|
PREDNISOLONE ACETATE 0.12 % EYE DROPS,SUSPENSION [27038]
|
Facility
|
IP
|
$38.50
|
|
|
Service Code
|
NDC 11980-174-05
|
| Hospital Charge Code |
1740164
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$21.18 |
| Max. Negotiated Rate |
$30.80 |
| Rate for Payer: Cash Price |
$17.33
|
| Rate for Payer: Cigna of CA HMO/PPO |
$30.80
|
| Rate for Payer: Health Smart Auto/Commercial |
$23.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.18
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$28.88
|
|
|
PREDNISOLONE ACETATE 0.12 % EYE DROPS,SUSPENSION [27038]
|
Facility
|
IP
|
$38.50
|
|
|
Service Code
|
NDC 11980-174-10
|
| Hospital Charge Code |
1740165
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$21.18 |
| Max. Negotiated Rate |
$30.80 |
| Rate for Payer: Cash Price |
$17.33
|
| Rate for Payer: Cigna of CA HMO/PPO |
$30.80
|
| Rate for Payer: Health Smart Auto/Commercial |
$23.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.18
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$28.88
|
|
|
PREDNISOLONE ACETATE 0.12 % EYE DROPS,SUSPENSION [27038]
|
Facility
|
OP
|
$38.50
|
|
|
Service Code
|
NDC 11980-174-10
|
| Hospital Charge Code |
1740165
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$21.18 |
| Max. Negotiated Rate |
$28.88 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$23.10
|
| Rate for Payer: Aetna of CA Government/Medicare |
$23.10
|
| Rate for Payer: Cash Price |
$17.33
|
| Rate for Payer: Health Smart Auto/Commercial |
$23.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$23.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.18
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$28.88
|
|
|
PREDNISOLONE ACETATE 0.12 % EYE DROPS,SUSPENSION [27038]
|
Facility
|
OP
|
$38.50
|
|
|
Service Code
|
NDC 11980-174-05
|
| Hospital Charge Code |
1740164
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$21.18 |
| Max. Negotiated Rate |
$28.88 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$23.10
|
| Rate for Payer: Aetna of CA Government/Medicare |
$23.10
|
| Rate for Payer: Cash Price |
$17.33
|
| Rate for Payer: Health Smart Auto/Commercial |
$23.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$23.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.18
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$28.88
|
|
|
PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION [6487]
|
Facility
|
IP
|
$38.50
|
|
|
Service Code
|
NDC 11980-180-05
|
| Hospital Charge Code |
1740162
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$21.18 |
| Max. Negotiated Rate |
$30.80 |
| Rate for Payer: Cash Price |
$17.33
|
| Rate for Payer: Cigna of CA HMO/PPO |
$30.80
|
| Rate for Payer: Health Smart Auto/Commercial |
$23.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.18
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$28.88
|
|
|
PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION [6487]
|
Facility
|
IP
|
$10.56
|
|
|
Service Code
|
NDC 60758-119-05
|
| Hospital Charge Code |
1740162
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.81 |
| Max. Negotiated Rate |
$8.45 |
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.45
|
| Rate for Payer: Health Smart Auto/Commercial |
$6.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.81
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$7.92
|
|
|
PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION [6487]
|
Facility
|
IP
|
$10.62
|
|
|
Service Code
|
NDC 61314-637-05
|
| Hospital Charge Code |
1740162
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.84 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: Cash Price |
$4.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.50
|
| Rate for Payer: Health Smart Auto/Commercial |
$6.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.84
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$7.96
|
|
|
PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION [6487]
|
Facility
|
OP
|
$10.62
|
|
|
Service Code
|
NDC 61314-637-05
|
| Hospital Charge Code |
1740162
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.84 |
| Max. Negotiated Rate |
$7.96 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$6.37
|
| Rate for Payer: Aetna of CA Government/Medicare |
$6.37
|
| Rate for Payer: Cash Price |
$4.78
|
| Rate for Payer: Health Smart Auto/Commercial |
$6.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$6.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.84
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$7.96
|
|
|
PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION [6487]
|
Facility
|
OP
|
$38.50
|
|
|
Service Code
|
NDC 11980-180-05
|
| Hospital Charge Code |
1740162
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$21.18 |
| Max. Negotiated Rate |
$28.88 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$23.10
|
| Rate for Payer: Aetna of CA Government/Medicare |
$23.10
|
| Rate for Payer: Cash Price |
$17.33
|
| Rate for Payer: Health Smart Auto/Commercial |
$23.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$23.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.18
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$28.88
|
|
|
PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION [6487]
|
Facility
|
OP
|
$10.56
|
|
|
Service Code
|
NDC 60758-119-05
|
| Hospital Charge Code |
1740162
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.81 |
| Max. Negotiated Rate |
$7.92 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$6.34
|
| Rate for Payer: Aetna of CA Government/Medicare |
$6.34
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Health Smart Auto/Commercial |
$6.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$6.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.81
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$7.92
|
|
|
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLUTION [29302]
|
Facility
|
IP
|
$0.26
|
|
|
Service Code
|
CPT J7510
|
| Hospital Charge Code |
1715180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.21
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.09
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.20
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.11
|
|
|
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLUTION [29302]
|
Facility
|
OP
|
$0.15
|
|
|
Service Code
|
CPT J7510
|
| Hospital Charge Code |
1715180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.09
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.16
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.16
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.09
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.16
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.11
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.20
|
|
|
PREDNISOLONE SODIUM PHOSPHATE 1 % EYE DROPS [6489]
|
Facility
|
IP
|
$6.33
|
|
|
Service Code
|
NDC 24208-715-10
|
| Hospital Charge Code |
1740150
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$5.06 |
| Rate for Payer: Cash Price |
$2.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.06
|
| Rate for Payer: Health Smart Auto/Commercial |
$3.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.48
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$4.75
|
|
|
PREDNISOLONE SODIUM PHOSPHATE 1 % EYE DROPS [6489]
|
Facility
|
OP
|
$6.33
|
|
|
Service Code
|
NDC 24208-715-10
|
| Hospital Charge Code |
1740150
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$3.80
|
| Rate for Payer: Aetna of CA Government/Medicare |
$3.80
|
| Rate for Payer: Cash Price |
$2.85
|
| Rate for Payer: Health Smart Auto/Commercial |
$3.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$3.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.48
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$4.75
|
|
|
PREDNISONE 10 MG TABLET [6494]
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
CPT J7512
|
| Hospital Charge Code |
1710075
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.16
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.14
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.16
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.17
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.20
|
|
|
PREDNISONE 10 MG TABLET [6494]
|
Facility
|
OP
|
$0.21
|
|
|
Service Code
|
CPT J7512
|
| Hospital Charge Code |
1710075
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.13
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.14
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.16
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.14
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.13
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.16
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.14
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.13
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.16
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.20
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.17
|
|
|
PREDNISONE 1 MG TABLET [6493]
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
CPT J7512
|
| Hospital Charge Code |
1710450
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.14
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.16
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.14
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.14
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.16
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.14
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.14
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.16
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.18
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.17
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.20
|
|
|
PREDNISONE 1 MG TABLET [6493]
|
Facility
|
IP
|
$0.24
|
|
|
Service Code
|
CPT J7512
|
| Hospital Charge Code |
1710450
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.19
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.14
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.16
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.20
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.17
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.18
|
|
|
PREDNISONE 20 MG TABLET [6496]
|
Facility
|
IP
|
$0.24
|
|
|
Service Code
|
CPT J7512
|
| Hospital Charge Code |
1710090
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.07
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.16
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.15
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.14
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.08
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.19
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.18
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.20
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.17
|
|
|
PREDNISONE 20 MG TABLET [6496]
|
Facility
|
OP
|
$0.25
|
|
|
Service Code
|
CPT J7512
|
| Hospital Charge Code |
1710090
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.15
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.14
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.16
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.13
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.07
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.07
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.13
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.16
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.15
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.14
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.15
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.07
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.14
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.13
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.08
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.18
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.20
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.19
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.17
|
|
|
PREDNISONE 2.5 MG TABLET [6495]
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
CPT J7512
|
| Hospital Charge Code |
1710095
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.10
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.10
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.10
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.10
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.10
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.12
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.13
|
|
|
PREDNISONE 2.5 MG TABLET [6495]
|
Facility
|
IP
|
$0.17
|
|
|
Service Code
|
CPT J7512
|
| Hospital Charge Code |
1710095
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.10
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.13
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.12
|
|
|
PREDNISONE 50 MG TABLET [6498]
|
Facility
|
IP
|
$0.39
|
|
|
Service Code
|
CPT J7512
|
| Hospital Charge Code |
1710048
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.32
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.23
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.30
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.29
|
|
|
PREDNISONE 50 MG TABLET [6498]
|
Facility
|
OP
|
$0.39
|
|
|
Service Code
|
CPT J7512
|
| Hospital Charge Code |
1710048
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.23
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.24
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.23
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.24
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.23
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.30
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.29
|
|
|
PREDNISONE 5 MG/ML ORAL CONCENTRATE [110852]
|
Facility
|
OP
|
$5.20
|
|
|
Service Code
|
CPT J7512
|
| Hospital Charge Code |
1715989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$3.12
|
| Rate for Payer: Aetna of CA Government/Medicare |
$3.12
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Health Smart Auto/Commercial |
$3.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$3.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.86
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$3.90
|
|
