|
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 |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| 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: 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
|
|
|
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
|
|
|
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 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 |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| 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: 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 (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
|
|
|
PYRIDOXINE (VITAMIN B6) 100 MG/ML INJECTION SOLUTION [6744]
|
Facility
IP
|
$22.87
|
|
|
Service Code
|
CPT J3415
|
| Hospital Charge Code |
1720634
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$17.15
|
| Rate for Payer: Blue Shield of California EPN |
$12.21
|
| 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: 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: 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
|
|
|
PYRIDOXINE (VITAMIN B6) 100 MG TABLET [6745]
|
Facility
IP
|
$0.03
|
|
|
Service Code
|
NDC 8770140730
|
| Hospital Charge Code |
1711339
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
PYRIDOXINE (VITAMIN B6) 100 MG TABLET [6745]
|
Facility
OP
|
$0.03
|
|
|
Service Code
|
NDC 8770140730
|
| Hospital Charge Code |
1711339
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: BCBS Transplant Transplant |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.03
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.02
|
| Rate for Payer: IEHP medi-cal |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: Riverside University Health MISP |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
PYRIDOXINE (VITAMIN B6) 25 MG TABLET [6746]
|
Facility
IP
|
$0.03
|
|
|
Service Code
|
NDC 536440601
|
| Hospital Charge Code |
ERX6746
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
PYRIDOXINE (VITAMIN B6) 25 MG TABLET [6746]
|
Facility
OP
|
$0.03
|
|
|
Service Code
|
NDC 536440601
|
| Hospital Charge Code |
ERX6746
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: BCBS Transplant Transplant |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.03
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.02
|
| Rate for Payer: IEHP medi-cal |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: Riverside University Health MISP |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET [6748]
|
Facility
IP
|
$0.02
|
|
|
Service Code
|
NDC 5789685301
|
| Hospital Charge Code |
1710834
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.02
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET [6748]
|
Facility
IP
|
$0.28
|
|
|
Service Code
|
NDC 5026885811
|
| Hospital Charge Code |
1710834
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cash Price |
$0.13
|
| 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: 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: 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
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET [6748]
|
Facility
IP
|
$0.28
|
|
|
Service Code
|
NDC 5026885815
|
| Hospital Charge Code |
1710834
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cash Price |
$0.13
|
| 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: 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: 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
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET [6748]
|
Facility
OP
|
$0.02
|
|
|
Service Code
|
NDC 5789685301
|
| Hospital Charge Code |
1710834
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: BCBS Transplant Transplant |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.02
|
| Rate for Payer: IEHP medi-cal |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.02
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: Riverside University Health MISP |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Vantage Medical Group Senior |
$0.02
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET [6748]
|
Facility
OP
|
$0.28
|
|
|
Service Code
|
NDC 5026885815
|
| Hospital Charge Code |
1710834
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: BCBS Transplant Transplant |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.13
|
| 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: Dignity Health Commercial/Exchange |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$0.21
|
| Rate for Payer: IEHP medi-cal |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.19
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.17
|
| Rate for Payer: Riverside University Health MISP |
$0.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO |
$0.14
|
| Rate for Payer: United Healthcare HMO Rider |
$0.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: Vantage Medical Group Senior |
$0.24
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET [6748]
|
Facility
OP
|
$0.28
|
|
|
Service Code
|
NDC 5026885811
|
| Hospital Charge Code |
1710834
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: BCBS Transplant Transplant |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.13
|
| 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: Dignity Health Commercial/Exchange |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$0.21
|
| Rate for Payer: IEHP medi-cal |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.19
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.17
|
| Rate for Payer: Riverside University Health MISP |
$0.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO |
$0.14
|
| Rate for Payer: United Healthcare HMO Rider |
$0.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: Vantage Medical Group Senior |
$0.24
|
|
|
PYRIDOXINE (VITAMIN B6) ORAL SOLUTION COMPOUND 1 MG/ML [4081140]
|
Facility
IP
|
$19.88
|
|
|
Service Code
|
NDC 9994-0811-40
|
| Hospital Charge Code |
NDC4081140
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$14.91
|
| Rate for Payer: Blue Shield of California EPN |
$10.62
|
| Rate for Payer: Cash Price |
$8.95
|
| Rate for Payer: Cash Price |
$8.95
|
| Rate for Payer: Central Health Plan Commercial |
$15.90
|
| Rate for Payer: Cigna of CA HMO |
$13.92
|
| Rate for Payer: Cigna of CA PPO |
$13.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.95
|
| Rate for Payer: Galaxy Health WC |
$16.90
|
| Rate for Payer: Global Benefits Group Commercial |
$11.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.98
|
| Rate for Payer: Multiplan Commercial |
$14.91
|
| Rate for Payer: Networks By Design Commercial |
$12.92
|
| Rate for Payer: Prime Health Services Commercial |
$16.90
|
|
|
PYRIDOXINE (VITAMIN B6) ORAL SOLUTION COMPOUND 1 MG/ML [4081140]
|
Facility
OP
|
$19.88
|
|
|
Service Code
|
NDC 9994-0811-40
|
| Hospital Charge Code |
NDC4081140
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$17.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.93
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.75
|
| Rate for Payer: BCBS Transplant Transplant |
$11.93
|
| Rate for Payer: Blue Shield of California Commercial |
$12.50
|
| Rate for Payer: Blue Shield of California EPN |
$9.72
|
| Rate for Payer: Cash Price |
$8.95
|
| Rate for Payer: Central Health Plan Commercial |
$15.90
|
| Rate for Payer: Cigna of CA HMO |
$13.92
|
| Rate for Payer: Cigna of CA PPO |
$13.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.95
|
| Rate for Payer: Galaxy Health WC |
$16.90
|
| Rate for Payer: Global Benefits Group Commercial |
$11.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.89
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14.91
|
| Rate for Payer: IEHP medi-cal |
$6.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.98
|
| Rate for Payer: Multiplan Commercial |
$14.91
|
| Rate for Payer: Networks By Design Commercial |
$12.92
|
| Rate for Payer: Prime Health Services Commercial |
$16.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$11.93
|
| Rate for Payer: Riverside University Health MISP |
$7.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.94
|
| Rate for Payer: United Healthcare All Other HMO |
$9.94
|
| Rate for Payer: United Healthcare HMO Rider |
$9.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.90
|
| Rate for Payer: Vantage Medical Group Senior |
$16.90
|
|
|
PYRIMETHAMINE 25 MG TABLET [11246]
|
Facility
IP
|
$900.00
|
|
|
Service Code
|
NDC 52054-330-95
|
| Hospital Charge Code |
1710061
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$675.00
|
| Rate for Payer: Blue Shield of California EPN |
$480.60
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Central Health Plan Commercial |
$720.00
|
| Rate for Payer: Cigna of CA HMO |
$630.00
|
| Rate for Payer: Cigna of CA PPO |
$630.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$360.00
|
| Rate for Payer: Galaxy Health WC |
$765.00
|
| Rate for Payer: Global Benefits Group Commercial |
$540.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$810.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$600.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.00
|
| Rate for Payer: Multiplan Commercial |
$675.00
|
| Rate for Payer: Networks By Design Commercial |
$585.00
|
| Rate for Payer: Prime Health Services Commercial |
$765.00
|
|
|
PYRIMETHAMINE 25 MG TABLET [11246]
|
Facility
OP
|
$900.00
|
|
|
Service Code
|
NDC 69413-330-30
|
| Hospital Charge Code |
1710061
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$810.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$546.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$765.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$495.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$495.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$435.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$531.72
|
| Rate for Payer: BCBS Transplant Transplant |
$540.00
|
| Rate for Payer: Blue Shield of California Commercial |
$566.10
|
| Rate for Payer: Blue Shield of California EPN |
$440.10
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Central Health Plan Commercial |
$720.00
|
| Rate for Payer: Cigna of CA HMO |
$630.00
|
| Rate for Payer: Cigna of CA PPO |
$630.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$360.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$360.00
|
| Rate for Payer: Galaxy Health WC |
$765.00
|
| Rate for Payer: Global Benefits Group Commercial |
$540.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$810.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$675.00
|
| Rate for Payer: IEHP medi-cal |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$600.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.00
|
| Rate for Payer: Multiplan Commercial |
$675.00
|
| Rate for Payer: Networks By Design Commercial |
$585.00
|
| Rate for Payer: Prime Health Services Commercial |
$765.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$540.00
|
| Rate for Payer: Riverside University Health MISP |
$360.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$540.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$540.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$450.00
|
| Rate for Payer: United Healthcare All Other HMO |
$450.00
|
| Rate for Payer: United Healthcare HMO Rider |
$450.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$450.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$765.00
|
| Rate for Payer: Vantage Medical Group Senior |
$765.00
|
|
|
PYRIMETHAMINE 25 MG TABLET [11246]
|
Facility
IP
|
$900.00
|
|
|
Service Code
|
NDC 69413-330-30
|
| Hospital Charge Code |
1710061
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$675.00
|
| Rate for Payer: Blue Shield of California EPN |
$480.60
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Central Health Plan Commercial |
$720.00
|
| Rate for Payer: Cigna of CA HMO |
$630.00
|
| Rate for Payer: Cigna of CA PPO |
$630.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$360.00
|
| Rate for Payer: Galaxy Health WC |
$765.00
|
| Rate for Payer: Global Benefits Group Commercial |
$540.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$810.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$600.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.00
|
| Rate for Payer: Multiplan Commercial |
$675.00
|
| Rate for Payer: Networks By Design Commercial |
$585.00
|
| Rate for Payer: Prime Health Services Commercial |
$765.00
|
|
|
PYRIMETHAMINE 25 MG TABLET [11246]
|
Facility
OP
|
$900.00
|
|
|
Service Code
|
NDC 52054-330-95
|
| Hospital Charge Code |
1710061
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$810.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$546.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$765.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$495.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$495.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$435.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$531.72
|
| Rate for Payer: BCBS Transplant Transplant |
$540.00
|
| Rate for Payer: Blue Shield of California Commercial |
$566.10
|
| Rate for Payer: Blue Shield of California EPN |
$440.10
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Central Health Plan Commercial |
$720.00
|
| Rate for Payer: Cigna of CA HMO |
$630.00
|
| Rate for Payer: Cigna of CA PPO |
$630.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$360.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$360.00
|
| Rate for Payer: Galaxy Health WC |
$765.00
|
| Rate for Payer: Global Benefits Group Commercial |
$540.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$810.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$675.00
|
| Rate for Payer: IEHP medi-cal |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$600.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.00
|
| Rate for Payer: Multiplan Commercial |
$675.00
|
| Rate for Payer: Networks By Design Commercial |
$585.00
|
| Rate for Payer: Prime Health Services Commercial |
$765.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$540.00
|
| Rate for Payer: Riverside University Health MISP |
$360.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$540.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$540.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$450.00
|
| Rate for Payer: United Healthcare All Other HMO |
$450.00
|
| Rate for Payer: United Healthcare HMO Rider |
$450.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$450.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$765.00
|
| Rate for Payer: Vantage Medical Group Senior |
$765.00
|
|
|
PYRIMETHAMINE ORAL SOLUTION COMPOUND 2 MG/ML [4080328]
|
Facility
OP
|
$0.09
|
|
|
Service Code
|
NDC 9994-0803-28
|
| Hospital Charge Code |
1715993
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: BCBS Transplant Transplant |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.08
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.07
|
| Rate for Payer: IEHP medi-cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: Riverside University Health MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
|
PYRIMETHAMINE ORAL SOLUTION COMPOUND 2 MG/ML [4080328]
|
Facility
IP
|
$0.09
|
|
|
Service Code
|
NDC 9994-0803-28
|
| Hospital Charge Code |
1715993
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
|
|
QUETIAPINE 100 MG TABLET [21824]
|
Facility
OP
|
$0.64
|
|
|
Service Code
|
NDC 60687-349-01
|
| Hospital Charge Code |
1713146
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.38
|
| Rate for Payer: BCBS Transplant Transplant |
$0.38
|
| Rate for Payer: Blue Shield of California Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: Central Health Plan Commercial |
$0.51
|
| Rate for Payer: Cigna of CA HMO |
$0.45
|
| Rate for Payer: Cigna of CA PPO |
$0.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.54
|
| Rate for Payer: Global Benefits Group Commercial |
$0.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.58
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.48
|
| Rate for Payer: IEHP medi-cal |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.42
|
| Rate for Payer: Prime Health Services Commercial |
$0.54
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.38
|
| Rate for Payer: Riverside University Health MISP |
$0.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.32
|
| Rate for Payer: United Healthcare All Other HMO |
$0.32
|
| Rate for Payer: United Healthcare HMO Rider |
$0.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.54
|
| Rate for Payer: Vantage Medical Group Senior |
$0.54
|
|
