|
PYRAZINAMIDE 500 MG TABLET [6738]
|
Facility
OP
|
$5.32
|
|
|
Service Code
|
NDC 33342-447-11
|
| Hospital Charge Code |
1712086
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$4.79 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.93
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.14
|
| Rate for Payer: BCBS Transplant Transplant |
$3.19
|
| Rate for Payer: Blue Shield of California Commercial |
$3.35
|
| Rate for Payer: Blue Shield of California EPN |
$2.60
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Central Health Plan Commercial |
$4.26
|
| Rate for Payer: Cigna of CA HMO |
$3.72
|
| Rate for Payer: Cigna of CA PPO |
$3.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.13
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.13
|
| Rate for Payer: Galaxy Health WC |
$4.52
|
| Rate for Payer: Global Benefits Group Commercial |
$3.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.79
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.99
|
| Rate for Payer: IEHP medi-cal |
$1.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Multiplan Commercial |
$3.99
|
| Rate for Payer: Networks By Design Commercial |
$3.46
|
| Rate for Payer: Prime Health Services Commercial |
$4.52
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.19
|
| Rate for Payer: Riverside University Health MISP |
$2.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.66
|
| Rate for Payer: United Healthcare All Other HMO |
$2.66
|
| Rate for Payer: United Healthcare HMO Rider |
$2.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.52
|
| Rate for Payer: Vantage Medical Group Senior |
$4.52
|
|
|
PYRAZINAMIDE 500 MG TABLET [6738]
|
Facility
OP
|
$5.46
|
|
|
Service Code
|
NDC 70954-484-10
|
| Hospital Charge Code |
1712086
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$4.91 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.23
|
| Rate for Payer: BCBS Transplant Transplant |
$3.28
|
| Rate for Payer: Blue Shield of California Commercial |
$3.43
|
| Rate for Payer: Blue Shield of California EPN |
$2.67
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Central Health Plan Commercial |
$4.37
|
| Rate for Payer: Cigna of CA HMO |
$3.82
|
| Rate for Payer: Cigna of CA PPO |
$3.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.18
|
| Rate for Payer: Galaxy Health WC |
$4.64
|
| Rate for Payer: Global Benefits Group Commercial |
$3.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.91
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.10
|
| Rate for Payer: IEHP medi-cal |
$1.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.09
|
| Rate for Payer: Multiplan Commercial |
$4.10
|
| Rate for Payer: Networks By Design Commercial |
$3.55
|
| Rate for Payer: Prime Health Services Commercial |
$4.64
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.28
|
| Rate for Payer: Riverside University Health MISP |
$2.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.73
|
| Rate for Payer: United Healthcare All Other HMO |
$2.73
|
| Rate for Payer: United Healthcare HMO Rider |
$2.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.64
|
| Rate for Payer: Vantage Medical Group Senior |
$4.64
|
|
|
PYRAZINAMIDE 500 MG TABLET [6738]
|
Facility
IP
|
$4.40
|
|
|
Service Code
|
NDC 10135-735-60
|
| Hospital Charge Code |
1712086
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: Blue Shield of California Commercial |
$3.30
|
| Rate for Payer: Blue Shield of California EPN |
$2.35
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Central Health Plan Commercial |
$3.52
|
| Rate for Payer: Cigna of CA HMO |
$3.08
|
| Rate for Payer: Cigna of CA PPO |
$3.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.76
|
| Rate for Payer: Galaxy Health WC |
$3.74
|
| Rate for Payer: Global Benefits Group Commercial |
$2.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.88
|
| Rate for Payer: Multiplan Commercial |
$3.30
|
| Rate for Payer: Networks By Design Commercial |
$2.86
|
| Rate for Payer: Prime Health Services Commercial |
$3.74
|
|
|
PYRAZINAMIDE 500 MG TABLET [6738]
|
Facility
IP
|
$5.32
|
|
|
Service Code
|
NDC 33342-447-11
|
| Hospital Charge Code |
1712086
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$4.79 |
| Rate for Payer: Blue Shield of California Commercial |
$3.99
|
| Rate for Payer: Blue Shield of California EPN |
$2.84
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Central Health Plan Commercial |
$4.26
|
| Rate for Payer: Cigna of CA HMO |
$3.72
|
| Rate for Payer: Cigna of CA PPO |
$3.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.13
|
| Rate for Payer: Galaxy Health WC |
$4.52
|
| Rate for Payer: Global Benefits Group Commercial |
$3.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Multiplan Commercial |
$3.99
|
| Rate for Payer: Networks By Design Commercial |
$3.46
|
| Rate for Payer: Prime Health Services Commercial |
$4.52
|
|
|
PYRAZINAMIDE 500 MG TABLET [6738]
|
Facility
OP
|
$6.03
|
|
|
Service Code
|
NDC 61748-012-09
|
| Hospital Charge Code |
1712086
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$5.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.56
|
| Rate for Payer: BCBS Transplant Transplant |
$3.62
|
| Rate for Payer: Blue Shield of California Commercial |
$3.79
|
| Rate for Payer: Blue Shield of California EPN |
$2.95
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Central Health Plan Commercial |
$4.82
|
| Rate for Payer: Cigna of CA HMO |
$4.22
|
| Rate for Payer: Cigna of CA PPO |
$4.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.41
|
| Rate for Payer: Galaxy Health WC |
$5.13
|
| Rate for Payer: Global Benefits Group Commercial |
$3.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.43
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.52
|
| Rate for Payer: IEHP medi-cal |
$2.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.21
|
| Rate for Payer: Multiplan Commercial |
$4.52
|
| Rate for Payer: Networks By Design Commercial |
$3.92
|
| Rate for Payer: Prime Health Services Commercial |
$5.13
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.62
|
| Rate for Payer: Riverside University Health MISP |
$2.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.02
|
| Rate for Payer: United Healthcare All Other HMO |
$3.02
|
| Rate for Payer: United Healthcare HMO Rider |
$3.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.13
|
| Rate for Payer: Vantage Medical Group Senior |
$5.13
|
|
|
PYRAZINAMIDE 500 MG TABLET [6738]
|
Facility
OP
|
$6.06
|
|
|
Service Code
|
NDC 61748-012-06
|
| Hospital Charge Code |
1712086
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$5.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.58
|
| Rate for Payer: BCBS Transplant Transplant |
$3.64
|
| Rate for Payer: Blue Shield of California Commercial |
$3.81
|
| Rate for Payer: Blue Shield of California EPN |
$2.96
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Central Health Plan Commercial |
$4.85
|
| Rate for Payer: Cigna of CA HMO |
$4.24
|
| Rate for Payer: Cigna of CA PPO |
$4.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.42
|
| Rate for Payer: Galaxy Health WC |
$5.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.45
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.54
|
| Rate for Payer: IEHP medi-cal |
$2.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.21
|
| Rate for Payer: Multiplan Commercial |
$4.54
|
| Rate for Payer: Networks By Design Commercial |
$3.94
|
| Rate for Payer: Prime Health Services Commercial |
$5.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.64
|
| Rate for Payer: Riverside University Health MISP |
$2.42
|
| 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 |
$3.03
|
| Rate for Payer: United Healthcare All Other HMO |
$3.03
|
| Rate for Payer: United Healthcare HMO Rider |
$3.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.15
|
| Rate for Payer: Vantage Medical Group Senior |
$5.15
|
|
|
PYRAZINAMIDE ORAL SUSPENSION COMPOUND 100 MG/ML [4080326]
|
Facility
OP
|
$6.32
|
|
|
Service Code
|
NDC 9994-0803-26
|
| Hospital Charge Code |
1715093
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.37
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.48
|
| 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 |
$3.98
|
| Rate for Payer: Blue Shield of California EPN |
$3.09
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Central Health Plan Commercial |
$5.06
|
| Rate for Payer: Cigna of CA HMO |
$4.42
|
| Rate for Payer: Cigna of CA PPO |
$4.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.53
|
| Rate for Payer: Galaxy Health WC |
$5.37
|
| Rate for Payer: Global Benefits Group Commercial |
$3.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.69
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.74
|
| Rate for Payer: IEHP medi-cal |
$2.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.22
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.79
|
| Rate for Payer: Riverside University Health MISP |
$2.53
|
| 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 |
$5.37
|
| Rate for Payer: Vantage Medical Group Senior |
$5.37
|
|
|
PYRAZINAMIDE ORAL SUSPENSION COMPOUND 100 MG/ML [4080326]
|
Facility
IP
|
$6.32
|
|
|
Service Code
|
NDC 9994-0803-26
|
| Hospital Charge Code |
1715093
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.69 |
| Rate for Payer: Blue Shield of California Commercial |
$4.74
|
| Rate for Payer: Blue Shield of California EPN |
$3.37
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Central Health Plan Commercial |
$5.06
|
| 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: 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: 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
|
|
|
PYRIDOSTIGMINE BROMIDE 5 MG/ML INJECTION SOLUTION [11237]
|
Facility
OP
|
$18.43
|
|
|
Service Code
|
NDC 0781-3040-72
|
| Hospital Charge Code |
1721076
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$16.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15.67
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.89
|
| Rate for Payer: BCBS Transplant Transplant |
$11.06
|
| Rate for Payer: Blue Shield of California Commercial |
$11.59
|
| Rate for Payer: Blue Shield of California EPN |
$9.01
|
| Rate for Payer: Cash Price |
$8.29
|
| Rate for Payer: Cash Price |
$8.29
|
| Rate for Payer: Central Health Plan Commercial |
$14.74
|
| Rate for Payer: Cigna of CA HMO |
$11.80
|
| Rate for Payer: Cigna of CA PPO |
$13.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.37
|
| Rate for Payer: Galaxy Health WC |
$15.67
|
| Rate for Payer: Global Benefits Group Commercial |
$11.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.59
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13.82
|
| Rate for Payer: IEHP medi-cal |
$6.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.69
|
| Rate for Payer: Multiplan Commercial |
$13.82
|
| Rate for Payer: Networks By Design Commercial |
$11.98
|
| Rate for Payer: Prime Health Services Commercial |
$15.67
|
| Rate for Payer: Riverside University Health MISP |
$7.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.22
|
| Rate for Payer: United Healthcare All Other HMO |
$9.22
|
| Rate for Payer: United Healthcare HMO Rider |
$9.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.67
|
| Rate for Payer: Vantage Medical Group Senior |
$15.67
|
|
|
PYRIDOSTIGMINE BROMIDE 5 MG/ML INJECTION SOLUTION [11237]
|
Facility
IP
|
$18.43
|
|
|
Service Code
|
NDC 0781-3040-95
|
| Hospital Charge Code |
1721076
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$16.59 |
| Rate for Payer: Blue Shield of California Commercial |
$13.82
|
| Rate for Payer: Blue Shield of California EPN |
$9.84
|
| Rate for Payer: Cash Price |
$8.29
|
| Rate for Payer: Central Health Plan Commercial |
$14.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.37
|
| Rate for Payer: Galaxy Health WC |
$15.67
|
| Rate for Payer: Global Benefits Group Commercial |
$11.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.69
|
| Rate for Payer: Multiplan Commercial |
$13.82
|
| Rate for Payer: Networks By Design Commercial |
$11.98
|
| Rate for Payer: Prime Health Services Commercial |
$15.67
|
|
|
PYRIDOSTIGMINE BROMIDE 5 MG/ML INJECTION SOLUTION [11237]
|
Facility
OP
|
$18.43
|
|
|
Service Code
|
NDC 0781-3040-95
|
| Hospital Charge Code |
1721076
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$16.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15.67
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.89
|
| Rate for Payer: BCBS Transplant Transplant |
$11.06
|
| Rate for Payer: Blue Shield of California Commercial |
$11.59
|
| Rate for Payer: Blue Shield of California EPN |
$9.01
|
| Rate for Payer: Cash Price |
$8.29
|
| Rate for Payer: Cash Price |
$8.29
|
| Rate for Payer: Central Health Plan Commercial |
$14.74
|
| Rate for Payer: Cigna of CA HMO |
$11.80
|
| Rate for Payer: Cigna of CA PPO |
$13.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.37
|
| Rate for Payer: Galaxy Health WC |
$15.67
|
| Rate for Payer: Global Benefits Group Commercial |
$11.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.59
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13.82
|
| Rate for Payer: IEHP medi-cal |
$6.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.69
|
| Rate for Payer: Multiplan Commercial |
$13.82
|
| Rate for Payer: Networks By Design Commercial |
$11.98
|
| Rate for Payer: Prime Health Services Commercial |
$15.67
|
| Rate for Payer: Riverside University Health MISP |
$7.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.22
|
| Rate for Payer: United Healthcare All Other HMO |
$9.22
|
| Rate for Payer: United Healthcare HMO Rider |
$9.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.67
|
| Rate for Payer: Vantage Medical Group Senior |
$15.67
|
|
|
PYRIDOSTIGMINE BROMIDE 5 MG/ML INJECTION SOLUTION [11237]
|
Facility
IP
|
$18.43
|
|
|
Service Code
|
NDC 0781-3040-72
|
| Hospital Charge Code |
1721076
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$16.59 |
| Rate for Payer: Blue Shield of California Commercial |
$13.82
|
| Rate for Payer: Blue Shield of California EPN |
$9.84
|
| Rate for Payer: Cash Price |
$8.29
|
| Rate for Payer: Central Health Plan Commercial |
$14.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.37
|
| Rate for Payer: Galaxy Health WC |
$15.67
|
| Rate for Payer: Global Benefits Group Commercial |
$11.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.69
|
| Rate for Payer: Multiplan Commercial |
$13.82
|
| Rate for Payer: Networks By Design Commercial |
$11.98
|
| Rate for Payer: Prime Health Services Commercial |
$15.67
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG/5 ML ORAL SYRUP [11238]
|
Facility
IP
|
$4.06
|
|
|
Service Code
|
NDC 0187-3012-20
|
| Hospital Charge Code |
1715939
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$3.65 |
| Rate for Payer: Blue Shield of California Commercial |
$3.04
|
| Rate for Payer: Blue Shield of California EPN |
$2.17
|
| Rate for Payer: Cash Price |
$1.83
|
| Rate for Payer: Central Health Plan Commercial |
$3.25
|
| Rate for Payer: Cigna of CA HMO |
$2.84
|
| Rate for Payer: Cigna of CA PPO |
$2.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.62
|
| Rate for Payer: Galaxy Health WC |
$3.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: Multiplan Commercial |
$3.04
|
| Rate for Payer: Networks By Design Commercial |
$2.64
|
| Rate for Payer: Prime Health Services Commercial |
$3.45
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG/5 ML ORAL SYRUP [11238]
|
Facility
OP
|
$4.06
|
|
|
Service Code
|
NDC 0187-3012-20
|
| Hospital Charge Code |
1715939
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$3.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.40
|
| Rate for Payer: BCBS Transplant Transplant |
$2.44
|
| Rate for Payer: Blue Shield of California Commercial |
$2.55
|
| Rate for Payer: Blue Shield of California EPN |
$1.99
|
| Rate for Payer: Cash Price |
$1.83
|
| Rate for Payer: Central Health Plan Commercial |
$3.25
|
| Rate for Payer: Cigna of CA HMO |
$2.84
|
| Rate for Payer: Cigna of CA PPO |
$2.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.62
|
| Rate for Payer: Galaxy Health WC |
$3.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.65
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.04
|
| Rate for Payer: IEHP medi-cal |
$1.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: Multiplan Commercial |
$3.04
|
| Rate for Payer: Networks By Design Commercial |
$2.64
|
| Rate for Payer: Prime Health Services Commercial |
$3.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.44
|
| Rate for Payer: Riverside University Health MISP |
$1.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.03
|
| Rate for Payer: United Healthcare All Other HMO |
$2.03
|
| Rate for Payer: United Healthcare HMO Rider |
$2.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.45
|
| Rate for Payer: Vantage Medical Group Senior |
$3.45
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG TABLET [11239]
|
Facility
IP
|
$1.22
|
|
|
Service Code
|
NDC 68682-302-10
|
| Hospital Charge Code |
1710447
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Blue Shield of California Commercial |
$0.92
|
| Rate for Payer: Blue Shield of California EPN |
$0.65
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Central Health Plan Commercial |
$0.98
|
| Rate for Payer: Cigna of CA HMO |
$0.85
|
| Rate for Payer: Cigna of CA PPO |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.49
|
| Rate for Payer: Galaxy Health WC |
$1.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.92
|
| Rate for Payer: Networks By Design Commercial |
$0.79
|
| Rate for Payer: Prime Health Services Commercial |
$1.04
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG TABLET [11239]
|
Facility
OP
|
$1.22
|
|
|
Service Code
|
NDC 68382-659-06
|
| Hospital Charge Code |
1710447
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.67
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.72
|
| Rate for Payer: BCBS Transplant Transplant |
$0.73
|
| Rate for Payer: Blue Shield of California Commercial |
$0.77
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Central Health Plan Commercial |
$0.98
|
| Rate for Payer: Cigna of CA HMO |
$0.85
|
| Rate for Payer: Cigna of CA PPO |
$0.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.49
|
| Rate for Payer: Galaxy Health WC |
$1.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.92
|
| Rate for Payer: IEHP medi-cal |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.92
|
| Rate for Payer: Networks By Design Commercial |
$0.79
|
| Rate for Payer: Prime Health Services Commercial |
$1.04
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.73
|
| Rate for Payer: Riverside University Health MISP |
$0.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.61
|
| Rate for Payer: United Healthcare All Other HMO |
$0.61
|
| Rate for Payer: United Healthcare HMO Rider |
$0.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.04
|
| Rate for Payer: Vantage Medical Group Senior |
$1.04
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG TABLET [11239]
|
Facility
IP
|
$1.22
|
|
|
Service Code
|
NDC 68382-659-06
|
| Hospital Charge Code |
1710447
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Blue Shield of California Commercial |
$0.92
|
| Rate for Payer: Blue Shield of California EPN |
$0.65
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Central Health Plan Commercial |
$0.98
|
| Rate for Payer: Cigna of CA HMO |
$0.85
|
| Rate for Payer: Cigna of CA PPO |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.49
|
| Rate for Payer: Galaxy Health WC |
$1.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.92
|
| Rate for Payer: Networks By Design Commercial |
$0.79
|
| Rate for Payer: Prime Health Services Commercial |
$1.04
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG TABLET [11239]
|
Facility
IP
|
$1.22
|
|
|
Service Code
|
NDC 71930-028-90
|
| Hospital Charge Code |
1710447
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Blue Shield of California Commercial |
$0.92
|
| Rate for Payer: Blue Shield of California EPN |
$0.65
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Central Health Plan Commercial |
$0.98
|
| Rate for Payer: Cigna of CA HMO |
$0.85
|
| Rate for Payer: Cigna of CA PPO |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.49
|
| Rate for Payer: Galaxy Health WC |
$1.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.92
|
| Rate for Payer: Networks By Design Commercial |
$0.79
|
| Rate for Payer: Prime Health Services Commercial |
$1.04
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG TABLET [11239]
|
Facility
OP
|
$1.22
|
|
|
Service Code
|
NDC 68682-302-10
|
| Hospital Charge Code |
1710447
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.67
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.72
|
| Rate for Payer: BCBS Transplant Transplant |
$0.73
|
| Rate for Payer: Blue Shield of California Commercial |
$0.77
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Central Health Plan Commercial |
$0.98
|
| Rate for Payer: Cigna of CA HMO |
$0.85
|
| Rate for Payer: Cigna of CA PPO |
$0.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.49
|
| Rate for Payer: Galaxy Health WC |
$1.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.92
|
| Rate for Payer: IEHP medi-cal |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.92
|
| Rate for Payer: Networks By Design Commercial |
$0.79
|
| Rate for Payer: Prime Health Services Commercial |
$1.04
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.73
|
| Rate for Payer: Riverside University Health MISP |
$0.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.61
|
| Rate for Payer: United Healthcare All Other HMO |
$0.61
|
| Rate for Payer: United Healthcare HMO Rider |
$0.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.04
|
| Rate for Payer: Vantage Medical Group Senior |
$1.04
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG TABLET [11239]
|
Facility
OP
|
$1.22
|
|
|
Service Code
|
NDC 71930-028-90
|
| Hospital Charge Code |
1710447
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.67
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.72
|
| Rate for Payer: BCBS Transplant Transplant |
$0.73
|
| Rate for Payer: Blue Shield of California Commercial |
$0.77
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Central Health Plan Commercial |
$0.98
|
| Rate for Payer: Cigna of CA HMO |
$0.85
|
| Rate for Payer: Cigna of CA PPO |
$0.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.49
|
| Rate for Payer: Galaxy Health WC |
$1.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.92
|
| Rate for Payer: IEHP medi-cal |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.92
|
| Rate for Payer: Networks By Design Commercial |
$0.79
|
| Rate for Payer: Prime Health Services Commercial |
$1.04
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.73
|
| Rate for Payer: Riverside University Health MISP |
$0.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.61
|
| Rate for Payer: United Healthcare All Other HMO |
$0.61
|
| Rate for Payer: United Healthcare HMO Rider |
$0.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.04
|
| Rate for Payer: Vantage Medical Group Senior |
$1.04
|
|
|
PYRIDOSTIGMINE BROMIDE ER 180 MG TABLET,EXTENDED RELEASE [11240]
|
Facility
OP
|
$24.83
|
|
|
Service Code
|
NDC 68682-301-30
|
| Hospital Charge Code |
1710454
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.97 |
| Max. Negotiated Rate |
$22.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$15.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.67
|
| Rate for Payer: BCBS Transplant Transplant |
$14.90
|
| Rate for Payer: Blue Shield of California Commercial |
$15.62
|
| Rate for Payer: Blue Shield of California EPN |
$12.14
|
| Rate for Payer: Cash Price |
$11.17
|
| Rate for Payer: Central Health Plan Commercial |
$19.86
|
| Rate for Payer: Cigna of CA HMO |
$17.38
|
| Rate for Payer: Cigna of CA PPO |
$17.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.93
|
| Rate for Payer: Galaxy Health WC |
$21.11
|
| Rate for Payer: Global Benefits Group Commercial |
$14.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.35
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$18.62
|
| Rate for Payer: IEHP medi-cal |
$8.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.97
|
| Rate for Payer: Multiplan Commercial |
$18.62
|
| Rate for Payer: Networks By Design Commercial |
$16.14
|
| Rate for Payer: Prime Health Services Commercial |
$21.11
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$14.90
|
| Rate for Payer: Riverside University Health MISP |
$9.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.42
|
| Rate for Payer: United Healthcare All Other HMO |
$12.42
|
| Rate for Payer: United Healthcare HMO Rider |
$12.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.11
|
| Rate for Payer: Vantage Medical Group Senior |
$21.11
|
|
|
PYRIDOSTIGMINE BROMIDE ER 180 MG TABLET,EXTENDED RELEASE [11240]
|
Facility
IP
|
$24.83
|
|
|
Service Code
|
NDC 68682-301-30
|
| Hospital Charge Code |
1710454
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.97 |
| Max. Negotiated Rate |
$22.35 |
| Rate for Payer: Blue Shield of California Commercial |
$18.62
|
| Rate for Payer: Blue Shield of California EPN |
$13.26
|
| Rate for Payer: Cash Price |
$11.17
|
| Rate for Payer: Central Health Plan Commercial |
$19.86
|
| Rate for Payer: Cigna of CA HMO |
$17.38
|
| Rate for Payer: Cigna of CA PPO |
$17.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.93
|
| Rate for Payer: Galaxy Health WC |
$21.11
|
| Rate for Payer: Global Benefits Group Commercial |
$14.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.97
|
| Rate for Payer: Multiplan Commercial |
$18.62
|
| Rate for Payer: Networks By Design Commercial |
$16.14
|
| Rate for Payer: Prime Health Services Commercial |
$21.11
|
|
|
PYRIDOXINE ORAL SOLUTION (IV FORM) 100 MG/ML [4080441]
|
Facility
IP
|
$10.79
|
|
|
Service Code
|
NDC 9994-0804-41
|
| Hospital Charge Code |
1715004
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$9.71 |
| Rate for Payer: Blue Shield of California Commercial |
$8.09
|
| Rate for Payer: Blue Shield of California EPN |
$5.76
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Central Health Plan Commercial |
$8.63
|
| Rate for Payer: Cigna of CA HMO |
$7.55
|
| Rate for Payer: Cigna of CA PPO |
$7.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.32
|
| Rate for Payer: Galaxy Health WC |
$9.17
|
| Rate for Payer: Global Benefits Group Commercial |
$6.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Multiplan Commercial |
$8.09
|
| Rate for Payer: Networks By Design Commercial |
$7.01
|
| Rate for Payer: Prime Health Services Commercial |
$9.17
|
|
|
PYRIDOXINE ORAL SOLUTION (IV FORM) 100 MG/ML [4080441]
|
Facility
OP
|
$10.79
|
|
|
Service Code
|
NDC 9994-0804-41
|
| Hospital Charge Code |
1715004
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$9.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.37
|
| Rate for Payer: BCBS Transplant Transplant |
$6.47
|
| Rate for Payer: Blue Shield of California Commercial |
$6.79
|
| Rate for Payer: Blue Shield of California EPN |
$5.28
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Central Health Plan Commercial |
$8.63
|
| Rate for Payer: Cigna of CA HMO |
$7.55
|
| Rate for Payer: Cigna of CA PPO |
$7.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.32
|
| Rate for Payer: Galaxy Health WC |
$9.17
|
| Rate for Payer: Global Benefits Group Commercial |
$6.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.71
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.09
|
| Rate for Payer: IEHP medi-cal |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Multiplan Commercial |
$8.09
|
| Rate for Payer: Networks By Design Commercial |
$7.01
|
| Rate for Payer: Prime Health Services Commercial |
$9.17
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.47
|
| Rate for Payer: Riverside University Health MISP |
$4.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.40
|
| Rate for Payer: United Healthcare All Other HMO |
$5.40
|
| Rate for Payer: United Healthcare HMO Rider |
$5.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.17
|
| Rate for Payer: Vantage Medical Group Senior |
$9.17
|
|
|
PYRIDOXINE (VITAMIN B6) 100 MG/ML INJECTION SOLUTION [6744]
|
Facility
OP
|
$22.87
|
|
|
Service Code
|
CPT J3415
|
| Hospital Charge Code |
1720634
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$91.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$91.85
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.04
|
| Rate for Payer: BCBS Transplant Transplant |
$13.72
|
| Rate for Payer: Blue Shield of California Commercial |
$20.06
|
| Rate for Payer: Blue Shield of California EPN |
$18.24
|
| Rate for Payer: Cash Price |
$10.29
|
| Rate for Payer: Cash Price |
$10.29
|
| Rate for Payer: Central Health Plan Commercial |
$18.30
|
| Rate for Payer: Cigna of CA HMO |
$16.01
|
| Rate for Payer: Cigna of CA PPO |
$16.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.15
|
| Rate for Payer: Galaxy Health WC |
$19.44
|
| Rate for Payer: Global Benefits Group Commercial |
$13.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.58
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$17.15
|
| Rate for Payer: IEHP medi-cal |
$10.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.57
|
| Rate for Payer: Multiplan Commercial |
$17.15
|
| Rate for Payer: Networks By Design Commercial |
$11.44
|
| Rate for Payer: Prime Health Services Commercial |
$19.44
|
| Rate for Payer: Riverside University Health MISP |
$9.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.44
|
| Rate for Payer: United Healthcare All Other HMO |
$11.44
|
| Rate for Payer: United Healthcare HMO Rider |
$11.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.44
|
| Rate for Payer: Vantage Medical Group Senior |
$19.44
|
|
