|
PYRAZINAMIDE 500 MG TABLET [6738]
|
Facility
|
OP
|
$5.46
|
|
|
Service Code
|
NDC 70954-484-10
|
| Hospital Charge Code |
1712086
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$4.64 |
| 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 |
$3.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.25
|
| Rate for Payer: Blue Distinction Transplant |
$3.28
|
| Rate for Payer: Blue Shield of California Commercial |
$4.02
|
| Rate for Payer: Blue Shield of California EPN |
$3.19
|
| 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 Media |
$4.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.18
|
| Rate for Payer: Galaxy Health WC |
$4.64
|
| Rate for Payer: Global Benefits Group Commercial |
$3.28
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.08
|
| 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
|
| 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
|
$6.06
|
|
|
Service Code
|
NDC 61748-012-06
|
| Hospital Charge Code |
1712086
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$5.15 |
| Rate for Payer: Blue Shield of California Commercial |
$4.31
|
| Rate for Payer: Blue Shield of California EPN |
$3.10
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cigna of CA HMO |
$4.24
|
| Rate for Payer: Cigna of CA PPO |
$4.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.42
|
| Rate for Payer: Galaxy Health WC |
$5.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.45
|
| Rate for Payer: Multiplan Commercial |
$4.85
|
| Rate for Payer: Networks By Design Commercial |
$3.94
|
| Rate for Payer: Prime Health Services Commercial |
$5.15
|
|
|
PYRAZINAMIDE 500 MG TABLET [6738]
|
Facility
|
OP
|
$4.40
|
|
|
Service Code
|
NDC 10135-735-60
|
| Hospital Charge Code |
1712086
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$3.74 |
| 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 |
$2.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.62
|
| Rate for Payer: Blue Distinction Transplant |
$2.64
|
| Rate for Payer: Blue Shield of California Commercial |
$3.24
|
| Rate for Payer: Blue Shield of California EPN |
$2.57
|
| 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 Media |
$3.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.76
|
| Rate for Payer: Galaxy Health WC |
$3.74
|
| Rate for Payer: Global Benefits Group Commercial |
$2.64
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.68
|
| 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
|
| 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
|
$4.40
|
|
|
Service Code
|
NDC 10135-735-60
|
| Hospital Charge Code |
1712086
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Blue Shield of California Commercial |
$3.13
|
| Rate for Payer: Blue Shield of California EPN |
$2.25
|
| 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: EPIC Health Plan Commercial |
$1.76
|
| Rate for Payer: Galaxy Health WC |
$3.74
|
| Rate for Payer: Global Benefits Group Commercial |
$2.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.68
|
| 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
|
$6.03
|
|
|
Service Code
|
NDC 61748-012-09
|
| Hospital Charge Code |
1712086
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$5.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.59
|
| Rate for Payer: Blue Distinction Transplant |
$3.62
|
| Rate for Payer: Blue Shield of California Commercial |
$4.44
|
| Rate for Payer: Blue Shield of California EPN |
$3.52
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Cigna of CA HMO |
$4.22
|
| Rate for Payer: Cigna of CA PPO |
$4.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.13
|
| Rate for Payer: Dignity Health Media |
$5.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.41
|
| Rate for Payer: Galaxy Health WC |
$5.13
|
| Rate for Payer: Global Benefits Group Commercial |
$3.62
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.45
|
| Rate for Payer: Multiplan Commercial |
$4.82
|
| Rate for Payer: Networks By Design Commercial |
$3.92
|
| Rate for Payer: Prime Health Services Commercial |
$5.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.02
|
| Rate for Payer: United Healthcare All Other HMO |
$3.02
|
| Rate for Payer: United Healthcare HMO Rider |
$3.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.13
|
| Rate for Payer: Vantage Medical Group Senior |
$5.13
|
|
|
PYRAZINAMIDE 500 MG TABLET [6738]
|
Facility
|
IP
|
$5.32
|
|
|
Service Code
|
NDC 33342-447-11
|
| Hospital Charge Code |
1712086
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$4.52 |
| Rate for Payer: Blue Shield of California Commercial |
$3.79
|
| Rate for Payer: Blue Shield of California EPN |
$2.72
|
| 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: EPIC Health Plan Commercial |
$2.13
|
| Rate for Payer: Galaxy Health WC |
$4.52
|
| Rate for Payer: Global Benefits Group Commercial |
$3.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.03
|
| 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 500 MG TABLET [6738]
|
Facility
|
IP
|
$5.46
|
|
|
Service Code
|
NDC 70954-484-10
|
| Hospital Charge Code |
1712086
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$4.64 |
| Rate for Payer: Blue Shield of California Commercial |
$3.89
|
| Rate for Payer: Blue Shield of California EPN |
$2.80
|
| 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: EPIC Health Plan Commercial |
$2.18
|
| Rate for Payer: Galaxy Health WC |
$4.64
|
| Rate for Payer: Global Benefits Group Commercial |
$3.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.08
|
| 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 ORAL SUSPENSION COMPOUND 100 MG/ML [4080326]
|
Facility
|
OP
|
$6.32
|
|
|
Service Code
|
NDC 9994-0803-26
|
| Hospital Charge Code |
1715093
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$5.37 |
| 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 |
$3.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.77
|
| Rate for Payer: Blue Distinction Transplant |
$3.79
|
| Rate for Payer: Blue Shield of California Commercial |
$4.66
|
| Rate for Payer: Blue Shield of California EPN |
$3.69
|
| 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 Media |
$5.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.53
|
| Rate for Payer: Galaxy Health WC |
$5.37
|
| Rate for Payer: Global Benefits Group Commercial |
$3.79
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.41
|
| 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
|
| 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
|
|
|
PYRAZINAMIDE ORAL SUSPENSION COMPOUND 100 MG/ML [4080326]
|
Facility
|
IP
|
$6.32
|
|
|
Service Code
|
NDC 9994-0803-26
|
| Hospital Charge Code |
1715093
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$5.37 |
| Rate for Payer: Blue Shield of California Commercial |
$4.50
|
| Rate for Payer: Blue Shield of California EPN |
$3.24
|
| 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: EPIC Health Plan Commercial |
$2.53
|
| Rate for Payer: Galaxy Health WC |
$5.37
|
| Rate for Payer: Global Benefits Group Commercial |
$3.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.41
|
| 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
|
|
|
PYRIDOSTIGMINE BROMIDE 5 MG/ML INJECTION SOLUTION [11237]
|
Facility
|
IP
|
$18.43
|
|
|
Service Code
|
NDC 0781-3040-95
|
| Hospital Charge Code |
1721076
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$15.67 |
| Rate for Payer: Blue Shield of California Commercial |
$13.12
|
| Rate for Payer: Blue Shield of California EPN |
$9.44
|
| Rate for Payer: Cash Price |
$8.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.37
|
| Rate for Payer: Galaxy Health WC |
$15.67
|
| Rate for Payer: Global Benefits Group Commercial |
$11.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.42
|
| Rate for Payer: Multiplan Commercial |
$14.74
|
| Rate for Payer: Networks By Design Commercial |
$11.98
|
| Rate for Payer: Prime Health Services Commercial |
$15.67
|
|
|
PYRIDOSTIGMINE BROMIDE 5 MG/ML INJECTION SOLUTION [11237]
|
Facility
|
IP
|
$18.43
|
|
|
Service Code
|
NDC 0781-3040-72
|
| Hospital Charge Code |
1721076
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$15.67 |
| Rate for Payer: Blue Shield of California Commercial |
$13.12
|
| Rate for Payer: Blue Shield of California EPN |
$9.44
|
| Rate for Payer: Cash Price |
$8.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.37
|
| Rate for Payer: Galaxy Health WC |
$15.67
|
| Rate for Payer: Global Benefits Group Commercial |
$11.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.42
|
| Rate for Payer: Multiplan Commercial |
$14.74
|
| Rate for Payer: Networks By Design Commercial |
$11.98
|
| Rate for Payer: Prime Health Services Commercial |
$15.67
|
|
|
PYRIDOSTIGMINE BROMIDE 5 MG/ML INJECTION SOLUTION [11237]
|
Facility
|
OP
|
$18.43
|
|
|
Service Code
|
NDC 0781-3040-95
|
| Hospital Charge Code |
1721076
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$15.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.98
|
| Rate for Payer: Blue Distinction Transplant |
$11.06
|
| Rate for Payer: Blue Shield of California Commercial |
$13.58
|
| Rate for Payer: Blue Shield of California EPN |
$10.76
|
| Rate for Payer: Cash Price |
$8.29
|
| Rate for Payer: Cigna of CA HMO |
$11.80
|
| Rate for Payer: Cigna of CA PPO |
$13.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.67
|
| Rate for Payer: Dignity Health Media |
$15.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.37
|
| Rate for Payer: Galaxy Health WC |
$15.67
|
| Rate for Payer: Global Benefits Group Commercial |
$11.06
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$13.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.42
|
| Rate for Payer: Multiplan Commercial |
$14.74
|
| Rate for Payer: Networks By Design Commercial |
$11.98
|
| Rate for Payer: Prime Health Services Commercial |
$15.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.22
|
| Rate for Payer: United Healthcare All Other HMO |
$9.22
|
| Rate for Payer: United Healthcare HMO Rider |
$9.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.67
|
| Rate for Payer: Vantage Medical Group Senior |
$15.67
|
|
|
PYRIDOSTIGMINE BROMIDE 5 MG/ML INJECTION SOLUTION [11237]
|
Facility
|
OP
|
$18.43
|
|
|
Service Code
|
NDC 0781-3040-72
|
| Hospital Charge Code |
1721076
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$15.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.98
|
| Rate for Payer: Blue Distinction Transplant |
$11.06
|
| Rate for Payer: Blue Shield of California Commercial |
$13.58
|
| Rate for Payer: Blue Shield of California EPN |
$10.76
|
| Rate for Payer: Cash Price |
$8.29
|
| Rate for Payer: Cigna of CA HMO |
$11.80
|
| Rate for Payer: Cigna of CA PPO |
$13.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.67
|
| Rate for Payer: Dignity Health Media |
$15.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.37
|
| Rate for Payer: Galaxy Health WC |
$15.67
|
| Rate for Payer: Global Benefits Group Commercial |
$11.06
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$13.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.42
|
| Rate for Payer: Multiplan Commercial |
$14.74
|
| Rate for Payer: Networks By Design Commercial |
$11.98
|
| Rate for Payer: Prime Health Services Commercial |
$15.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.22
|
| Rate for Payer: United Healthcare All Other HMO |
$9.22
|
| Rate for Payer: United Healthcare HMO Rider |
$9.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.67
|
| Rate for Payer: Vantage Medical Group Senior |
$15.67
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG/5 ML ORAL SYRUP [11238]
|
Facility
|
OP
|
$4.06
|
|
|
Service Code
|
NDC 0187-3012-20
|
| Hospital Charge Code |
1715939
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$3.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.42
|
| Rate for Payer: Blue Distinction Transplant |
$2.44
|
| Rate for Payer: Blue Shield of California Commercial |
$2.99
|
| Rate for Payer: Blue Shield of California EPN |
$2.37
|
| Rate for Payer: Cash Price |
$1.83
|
| Rate for Payer: Cigna of CA HMO |
$2.84
|
| Rate for Payer: Cigna of CA PPO |
$2.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.45
|
| Rate for Payer: Dignity Health Media |
$3.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.62
|
| Rate for Payer: Galaxy Health WC |
$3.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2.44
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.97
|
| Rate for Payer: Multiplan Commercial |
$3.25
|
| Rate for Payer: Networks By Design Commercial |
$2.64
|
| Rate for Payer: Prime Health Services Commercial |
$3.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.03
|
| Rate for Payer: United Healthcare All Other HMO |
$2.03
|
| Rate for Payer: United Healthcare HMO Rider |
$2.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.45
|
| Rate for Payer: Vantage Medical Group Senior |
$3.45
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG/5 ML ORAL SYRUP [11238]
|
Facility
|
IP
|
$4.06
|
|
|
Service Code
|
NDC 0187-3012-20
|
| Hospital Charge Code |
1715939
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$3.45 |
| Rate for Payer: Blue Shield of California Commercial |
$2.89
|
| Rate for Payer: Blue Shield of California EPN |
$2.08
|
| Rate for Payer: Cash Price |
$1.83
|
| Rate for Payer: Cigna of CA HMO |
$2.84
|
| Rate for Payer: Cigna of CA PPO |
$2.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.62
|
| Rate for Payer: Galaxy Health WC |
$3.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.97
|
| Rate for Payer: Multiplan Commercial |
$3.25
|
| Rate for Payer: Networks By Design Commercial |
$2.64
|
| Rate for Payer: Prime Health Services Commercial |
$3.45
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG TABLET [11239]
|
Facility
|
IP
|
$1.22
|
|
|
Service Code
|
NDC 71930-028-90
|
| Hospital Charge Code |
1710447
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Blue Shield of California Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$0.62
|
| 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: EPIC Health Plan Commercial |
$0.49
|
| Rate for Payer: Galaxy Health WC |
$1.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| 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
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG TABLET [11239]
|
Facility
|
IP
|
$1.22
|
|
|
Service Code
|
NDC 68682-302-10
|
| Hospital Charge Code |
1710447
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Blue Shield of California Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$0.62
|
| 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: EPIC Health Plan Commercial |
$0.49
|
| Rate for Payer: Galaxy Health WC |
$1.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| 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
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG TABLET [11239]
|
Facility
|
OP
|
$1.22
|
|
|
Service Code
|
NDC 68682-302-10
|
| Hospital Charge Code |
1710447
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.73
|
| Rate for Payer: Blue Distinction Transplant |
$0.73
|
| Rate for Payer: Blue Shield of California Commercial |
$0.90
|
| Rate for Payer: Blue Shield of California EPN |
$0.71
|
| 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: Dignity Health Commercial/Exchange |
$1.04
|
| Rate for Payer: Dignity Health Media |
$1.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.49
|
| Rate for Payer: Galaxy Health WC |
$1.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.73
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.61
|
| Rate for Payer: United Healthcare All Other HMO |
$0.61
|
| Rate for Payer: United Healthcare HMO Rider |
$0.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.04
|
| Rate for Payer: Vantage Medical Group Senior |
$1.04
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG TABLET [11239]
|
Facility
|
OP
|
$1.22
|
|
|
Service Code
|
NDC 71930-028-90
|
| Hospital Charge Code |
1710447
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.73
|
| Rate for Payer: Blue Distinction Transplant |
$0.73
|
| Rate for Payer: Blue Shield of California Commercial |
$0.90
|
| Rate for Payer: Blue Shield of California EPN |
$0.71
|
| 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: Dignity Health Commercial/Exchange |
$1.04
|
| Rate for Payer: Dignity Health Media |
$1.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.49
|
| Rate for Payer: Galaxy Health WC |
$1.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.73
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.61
|
| Rate for Payer: United Healthcare All Other HMO |
$0.61
|
| Rate for Payer: United Healthcare HMO Rider |
$0.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.04
|
| Rate for Payer: Vantage Medical Group Senior |
$1.04
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG TABLET [11239]
|
Facility
|
IP
|
$1.22
|
|
|
Service Code
|
NDC 68382-659-06
|
| Hospital Charge Code |
1710447
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Blue Shield of California Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$0.62
|
| 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: EPIC Health Plan Commercial |
$0.49
|
| Rate for Payer: Galaxy Health WC |
$1.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| 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
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG TABLET [11239]
|
Facility
|
OP
|
$1.22
|
|
|
Service Code
|
NDC 68382-659-06
|
| Hospital Charge Code |
1710447
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.73
|
| Rate for Payer: Blue Distinction Transplant |
$0.73
|
| Rate for Payer: Blue Shield of California Commercial |
$0.90
|
| Rate for Payer: Blue Shield of California EPN |
$0.71
|
| 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: Dignity Health Commercial/Exchange |
$1.04
|
| Rate for Payer: Dignity Health Media |
$1.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.49
|
| Rate for Payer: Galaxy Health WC |
$1.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.73
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.61
|
| Rate for Payer: United Healthcare All Other HMO |
$0.61
|
| Rate for Payer: United Healthcare HMO Rider |
$0.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.04
|
| Rate for Payer: Vantage Medical Group Senior |
$1.04
|
|
|
PYRIDOSTIGMINE BROMIDE ER 180 MG TABLET,EXTENDED RELEASE [11240]
|
Facility
|
OP
|
$24.83
|
|
|
Service Code
|
NDC 68682-301-30
|
| Hospital Charge Code |
1710454
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.96 |
| Max. Negotiated Rate |
$21.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$16.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.79
|
| Rate for Payer: Blue Distinction Transplant |
$14.90
|
| Rate for Payer: Blue Shield of California Commercial |
$18.30
|
| Rate for Payer: Blue Shield of California EPN |
$14.50
|
| Rate for Payer: Cash Price |
$11.17
|
| Rate for Payer: Cigna of CA HMO |
$17.38
|
| Rate for Payer: Cigna of CA PPO |
$17.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.11
|
| Rate for Payer: Dignity Health Media |
$21.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.93
|
| Rate for Payer: Galaxy Health WC |
$21.11
|
| Rate for Payer: Global Benefits Group Commercial |
$14.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$18.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.96
|
| Rate for Payer: Multiplan Commercial |
$19.86
|
| Rate for Payer: Networks By Design Commercial |
$16.14
|
| Rate for Payer: Prime Health Services Commercial |
$21.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.42
|
| Rate for Payer: United Healthcare All Other HMO |
$12.42
|
| Rate for Payer: United Healthcare HMO Rider |
$12.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.11
|
| Rate for Payer: Vantage Medical Group Senior |
$21.11
|
|
|
PYRIDOSTIGMINE BROMIDE ER 180 MG TABLET,EXTENDED RELEASE [11240]
|
Facility
|
IP
|
$24.83
|
|
|
Service Code
|
NDC 68682-301-30
|
| Hospital Charge Code |
1710454
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.96 |
| Max. Negotiated Rate |
$21.11 |
| Rate for Payer: Blue Shield of California Commercial |
$17.68
|
| Rate for Payer: Blue Shield of California EPN |
$12.71
|
| Rate for Payer: Cash Price |
$11.17
|
| Rate for Payer: Cigna of CA HMO |
$17.38
|
| Rate for Payer: Cigna of CA PPO |
$17.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.93
|
| Rate for Payer: Galaxy Health WC |
$21.11
|
| Rate for Payer: Global Benefits Group Commercial |
$14.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.96
|
| Rate for Payer: Multiplan Commercial |
$19.86
|
| Rate for Payer: Networks By Design Commercial |
$16.14
|
| Rate for Payer: Prime Health Services Commercial |
$21.11
|
|
|
PYRIDOXINE ORAL SOLUTION (IV FORM) 100 MG/ML [4080441]
|
Facility
|
OP
|
$10.79
|
|
|
Service Code
|
NDC 9994-0804-41
|
| Hospital Charge Code |
1715004
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$9.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.43
|
| Rate for Payer: Blue Distinction Transplant |
$6.47
|
| Rate for Payer: Blue Shield of California Commercial |
$7.95
|
| Rate for Payer: Blue Shield of California EPN |
$6.30
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Cigna of CA HMO |
$7.55
|
| Rate for Payer: Cigna of CA PPO |
$7.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.17
|
| Rate for Payer: Dignity Health Media |
$9.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.32
|
| Rate for Payer: Galaxy Health WC |
$9.17
|
| Rate for Payer: Global Benefits Group Commercial |
$6.47
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.59
|
| Rate for Payer: Multiplan Commercial |
$8.63
|
| Rate for Payer: Networks By Design Commercial |
$7.01
|
| Rate for Payer: Prime Health Services Commercial |
$9.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.40
|
| Rate for Payer: United Healthcare All Other HMO |
$5.40
|
| Rate for Payer: United Healthcare HMO Rider |
$5.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.17
|
| Rate for Payer: Vantage Medical Group Senior |
$9.17
|
|
|
PYRIDOXINE ORAL SOLUTION (IV FORM) 100 MG/ML [4080441]
|
Facility
|
IP
|
$10.79
|
|
|
Service Code
|
NDC 9994-0804-41
|
| Hospital Charge Code |
1715004
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$9.17 |
| Rate for Payer: Blue Shield of California Commercial |
$7.68
|
| Rate for Payer: Blue Shield of California EPN |
$5.52
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Cigna of CA HMO |
$7.55
|
| Rate for Payer: Cigna of CA PPO |
$7.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.32
|
| Rate for Payer: Galaxy Health WC |
$9.17
|
| Rate for Payer: Global Benefits Group Commercial |
$6.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.59
|
| Rate for Payer: Multiplan Commercial |
$8.63
|
| Rate for Payer: Networks By Design Commercial |
$7.01
|
| Rate for Payer: Prime Health Services Commercial |
$9.17
|
|
