|
|
|
Service Code
|
CPT J3285
|
| Hospital Charge Code |
NDG32934
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$131.37 |
| Max. Negotiated Rate |
$544.34 |
| Rate for Payer: Adventist Health Commercial |
$145.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$498.62
|
| 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 |
$491.36
|
| Rate for Payer: Heritage Provider Network Senior |
$491.36
|
| 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 |
$264.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$242.49
|
|
|
TREPROSTINIL SODIUM 10 MG/ML INJECTION SOLUTION [32934]
|
Facility
OP
|
$725.79
|
|
|
Service Code
|
CPT J3285
|
| Hospital Charge Code |
NDG32934
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.38 |
| Max. Negotiated Rate |
$544.34 |
| Rate for Payer: Adventist Health Commercial |
$145.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$138.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$498.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$70.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$62.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$62.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.80
|
| Rate for Payer: Blue Shield of California Commercial |
$61.42
|
| Rate for Payer: Blue Shield of California EPN |
$61.42
|
| 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 |
$84.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.02
|
| Rate for Payer: Dignity Health Senior |
$62.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$464.51
|
| Rate for Payer: EPIC Health Plan Medicare |
$56.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$336.04
|
| Rate for Payer: Heritage Provider Network Senior |
$336.04
|
| Rate for Payer: Humana Medicare |
$56.38
|
| Rate for Payer: IEHP Medi-Cal |
$94.91
|
| Rate for Payer: IEHP Medicare Advantage |
$56.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$107.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$66.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$71.04
|
| Rate for Payer: Multiplan Commercial |
$544.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$62.02
|
| Rate for Payer: TriValley Medical Group Senior |
$56.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$264.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$242.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$84.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.02
|
| Rate for Payer: Vantage Medical Group Senior |
$56.38
|
|
|
TREPROSTINIL SODIUM 2.5 MG/ML INJECTION SOLUTION [32932]
|
Facility
OP
|
$181.45
|
|
|
Service Code
|
CPT J3285
|
| Hospital Charge Code |
NDG32932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.84 |
| Max. Negotiated Rate |
$138.52 |
| Rate for Payer: Adventist Health Commercial |
$36.29
|
| Rate for Payer: Adventist Health Commercial |
$38.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$138.52
|
| Rate for Payer: Aetna of CA Gatekeeper |
$138.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$131.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$124.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$70.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$70.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$62.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$62.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$62.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$62.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.80
|
| Rate for Payer: Blue Shield of California Commercial |
$112.68
|
| Rate for Payer: Blue Shield of California Commercial |
$118.61
|
| Rate for Payer: Blue Shield of California EPN |
$106.51
|
| Rate for Payer: Blue Shield of California EPN |
$112.12
|
| Rate for Payer: Cash Price |
$81.65
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Cash Price |
$81.65
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$124.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$117.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$84.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$84.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.02
|
| Rate for Payer: Dignity Health Senior |
$62.02
|
| Rate for Payer: Dignity Health Senior |
$62.02
|
| 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 |
$56.38
|
| Rate for Payer: EPIC Health Plan Medicare |
$56.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$118.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$112.32
|
| Rate for Payer: Heritage Provider Network Senior |
$118.23
|
| Rate for Payer: Heritage Provider Network Senior |
$112.32
|
| Rate for Payer: Humana Medicare |
$56.38
|
| Rate for Payer: Humana Medicare |
$56.38
|
| Rate for Payer: IEHP Medi-Cal |
$94.91
|
| Rate for Payer: IEHP Medi-Cal |
$94.91
|
| Rate for Payer: IEHP Medicare Advantage |
$56.38
|
| Rate for Payer: IEHP Medicare Advantage |
$56.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$107.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$107.13
|
| 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 |
$66.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$66.53
|
| 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 |
$71.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$71.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$71.04
|
| Rate for Payer: Multiplan Commercial |
$143.25
|
| Rate for Payer: Multiplan Commercial |
$136.09
|
| Rate for Payer: TriValley Medical Group Commercial |
$62.02
|
| Rate for Payer: TriValley Medical Group Commercial |
$62.02
|
| Rate for Payer: TriValley Medical Group Senior |
$56.38
|
| Rate for Payer: TriValley Medical Group Senior |
$56.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$84.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$84.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.02
|
| Rate for Payer: Vantage Medical Group Senior |
$56.38
|
| Rate for Payer: Vantage Medical Group Senior |
$56.38
|
|
|
TREPROSTINIL SODIUM 2.5 MG/ML INJECTION SOLUTION [32932]
|
Facility
IP
|
$181.45
|
|
|
Service Code
|
CPT J3285
|
| Hospital Charge Code |
NDG32932
|
|
Hospital Revenue Code
|
250
|
| 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 |
$131.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$124.66
|
| Rate for Payer: Cash Price |
$81.65
|
| Rate for Payer: Cash Price |
$85.95
|
| 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 |
$122.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.31
|
| Rate for Payer: Heritage Provider Network Senior |
$122.84
|
| Rate for Payer: Heritage Provider Network Senior |
$129.31
|
| 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
|
|
