|
PRAZOSIN 5 MG CAPSULE [6470]
|
Facility
|
IP
|
$4.31
|
|
|
Service Code
|
NDC 51079-632-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Blue Shield of California Commercial |
$3.33
|
| Rate for Payer: Blue Shield of California EPN |
$2.17
|
| Rate for Payer: Cash Price |
$2.37
|
| Rate for Payer: Central Health Plan Commercial |
$3.45
|
| 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: EPIC Health Plan Senior |
$1.72
|
| Rate for Payer: Galaxy Health WC |
$3.66
|
| Rate for Payer: Global Benefits Group Commercial |
$2.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.88
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$2.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$3.23
|
| 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
|
$4.11
|
|
|
Service Code
|
NDC 60687-572-32
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$3.70 |
| Rate for Payer: Adventist Health Commercial |
$0.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.41
|
| Rate for Payer: Blue Shield of California Commercial |
$2.51
|
| Rate for Payer: Blue Shield of California EPN |
$1.64
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Central Health Plan Commercial |
$3.29
|
| Rate for Payer: Cigna of CA HMO |
$2.88
|
| Rate for Payer: Cigna of CA PPO |
$2.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.64
|
| Rate for Payer: EPIC Health Plan Senior |
$1.64
|
| Rate for Payer: Galaxy Health WC |
$3.49
|
| Rate for Payer: Global Benefits Group Commercial |
$2.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.70
|
| Rate for Payer: InnovAge PACE Commercial |
$2.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$3.08
|
| Rate for Payer: Networks By Design Commercial |
$2.67
|
| Rate for Payer: Prime Health Services Commercial |
$3.49
|
| Rate for Payer: Riverside University Health System MISP |
$1.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.06
|
| Rate for Payer: United Healthcare All Other HMO |
$2.06
|
| Rate for Payer: United Healthcare HMO Rider |
$2.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.49
|
| Rate for Payer: Vantage Medical Group Senior |
$3.49
|
|
|
PRAZOSIN 5 MG CAPSULE [6470]
|
Facility
|
IP
|
$0.33
|
|
|
Service Code
|
NDC 70954-021-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Central Health Plan Commercial |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.23
|
| Rate for Payer: Cigna of CA PPO |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: EPIC Health Plan Senior |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.28
|
|
|
PRAZOSIN 5 MG CAPSULE [6470]
|
Facility
|
OP
|
$1.26
|
|
|
Service Code
|
NDC 0093-4069-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.13 |
| Rate for Payer: Adventist Health Commercial |
$0.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.74
|
| Rate for Payer: Blue Shield of California Commercial |
$0.77
|
| Rate for Payer: Blue Shield of California EPN |
$0.50
|
| Rate for Payer: Cash Price |
$0.69
|
| Rate for Payer: Central Health Plan Commercial |
$1.01
|
| Rate for Payer: Cigna of CA HMO |
$0.88
|
| Rate for Payer: Cigna of CA PPO |
$0.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
| Rate for Payer: EPIC Health Plan Senior |
$0.50
|
| Rate for Payer: Galaxy Health WC |
$1.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.13
|
| Rate for Payer: InnovAge PACE Commercial |
$0.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.88
|
| Rate for Payer: Multiplan Commercial |
$0.95
|
| Rate for Payer: Networks By Design Commercial |
$0.82
|
| Rate for Payer: Prime Health Services Commercial |
$1.07
|
| Rate for Payer: Riverside University Health System MISP |
$0.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.63
|
| Rate for Payer: United Healthcare All Other HMO |
$0.63
|
| Rate for Payer: United Healthcare HMO Rider |
$0.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.07
|
| Rate for Payer: Vantage Medical Group Senior |
$1.07
|
|
|
PRAZOSIN 5 MG CAPSULE [6470]
|
Facility
|
IP
|
$0.28
|
|
|
Service Code
|
NDC 70756-440-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Senior |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.24
|
|
|
PRAZOSIN 5 MG CAPSULE [6470]
|
Facility
|
OP
|
$4.11
|
|
|
Service Code
|
NDC 60687-572-33
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$3.70 |
| Rate for Payer: Adventist Health Commercial |
$0.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.41
|
| Rate for Payer: Blue Shield of California Commercial |
$2.51
|
| Rate for Payer: Blue Shield of California EPN |
$1.64
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Central Health Plan Commercial |
$3.29
|
| Rate for Payer: Cigna of CA HMO |
$2.88
|
| Rate for Payer: Cigna of CA PPO |
$2.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.64
|
| Rate for Payer: EPIC Health Plan Senior |
$1.64
|
| Rate for Payer: Galaxy Health WC |
$3.49
|
| Rate for Payer: Global Benefits Group Commercial |
$2.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.70
|
| Rate for Payer: InnovAge PACE Commercial |
$2.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$3.08
|
| Rate for Payer: Networks By Design Commercial |
$2.67
|
| Rate for Payer: Prime Health Services Commercial |
$3.49
|
| Rate for Payer: Riverside University Health System MISP |
$1.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.06
|
| Rate for Payer: United Healthcare All Other HMO |
$2.06
|
| Rate for Payer: United Healthcare HMO Rider |
$2.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.49
|
| Rate for Payer: Vantage Medical Group Senior |
$3.49
|
|
|
PRAZOSIN 5 MG CAPSULE [6470]
|
Facility
|
IP
|
$4.11
|
|
|
Service Code
|
NDC 60687-572-33
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$3.70 |
| Rate for Payer: Adventist Health Commercial |
$0.82
|
| Rate for Payer: Blue Shield of California Commercial |
$3.18
|
| Rate for Payer: Blue Shield of California EPN |
$2.07
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Central Health Plan Commercial |
$3.29
|
| Rate for Payer: Cigna of CA HMO |
$2.88
|
| Rate for Payer: Cigna of CA PPO |
$2.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.64
|
| Rate for Payer: EPIC Health Plan Senior |
$1.64
|
| Rate for Payer: Galaxy Health WC |
$3.49
|
| Rate for Payer: Global Benefits Group Commercial |
$2.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.82
|
| Rate for Payer: Multiplan Commercial |
$3.08
|
| Rate for Payer: Networks By Design Commercial |
$2.67
|
| Rate for Payer: Prime Health Services Commercial |
$3.49
|
|
|
PRAZOSIN 5 MG CAPSULE [6470]
|
Facility
|
IP
|
$1.26
|
|
|
Service Code
|
NDC 0093-4069-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.13 |
| Rate for Payer: Adventist Health Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California Commercial |
$0.97
|
| Rate for Payer: Blue Shield of California EPN |
$0.64
|
| Rate for Payer: Cash Price |
$0.69
|
| Rate for Payer: Central Health Plan Commercial |
$1.01
|
| Rate for Payer: Cigna of CA HMO |
$0.88
|
| Rate for Payer: Cigna of CA PPO |
$0.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
| Rate for Payer: EPIC Health Plan Senior |
$0.50
|
| Rate for Payer: Galaxy Health WC |
$1.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.95
|
| Rate for Payer: Networks By Design Commercial |
$0.82
|
| Rate for Payer: Prime Health Services Commercial |
$1.07
|
|
|
PRAZOSIN 5 MG CAPSULE [6470]
|
Facility
|
OP
|
$4.31
|
|
|
Service Code
|
NDC 51079-632-20
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.62
|
| 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 |
$3.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.53
|
| Rate for Payer: Blue Shield of California Commercial |
$2.63
|
| Rate for Payer: Blue Shield of California EPN |
$1.72
|
| Rate for Payer: Cash Price |
$2.37
|
| Rate for Payer: Central Health Plan Commercial |
$3.45
|
| 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 Medi-Cal |
$3.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.72
|
| Rate for Payer: EPIC Health Plan Senior |
$1.72
|
| Rate for Payer: Galaxy Health WC |
$3.66
|
| Rate for Payer: Global Benefits Group Commercial |
$2.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.88
|
| Rate for Payer: InnovAge PACE Commercial |
$2.15
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$2.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.02
|
| Rate for Payer: Multiplan Commercial |
$3.23
|
| Rate for Payer: Networks By Design Commercial |
$2.80
|
| Rate for Payer: Prime Health Services Commercial |
$3.66
|
| Rate for Payer: Riverside University Health System MISP |
$1.72
|
| 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 |
$2.15
|
| Rate for Payer: United Healthcare All Other HMO |
$2.15
|
| Rate for Payer: United Healthcare HMO Rider |
$2.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.15
|
| 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
|
$4.11
|
|
|
Service Code
|
NDC 60687-572-32
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$3.70 |
| Rate for Payer: Adventist Health Commercial |
$0.82
|
| Rate for Payer: Blue Shield of California Commercial |
$3.18
|
| Rate for Payer: Blue Shield of California EPN |
$2.07
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Central Health Plan Commercial |
$3.29
|
| Rate for Payer: Cigna of CA HMO |
$2.88
|
| Rate for Payer: Cigna of CA PPO |
$2.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.64
|
| Rate for Payer: EPIC Health Plan Senior |
$1.64
|
| Rate for Payer: Galaxy Health WC |
$3.49
|
| Rate for Payer: Global Benefits Group Commercial |
$2.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.82
|
| Rate for Payer: Multiplan Commercial |
$3.08
|
| Rate for Payer: Networks By Design Commercial |
$2.67
|
| Rate for Payer: Prime Health Services Commercial |
$3.49
|
|
|
PREDNISOLONE 15 MG/5 ML ORAL SOLUTION [11117]
|
Facility
|
OP
|
$1.44
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$5.74 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.56
|
| Rate for Payer: Blue Shield of California Commercial |
$5.74
|
| Rate for Payer: Blue Shield of California EPN |
$5.22
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: Central Health Plan Commercial |
$1.15
|
| Rate for Payer: Cigna of CA HMO |
$1.01
|
| Rate for Payer: Cigna of CA PPO |
$1.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Senior |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.48
|
| Rate for Payer: InnovAge PACE Commercial |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.01
|
| Rate for Payer: Multiplan Commercial |
$1.08
|
| Rate for Payer: Networks By Design Commercial |
$0.72
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
| Rate for Payer: Riverside University Health System MISP |
$0.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.54
|
| Rate for Payer: United Healthcare All Other HMO |
$0.53
|
| Rate for Payer: United Healthcare HMO Rider |
$0.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.22
|
| Rate for Payer: Vantage Medical Group Senior |
$1.22
|
|
|
PREDNISOLONE 15 MG/5 ML ORAL SOLUTION [11117]
|
Facility
|
IP
|
$1.44
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$1.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.73
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: Central Health Plan Commercial |
$1.15
|
| Rate for Payer: Cigna of CA HMO |
$1.01
|
| Rate for Payer: Cigna of CA PPO |
$1.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Senior |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$1.08
|
| Rate for Payer: Networks By Design Commercial |
$0.72
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.54
|
| Rate for Payer: United Healthcare All Other HMO |
$0.53
|
| Rate for Payer: United Healthcare HMO Rider |
$0.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.47
|
|
|
PREDNISOLONE ACETATE 0.12 % EYE DROPS,SUSPENSION [27038]
|
Facility
|
IP
|
$38.50
|
|
|
Service Code
|
NDC 11980-174-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.70 |
| Max. Negotiated Rate |
$34.65 |
| Rate for Payer: Adventist Health Commercial |
$7.70
|
| Rate for Payer: Blue Shield of California Commercial |
$29.76
|
| Rate for Payer: Blue Shield of California EPN |
$19.40
|
| Rate for Payer: Cash Price |
$21.17
|
| Rate for Payer: Central Health Plan Commercial |
$30.80
|
| 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: EPIC Health Plan Senior |
$15.40
|
| Rate for Payer: Galaxy Health WC |
$32.73
|
| Rate for Payer: Global Benefits Group Commercial |
$23.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.65
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$23.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.70
|
| Rate for Payer: Multiplan Commercial |
$28.88
|
| Rate for Payer: Networks By Design Commercial |
$25.02
|
| Rate for Payer: Prime Health Services Commercial |
$32.73
|
|
|
PREDNISOLONE ACETATE 0.12 % EYE DROPS,SUSPENSION [27038]
|
Facility
|
OP
|
$38.50
|
|
|
Service Code
|
NDC 11980-174-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.70 |
| Max. Negotiated Rate |
$34.65 |
| Rate for Payer: Adventist Health Commercial |
$7.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.61
|
| Rate for Payer: Blue Shield of California Commercial |
$23.52
|
| Rate for Payer: Blue Shield of California EPN |
$15.36
|
| Rate for Payer: Cash Price |
$21.17
|
| Rate for Payer: Central Health Plan Commercial |
$30.80
|
| 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 |
$32.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.40
|
| Rate for Payer: EPIC Health Plan Senior |
$15.40
|
| Rate for Payer: Galaxy Health WC |
$32.73
|
| Rate for Payer: Global Benefits Group Commercial |
$23.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.65
|
| Rate for Payer: InnovAge PACE Commercial |
$19.25
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$23.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.95
|
| Rate for Payer: Multiplan Commercial |
$28.88
|
| Rate for Payer: Networks By Design Commercial |
$25.02
|
| Rate for Payer: Prime Health Services Commercial |
$32.73
|
| Rate for Payer: Riverside University Health System MISP |
$15.40
|
| 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 |
$32.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.73
|
| Rate for Payer: Vantage Medical Group Senior |
$32.73
|
|
|
PREDNISOLONE ACETATE 0.12 % EYE DROPS,SUSPENSION [27038]
|
Facility
|
IP
|
$38.50
|
|
|
Service Code
|
NDC 11980-174-05
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.70 |
| Max. Negotiated Rate |
$34.65 |
| Rate for Payer: Adventist Health Commercial |
$7.70
|
| Rate for Payer: Blue Shield of California Commercial |
$29.76
|
| Rate for Payer: Blue Shield of California EPN |
$19.40
|
| Rate for Payer: Cash Price |
$21.17
|
| Rate for Payer: Central Health Plan Commercial |
$30.80
|
| 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: EPIC Health Plan Senior |
$15.40
|
| Rate for Payer: Galaxy Health WC |
$32.73
|
| Rate for Payer: Global Benefits Group Commercial |
$23.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.65
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$23.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.70
|
| Rate for Payer: Multiplan Commercial |
$28.88
|
| Rate for Payer: Networks By Design Commercial |
$25.02
|
| Rate for Payer: Prime Health Services Commercial |
$32.73
|
|
|
PREDNISOLONE ACETATE 0.12 % EYE DROPS,SUSPENSION [27038]
|
Facility
|
OP
|
$38.50
|
|
|
Service Code
|
NDC 11980-174-05
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.70 |
| Max. Negotiated Rate |
$34.65 |
| Rate for Payer: Adventist Health Commercial |
$7.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.61
|
| Rate for Payer: Blue Shield of California Commercial |
$23.52
|
| Rate for Payer: Blue Shield of California EPN |
$15.36
|
| Rate for Payer: Cash Price |
$21.17
|
| Rate for Payer: Central Health Plan Commercial |
$30.80
|
| 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 |
$32.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.40
|
| Rate for Payer: EPIC Health Plan Senior |
$15.40
|
| Rate for Payer: Galaxy Health WC |
$32.73
|
| Rate for Payer: Global Benefits Group Commercial |
$23.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.65
|
| Rate for Payer: InnovAge PACE Commercial |
$19.25
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$23.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.95
|
| Rate for Payer: Multiplan Commercial |
$28.88
|
| Rate for Payer: Networks By Design Commercial |
$25.02
|
| Rate for Payer: Prime Health Services Commercial |
$32.73
|
| Rate for Payer: Riverside University Health System MISP |
$15.40
|
| 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 |
$32.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.73
|
| Rate for Payer: Vantage Medical Group Senior |
$32.73
|
|
|
PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION [6487]
|
Facility
|
IP
|
$10.56
|
|
|
Service Code
|
NDC 60758-119-05
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: Adventist Health Commercial |
$2.11
|
| Rate for Payer: Blue Shield of California Commercial |
$8.16
|
| Rate for Payer: Blue Shield of California EPN |
$5.32
|
| Rate for Payer: Cash Price |
$5.81
|
| Rate for Payer: Central Health Plan Commercial |
$8.45
|
| 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: EPIC Health Plan Senior |
$4.22
|
| Rate for Payer: Galaxy Health WC |
$8.98
|
| Rate for Payer: Global Benefits Group Commercial |
$6.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.50
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$6.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.11
|
| Rate for Payer: Multiplan Commercial |
$7.92
|
| 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
|
$38.50
|
|
|
Service Code
|
NDC 11980-180-05
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.70 |
| Max. Negotiated Rate |
$34.65 |
| Rate for Payer: Adventist Health Commercial |
$7.70
|
| Rate for Payer: Blue Shield of California Commercial |
$29.76
|
| Rate for Payer: Blue Shield of California EPN |
$19.40
|
| Rate for Payer: Cash Price |
$21.17
|
| Rate for Payer: Central Health Plan Commercial |
$30.80
|
| 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: EPIC Health Plan Senior |
$15.40
|
| Rate for Payer: Galaxy Health WC |
$32.73
|
| Rate for Payer: Global Benefits Group Commercial |
$23.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.65
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$23.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.70
|
| Rate for Payer: Multiplan Commercial |
$28.88
|
| Rate for Payer: Networks By Design Commercial |
$25.02
|
| Rate for Payer: Prime Health Services Commercial |
$32.73
|
|
|
PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION [6487]
|
Facility
|
OP
|
$10.56
|
|
|
Service Code
|
NDC 60758-119-05
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: Adventist Health Commercial |
$2.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.41
|
| 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 |
$7.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6.45
|
| Rate for Payer: Blue Shield of California EPN |
$4.21
|
| Rate for Payer: Cash Price |
$5.81
|
| Rate for Payer: Central Health Plan Commercial |
$8.45
|
| 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 Medi-Cal |
$8.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.22
|
| Rate for Payer: EPIC Health Plan Senior |
$4.22
|
| Rate for Payer: Galaxy Health WC |
$8.98
|
| Rate for Payer: Global Benefits Group Commercial |
$6.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.50
|
| Rate for Payer: InnovAge PACE Commercial |
$5.28
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$6.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.39
|
| Rate for Payer: Multiplan Commercial |
$7.92
|
| Rate for Payer: Networks By Design Commercial |
$6.86
|
| Rate for Payer: Prime Health Services Commercial |
$8.98
|
| Rate for Payer: Riverside University Health System MISP |
$4.22
|
| 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 ACETATE 1 % EYE DROPS,SUSPENSION [6487]
|
Facility
|
OP
|
$10.62
|
|
|
Service Code
|
NDC 61314-637-05
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.12 |
| Max. Negotiated Rate |
$9.56 |
| Rate for Payer: Adventist Health Commercial |
$2.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.45
|
| 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 |
$7.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.24
|
| Rate for Payer: Blue Shield of California Commercial |
$6.49
|
| Rate for Payer: Blue Shield of California EPN |
$4.24
|
| Rate for Payer: Cash Price |
$5.84
|
| Rate for Payer: Central Health Plan Commercial |
$8.50
|
| 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 Medi-Cal |
$9.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.25
|
| Rate for Payer: EPIC Health Plan Senior |
$4.25
|
| Rate for Payer: Galaxy Health WC |
$9.03
|
| Rate for Payer: Global Benefits Group Commercial |
$6.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.56
|
| Rate for Payer: InnovAge PACE Commercial |
$5.31
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$6.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.43
|
| Rate for Payer: Multiplan Commercial |
$7.96
|
| Rate for Payer: Networks By Design Commercial |
$6.90
|
| Rate for Payer: Prime Health Services Commercial |
$9.03
|
| Rate for Payer: Riverside University Health System MISP |
$4.25
|
| 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
|
$10.62
|
|
|
Service Code
|
NDC 61314-637-05
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.12 |
| Max. Negotiated Rate |
$9.56 |
| Rate for Payer: Adventist Health Commercial |
$2.12
|
| Rate for Payer: Blue Shield of California Commercial |
$8.21
|
| Rate for Payer: Blue Shield of California EPN |
$5.35
|
| Rate for Payer: Cash Price |
$5.84
|
| Rate for Payer: Central Health Plan Commercial |
$8.50
|
| 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: EPIC Health Plan Senior |
$4.25
|
| Rate for Payer: Galaxy Health WC |
$9.03
|
| Rate for Payer: Global Benefits Group Commercial |
$6.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.56
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$6.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.12
|
| Rate for Payer: Multiplan Commercial |
$7.96
|
| 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
|
$38.50
|
|
|
Service Code
|
NDC 11980-180-05
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.70 |
| Max. Negotiated Rate |
$34.65 |
| Rate for Payer: Adventist Health Commercial |
$7.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.61
|
| Rate for Payer: Blue Shield of California Commercial |
$23.52
|
| Rate for Payer: Blue Shield of California EPN |
$15.36
|
| Rate for Payer: Cash Price |
$21.17
|
| Rate for Payer: Central Health Plan Commercial |
$30.80
|
| 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 |
$32.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.40
|
| Rate for Payer: EPIC Health Plan Senior |
$15.40
|
| Rate for Payer: Galaxy Health WC |
$32.73
|
| Rate for Payer: Global Benefits Group Commercial |
$23.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.65
|
| Rate for Payer: InnovAge PACE Commercial |
$19.25
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$23.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.95
|
| Rate for Payer: Multiplan Commercial |
$28.88
|
| Rate for Payer: Networks By Design Commercial |
$25.02
|
| Rate for Payer: Prime Health Services Commercial |
$32.73
|
| Rate for Payer: Riverside University Health System MISP |
$15.40
|
| 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 |
$32.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.73
|
| Rate for Payer: Vantage Medical Group Senior |
$32.73
|
|
|
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLUTION [29302]
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$5.74 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.56
|
| Rate for Payer: Blue Shield of California Commercial |
$5.74
|
| Rate for Payer: Blue Shield of California Commercial |
$5.74
|
| Rate for Payer: Blue Shield of California EPN |
$5.22
|
| Rate for Payer: Blue Shield of California EPN |
$5.22
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Central Health Plan Commercial |
$0.21
|
| Rate for Payer: Central Health Plan Commercial |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.14
|
| 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 |
$0.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.17
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.48
|
| Rate for Payer: InnovAge PACE Commercial |
$0.10
|
| Rate for Payer: InnovAge PACE Commercial |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| 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 |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| 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 |
$0.17
|
| Rate for Payer: Riverside University Health System MISP |
$0.08
|
| Rate for Payer: Riverside University Health System MISP |
$0.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.17
|
| 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 |
$0.17
|
|
|
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLUTION [29302]
|
Facility
|
IP
|
$0.26
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Central Health Plan Commercial |
$0.21
|
| Rate for Payer: Central Health Plan Commercial |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.14
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.17
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| 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 |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| 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 |
$0.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
|
|
PREDNISOLONE SODIUM PHOSPHATE 1 % EYE DROPS [6489]
|
Facility
|
IP
|
$6.32
|
|
|
Service Code
|
NDC 24208-715-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.69 |
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Blue Shield of California Commercial |
$4.89
|
| Rate for Payer: Blue Shield of California EPN |
$3.19
|
| Rate for Payer: Cash Price |
$3.48
|
| Rate for Payer: Central Health Plan Commercial |
$5.06
|
| 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: EPIC Health Plan Senior |
$2.53
|
| Rate for Payer: Galaxy Health WC |
$5.37
|
| Rate for Payer: Global Benefits Group Commercial |
$3.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.69
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$3.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$4.74
|
| Rate for Payer: Networks By Design Commercial |
$4.11
|
| Rate for Payer: Prime Health Services Commercial |
$5.37
|
|
