|
PHYTONADIONE (VITAMIN K1) 5 MG TABLET [11024]
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
NDC 6923810513
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.80
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna of CA HMO |
$33.60
|
| Rate for Payer: Cigna of CA PPO |
$33.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Senior |
$19.20
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: Networks By Design Commercial |
$31.20
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.00
|
| Rate for Payer: United Healthcare All Other HMO |
$24.00
|
| Rate for Payer: United Healthcare HMO Rider |
$24.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.80
|
| Rate for Payer: Vantage Medical Group Senior |
$40.80
|
|
|
PHYTONADIONE (VITAMIN K1) 5 MG TABLET [11024]
|
Facility
|
OP
|
$33.76
|
|
|
Service Code
|
NDC 7071010143
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$28.70 |
| Rate for Payer: Adventist Health Commercial |
$6.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.66
|
| Rate for Payer: Cash Price |
$15.19
|
| Rate for Payer: Cigna of CA HMO |
$23.63
|
| Rate for Payer: Cigna of CA PPO |
$23.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.50
|
| Rate for Payer: EPIC Health Plan Senior |
$13.50
|
| Rate for Payer: Galaxy Health WC |
$28.70
|
| Rate for Payer: Global Benefits Group Commercial |
$20.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.63
|
| Rate for Payer: Multiplan Commercial |
$27.01
|
| Rate for Payer: Networks By Design Commercial |
$21.94
|
| Rate for Payer: Prime Health Services Commercial |
$28.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.88
|
| Rate for Payer: United Healthcare All Other HMO |
$16.88
|
| Rate for Payer: United Healthcare HMO Rider |
$16.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.70
|
| Rate for Payer: Vantage Medical Group Senior |
$28.70
|
|
|
PHYTONADIONE (VITAMIN K1) 5 MG TABLET [11024]
|
Facility
|
IP
|
$80.85
|
|
|
Service Code
|
NDC 6068738111
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.17 |
| Max. Negotiated Rate |
$68.72 |
| Rate for Payer: Adventist Health Commercial |
$16.17
|
| Rate for Payer: Blue Shield of California Commercial |
$40.99
|
| Rate for Payer: Blue Shield of California Commercial |
$62.17
|
| Rate for Payer: Cash Price |
$36.38
|
| Rate for Payer: Cigna of CA HMO |
$56.59
|
| Rate for Payer: Cigna of CA PPO |
$56.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.34
|
| Rate for Payer: EPIC Health Plan Senior |
$32.34
|
| Rate for Payer: Galaxy Health WC |
$68.72
|
| Rate for Payer: Global Benefits Group Commercial |
$48.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$51.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.40
|
| Rate for Payer: Multiplan Commercial |
$64.68
|
| Rate for Payer: Networks By Design Commercial |
$52.55
|
| Rate for Payer: Prime Health Services Commercial |
$68.72
|
|
|
PHYTONADIONE (VITAMIN K1) 5 MG TABLET [11024]
|
Facility
|
IP
|
$27.01
|
|
|
Service Code
|
NDC 6909799902
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$22.96 |
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Blue Shield of California Commercial |
$13.69
|
| Rate for Payer: Blue Shield of California Commercial |
$20.77
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cigna of CA HMO |
$18.91
|
| Rate for Payer: Cigna of CA PPO |
$18.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.80
|
| Rate for Payer: EPIC Health Plan Senior |
$10.80
|
| Rate for Payer: Galaxy Health WC |
$22.96
|
| Rate for Payer: Global Benefits Group Commercial |
$16.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.48
|
| Rate for Payer: Multiplan Commercial |
$21.61
|
| Rate for Payer: Networks By Design Commercial |
$17.56
|
| Rate for Payer: Prime Health Services Commercial |
$22.96
|
|
|
PILOCARPINE 1 % EYE DROPS [6279]
|
Facility
|
IP
|
$5.04
|
|
|
Service Code
|
NDC 6923817458
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Adventist Health Commercial |
$1.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2.56
|
| Rate for Payer: Blue Shield of California Commercial |
$3.88
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cigna of CA HMO |
$3.53
|
| Rate for Payer: Cigna of CA PPO |
$3.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.02
|
| Rate for Payer: EPIC Health Plan Senior |
$2.02
|
| Rate for Payer: Galaxy Health WC |
$4.28
|
| Rate for Payer: Global Benefits Group Commercial |
$3.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.21
|
| Rate for Payer: Multiplan Commercial |
$4.03
|
| Rate for Payer: Networks By Design Commercial |
$3.28
|
| Rate for Payer: Prime Health Services Commercial |
$4.28
|
|
|
PILOCARPINE 1 % EYE DROPS [6279]
|
Facility
|
OP
|
$6.31
|
|
|
Service Code
|
NDC 6131420315
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.05
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Cigna of CA HMO |
$4.42
|
| Rate for Payer: Cigna of CA PPO |
$4.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.52
|
| Rate for Payer: EPIC Health Plan Senior |
$2.52
|
| Rate for Payer: Galaxy Health WC |
$5.36
|
| Rate for Payer: Global Benefits Group Commercial |
$3.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.42
|
| Rate for Payer: Multiplan Commercial |
$5.05
|
| Rate for Payer: Networks By Design Commercial |
$4.10
|
| Rate for Payer: Prime Health Services Commercial |
$5.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.15
|
| Rate for Payer: United Healthcare All Other HMO |
$3.15
|
| Rate for Payer: United Healthcare HMO Rider |
$3.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.36
|
| Rate for Payer: Vantage Medical Group Senior |
$5.36
|
|
|
PILOCARPINE 1 % EYE DROPS [6279]
|
Facility
|
OP
|
$5.04
|
|
|
Service Code
|
NDC 6923817458
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Adventist Health Commercial |
$1.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.23
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cigna of CA HMO |
$3.53
|
| Rate for Payer: Cigna of CA PPO |
$3.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.02
|
| Rate for Payer: EPIC Health Plan Senior |
$2.02
|
| Rate for Payer: Galaxy Health WC |
$4.28
|
| Rate for Payer: Global Benefits Group Commercial |
$3.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.53
|
| Rate for Payer: Multiplan Commercial |
$4.03
|
| Rate for Payer: Networks By Design Commercial |
$3.28
|
| Rate for Payer: Prime Health Services Commercial |
$4.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.52
|
| Rate for Payer: United Healthcare All Other HMO |
$2.52
|
| Rate for Payer: United Healthcare HMO Rider |
$2.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.28
|
| Rate for Payer: Vantage Medical Group Senior |
$4.28
|
|
|
PILOCARPINE 1 % EYE DROPS [6279]
|
Facility
|
OP
|
$5.94
|
|
|
Service Code
|
NDC 7006918101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$5.05 |
| Rate for Payer: Adventist Health Commercial |
$1.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.81
|
| Rate for Payer: Cash Price |
$2.67
|
| Rate for Payer: Cigna of CA HMO |
$4.16
|
| Rate for Payer: Cigna of CA PPO |
$4.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.38
|
| Rate for Payer: EPIC Health Plan Senior |
$2.38
|
| Rate for Payer: Galaxy Health WC |
$5.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.16
|
| Rate for Payer: Multiplan Commercial |
$4.75
|
| Rate for Payer: Networks By Design Commercial |
$3.86
|
| Rate for Payer: Prime Health Services Commercial |
$5.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.97
|
| Rate for Payer: United Healthcare All Other HMO |
$2.97
|
| Rate for Payer: United Healthcare HMO Rider |
$2.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.05
|
| Rate for Payer: Vantage Medical Group Senior |
$5.05
|
|
|
PILOCARPINE 1 % EYE DROPS [6279]
|
Facility
|
IP
|
$6.31
|
|
|
Service Code
|
NDC 6131420315
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Blue Shield of California Commercial |
$3.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4.85
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Cigna of CA HMO |
$4.42
|
| Rate for Payer: Cigna of CA PPO |
$4.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.52
|
| Rate for Payer: EPIC Health Plan Senior |
$2.52
|
| Rate for Payer: Galaxy Health WC |
$5.36
|
| Rate for Payer: Global Benefits Group Commercial |
$3.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.51
|
| Rate for Payer: Multiplan Commercial |
$5.05
|
| Rate for Payer: Networks By Design Commercial |
$4.10
|
| Rate for Payer: Prime Health Services Commercial |
$5.36
|
|
|
PILOCARPINE 1 % EYE DROPS [6279]
|
Facility
|
IP
|
$5.94
|
|
|
Service Code
|
NDC 7006918101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$5.05 |
| Rate for Payer: Adventist Health Commercial |
$1.19
|
| Rate for Payer: Blue Shield of California Commercial |
$3.01
|
| Rate for Payer: Blue Shield of California Commercial |
$4.57
|
| Rate for Payer: Cash Price |
$2.67
|
| Rate for Payer: Cigna of CA HMO |
$4.16
|
| Rate for Payer: Cigna of CA PPO |
$4.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.38
|
| Rate for Payer: EPIC Health Plan Senior |
$2.38
|
| Rate for Payer: Galaxy Health WC |
$5.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.43
|
| Rate for Payer: Multiplan Commercial |
$4.75
|
| Rate for Payer: Networks By Design Commercial |
$3.86
|
| Rate for Payer: Prime Health Services Commercial |
$5.05
|
|
|
PILOCARPINE 2 % EYE DROPS [6280]
|
Facility
|
OP
|
$6.07
|
|
|
Service Code
|
NDC 7006919101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$5.16 |
| Rate for Payer: Adventist Health Commercial |
$1.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.90
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cigna of CA HMO |
$4.25
|
| Rate for Payer: Cigna of CA PPO |
$4.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.43
|
| Rate for Payer: EPIC Health Plan Senior |
$2.43
|
| Rate for Payer: Galaxy Health WC |
$5.16
|
| Rate for Payer: Global Benefits Group Commercial |
$3.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.25
|
| Rate for Payer: Multiplan Commercial |
$4.86
|
| Rate for Payer: Networks By Design Commercial |
$3.95
|
| Rate for Payer: Prime Health Services Commercial |
$5.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.04
|
| Rate for Payer: United Healthcare All Other HMO |
$3.04
|
| Rate for Payer: United Healthcare HMO Rider |
$3.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.16
|
| Rate for Payer: Vantage Medical Group Senior |
$5.16
|
|
|
PILOCARPINE 2 % EYE DROPS [6280]
|
Facility
|
IP
|
$6.07
|
|
|
Service Code
|
NDC 7006919101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$5.16 |
| Rate for Payer: Adventist Health Commercial |
$1.21
|
| Rate for Payer: Blue Shield of California Commercial |
$3.08
|
| Rate for Payer: Blue Shield of California Commercial |
$4.67
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cigna of CA HMO |
$4.25
|
| Rate for Payer: Cigna of CA PPO |
$4.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.43
|
| Rate for Payer: EPIC Health Plan Senior |
$2.43
|
| Rate for Payer: Galaxy Health WC |
$5.16
|
| Rate for Payer: Global Benefits Group Commercial |
$3.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.46
|
| Rate for Payer: Multiplan Commercial |
$4.86
|
| Rate for Payer: Networks By Design Commercial |
$3.95
|
| Rate for Payer: Prime Health Services Commercial |
$5.16
|
|
|
PILOCARPINE 4 % EYE DROPS [6282]
|
Facility
|
OP
|
$6.36
|
|
|
Service Code
|
NDC 7006920101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$5.41 |
| Rate for Payer: Adventist Health Commercial |
$1.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.08
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Cigna of CA HMO |
$4.45
|
| Rate for Payer: Cigna of CA PPO |
$4.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.54
|
| Rate for Payer: EPIC Health Plan Senior |
$2.54
|
| Rate for Payer: Galaxy Health WC |
$5.41
|
| Rate for Payer: Global Benefits Group Commercial |
$3.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.45
|
| Rate for Payer: Multiplan Commercial |
$5.09
|
| Rate for Payer: Networks By Design Commercial |
$4.13
|
| Rate for Payer: Prime Health Services Commercial |
$5.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.18
|
| Rate for Payer: United Healthcare All Other HMO |
$3.18
|
| Rate for Payer: United Healthcare HMO Rider |
$3.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.41
|
| Rate for Payer: Vantage Medical Group Senior |
$5.41
|
|
|
PILOCARPINE 4 % EYE DROPS [6282]
|
Facility
|
IP
|
$6.36
|
|
|
Service Code
|
NDC 7006920101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$5.41 |
| Rate for Payer: Adventist Health Commercial |
$1.27
|
| Rate for Payer: Blue Shield of California Commercial |
$3.22
|
| Rate for Payer: Blue Shield of California Commercial |
$4.89
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Cigna of CA HMO |
$4.45
|
| Rate for Payer: Cigna of CA PPO |
$4.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.54
|
| Rate for Payer: EPIC Health Plan Senior |
$2.54
|
| Rate for Payer: Galaxy Health WC |
$5.41
|
| Rate for Payer: Global Benefits Group Commercial |
$3.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.53
|
| Rate for Payer: Multiplan Commercial |
$5.09
|
| Rate for Payer: Networks By Design Commercial |
$4.13
|
| Rate for Payer: Prime Health Services Commercial |
$5.41
|
|
|
PILOCARPINE 5 MG TABLET [12803]
|
Facility
|
IP
|
$2.73
|
|
|
Service Code
|
NDC 6808492825
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$2.32 |
| Rate for Payer: Adventist Health Commercial |
$0.55
|
| Rate for Payer: Blue Shield of California Commercial |
$1.38
|
| Rate for Payer: Blue Shield of California Commercial |
$2.10
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: Cigna of CA HMO |
$1.91
|
| Rate for Payer: Cigna of CA PPO |
$1.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.09
|
| Rate for Payer: EPIC Health Plan Senior |
$1.09
|
| Rate for Payer: Galaxy Health WC |
$2.32
|
| Rate for Payer: Global Benefits Group Commercial |
$1.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$2.18
|
| Rate for Payer: Networks By Design Commercial |
$1.77
|
| Rate for Payer: Prime Health Services Commercial |
$2.32
|
|
|
PILOCARPINE 5 MG TABLET [12803]
|
Facility
|
IP
|
$0.39
|
|
|
Service Code
|
NDC 0527131301
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.33 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.27
|
| Rate for Payer: Cigna of CA PPO |
$0.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Senior |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.33
|
| Rate for Payer: Global Benefits Group Commercial |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.31
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.33
|
|
|
PILOCARPINE 5 MG TABLET [12803]
|
Facility
|
OP
|
$2.57
|
|
|
Service Code
|
NDC 5026865212
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$2.18 |
| Rate for Payer: Adventist Health Commercial |
$0.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.65
|
| Rate for Payer: Cash Price |
$1.16
|
| Rate for Payer: Cigna of CA HMO |
$1.80
|
| Rate for Payer: Cigna of CA PPO |
$1.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.03
|
| Rate for Payer: EPIC Health Plan Senior |
$1.03
|
| Rate for Payer: Galaxy Health WC |
$2.18
|
| Rate for Payer: Global Benefits Group Commercial |
$1.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.80
|
| Rate for Payer: Multiplan Commercial |
$2.06
|
| Rate for Payer: Networks By Design Commercial |
$1.67
|
| Rate for Payer: Prime Health Services Commercial |
$2.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.28
|
| Rate for Payer: United Healthcare All Other HMO |
$1.28
|
| Rate for Payer: United Healthcare HMO Rider |
$1.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.18
|
| Rate for Payer: Vantage Medical Group Senior |
$2.18
|
|
|
PILOCARPINE 5 MG TABLET [12803]
|
Facility
|
OP
|
$0.39
|
|
|
Service Code
|
NDC 0527131301
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.33 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.25
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.27
|
| Rate for Payer: Cigna of CA PPO |
$0.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Senior |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.33
|
| Rate for Payer: Global Benefits Group Commercial |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.31
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.20
|
| Rate for Payer: United Healthcare All Other HMO |
$0.20
|
| Rate for Payer: United Healthcare HMO Rider |
$0.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: Vantage Medical Group Senior |
$0.33
|
|
|
PILOCARPINE 5 MG TABLET [12803]
|
Facility
|
OP
|
$2.57
|
|
|
Service Code
|
NDC 5026865211
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$2.18 |
| Rate for Payer: Adventist Health Commercial |
$0.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.65
|
| Rate for Payer: Cash Price |
$1.16
|
| Rate for Payer: Cigna of CA HMO |
$1.80
|
| Rate for Payer: Cigna of CA PPO |
$1.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.03
|
| Rate for Payer: EPIC Health Plan Senior |
$1.03
|
| Rate for Payer: Galaxy Health WC |
$2.18
|
| Rate for Payer: Global Benefits Group Commercial |
$1.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.80
|
| Rate for Payer: Multiplan Commercial |
$2.06
|
| Rate for Payer: Networks By Design Commercial |
$1.67
|
| Rate for Payer: Prime Health Services Commercial |
$2.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.28
|
| Rate for Payer: United Healthcare All Other HMO |
$1.28
|
| Rate for Payer: United Healthcare HMO Rider |
$1.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.18
|
| Rate for Payer: Vantage Medical Group Senior |
$2.18
|
|
|
PILOCARPINE 5 MG TABLET [12803]
|
Facility
|
IP
|
$2.57
|
|
|
Service Code
|
NDC 5026865212
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$2.18 |
| Rate for Payer: Adventist Health Commercial |
$0.51
|
| Rate for Payer: Blue Shield of California Commercial |
$1.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1.98
|
| Rate for Payer: Cash Price |
$1.16
|
| Rate for Payer: Cigna of CA HMO |
$1.80
|
| Rate for Payer: Cigna of CA PPO |
$1.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.03
|
| Rate for Payer: EPIC Health Plan Senior |
$1.03
|
| Rate for Payer: Galaxy Health WC |
$2.18
|
| Rate for Payer: Global Benefits Group Commercial |
$1.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Multiplan Commercial |
$2.06
|
| Rate for Payer: Networks By Design Commercial |
$1.67
|
| Rate for Payer: Prime Health Services Commercial |
$2.18
|
|
|
PILOCARPINE 5 MG TABLET [12803]
|
Facility
|
IP
|
$2.73
|
|
|
Service Code
|
NDC 6808492895
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$2.32 |
| Rate for Payer: Adventist Health Commercial |
$0.55
|
| Rate for Payer: Blue Shield of California Commercial |
$1.38
|
| Rate for Payer: Blue Shield of California Commercial |
$2.10
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: Cigna of CA HMO |
$1.91
|
| Rate for Payer: Cigna of CA PPO |
$1.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.09
|
| Rate for Payer: EPIC Health Plan Senior |
$1.09
|
| Rate for Payer: Galaxy Health WC |
$2.32
|
| Rate for Payer: Global Benefits Group Commercial |
$1.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$2.18
|
| Rate for Payer: Networks By Design Commercial |
$1.77
|
| Rate for Payer: Prime Health Services Commercial |
$2.32
|
|
|
PILOCARPINE 5 MG TABLET [12803]
|
Facility
|
IP
|
$2.57
|
|
|
Service Code
|
NDC 5026865211
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$2.18 |
| Rate for Payer: Adventist Health Commercial |
$0.51
|
| Rate for Payer: Blue Shield of California Commercial |
$1.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1.98
|
| Rate for Payer: Cash Price |
$1.16
|
| Rate for Payer: Cigna of CA HMO |
$1.80
|
| Rate for Payer: Cigna of CA PPO |
$1.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.03
|
| Rate for Payer: EPIC Health Plan Senior |
$1.03
|
| Rate for Payer: Galaxy Health WC |
$2.18
|
| Rate for Payer: Global Benefits Group Commercial |
$1.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Multiplan Commercial |
$2.06
|
| Rate for Payer: Networks By Design Commercial |
$1.67
|
| Rate for Payer: Prime Health Services Commercial |
$2.18
|
|
|
PILOCARPINE 5 MG TABLET [12803]
|
Facility
|
OP
|
$2.73
|
|
|
Service Code
|
NDC 6808492825
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$2.32 |
| Rate for Payer: Adventist Health Commercial |
$0.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.75
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: Cigna of CA HMO |
$1.91
|
| Rate for Payer: Cigna of CA PPO |
$1.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.09
|
| Rate for Payer: EPIC Health Plan Senior |
$1.09
|
| Rate for Payer: Galaxy Health WC |
$2.32
|
| Rate for Payer: Global Benefits Group Commercial |
$1.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$2.18
|
| Rate for Payer: Networks By Design Commercial |
$1.77
|
| Rate for Payer: Prime Health Services Commercial |
$2.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.36
|
| Rate for Payer: United Healthcare All Other HMO |
$1.36
|
| Rate for Payer: United Healthcare HMO Rider |
$1.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.32
|
| Rate for Payer: Vantage Medical Group Senior |
$2.32
|
|
|
PILOCARPINE 5 MG TABLET [12803]
|
Facility
|
OP
|
$2.73
|
|
|
Service Code
|
NDC 6808492895
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$2.32 |
| Rate for Payer: Adventist Health Commercial |
$0.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.75
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: Cigna of CA HMO |
$1.91
|
| Rate for Payer: Cigna of CA PPO |
$1.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.09
|
| Rate for Payer: EPIC Health Plan Senior |
$1.09
|
| Rate for Payer: Galaxy Health WC |
$2.32
|
| Rate for Payer: Global Benefits Group Commercial |
$1.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$2.18
|
| Rate for Payer: Networks By Design Commercial |
$1.77
|
| Rate for Payer: Prime Health Services Commercial |
$2.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.36
|
| Rate for Payer: United Healthcare All Other HMO |
$1.36
|
| Rate for Payer: United Healthcare HMO Rider |
$1.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.32
|
| Rate for Payer: Vantage Medical Group Senior |
$2.32
|
|
|
PIOGLITAZONE 30 MG TABLET [25529]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 3334205507
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
|
