|
PRAZOSIN 5 MG CAPSULE [6470]
|
Facility
|
IP
|
$4.31
|
|
|
Service Code
|
NDC 51079-632-01
|
| Hospital Charge Code |
1710615
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$3.66 |
| Rate for Payer: Blue Shield of California Commercial |
$3.07
|
| Rate for Payer: Blue Shield of California EPN |
$2.21
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cigna of CA HMO |
$3.02
|
| Rate for Payer: Cigna of CA PPO |
$3.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.72
|
| Rate for Payer: Galaxy Health WC |
$3.66
|
| Rate for Payer: Global Benefits Group Commercial |
$2.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.03
|
| Rate for Payer: Multiplan Commercial |
$3.45
|
| Rate for Payer: Networks By Design Commercial |
$2.80
|
| Rate for Payer: Prime Health Services Commercial |
$3.66
|
|
|
PRAZOSIN 5 MG CAPSULE [6470]
|
Facility
|
IP
|
$1.57
|
|
|
Service Code
|
NDC 0093-4069-01
|
| Hospital Charge Code |
1710615
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.33 |
| Rate for Payer: Blue Shield of California Commercial |
$1.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.80
|
| Rate for Payer: Cash Price |
$0.71
|
| Rate for Payer: Cigna of CA HMO |
$1.10
|
| Rate for Payer: Cigna of CA PPO |
$1.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.63
|
| Rate for Payer: Galaxy Health WC |
$1.33
|
| Rate for Payer: Global Benefits Group Commercial |
$0.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
| Rate for Payer: Networks By Design Commercial |
$1.02
|
| Rate for Payer: Prime Health Services Commercial |
$1.33
|
|
|
PRAZOSIN 5 MG CAPSULE [6470]
|
Facility
|
OP
|
$4.31
|
|
|
Service Code
|
NDC 51079-632-20
|
| Hospital Charge Code |
1710615
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$3.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.57
|
| Rate for Payer: Blue Distinction Transplant |
$2.59
|
| Rate for Payer: Blue Shield of California Commercial |
$3.18
|
| Rate for Payer: Blue Shield of California EPN |
$2.52
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cigna of CA HMO |
$3.02
|
| Rate for Payer: Cigna of CA PPO |
$3.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.66
|
| Rate for Payer: Dignity Health Media |
$3.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.72
|
| Rate for Payer: Galaxy Health WC |
$3.66
|
| Rate for Payer: Global Benefits Group Commercial |
$2.59
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.03
|
| Rate for Payer: Multiplan Commercial |
$3.45
|
| Rate for Payer: Networks By Design Commercial |
$2.80
|
| Rate for Payer: Prime Health Services Commercial |
$3.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.16
|
| Rate for Payer: United Healthcare All Other HMO |
$2.16
|
| Rate for Payer: United Healthcare HMO Rider |
$2.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.66
|
| Rate for Payer: Vantage Medical Group Senior |
$3.66
|
|
|
PRAZOSIN 5 MG CAPSULE [6470]
|
Facility
|
OP
|
$4.31
|
|
|
Service Code
|
NDC 51079-632-01
|
| Hospital Charge Code |
1710615
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$3.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.57
|
| Rate for Payer: Blue Distinction Transplant |
$2.59
|
| Rate for Payer: Blue Shield of California Commercial |
$3.18
|
| Rate for Payer: Blue Shield of California EPN |
$2.52
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cigna of CA HMO |
$3.02
|
| Rate for Payer: Cigna of CA PPO |
$3.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.66
|
| Rate for Payer: Dignity Health Media |
$3.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.72
|
| Rate for Payer: Galaxy Health WC |
$3.66
|
| Rate for Payer: Global Benefits Group Commercial |
$2.59
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.03
|
| Rate for Payer: Multiplan Commercial |
$3.45
|
| Rate for Payer: Networks By Design Commercial |
$2.80
|
| Rate for Payer: Prime Health Services Commercial |
$3.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.16
|
| Rate for Payer: United Healthcare All Other HMO |
$2.16
|
| Rate for Payer: United Healthcare HMO Rider |
$2.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.66
|
| Rate for Payer: Vantage Medical Group Senior |
$3.66
|
|
|
PRAZOSIN 5 MG CAPSULE [6470]
|
Facility
|
IP
|
$0.88
|
|
|
Service Code
|
NDC 59762-5350-1
|
| Hospital Charge Code |
1710615
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Blue Shield of California Commercial |
$0.63
|
| Rate for Payer: Blue Shield of California EPN |
$0.45
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Cigna of CA HMO |
$0.62
|
| Rate for Payer: Cigna of CA PPO |
$0.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: Galaxy Health WC |
$0.75
|
| Rate for Payer: Global Benefits Group Commercial |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.70
|
| Rate for Payer: Networks By Design Commercial |
$0.57
|
| Rate for Payer: Prime Health Services Commercial |
$0.75
|
|
|
PRAZOSIN 5 MG CAPSULE [6470]
|
Facility
|
IP
|
$0.41
|
|
|
Service Code
|
NDC 70954-021-10
|
| Hospital Charge Code |
1710615
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.29
|
| Rate for Payer: Cigna of CA PPO |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.35
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.33
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Prime Health Services Commercial |
$0.35
|
|
|
PRAZOSIN 5 MG CAPSULE [6470]
|
Facility
|
IP
|
$0.41
|
|
|
Service Code
|
NDC 70954-021-20
|
| Hospital Charge Code |
1710615
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.29
|
| Rate for Payer: Cigna of CA PPO |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.35
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.33
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Prime Health Services Commercial |
$0.35
|
|
|
PRAZOSIN 5 MG CAPSULE [6470]
|
Facility
|
OP
|
$0.41
|
|
|
Service Code
|
NDC 70954-021-20
|
| Hospital Charge Code |
1710615
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.24
|
| Rate for Payer: Blue Distinction Transplant |
$0.25
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.29
|
| Rate for Payer: Cigna of CA PPO |
$0.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.35
|
| Rate for Payer: Dignity Health Media |
$0.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.35
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.33
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Prime Health Services Commercial |
$0.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.21
|
| Rate for Payer: United Healthcare All Other HMO |
$0.21
|
| Rate for Payer: United Healthcare HMO Rider |
$0.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.35
|
| Rate for Payer: Vantage Medical Group Senior |
$0.35
|
|
|
PRAZOSIN 5 MG CAPSULE [6470]
|
Facility
|
OP
|
$0.41
|
|
|
Service Code
|
NDC 70954-021-10
|
| Hospital Charge Code |
1710615
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.24
|
| Rate for Payer: Blue Distinction Transplant |
$0.25
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.29
|
| Rate for Payer: Cigna of CA PPO |
$0.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.35
|
| Rate for Payer: Dignity Health Media |
$0.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.35
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.33
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Prime Health Services Commercial |
$0.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.21
|
| Rate for Payer: United Healthcare All Other HMO |
$0.21
|
| Rate for Payer: United Healthcare HMO Rider |
$0.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.35
|
| Rate for Payer: Vantage Medical Group Senior |
$0.35
|
|
|
PRAZOSIN 5 MG CAPSULE [6470]
|
Facility
|
IP
|
$4.31
|
|
|
Service Code
|
NDC 51079-632-20
|
| Hospital Charge Code |
1710615
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$3.66 |
| Rate for Payer: Blue Shield of California Commercial |
$3.07
|
| Rate for Payer: Blue Shield of California EPN |
$2.21
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cigna of CA HMO |
$3.02
|
| Rate for Payer: Cigna of CA PPO |
$3.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.72
|
| Rate for Payer: Galaxy Health WC |
$3.66
|
| Rate for Payer: Global Benefits Group Commercial |
$2.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.03
|
| Rate for Payer: Multiplan Commercial |
$3.45
|
| Rate for Payer: Networks By Design Commercial |
$2.80
|
| Rate for Payer: Prime Health Services Commercial |
$3.66
|
|
|
PRAZOSIN 5 MG CAPSULE [6470]
|
Facility
|
OP
|
$1.57
|
|
|
Service Code
|
NDC 0093-4069-01
|
| Hospital Charge Code |
1710615
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.94
|
| Rate for Payer: Blue Distinction Transplant |
$0.94
|
| Rate for Payer: Blue Shield of California Commercial |
$1.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.92
|
| Rate for Payer: Cash Price |
$0.71
|
| Rate for Payer: Cigna of CA HMO |
$1.10
|
| Rate for Payer: Cigna of CA PPO |
$1.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.33
|
| Rate for Payer: Dignity Health Media |
$1.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.63
|
| Rate for Payer: Galaxy Health WC |
$1.33
|
| Rate for Payer: Global Benefits Group Commercial |
$0.94
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
| Rate for Payer: Networks By Design Commercial |
$1.02
|
| Rate for Payer: Prime Health Services Commercial |
$1.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.79
|
| Rate for Payer: United Healthcare All Other HMO |
$0.79
|
| Rate for Payer: United Healthcare HMO Rider |
$0.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.33
|
| Rate for Payer: Vantage Medical Group Senior |
$1.33
|
|
|
PREDNISOLONE 15 MG/5 ML ORAL SOLUTION [11117]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
CPT J7510
|
| Hospital Charge Code |
1715149
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| 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: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
|
|
PREDNISOLONE 15 MG/5 ML ORAL SOLUTION [11117]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
CPT J7510
|
| Hospital Charge Code |
1715149
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$5.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.62
|
| 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 |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.97
|
| Rate for Payer: Blue Distinction Transplant |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$5.92
|
| Rate for Payer: Cash Price |
$0.10
|
| 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 Media |
$0.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| 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
|
|
|
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 |
$9.24 |
| Max. Negotiated Rate |
$32.72 |
| Rate for Payer: Blue Shield of California Commercial |
$27.41
|
| Rate for Payer: Blue Shield of California EPN |
$19.71
|
| Rate for Payer: Cash Price |
$17.33
|
| Rate for Payer: Cigna of CA HMO |
$26.95
|
| Rate for Payer: Cigna of CA PPO |
$26.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.40
|
| Rate for Payer: Galaxy Health WC |
$32.72
|
| Rate for Payer: Global Benefits Group Commercial |
$23.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$30.80
|
| Rate for Payer: Networks By Design Commercial |
$25.02
|
| Rate for Payer: Prime Health Services Commercial |
$32.72
|
|
|
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 |
$9.24 |
| Max. Negotiated Rate |
$32.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.94
|
| Rate for Payer: Blue Distinction Transplant |
$23.10
|
| Rate for Payer: Blue Shield of California Commercial |
$28.37
|
| Rate for Payer: Blue Shield of California EPN |
$22.48
|
| Rate for Payer: Cash Price |
$17.33
|
| Rate for Payer: Cigna of CA HMO |
$26.95
|
| Rate for Payer: Cigna of CA PPO |
$26.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.72
|
| Rate for Payer: Dignity Health Media |
$32.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.40
|
| Rate for Payer: Galaxy Health WC |
$32.72
|
| Rate for Payer: Global Benefits Group Commercial |
$23.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$28.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$30.80
|
| Rate for Payer: Networks By Design Commercial |
$25.02
|
| Rate for Payer: Prime Health Services Commercial |
$32.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.25
|
| Rate for Payer: United Healthcare All Other HMO |
$19.25
|
| Rate for Payer: United Healthcare HMO Rider |
$19.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.72
|
| Rate for Payer: Vantage Medical Group Senior |
$32.72
|
|
|
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 |
$9.24 |
| Max. Negotiated Rate |
$32.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.94
|
| Rate for Payer: Blue Distinction Transplant |
$23.10
|
| Rate for Payer: Blue Shield of California Commercial |
$28.37
|
| Rate for Payer: Blue Shield of California EPN |
$22.48
|
| Rate for Payer: Cash Price |
$17.33
|
| Rate for Payer: Cigna of CA HMO |
$26.95
|
| Rate for Payer: Cigna of CA PPO |
$26.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.72
|
| Rate for Payer: Dignity Health Media |
$32.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.40
|
| Rate for Payer: Galaxy Health WC |
$32.72
|
| Rate for Payer: Global Benefits Group Commercial |
$23.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$28.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$30.80
|
| Rate for Payer: Networks By Design Commercial |
$25.02
|
| Rate for Payer: Prime Health Services Commercial |
$32.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.25
|
| Rate for Payer: United Healthcare All Other HMO |
$19.25
|
| Rate for Payer: United Healthcare HMO Rider |
$19.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.72
|
| Rate for Payer: Vantage Medical Group Senior |
$32.72
|
|
|
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 |
$9.24 |
| Max. Negotiated Rate |
$32.72 |
| Rate for Payer: Blue Shield of California Commercial |
$27.41
|
| Rate for Payer: Blue Shield of California EPN |
$19.71
|
| Rate for Payer: Cash Price |
$17.33
|
| Rate for Payer: Cigna of CA HMO |
$26.95
|
| Rate for Payer: Cigna of CA PPO |
$26.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.40
|
| Rate for Payer: Galaxy Health WC |
$32.72
|
| Rate for Payer: Global Benefits Group Commercial |
$23.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$30.80
|
| Rate for Payer: Networks By Design Commercial |
$25.02
|
| Rate for Payer: Prime Health Services Commercial |
$32.72
|
|
|
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 |
$9.24 |
| Max. Negotiated Rate |
$32.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.94
|
| Rate for Payer: Blue Distinction Transplant |
$23.10
|
| Rate for Payer: Blue Shield of California Commercial |
$28.37
|
| Rate for Payer: Blue Shield of California EPN |
$22.48
|
| Rate for Payer: Cash Price |
$17.33
|
| Rate for Payer: Cigna of CA HMO |
$26.95
|
| Rate for Payer: Cigna of CA PPO |
$26.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.72
|
| Rate for Payer: Dignity Health Media |
$32.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.40
|
| Rate for Payer: Galaxy Health WC |
$32.72
|
| Rate for Payer: Global Benefits Group Commercial |
$23.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$28.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$30.80
|
| Rate for Payer: Networks By Design Commercial |
$25.02
|
| Rate for Payer: Prime Health Services Commercial |
$32.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.25
|
| Rate for Payer: United Healthcare All Other HMO |
$19.25
|
| Rate for Payer: United Healthcare HMO Rider |
$19.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.72
|
| Rate for Payer: Vantage Medical Group Senior |
$32.72
|
|
|
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 |
$2.53 |
| Max. Negotiated Rate |
$8.98 |
| Rate for Payer: Blue Shield of California Commercial |
$7.52
|
| Rate for Payer: Blue Shield of California EPN |
$5.41
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Cigna of CA HMO |
$7.39
|
| Rate for Payer: Cigna of CA PPO |
$7.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.22
|
| Rate for Payer: Galaxy Health WC |
$8.98
|
| Rate for Payer: Global Benefits Group Commercial |
$6.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.53
|
| Rate for Payer: Multiplan Commercial |
$8.45
|
| Rate for Payer: Networks By Design Commercial |
$6.86
|
| Rate for Payer: Prime Health Services Commercial |
$8.98
|
|
|
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 |
$2.55 |
| Max. Negotiated Rate |
$9.03 |
| Rate for Payer: Blue Shield of California Commercial |
$7.56
|
| Rate for Payer: Blue Shield of California EPN |
$5.44
|
| Rate for Payer: Cash Price |
$4.78
|
| Rate for Payer: Cigna of CA HMO |
$7.43
|
| Rate for Payer: Cigna of CA PPO |
$7.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.25
|
| Rate for Payer: Galaxy Health WC |
$9.03
|
| Rate for Payer: Global Benefits Group Commercial |
$6.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.55
|
| Rate for Payer: Multiplan Commercial |
$8.50
|
| Rate for Payer: Networks By Design Commercial |
$6.90
|
| Rate for Payer: Prime Health Services Commercial |
$9.03
|
|
|
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 |
$2.55 |
| Max. Negotiated Rate |
$9.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.33
|
| Rate for Payer: Blue Distinction Transplant |
$6.37
|
| Rate for Payer: Blue Shield of California Commercial |
$7.83
|
| Rate for Payer: Blue Shield of California EPN |
$6.20
|
| Rate for Payer: Cash Price |
$4.78
|
| Rate for Payer: Cigna of CA HMO |
$7.43
|
| Rate for Payer: Cigna of CA PPO |
$7.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.03
|
| Rate for Payer: Dignity Health Media |
$9.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.25
|
| Rate for Payer: Galaxy Health WC |
$9.03
|
| Rate for Payer: Global Benefits Group Commercial |
$6.37
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.55
|
| Rate for Payer: Multiplan Commercial |
$8.50
|
| Rate for Payer: Networks By Design Commercial |
$6.90
|
| Rate for Payer: Prime Health Services Commercial |
$9.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.31
|
| Rate for Payer: United Healthcare All Other HMO |
$5.31
|
| Rate for Payer: United Healthcare HMO Rider |
$5.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.03
|
| Rate for Payer: Vantage Medical Group Senior |
$9.03
|
|
|
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 |
$9.24 |
| Max. Negotiated Rate |
$32.72 |
| Rate for Payer: Blue Shield of California Commercial |
$27.41
|
| Rate for Payer: Blue Shield of California EPN |
$19.71
|
| Rate for Payer: Cash Price |
$17.33
|
| Rate for Payer: Cigna of CA HMO |
$26.95
|
| Rate for Payer: Cigna of CA PPO |
$26.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.40
|
| Rate for Payer: Galaxy Health WC |
$32.72
|
| Rate for Payer: Global Benefits Group Commercial |
$23.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$30.80
|
| Rate for Payer: Networks By Design Commercial |
$25.02
|
| Rate for Payer: Prime Health Services Commercial |
$32.72
|
|
|
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 |
$2.53 |
| Max. Negotiated Rate |
$8.98 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.29
|
| Rate for Payer: Blue Distinction Transplant |
$6.34
|
| Rate for Payer: Blue Shield of California Commercial |
$7.78
|
| Rate for Payer: Blue Shield of California EPN |
$6.17
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Cigna of CA HMO |
$7.39
|
| Rate for Payer: Cigna of CA PPO |
$7.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.98
|
| Rate for Payer: Dignity Health Media |
$8.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.22
|
| Rate for Payer: Galaxy Health WC |
$8.98
|
| Rate for Payer: Global Benefits Group Commercial |
$6.34
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.53
|
| Rate for Payer: Multiplan Commercial |
$8.45
|
| Rate for Payer: Networks By Design Commercial |
$6.86
|
| Rate for Payer: Prime Health Services Commercial |
$8.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.28
|
| Rate for Payer: United Healthcare All Other HMO |
$5.28
|
| Rate for Payer: United Healthcare HMO Rider |
$5.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.98
|
| Rate for Payer: Vantage Medical Group Senior |
$8.98
|
|
|
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLUTION [29302]
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
CPT J7510
|
| Hospital Charge Code |
1715180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$5.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.97
|
| Rate for Payer: Blue Distinction Transplant |
$0.16
|
| Rate for Payer: Blue Distinction Transplant |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$5.92
|
| Rate for Payer: Blue Shield of California EPN |
$5.92
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.22
|
| Rate for Payer: Dignity Health Media |
$0.22
|
| Rate for Payer: Dignity Health Media |
$0.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.11
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.13
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
| Rate for Payer: Prime Health Services Commercial |
$0.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Vantage Medical Group Senior |
$0.22
|
| Rate for Payer: Vantage Medical Group Senior |
$0.13
|
|
|
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLUTION [29302]
|
Facility
|
IP
|
$0.15
|
|
|
Service Code
|
CPT J7510
|
| Hospital Charge Code |
1715180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.13
|
| Rate for Payer: Prime Health Services Commercial |
$0.13
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
|
