|
PHYTONADIONE (VITAMIN K1) 5 MG TABLET [11024]
|
Facility
OP
|
$48.00
|
|
|
Service Code
|
NDC 69238-1051-3
|
| Hospital Charge Code |
1710433
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$29.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$26.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.36
|
| Rate for Payer: BCBS Transplant Transplant |
$28.80
|
| Rate for Payer: Blue Shield of California Commercial |
$30.19
|
| Rate for Payer: Blue Shield of California EPN |
$23.47
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Central Health Plan Commercial |
$38.40
|
| Rate for Payer: Cigna of CA HMO |
$33.60
|
| Rate for Payer: Cigna of CA PPO |
$33.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$19.20
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$36.00
|
| Rate for Payer: IEHP medi-cal |
$16.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$31.20
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$28.80
|
| Rate for Payer: Riverside University Health MISP |
$19.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.00
|
| Rate for Payer: United Healthcare All Other HMO |
$24.00
|
| Rate for Payer: United Healthcare HMO Rider |
$24.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.80
|
| Rate for Payer: Vantage Medical Group Senior |
$40.80
|
|
|
PHYTONADIONE (VITAMIN K1) 5 MG TABLET [11024]
|
Facility
OP
|
$80.85
|
|
|
Service Code
|
NDC 60687-381-11
|
| Hospital Charge Code |
1710433
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.17 |
| Max. Negotiated Rate |
$72.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$68.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$44.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$44.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.77
|
| Rate for Payer: BCBS Transplant Transplant |
$48.51
|
| Rate for Payer: Blue Shield of California Commercial |
$50.85
|
| Rate for Payer: Blue Shield of California EPN |
$39.54
|
| Rate for Payer: Cash Price |
$36.38
|
| Rate for Payer: Central Health Plan Commercial |
$64.68
|
| Rate for Payer: Cigna of CA HMO |
$56.60
|
| Rate for Payer: Cigna of CA PPO |
$56.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$32.34
|
| Rate for Payer: Galaxy Health WC |
$68.72
|
| Rate for Payer: Global Benefits Group Commercial |
$48.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.76
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$60.64
|
| Rate for Payer: IEHP medi-cal |
$28.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.17
|
| Rate for Payer: Multiplan Commercial |
$60.64
|
| Rate for Payer: Networks By Design Commercial |
$52.55
|
| Rate for Payer: Prime Health Services Commercial |
$68.72
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$48.51
|
| Rate for Payer: Riverside University Health MISP |
$32.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.42
|
| Rate for Payer: United Healthcare All Other HMO |
$40.42
|
| Rate for Payer: United Healthcare HMO Rider |
$40.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$40.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.72
|
| Rate for Payer: Vantage Medical Group Senior |
$68.72
|
|
|
PIFLUFOLASTAT F 18 37 MBQ/ML TO 2,960 MBQ/ML (1-80 MCI/ML) IV SOLUTION [231930]
|
Facility
OP
|
$4,738.00
|
|
|
Service Code
|
CPT A9595
|
| Hospital Charge Code |
ERX231930
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$580.35 |
| Max. Negotiated Rate |
$4,264.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$580.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,345.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$870.53
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$638.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$580.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,011.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,107.53
|
| Rate for Payer: BCBS Transplant Transplant |
$2,842.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,928.08
|
| Rate for Payer: Blue Shield of California EPN |
$2,302.67
|
| Rate for Payer: Caremore Medicare Advantage |
$580.35
|
| Rate for Payer: Cash Price |
$2,132.10
|
| Rate for Payer: Cash Price |
$2,132.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,790.40
|
| Rate for Payer: Cigna of CA HMO |
$3,032.32
|
| Rate for Payer: Cigna of CA PPO |
$3,506.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$725.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$783.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$580.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$580.35
|
| Rate for Payer: Galaxy Health WC |
$4,027.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,842.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,264.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,553.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$951.78
|
| Rate for Payer: IEHP medi-cal |
$957.58
|
| Rate for Payer: IEHP Medicare Advantage |
$580.35
|
| Rate for Payer: Innovage PACE Commercial |
$870.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,160.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$580.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$947.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$777.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$777.67
|
| Rate for Payer: Multiplan Commercial |
$3,553.50
|
| Rate for Payer: Networks By Design Commercial |
$3,079.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,027.30
|
| Rate for Payer: Prime Health Services Medicare |
$615.17
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,842.80
|
| Rate for Payer: Riverside University Health MISP |
$638.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,842.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,842.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,369.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,369.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,369.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,369.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$725.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$638.39
|
| Rate for Payer: Vantage Medical Group Senior |
$638.39
|
|
|
PIFLUFOLASTAT F 18 37 MBQ/ML TO 2,960 MBQ/ML (1-80 MCI/ML) IV SOLUTION [231930]
|
Facility
IP
|
$4,738.00
|
|
|
Service Code
|
CPT A9595
|
| Hospital Charge Code |
ERX231930
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$947.60 |
| Max. Negotiated Rate |
$4,264.20 |
| Rate for Payer: Blue Shield of California Commercial |
$3,553.50
|
| Rate for Payer: Blue Shield of California EPN |
$2,530.09
|
| Rate for Payer: Cash Price |
$2,132.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,790.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,895.20
|
| Rate for Payer: Galaxy Health WC |
$4,027.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,842.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,264.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,160.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$947.60
|
| Rate for Payer: Multiplan Commercial |
$3,553.50
|
| Rate for Payer: Networks By Design Commercial |
$3,079.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,027.30
|
|
|
PILOCARPINE 1 % EYE DROPS [6279]
|
Facility
OP
|
$6.31
|
|
|
Service Code
|
NDC 61314-203-15
|
| Hospital Charge Code |
1740073
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.73
|
| Rate for Payer: BCBS Transplant Transplant |
$3.79
|
| Rate for Payer: Blue Shield of California Commercial |
$3.97
|
| Rate for Payer: Blue Shield of California EPN |
$3.09
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Central Health Plan Commercial |
$5.05
|
| Rate for Payer: Cigna of CA HMO |
$4.42
|
| Rate for Payer: Cigna of CA PPO |
$4.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.52
|
| Rate for Payer: Galaxy Health WC |
$5.36
|
| Rate for Payer: Global Benefits Group Commercial |
$3.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.68
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.73
|
| Rate for Payer: IEHP medi-cal |
$2.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$4.73
|
| Rate for Payer: Networks By Design Commercial |
$4.10
|
| Rate for Payer: Prime Health Services Commercial |
$5.36
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.79
|
| Rate for Payer: Riverside University Health MISP |
$2.52
|
| 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 Medi-Cal |
$5.36
|
| Rate for Payer: Vantage Medical Group Senior |
$5.36
|
|
|
PILOCARPINE 1 % EYE DROPS [6279]
|
Facility
OP
|
$5.05
|
|
|
Service Code
|
NDC 69238-1745-8
|
| Hospital Charge Code |
1740073
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$4.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.29
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.98
|
| Rate for Payer: BCBS Transplant Transplant |
$3.03
|
| Rate for Payer: Blue Shield of California Commercial |
$3.18
|
| Rate for Payer: Blue Shield of California EPN |
$2.47
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Central Health Plan Commercial |
$4.04
|
| Rate for Payer: Cigna of CA HMO |
$3.54
|
| Rate for Payer: Cigna of CA PPO |
$3.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.02
|
| Rate for Payer: Galaxy Health WC |
$4.29
|
| Rate for Payer: Global Benefits Group Commercial |
$3.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.54
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.79
|
| Rate for Payer: IEHP medi-cal |
$1.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: Multiplan Commercial |
$3.79
|
| Rate for Payer: Networks By Design Commercial |
$3.28
|
| Rate for Payer: Prime Health Services Commercial |
$4.29
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.03
|
| Rate for Payer: Riverside University Health MISP |
$2.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.52
|
| Rate for Payer: United Healthcare All Other HMO |
$2.52
|
| Rate for Payer: United Healthcare HMO Rider |
$2.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4.29
|
|
|
PILOCARPINE 1 % EYE DROPS [6279]
|
Facility
OP
|
$5.94
|
|
|
Service Code
|
NDC 70069-181-01
|
| Hospital Charge Code |
1740073
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$5.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.27
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.51
|
| Rate for Payer: BCBS Transplant Transplant |
$3.56
|
| Rate for Payer: Blue Shield of California Commercial |
$3.74
|
| Rate for Payer: Blue Shield of California EPN |
$2.90
|
| Rate for Payer: Cash Price |
$2.67
|
| Rate for Payer: Central Health Plan Commercial |
$4.75
|
| Rate for Payer: Cigna of CA HMO |
$4.16
|
| Rate for Payer: Cigna of CA PPO |
$4.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.38
|
| Rate for Payer: Galaxy Health WC |
$5.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.35
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.46
|
| Rate for Payer: IEHP medi-cal |
$2.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.19
|
| Rate for Payer: Multiplan Commercial |
$4.46
|
| Rate for Payer: Networks By Design Commercial |
$3.86
|
| Rate for Payer: Prime Health Services Commercial |
$5.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.56
|
| Rate for Payer: Riverside University Health MISP |
$2.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.97
|
| Rate for Payer: United Healthcare All Other HMO |
$2.97
|
| Rate for Payer: United Healthcare HMO Rider |
$2.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.05
|
| Rate for Payer: Vantage Medical Group Senior |
$5.05
|
|
|
PILOCARPINE 1 % EYE DROPS [6279]
|
Facility
IP
|
$6.31
|
|
|
Service Code
|
NDC 61314-203-15
|
| Hospital Charge Code |
1740073
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.68 |
| Rate for Payer: Blue Shield of California Commercial |
$4.73
|
| Rate for Payer: Blue Shield of California EPN |
$3.37
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Central Health Plan Commercial |
$5.05
|
| 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 |
$2.52
|
| Rate for Payer: Galaxy Health WC |
$5.36
|
| Rate for Payer: Global Benefits Group Commercial |
$3.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$4.73
|
| Rate for Payer: Networks By Design Commercial |
$4.10
|
| Rate for Payer: Prime Health Services Commercial |
$5.36
|
|
|
PILOCARPINE 1 % EYE DROPS [6279]
|
Facility
IP
|
$5.05
|
|
|
Service Code
|
NDC 69238-1745-8
|
| Hospital Charge Code |
1740073
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$4.54 |
| Rate for Payer: Blue Shield of California Commercial |
$3.79
|
| Rate for Payer: Blue Shield of California EPN |
$2.70
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Central Health Plan Commercial |
$4.04
|
| Rate for Payer: Cigna of CA HMO |
$3.54
|
| Rate for Payer: Cigna of CA PPO |
$3.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.02
|
| Rate for Payer: Galaxy Health WC |
$4.29
|
| Rate for Payer: Global Benefits Group Commercial |
$3.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: Multiplan Commercial |
$3.79
|
| Rate for Payer: Networks By Design Commercial |
$3.28
|
| Rate for Payer: Prime Health Services Commercial |
$4.29
|
|
|
PILOCARPINE 1 % EYE DROPS [6279]
|
Facility
IP
|
$5.94
|
|
|
Service Code
|
NDC 70069-181-01
|
| Hospital Charge Code |
1740073
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$5.35 |
| Rate for Payer: Blue Shield of California Commercial |
$4.46
|
| Rate for Payer: Blue Shield of California EPN |
$3.17
|
| Rate for Payer: Cash Price |
$2.67
|
| Rate for Payer: Central Health Plan Commercial |
$4.75
|
| Rate for Payer: Cigna of CA HMO |
$4.16
|
| Rate for Payer: Cigna of CA PPO |
$4.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.38
|
| Rate for Payer: Galaxy Health WC |
$5.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.19
|
| Rate for Payer: Multiplan Commercial |
$4.46
|
| Rate for Payer: Networks By Design Commercial |
$3.86
|
| Rate for Payer: Prime Health Services Commercial |
$5.05
|
|
|
PILOCARPINE 2 % EYE DROPS [6280]
|
Facility
OP
|
$6.07
|
|
|
Service Code
|
NDC 70069-191-01
|
| Hospital Charge Code |
1740090
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$5.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.59
|
| Rate for Payer: BCBS Transplant Transplant |
$3.64
|
| Rate for Payer: Blue Shield of California Commercial |
$3.82
|
| Rate for Payer: Blue Shield of California EPN |
$2.97
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Central Health Plan Commercial |
$4.86
|
| Rate for Payer: Cigna of CA HMO |
$4.25
|
| Rate for Payer: Cigna of CA PPO |
$4.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.43
|
| Rate for Payer: Galaxy Health WC |
$5.16
|
| Rate for Payer: Global Benefits Group Commercial |
$3.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.46
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.55
|
| Rate for Payer: IEHP medi-cal |
$2.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.21
|
| Rate for Payer: Multiplan Commercial |
$4.55
|
| Rate for Payer: Networks By Design Commercial |
$3.95
|
| Rate for Payer: Prime Health Services Commercial |
$5.16
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.64
|
| Rate for Payer: Riverside University Health MISP |
$2.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.04
|
| Rate for Payer: United Healthcare All Other HMO |
$3.04
|
| Rate for Payer: United Healthcare HMO Rider |
$3.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.16
|
| Rate for Payer: Vantage Medical Group Senior |
$5.16
|
|
|
PILOCARPINE 2 % EYE DROPS [6280]
|
Facility
IP
|
$6.07
|
|
|
Service Code
|
NDC 70069-191-01
|
| Hospital Charge Code |
1740090
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$5.46 |
| Rate for Payer: Blue Shield of California Commercial |
$4.55
|
| Rate for Payer: Blue Shield of California EPN |
$3.24
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Central Health Plan Commercial |
$4.86
|
| Rate for Payer: Cigna of CA HMO |
$4.25
|
| Rate for Payer: Cigna of CA PPO |
$4.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.43
|
| Rate for Payer: Galaxy Health WC |
$5.16
|
| Rate for Payer: Global Benefits Group Commercial |
$3.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.21
|
| Rate for Payer: Multiplan Commercial |
$4.55
|
| Rate for Payer: Networks By Design Commercial |
$3.95
|
| Rate for Payer: Prime Health Services Commercial |
$5.16
|
|
|
PILOCARPINE 2 % EYE DROPS [6280]
|
Facility
OP
|
$6.45
|
|
|
Service Code
|
NDC 61314-204-15
|
| Hospital Charge Code |
1740090
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$5.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.81
|
| Rate for Payer: BCBS Transplant Transplant |
$3.87
|
| Rate for Payer: Blue Shield of California Commercial |
$4.06
|
| Rate for Payer: Blue Shield of California EPN |
$3.15
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: Central Health Plan Commercial |
$5.16
|
| Rate for Payer: Cigna of CA HMO |
$4.52
|
| Rate for Payer: Cigna of CA PPO |
$4.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.58
|
| Rate for Payer: Galaxy Health WC |
$5.48
|
| Rate for Payer: Global Benefits Group Commercial |
$3.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.84
|
| Rate for Payer: IEHP medi-cal |
$2.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.29
|
| Rate for Payer: Multiplan Commercial |
$4.84
|
| Rate for Payer: Networks By Design Commercial |
$4.19
|
| Rate for Payer: Prime Health Services Commercial |
$5.48
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.87
|
| Rate for Payer: Riverside University Health MISP |
$2.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.22
|
| Rate for Payer: United Healthcare All Other HMO |
$3.22
|
| Rate for Payer: United Healthcare HMO Rider |
$3.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.48
|
| Rate for Payer: Vantage Medical Group Senior |
$5.48
|
|
|
PILOCARPINE 2 % EYE DROPS [6280]
|
Facility
IP
|
$7.61
|
|
|
Service Code
|
NDC 0998-0204-15
|
| Hospital Charge Code |
1740090
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$6.85 |
| Rate for Payer: Blue Shield of California Commercial |
$5.71
|
| Rate for Payer: Blue Shield of California EPN |
$4.06
|
| Rate for Payer: Cash Price |
$3.42
|
| Rate for Payer: Central Health Plan Commercial |
$6.09
|
| Rate for Payer: Cigna of CA HMO |
$5.33
|
| Rate for Payer: Cigna of CA PPO |
$5.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.04
|
| Rate for Payer: Galaxy Health WC |
$6.47
|
| Rate for Payer: Global Benefits Group Commercial |
$4.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.52
|
| Rate for Payer: Multiplan Commercial |
$5.71
|
| Rate for Payer: Networks By Design Commercial |
$4.95
|
| Rate for Payer: Prime Health Services Commercial |
$6.47
|
|
|
PILOCARPINE 2 % EYE DROPS [6280]
|
Facility
OP
|
$7.61
|
|
|
Service Code
|
NDC 0998-0204-15
|
| Hospital Charge Code |
1740090
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$6.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.47
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.50
|
| Rate for Payer: BCBS Transplant Transplant |
$4.57
|
| Rate for Payer: Blue Shield of California Commercial |
$4.79
|
| Rate for Payer: Blue Shield of California EPN |
$3.72
|
| Rate for Payer: Cash Price |
$3.42
|
| Rate for Payer: Central Health Plan Commercial |
$6.09
|
| Rate for Payer: Cigna of CA HMO |
$5.33
|
| Rate for Payer: Cigna of CA PPO |
$5.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.04
|
| Rate for Payer: Galaxy Health WC |
$6.47
|
| Rate for Payer: Global Benefits Group Commercial |
$4.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.85
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.71
|
| Rate for Payer: IEHP medi-cal |
$2.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.52
|
| Rate for Payer: Multiplan Commercial |
$5.71
|
| Rate for Payer: Networks By Design Commercial |
$4.95
|
| Rate for Payer: Prime Health Services Commercial |
$6.47
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.57
|
| Rate for Payer: Riverside University Health MISP |
$3.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.80
|
| Rate for Payer: United Healthcare All Other HMO |
$3.80
|
| Rate for Payer: United Healthcare HMO Rider |
$3.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.47
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
PILOCARPINE 2 % EYE DROPS [6280]
|
Facility
IP
|
$6.26
|
|
|
Service Code
|
NDC 17478-224-12
|
| Hospital Charge Code |
1740090
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$5.63 |
| Rate for Payer: Blue Shield of California Commercial |
$4.70
|
| Rate for Payer: Blue Shield of California EPN |
$3.34
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Central Health Plan Commercial |
$5.01
|
| Rate for Payer: Cigna of CA HMO |
$4.38
|
| Rate for Payer: Cigna of CA PPO |
$4.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.50
|
| Rate for Payer: Galaxy Health WC |
$5.32
|
| Rate for Payer: Global Benefits Group Commercial |
$3.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.25
|
| Rate for Payer: Multiplan Commercial |
$4.70
|
| Rate for Payer: Networks By Design Commercial |
$4.07
|
| Rate for Payer: Prime Health Services Commercial |
$5.32
|
|
|
PILOCARPINE 2 % EYE DROPS [6280]
|
Facility
IP
|
$6.45
|
|
|
Service Code
|
NDC 61314-204-15
|
| Hospital Charge Code |
1740090
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$5.80 |
| Rate for Payer: Blue Shield of California Commercial |
$4.84
|
| Rate for Payer: Blue Shield of California EPN |
$3.44
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: Central Health Plan Commercial |
$5.16
|
| Rate for Payer: Cigna of CA HMO |
$4.52
|
| Rate for Payer: Cigna of CA PPO |
$4.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.58
|
| Rate for Payer: Galaxy Health WC |
$5.48
|
| Rate for Payer: Global Benefits Group Commercial |
$3.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.29
|
| Rate for Payer: Multiplan Commercial |
$4.84
|
| Rate for Payer: Networks By Design Commercial |
$4.19
|
| Rate for Payer: Prime Health Services Commercial |
$5.48
|
|
|
PILOCARPINE 2 % EYE DROPS [6280]
|
Facility
OP
|
$6.26
|
|
|
Service Code
|
NDC 17478-224-12
|
| Hospital Charge Code |
1740090
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$5.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.70
|
| Rate for Payer: BCBS Transplant Transplant |
$3.76
|
| Rate for Payer: Blue Shield of California Commercial |
$3.94
|
| Rate for Payer: Blue Shield of California EPN |
$3.06
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Central Health Plan Commercial |
$5.01
|
| Rate for Payer: Cigna of CA HMO |
$4.38
|
| Rate for Payer: Cigna of CA PPO |
$4.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.50
|
| Rate for Payer: Galaxy Health WC |
$5.32
|
| Rate for Payer: Global Benefits Group Commercial |
$3.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.63
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.70
|
| Rate for Payer: IEHP medi-cal |
$2.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.25
|
| Rate for Payer: Multiplan Commercial |
$4.70
|
| Rate for Payer: Networks By Design Commercial |
$4.07
|
| Rate for Payer: Prime Health Services Commercial |
$5.32
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.76
|
| Rate for Payer: Riverside University Health MISP |
$2.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.13
|
| Rate for Payer: United Healthcare All Other HMO |
$3.13
|
| Rate for Payer: United Healthcare HMO Rider |
$3.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.32
|
| Rate for Payer: Vantage Medical Group Senior |
$5.32
|
|
|
PILOCARPINE 4 % EYE DROPS [6282]
|
Facility
OP
|
$6.36
|
|
|
Service Code
|
NDC 70069-201-01
|
| Hospital Charge Code |
1740061
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$5.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.76
|
| Rate for Payer: BCBS Transplant Transplant |
$3.82
|
| Rate for Payer: Blue Shield of California Commercial |
$4.00
|
| Rate for Payer: Blue Shield of California EPN |
$3.11
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Central Health Plan Commercial |
$5.09
|
| Rate for Payer: Cigna of CA HMO |
$4.45
|
| Rate for Payer: Cigna of CA PPO |
$4.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.54
|
| Rate for Payer: Galaxy Health WC |
$5.41
|
| Rate for Payer: Global Benefits Group Commercial |
$3.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.72
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.77
|
| Rate for Payer: IEHP medi-cal |
$2.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: Multiplan Commercial |
$4.77
|
| Rate for Payer: Networks By Design Commercial |
$4.13
|
| Rate for Payer: Prime Health Services Commercial |
$5.41
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.82
|
| Rate for Payer: Riverside University Health MISP |
$2.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.18
|
| Rate for Payer: United Healthcare All Other HMO |
$3.18
|
| Rate for Payer: United Healthcare HMO Rider |
$3.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.41
|
| Rate for Payer: Vantage Medical Group Senior |
$5.41
|
|
|
PILOCARPINE 4 % EYE DROPS [6282]
|
Facility
IP
|
$6.36
|
|
|
Service Code
|
NDC 70069-201-01
|
| Hospital Charge Code |
1740061
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$5.72 |
| Rate for Payer: Blue Shield of California Commercial |
$4.77
|
| Rate for Payer: Blue Shield of California EPN |
$3.40
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Central Health Plan Commercial |
$5.09
|
| Rate for Payer: Cigna of CA HMO |
$4.45
|
| Rate for Payer: Cigna of CA PPO |
$4.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.54
|
| Rate for Payer: Galaxy Health WC |
$5.41
|
| Rate for Payer: Global Benefits Group Commercial |
$3.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: Multiplan Commercial |
$4.77
|
| Rate for Payer: Networks By Design Commercial |
$4.13
|
| Rate for Payer: Prime Health Services Commercial |
$5.41
|
|
|
PILOCARPINE 5 MG TABLET [12803]
|
Facility
IP
|
$2.73
|
|
|
Service Code
|
NDC 68084-928-25
|
| Hospital Charge Code |
1711692
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Blue Shield of California Commercial |
$2.05
|
| Rate for Payer: Blue Shield of California EPN |
$1.46
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: Central Health Plan Commercial |
$2.18
|
| Rate for Payer: Cigna of CA HMO |
$1.91
|
| Rate for Payer: Cigna of CA PPO |
$1.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.09
|
| Rate for Payer: Galaxy Health WC |
$2.32
|
| Rate for Payer: Global Benefits Group Commercial |
$1.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$2.05
|
| Rate for Payer: Networks By Design Commercial |
$1.77
|
| Rate for Payer: Prime Health Services Commercial |
$2.32
|
|
|
PILOCARPINE 5 MG TABLET [12803]
|
Facility
OP
|
$0.49
|
|
|
Service Code
|
NDC 0527-1313-01
|
| Hospital Charge Code |
1711692
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.42
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.27
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.29
|
| Rate for Payer: BCBS Transplant Transplant |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.39
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.44
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.37
|
| Rate for Payer: IEHP medi-cal |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.32
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: Riverside University Health MISP |
$0.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.25
|
| Rate for Payer: United Healthcare All Other HMO |
$0.25
|
| Rate for Payer: United Healthcare HMO Rider |
$0.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.42
|
| Rate for Payer: Vantage Medical Group Senior |
$0.42
|
|
|
PILOCARPINE 5 MG TABLET [12803]
|
Facility
OP
|
$2.73
|
|
|
Service Code
|
NDC 68084-928-25
|
| Hospital Charge Code |
1711692
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.61
|
| Rate for Payer: BCBS Transplant Transplant |
$1.64
|
| Rate for Payer: Blue Shield of California Commercial |
$1.72
|
| Rate for Payer: Blue Shield of California EPN |
$1.33
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: Central Health Plan Commercial |
$2.18
|
| Rate for Payer: Cigna of CA HMO |
$1.91
|
| Rate for Payer: Cigna of CA PPO |
$1.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.09
|
| Rate for Payer: Galaxy Health WC |
$2.32
|
| Rate for Payer: Global Benefits Group Commercial |
$1.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.46
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.05
|
| Rate for Payer: IEHP medi-cal |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$2.05
|
| Rate for Payer: Networks By Design Commercial |
$1.77
|
| Rate for Payer: Prime Health Services Commercial |
$2.32
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.64
|
| Rate for Payer: Riverside University Health MISP |
$1.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.36
|
| Rate for Payer: United Healthcare All Other HMO |
$1.36
|
| Rate for Payer: United Healthcare HMO Rider |
$1.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.32
|
| Rate for Payer: Vantage Medical Group Senior |
$2.32
|
|
|
PILOCARPINE 5 MG TABLET [12803]
|
Facility
IP
|
$2.73
|
|
|
Service Code
|
NDC 68084-928-95
|
| Hospital Charge Code |
1711692
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Blue Shield of California Commercial |
$2.05
|
| Rate for Payer: Blue Shield of California EPN |
$1.46
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: Central Health Plan Commercial |
$2.18
|
| Rate for Payer: Cigna of CA HMO |
$1.91
|
| Rate for Payer: Cigna of CA PPO |
$1.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.09
|
| Rate for Payer: Galaxy Health WC |
$2.32
|
| Rate for Payer: Global Benefits Group Commercial |
$1.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$2.05
|
| Rate for Payer: Networks By Design Commercial |
$1.77
|
| Rate for Payer: Prime Health Services Commercial |
$2.32
|
|
|
PILOCARPINE 5 MG TABLET [12803]
|
Facility
IP
|
$0.49
|
|
|
Service Code
|
NDC 0527-1313-01
|
| Hospital Charge Code |
1711692
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.39
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.32
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
|
