|
PULMONARY EMBOLISM
|
Facility
|
IP
|
$15,877.16
|
|
|
Service Code
|
APR-DRG 1342
|
| Min. Negotiated Rate |
$12,680.84 |
| Max. Negotiated Rate |
$15,877.16 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12,680.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15,877.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,205.88
|
|
|
PULMONARY EMBOLISM
|
Facility
|
IP
|
$50,620.12
|
|
|
Service Code
|
APR-DRG 1344
|
| Min. Negotiated Rate |
$40,429.49 |
| Max. Negotiated Rate |
$50,620.12 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40,429.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50,620.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45,291.69
|
|
|
PULMONARY EMBOLISM
|
Facility
|
IP
|
$12,200.85
|
|
|
Service Code
|
APR-DRG 1341
|
| Min. Negotiated Rate |
$9,744.63 |
| Max. Negotiated Rate |
$12,200.85 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9,744.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,200.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,916.55
|
|
|
PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE
|
Facility
|
IP
|
$103,623.89
|
|
|
Service Code
|
MSDRG 175
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$103,623.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$41,642.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$103,623.89
|
| Rate for Payer: EPIC Health Plan Senior |
$69,082.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62,802.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87,923.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84,155.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
PULMONARY EMBOLISM WITHOUT MCC
|
Facility
|
IP
|
$93,534.21
|
|
|
Service Code
|
MSDRG 176
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$93,534.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24,404.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$93,534.21
|
| Rate for Payer: EPIC Health Plan Senior |
$62,356.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$56,687.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79,362.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$75,961.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
PUNCH BIOPSY OF SKIN (INCLUDING SIMPLE CLOSURE, WHEN PERFORMED); SINGLE LESION
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 11104
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$188.26 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$188.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$212.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$731.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$658.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$700.62
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
PYRAZINAMIDE 500 MG TABLET [6738]
|
Facility
|
OP
|
$6.96
|
|
|
Service Code
|
NDC 6068778911
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$5.92 |
| Rate for Payer: Adventist Health Commercial |
$1.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.47
|
| Rate for Payer: Cash Price |
$3.13
|
| Rate for Payer: Cigna of CA HMO |
$4.87
|
| Rate for Payer: Cigna of CA PPO |
$4.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.78
|
| Rate for Payer: EPIC Health Plan Senior |
$2.78
|
| Rate for Payer: Galaxy Health WC |
$5.92
|
| Rate for Payer: Global Benefits Group Commercial |
$4.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.87
|
| Rate for Payer: Multiplan Commercial |
$5.57
|
| Rate for Payer: Networks By Design Commercial |
$4.52
|
| Rate for Payer: Prime Health Services Commercial |
$5.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.48
|
| Rate for Payer: United Healthcare All Other HMO |
$3.48
|
| Rate for Payer: United Healthcare HMO Rider |
$3.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.92
|
| Rate for Payer: Vantage Medical Group Senior |
$5.92
|
|
|
PYRAZINAMIDE 500 MG TABLET [6738]
|
Facility
|
IP
|
$5.42
|
|
|
Service Code
|
NDC 7095448420
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$4.61 |
| Rate for Payer: Adventist Health Commercial |
$1.08
|
| Rate for Payer: Blue Shield of California Commercial |
$2.75
|
| Rate for Payer: Blue Shield of California Commercial |
$4.17
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Cigna of CA HMO |
$3.79
|
| Rate for Payer: Cigna of CA PPO |
$3.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.17
|
| Rate for Payer: EPIC Health Plan Senior |
$2.17
|
| Rate for Payer: Galaxy Health WC |
$4.61
|
| Rate for Payer: Global Benefits Group Commercial |
$3.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.30
|
| Rate for Payer: Multiplan Commercial |
$4.34
|
| Rate for Payer: Networks By Design Commercial |
$3.52
|
| Rate for Payer: Prime Health Services Commercial |
$4.61
|
|
|
PYRAZINAMIDE 500 MG TABLET [6738]
|
Facility
|
OP
|
$5.42
|
|
|
Service Code
|
NDC 7095448420
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$4.61 |
| Rate for Payer: Adventist Health Commercial |
$1.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.48
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Cigna of CA HMO |
$3.79
|
| Rate for Payer: Cigna of CA PPO |
$3.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.17
|
| Rate for Payer: EPIC Health Plan Senior |
$2.17
|
| Rate for Payer: Galaxy Health WC |
$4.61
|
| Rate for Payer: Global Benefits Group Commercial |
$3.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.79
|
| Rate for Payer: Multiplan Commercial |
$4.34
|
| Rate for Payer: Networks By Design Commercial |
$3.52
|
| Rate for Payer: Prime Health Services Commercial |
$4.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.71
|
| Rate for Payer: United Healthcare All Other HMO |
$2.71
|
| Rate for Payer: United Healthcare HMO Rider |
$2.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.61
|
| Rate for Payer: Vantage Medical Group Senior |
$4.61
|
|
|
PYRAZINAMIDE 500 MG TABLET [6738]
|
Facility
|
IP
|
$6.96
|
|
|
Service Code
|
NDC 6068778911
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$5.92 |
| Rate for Payer: Adventist Health Commercial |
$1.39
|
| Rate for Payer: Blue Shield of California Commercial |
$3.53
|
| Rate for Payer: Blue Shield of California Commercial |
$5.35
|
| Rate for Payer: Cash Price |
$3.13
|
| Rate for Payer: Cigna of CA HMO |
$4.87
|
| Rate for Payer: Cigna of CA PPO |
$4.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.78
|
| Rate for Payer: EPIC Health Plan Senior |
$2.78
|
| Rate for Payer: Galaxy Health WC |
$5.92
|
| Rate for Payer: Global Benefits Group Commercial |
$4.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.67
|
| Rate for Payer: Multiplan Commercial |
$5.57
|
| Rate for Payer: Networks By Design Commercial |
$4.52
|
| Rate for Payer: Prime Health Services Commercial |
$5.92
|
|
|
PYRAZINAMIDE 500 MG TABLET [6738]
|
Facility
|
OP
|
$6.96
|
|
|
Service Code
|
NDC 6068778901
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$5.92 |
| Rate for Payer: Adventist Health Commercial |
$1.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.47
|
| Rate for Payer: Cash Price |
$3.13
|
| Rate for Payer: Cigna of CA HMO |
$4.87
|
| Rate for Payer: Cigna of CA PPO |
$4.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.78
|
| Rate for Payer: EPIC Health Plan Senior |
$2.78
|
| Rate for Payer: Galaxy Health WC |
$5.92
|
| Rate for Payer: Global Benefits Group Commercial |
$4.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.87
|
| Rate for Payer: Multiplan Commercial |
$5.57
|
| Rate for Payer: Networks By Design Commercial |
$4.52
|
| Rate for Payer: Prime Health Services Commercial |
$5.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.48
|
| Rate for Payer: United Healthcare All Other HMO |
$3.48
|
| Rate for Payer: United Healthcare HMO Rider |
$3.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.92
|
| Rate for Payer: Vantage Medical Group Senior |
$5.92
|
|
|
PYRAZINAMIDE 500 MG TABLET [6738]
|
Facility
|
OP
|
$5.32
|
|
|
Service Code
|
NDC 3334244711
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$4.52 |
| Rate for Payer: Adventist Health Commercial |
$1.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.41
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Cigna of CA HMO |
$3.72
|
| Rate for Payer: Cigna of CA PPO |
$3.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.13
|
| Rate for Payer: EPIC Health Plan Senior |
$2.13
|
| Rate for Payer: Galaxy Health WC |
$4.52
|
| Rate for Payer: Global Benefits Group Commercial |
$3.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.72
|
| Rate for Payer: Multiplan Commercial |
$4.26
|
| Rate for Payer: Networks By Design Commercial |
$3.46
|
| Rate for Payer: Prime Health Services Commercial |
$4.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.66
|
| Rate for Payer: United Healthcare All Other HMO |
$2.66
|
| Rate for Payer: United Healthcare HMO Rider |
$2.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.52
|
| Rate for Payer: Vantage Medical Group Senior |
$4.52
|
|
|
PYRAZINAMIDE 500 MG TABLET [6738]
|
Facility
|
IP
|
$4.40
|
|
|
Service Code
|
NDC 1013573560
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Adventist Health Commercial |
$0.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2.23
|
| Rate for Payer: Blue Shield of California Commercial |
$3.38
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cigna of CA HMO |
$3.08
|
| Rate for Payer: Cigna of CA PPO |
$3.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.76
|
| Rate for Payer: EPIC Health Plan Senior |
$1.76
|
| Rate for Payer: Galaxy Health WC |
$3.74
|
| Rate for Payer: Global Benefits Group Commercial |
$2.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Multiplan Commercial |
$3.52
|
| Rate for Payer: Networks By Design Commercial |
$2.86
|
| Rate for Payer: Prime Health Services Commercial |
$3.74
|
|
|
PYRAZINAMIDE 500 MG TABLET [6738]
|
Facility
|
OP
|
$4.40
|
|
|
Service Code
|
NDC 1013573560
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Adventist Health Commercial |
$0.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.82
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cigna of CA HMO |
$3.08
|
| Rate for Payer: Cigna of CA PPO |
$3.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.76
|
| Rate for Payer: EPIC Health Plan Senior |
$1.76
|
| Rate for Payer: Galaxy Health WC |
$3.74
|
| Rate for Payer: Global Benefits Group Commercial |
$2.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.08
|
| Rate for Payer: Multiplan Commercial |
$3.52
|
| Rate for Payer: Networks By Design Commercial |
$2.86
|
| Rate for Payer: Prime Health Services Commercial |
$3.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.20
|
| Rate for Payer: United Healthcare All Other HMO |
$2.20
|
| Rate for Payer: United Healthcare HMO Rider |
$2.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.74
|
| Rate for Payer: Vantage Medical Group Senior |
$3.74
|
|
|
PYRAZINAMIDE 500 MG TABLET [6738]
|
Facility
|
IP
|
$6.96
|
|
|
Service Code
|
NDC 6068778901
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$5.92 |
| Rate for Payer: Adventist Health Commercial |
$1.39
|
| Rate for Payer: Blue Shield of California Commercial |
$3.53
|
| Rate for Payer: Blue Shield of California Commercial |
$5.35
|
| Rate for Payer: Cash Price |
$3.13
|
| Rate for Payer: Cigna of CA HMO |
$4.87
|
| Rate for Payer: Cigna of CA PPO |
$4.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.78
|
| Rate for Payer: EPIC Health Plan Senior |
$2.78
|
| Rate for Payer: Galaxy Health WC |
$5.92
|
| Rate for Payer: Global Benefits Group Commercial |
$4.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.67
|
| Rate for Payer: Multiplan Commercial |
$5.57
|
| Rate for Payer: Networks By Design Commercial |
$4.52
|
| Rate for Payer: Prime Health Services Commercial |
$5.92
|
|
|
PYRAZINAMIDE 500 MG TABLET [6738]
|
Facility
|
OP
|
$5.46
|
|
|
Service Code
|
NDC 7095448410
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$4.64 |
| Rate for Payer: Adventist Health Commercial |
$1.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.50
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cigna of CA HMO |
$3.82
|
| Rate for Payer: Cigna of CA PPO |
$3.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.18
|
| Rate for Payer: EPIC Health Plan Senior |
$2.18
|
| Rate for Payer: Galaxy Health WC |
$4.64
|
| Rate for Payer: Global Benefits Group Commercial |
$3.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.82
|
| Rate for Payer: Multiplan Commercial |
$4.37
|
| Rate for Payer: Networks By Design Commercial |
$3.55
|
| Rate for Payer: Prime Health Services Commercial |
$4.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.73
|
| Rate for Payer: United Healthcare All Other HMO |
$2.73
|
| Rate for Payer: United Healthcare HMO Rider |
$2.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.64
|
| Rate for Payer: Vantage Medical Group Senior |
$4.64
|
|
|
PYRAZINAMIDE 500 MG TABLET [6738]
|
Facility
|
IP
|
$5.46
|
|
|
Service Code
|
NDC 7095448410
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$4.64 |
| Rate for Payer: Adventist Health Commercial |
$1.09
|
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Blue Shield of California Commercial |
$4.20
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cigna of CA HMO |
$3.82
|
| Rate for Payer: Cigna of CA PPO |
$3.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.18
|
| Rate for Payer: EPIC Health Plan Senior |
$2.18
|
| Rate for Payer: Galaxy Health WC |
$4.64
|
| Rate for Payer: Global Benefits Group Commercial |
$3.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.31
|
| Rate for Payer: Multiplan Commercial |
$4.37
|
| Rate for Payer: Networks By Design Commercial |
$3.55
|
| Rate for Payer: Prime Health Services Commercial |
$4.64
|
|
|
PYRAZINAMIDE 500 MG TABLET [6738]
|
Facility
|
IP
|
$5.32
|
|
|
Service Code
|
NDC 3334244711
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$4.52 |
| Rate for Payer: Adventist Health Commercial |
$1.06
|
| Rate for Payer: Blue Shield of California Commercial |
$2.70
|
| Rate for Payer: Blue Shield of California Commercial |
$4.09
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Cigna of CA HMO |
$3.72
|
| Rate for Payer: Cigna of CA PPO |
$3.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.13
|
| Rate for Payer: EPIC Health Plan Senior |
$2.13
|
| Rate for Payer: Galaxy Health WC |
$4.52
|
| Rate for Payer: Global Benefits Group Commercial |
$3.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: Multiplan Commercial |
$4.26
|
| Rate for Payer: Networks By Design Commercial |
$3.46
|
| Rate for Payer: Prime Health Services Commercial |
$4.52
|
|
|
PYRAZINAMIDE ORAL SUSPENSION COMPOUND 100 MG/ML [4080326]
|
Facility
|
IP
|
$6.32
|
|
|
Service Code
|
NDC 9994080326
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.37 |
| 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 |
$4.86
|
| 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 |
$2.53
|
| Rate for Payer: EPIC Health Plan Senior |
$2.53
|
| Rate for Payer: Galaxy Health WC |
$5.37
|
| 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 |
$3.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.52
|
| Rate for Payer: Multiplan Commercial |
$5.06
|
| Rate for Payer: Networks By Design Commercial |
$4.11
|
| Rate for Payer: Prime Health Services Commercial |
$5.37
|
|
|
PYRAZINAMIDE ORAL SUSPENSION COMPOUND 100 MG/ML [4080326]
|
Facility
|
OP
|
$6.32
|
|
|
Service Code
|
NDC 9994080326
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.37 |
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.06
|
| 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 |
$5.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.53
|
| Rate for Payer: EPIC Health Plan Senior |
$2.53
|
| Rate for Payer: Galaxy Health WC |
$5.37
|
| 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 |
$3.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.52
|
| 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 |
$5.06
|
| Rate for Payer: Networks By Design Commercial |
$4.11
|
| Rate for Payer: Prime Health Services Commercial |
$5.37
|
| 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 |
$3.16
|
| Rate for Payer: United Healthcare All Other HMO |
$3.16
|
| Rate for Payer: United Healthcare HMO Rider |
$3.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.37
|
| Rate for Payer: Vantage Medical Group Senior |
$5.37
|
|
|
PYRIDOSTIGMINE BROMIDE 5 MG/ML INJECTION SOLUTION [11237]
|
Facility
|
OP
|
$20.26
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$17.22 |
| Rate for Payer: Adventist Health Commercial |
$4.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.20
|
| Rate for Payer: Cash Price |
$9.12
|
| Rate for Payer: Cigna of CA HMO |
$14.18
|
| Rate for Payer: Cigna of CA PPO |
$14.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.10
|
| Rate for Payer: EPIC Health Plan Senior |
$8.10
|
| Rate for Payer: Galaxy Health WC |
$17.22
|
| Rate for Payer: Global Benefits Group Commercial |
$12.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.18
|
| Rate for Payer: Multiplan Commercial |
$16.21
|
| Rate for Payer: Networks By Design Commercial |
$10.13
|
| Rate for Payer: Prime Health Services Commercial |
$17.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.60
|
| Rate for Payer: United Healthcare All Other HMO |
$7.40
|
| Rate for Payer: United Healthcare HMO Rider |
$7.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.22
|
| Rate for Payer: Vantage Medical Group Senior |
$17.22
|
|
|
PYRIDOSTIGMINE BROMIDE 5 MG/ML INJECTION SOLUTION [11237]
|
Facility
|
IP
|
$20.26
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$17.22 |
| Rate for Payer: Adventist Health Commercial |
$4.05
|
| Rate for Payer: Blue Shield of California Commercial |
$10.27
|
| Rate for Payer: Blue Shield of California Commercial |
$15.58
|
| Rate for Payer: Cash Price |
$9.12
|
| Rate for Payer: Cigna of CA HMO |
$14.18
|
| Rate for Payer: Cigna of CA PPO |
$14.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.10
|
| Rate for Payer: EPIC Health Plan Senior |
$8.10
|
| Rate for Payer: Galaxy Health WC |
$17.22
|
| Rate for Payer: Global Benefits Group Commercial |
$12.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.86
|
| Rate for Payer: Multiplan Commercial |
$16.21
|
| Rate for Payer: Networks By Design Commercial |
$10.13
|
| Rate for Payer: Prime Health Services Commercial |
$17.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.60
|
| Rate for Payer: United Healthcare All Other HMO |
$7.40
|
| Rate for Payer: United Healthcare HMO Rider |
$7.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.64
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG/5 ML ORAL SYRUP [11238]
|
Facility
|
IP
|
$4.90
|
|
|
Service Code
|
NDC 0187301220
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$4.17 |
| Rate for Payer: Adventist Health Commercial |
$0.98
|
| Rate for Payer: Blue Shield of California Commercial |
$2.48
|
| Rate for Payer: Blue Shield of California Commercial |
$3.77
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna of CA HMO |
$3.43
|
| Rate for Payer: Cigna of CA PPO |
$3.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.96
|
| Rate for Payer: EPIC Health Plan Senior |
$1.96
|
| Rate for Payer: Galaxy Health WC |
$4.17
|
| Rate for Payer: Global Benefits Group Commercial |
$2.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$3.92
|
| Rate for Payer: Networks By Design Commercial |
$3.19
|
| Rate for Payer: Prime Health Services Commercial |
$4.17
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG/5 ML ORAL SYRUP [11238]
|
Facility
|
OP
|
$4.90
|
|
|
Service Code
|
NDC 0187301220
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$4.17 |
| Rate for Payer: Adventist Health Commercial |
$0.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.14
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna of CA HMO |
$3.43
|
| Rate for Payer: Cigna of CA PPO |
$3.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.96
|
| Rate for Payer: EPIC Health Plan Senior |
$1.96
|
| Rate for Payer: Galaxy Health WC |
$4.17
|
| Rate for Payer: Global Benefits Group Commercial |
$2.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.43
|
| Rate for Payer: Multiplan Commercial |
$3.92
|
| Rate for Payer: Networks By Design Commercial |
$3.19
|
| Rate for Payer: Prime Health Services Commercial |
$4.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.45
|
| Rate for Payer: United Healthcare All Other HMO |
$2.45
|
| Rate for Payer: United Healthcare HMO Rider |
$2.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4.17
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG TABLET [11239]
|
Facility
|
IP
|
$1.22
|
|
|
Service Code
|
NDC 6838265906
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California Commercial |
$0.62
|
| Rate for Payer: Blue Shield of California Commercial |
$0.94
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Cigna of CA HMO |
$0.85
|
| Rate for Payer: Cigna of CA PPO |
$0.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.49
|
| Rate for Payer: EPIC Health Plan Senior |
$0.49
|
| Rate for Payer: Galaxy Health WC |
$1.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.98
|
| Rate for Payer: Networks By Design Commercial |
$0.79
|
| Rate for Payer: Prime Health Services Commercial |
$1.04
|
|
