|
PRAVASTATIN 40 MG TABLET [11112]
|
Facility
|
IP
|
$0.85
|
|
|
Service Code
|
NDC 0904-5893-61
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.58
|
| Rate for Payer: Heritage Provider Network Senior |
$0.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.64
|
|
|
PRAVASTATIN 40 MG TABLET [11112]
|
Facility
|
IP
|
$0.46
|
|
|
Service Code
|
NDC 60505-0170-9
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.31
|
| Rate for Payer: Heritage Provider Network Senior |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
|
|
PRAVASTATIN 40 MG TABLET [11112]
|
Facility
|
IP
|
$1.08
|
|
|
Service Code
|
NDC 60687-908-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.81 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.73
|
| Rate for Payer: Heritage Provider Network Senior |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.81
|
|
|
PRAVASTATIN 40 MG TABLET [11112]
|
Facility
|
OP
|
$1.08
|
|
|
Service Code
|
NDC 60687-908-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.81
|
| Rate for Payer: Blue Shield of California Commercial |
$0.66
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.92
|
| Rate for Payer: Dignity Health Senior |
$0.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.67
|
| Rate for Payer: Heritage Provider Network Senior |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$0.81
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.43
|
| Rate for Payer: TriValley Medical Group Senior |
$0.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: Vantage Medical Group Senior |
$0.92
|
|
|
PRAVASTATIN 5 MG PARTIAL TABLET [40811110]
|
Facility
|
OP
|
$0.15
|
|
|
Service Code
|
NDC 9999-9998-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.13
|
| Rate for Payer: Dignity Health Senior |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Senior |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Vantage Medical Group Senior |
$0.13
|
|
|
PRAVASTATIN 5 MG PARTIAL TABLET [40811110]
|
Facility
|
IP
|
$0.15
|
|
|
Service Code
|
NDC 9999-9998-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Senior |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
|
|
PRAZIQUANTEL 600 MG TABLET [11113]
|
Facility
|
OP
|
$79.72
|
|
|
Service Code
|
NDC 49884-231-83
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.43 |
| Max. Negotiated Rate |
$67.76 |
| Rate for Payer: Adventist Health Commercial |
$15.94
|
| Rate for Payer: Aetna of CA Gatekeeper |
$42.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.79
|
| Rate for Payer: Blue Shield of California Commercial |
$48.63
|
| Rate for Payer: Blue Shield of California EPN |
$38.90
|
| Rate for Payer: Cash Price |
$43.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$51.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.76
|
| Rate for Payer: Dignity Health Senior |
$67.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$49.35
|
| Rate for Payer: Heritage Provider Network Senior |
$49.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$38.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55.80
|
| Rate for Payer: Multiplan Commercial |
$59.79
|
| Rate for Payer: TriValley Medical Group Commercial |
$31.89
|
| Rate for Payer: TriValley Medical Group Senior |
$31.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$39.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$39.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$67.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67.76
|
| Rate for Payer: Vantage Medical Group Senior |
$67.76
|
|
|
PRAZIQUANTEL 600 MG TABLET [11113]
|
Facility
|
IP
|
$79.72
|
|
|
Service Code
|
NDC 49884-231-83
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.43 |
| Max. Negotiated Rate |
$59.79 |
| Rate for Payer: Adventist Health Commercial |
$15.94
|
| Rate for Payer: Cash Price |
$43.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.97
|
| Rate for Payer: Heritage Provider Network Senior |
$53.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.93
|
| Rate for Payer: Multiplan Commercial |
$59.79
|
|
|
PRAZIQUANTEL (BULK) 98.5 %-101 % POWDER [23284]
|
Facility
|
IP
|
$30.69
|
|
|
Service Code
|
NDC 38779-0090-4
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.55 |
| Max. Negotiated Rate |
$23.02 |
| Rate for Payer: Adventist Health Commercial |
$6.14
|
| Rate for Payer: Cash Price |
$16.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.78
|
| Rate for Payer: Heritage Provider Network Senior |
$20.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.67
|
| Rate for Payer: Multiplan Commercial |
$23.02
|
|
|
PRAZIQUANTEL (BULK) 98.5 %-101 % POWDER [23284]
|
Facility
|
OP
|
$30.69
|
|
|
Service Code
|
NDC 38779-0090-4
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.55 |
| Max. Negotiated Rate |
$26.09 |
| Rate for Payer: Adventist Health Commercial |
$6.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.02
|
| Rate for Payer: Blue Shield of California Commercial |
$18.72
|
| Rate for Payer: Blue Shield of California EPN |
$14.98
|
| Rate for Payer: Cash Price |
$16.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.09
|
| Rate for Payer: Dignity Health Senior |
$26.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.00
|
| Rate for Payer: Heritage Provider Network Senior |
$19.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.48
|
| Rate for Payer: Multiplan Commercial |
$23.02
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.28
|
| Rate for Payer: TriValley Medical Group Senior |
$12.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.09
|
| Rate for Payer: Vantage Medical Group Senior |
$26.09
|
|
|
PRAZOSIN 1 MG CAPSULE [6468]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 70010-084-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
| Rate for Payer: Dignity Health Senior |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Senior |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Senior |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
|
|
PRAZOSIN 1 MG CAPSULE [6468]
|
Facility
|
OP
|
$1.78
|
|
|
Service Code
|
NDC 68084-996-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.51 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.33
|
| Rate for Payer: Blue Shield of California Commercial |
$1.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.87
|
| Rate for Payer: Cash Price |
$0.98
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.51
|
| Rate for Payer: Dignity Health Senior |
$1.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.10
|
| Rate for Payer: Heritage Provider Network Senior |
$1.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.25
|
| Rate for Payer: Multiplan Commercial |
$1.33
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.71
|
| Rate for Payer: TriValley Medical Group Senior |
$0.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.51
|
| Rate for Payer: Vantage Medical Group Senior |
$1.51
|
|
|
PRAZOSIN 1 MG CAPSULE [6468]
|
Facility
|
IP
|
$1.78
|
|
|
Service Code
|
NDC 68084-996-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.33 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Cash Price |
$0.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.21
|
| Rate for Payer: Heritage Provider Network Senior |
$1.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.33
|
|
|
PRAZOSIN 1 MG CAPSULE [6468]
|
Facility
|
OP
|
$1.78
|
|
|
Service Code
|
NDC 68084-996-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.51 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.33
|
| Rate for Payer: Blue Shield of California Commercial |
$1.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.87
|
| Rate for Payer: Cash Price |
$0.98
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.51
|
| Rate for Payer: Dignity Health Senior |
$1.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.10
|
| Rate for Payer: Heritage Provider Network Senior |
$1.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.25
|
| Rate for Payer: Multiplan Commercial |
$1.33
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.71
|
| Rate for Payer: TriValley Medical Group Senior |
$0.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.51
|
| Rate for Payer: Vantage Medical Group Senior |
$1.51
|
|
|
PRAZOSIN 1 MG CAPSULE [6468]
|
Facility
|
OP
|
$1.81
|
|
|
Service Code
|
NDC 51079-630-20
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.36
|
| Rate for Payer: Blue Shield of California Commercial |
$1.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.88
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.54
|
| Rate for Payer: Dignity Health Senior |
$1.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.12
|
| Rate for Payer: Heritage Provider Network Senior |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.27
|
| Rate for Payer: Multiplan Commercial |
$1.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.72
|
| Rate for Payer: TriValley Medical Group Senior |
$0.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.54
|
| Rate for Payer: Vantage Medical Group Senior |
$1.54
|
|
|
PRAZOSIN 1 MG CAPSULE [6468]
|
Facility
|
OP
|
$1.81
|
|
|
Service Code
|
NDC 51079-630-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.36
|
| Rate for Payer: Blue Shield of California Commercial |
$1.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.88
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.54
|
| Rate for Payer: Dignity Health Senior |
$1.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.12
|
| Rate for Payer: Heritage Provider Network Senior |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.27
|
| Rate for Payer: Multiplan Commercial |
$1.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.72
|
| Rate for Payer: TriValley Medical Group Senior |
$0.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.54
|
| Rate for Payer: Vantage Medical Group Senior |
$1.54
|
|
|
PRAZOSIN 1 MG CAPSULE [6468]
|
Facility
|
IP
|
$1.62
|
|
|
Service Code
|
NDC 0904-7020-61
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Adventist Health Commercial |
$0.32
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.10
|
| Rate for Payer: Heritage Provider Network Senior |
$1.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$1.22
|
|
|
PRAZOSIN 1 MG CAPSULE [6468]
|
Facility
|
OP
|
$1.62
|
|
|
Service Code
|
NDC 0904-7020-61
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.38 |
| Rate for Payer: Adventist Health Commercial |
$0.32
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.99
|
| Rate for Payer: Blue Shield of California EPN |
$0.79
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.38
|
| Rate for Payer: Dignity Health Senior |
$1.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.13
|
| Rate for Payer: Multiplan Commercial |
$1.22
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.65
|
| Rate for Payer: TriValley Medical Group Senior |
$0.65
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.38
|
| Rate for Payer: Vantage Medical Group Senior |
$1.38
|
|
|
PRAZOSIN 1 MG CAPSULE [6468]
|
Facility
|
IP
|
$1.81
|
|
|
Service Code
|
NDC 51079-630-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.36 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.23
|
| Rate for Payer: Heritage Provider Network Senior |
$1.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.36
|
|
|
PRAZOSIN 1 MG CAPSULE [6468]
|
Facility
|
IP
|
$1.81
|
|
|
Service Code
|
NDC 51079-630-20
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.36 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.23
|
| Rate for Payer: Heritage Provider Network Senior |
$1.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.36
|
|
|
PRAZOSIN 1 MG CAPSULE [6468]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 70010-084-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Senior |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
|
|
PRAZOSIN 1 MG CAPSULE [6468]
|
Facility
|
IP
|
$1.78
|
|
|
Service Code
|
NDC 68084-996-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.33 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Cash Price |
$0.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.21
|
| Rate for Payer: Heritage Provider Network Senior |
$1.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.33
|
|
|
PRAZOSIN 2 MG CAPSULE [6469]
|
Facility
|
IP
|
$0.26
|
|
|
Service Code
|
NDC 70010-085-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Senior |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
|
|
PRAZOSIN 2 MG CAPSULE [6469]
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
NDC 70954-020-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: Dignity Health Senior |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Senior |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Senior |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
PRAZOSIN 2 MG CAPSULE [6469]
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
NDC 70954-020-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Senior |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
|
