|
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 5 MG CAPSULE [6470]
|
Facility
|
OP
|
$4.11
|
|
|
Service Code
|
NDC 60687-572-33
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$3.49 |
| Rate for Payer: Adventist Health Commercial |
$0.82
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.08
|
| Rate for Payer: Blue Shield of California Commercial |
$2.51
|
| Rate for Payer: Blue Shield of California EPN |
$2.01
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.49
|
| Rate for Payer: Dignity Health Senior |
$3.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.54
|
| Rate for Payer: Heritage Provider Network Senior |
$2.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$3.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.64
|
| Rate for Payer: TriValley Medical Group Senior |
$1.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.49
|
| Rate for Payer: Vantage Medical Group Senior |
$3.49
|
|
|
PRAZOSIN 5 MG CAPSULE [6470]
|
Facility
|
IP
|
$4.11
|
|
|
Service Code
|
NDC 60687-572-32
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$3.08 |
| Rate for Payer: Adventist Health Commercial |
$0.82
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.78
|
| Rate for Payer: Heritage Provider Network Senior |
$2.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.03
|
| Rate for Payer: Multiplan Commercial |
$3.08
|
|
|
PRAZOSIN 5 MG CAPSULE [6470]
|
Facility
|
IP
|
$1.26
|
|
|
Service Code
|
NDC 0093-4069-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Adventist Health Commercial |
$0.25
|
| Rate for Payer: Cash Price |
$0.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.85
|
| Rate for Payer: Heritage Provider Network Senior |
$0.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$0.95
|
|
|
PRAZOSIN 5 MG CAPSULE [6470]
|
Facility
|
IP
|
$0.28
|
|
|
Service Code
|
NDC 70756-440-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Senior |
$0.19
|
| 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 |
$0.21
|
|
|
PRAZOSIN 5 MG CAPSULE [6470]
|
Facility
|
OP
|
$4.31
|
|
|
Service Code
|
NDC 51079-632-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$3.66 |
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.23
|
| Rate for Payer: Blue Shield of California Commercial |
$2.63
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Cash Price |
$2.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.66
|
| Rate for Payer: Dignity Health Senior |
$3.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.67
|
| Rate for Payer: Heritage Provider Network Senior |
$2.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.02
|
| Rate for Payer: Multiplan Commercial |
$3.23
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.72
|
| Rate for Payer: TriValley Medical Group Senior |
$1.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.66
|
| Rate for Payer: Vantage Medical Group Senior |
$3.66
|
|
|
PRAZOSIN 5 MG CAPSULE [6470]
|
Facility
|
IP
|
$4.31
|
|
|
Service Code
|
NDC 51079-632-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$3.23 |
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Cash Price |
$2.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.92
|
| Rate for Payer: Heritage Provider Network Senior |
$2.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: Multiplan Commercial |
$3.23
|
|
|
PRAZOSIN 5 MG CAPSULE [6470]
|
Facility
|
IP
|
$0.33
|
|
|
Service Code
|
NDC 70954-021-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Senior |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
|
|
PRAZOSIN 5 MG CAPSULE [6470]
|
Facility
|
OP
|
$0.33
|
|
|
Service Code
|
NDC 70954-021-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.25
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.28
|
| Rate for Payer: Dignity Health Senior |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.20
|
| Rate for Payer: Heritage Provider Network Senior |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Senior |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Vantage Medical Group Senior |
$0.28
|
|
|
PRAZOSIN 5 MG CAPSULE [6470]
|
Facility
|
OP
|
$1.26
|
|
|
Service Code
|
NDC 0093-4069-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$1.07 |
| Rate for Payer: Adventist Health Commercial |
$0.25
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.95
|
| Rate for Payer: Blue Shield of California Commercial |
$0.77
|
| Rate for Payer: Blue Shield of California EPN |
$0.61
|
| Rate for Payer: Cash Price |
$0.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.07
|
| Rate for Payer: Dignity Health Senior |
$1.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.78
|
| Rate for Payer: Heritage Provider Network Senior |
$0.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.88
|
| Rate for Payer: Multiplan Commercial |
$0.95
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.50
|
| Rate for Payer: TriValley Medical Group Senior |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.07
|
| Rate for Payer: Vantage Medical Group Senior |
$1.07
|
|
|
PRAZOSIN 5 MG CAPSULE [6470]
|
Facility
|
IP
|
$4.31
|
|
|
Service Code
|
NDC 51079-632-20
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$3.23 |
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Cash Price |
$2.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.92
|
| Rate for Payer: Heritage Provider Network Senior |
$2.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: Multiplan Commercial |
$3.23
|
|
|
PRAZOSIN 5 MG CAPSULE [6470]
|
Facility
|
OP
|
$4.11
|
|
|
Service Code
|
NDC 60687-572-32
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$3.49 |
| Rate for Payer: Adventist Health Commercial |
$0.82
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.08
|
| Rate for Payer: Blue Shield of California Commercial |
$2.51
|
| Rate for Payer: Blue Shield of California EPN |
$2.01
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.49
|
| Rate for Payer: Dignity Health Senior |
$3.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.54
|
| Rate for Payer: Heritage Provider Network Senior |
$2.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$3.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.64
|
| Rate for Payer: TriValley Medical Group Senior |
$1.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.49
|
| Rate for Payer: Vantage Medical Group Senior |
$3.49
|
|
|
PRAZOSIN 5 MG CAPSULE [6470]
|
Facility
|
IP
|
$4.11
|
|
|
Service Code
|
NDC 60687-572-33
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$3.08 |
| Rate for Payer: Adventist Health Commercial |
$0.82
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.78
|
| Rate for Payer: Heritage Provider Network Senior |
$2.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.03
|
| Rate for Payer: Multiplan Commercial |
$3.08
|
|
|
PRAZOSIN 5 MG CAPSULE [6470]
|
Facility
|
OP
|
$0.28
|
|
|
Service Code
|
NDC 70756-440-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.21
|
| Rate for Payer: Blue Shield of California Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.24
|
| Rate for Payer: Dignity Health Senior |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Senior |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.13
|
| 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: Molina Healthcare of CA Medi-Cal |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: Vantage Medical Group Senior |
$0.24
|
|
|
PRAZOSIN 5 MG CAPSULE [6470]
|
Facility
|
OP
|
$4.31
|
|
|
Service Code
|
NDC 51079-632-20
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$3.66 |
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.23
|
| Rate for Payer: Blue Shield of California Commercial |
$2.63
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Cash Price |
$2.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.66
|
| Rate for Payer: Dignity Health Senior |
$3.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.67
|
| Rate for Payer: Heritage Provider Network Senior |
$2.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.02
|
| Rate for Payer: Multiplan Commercial |
$3.23
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.72
|
| Rate for Payer: TriValley Medical Group Senior |
$1.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.66
|
| Rate for Payer: Vantage Medical Group Senior |
$3.66
|
|
|
PREDNISOLONE 15 MG/5 ML ORAL SOLUTION [11117]
|
Facility
|
IP
|
$1.44
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.78
|
| 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 Medi-Cal |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.48
|
|
|
PREDNISOLONE 15 MG/5 ML ORAL SOLUTION [11117]
|
Facility
|
OP
|
$1.44
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4.44
|
| Rate for Payer: Blue Shield of California EPN |
$4.44
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.22
|
| Rate for Payer: Dignity Health Senior |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.67
|
| Rate for Payer: Heritage Provider Network Senior |
$0.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.01
|
| Rate for Payer: Multiplan Commercial |
$1.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.58
|
| Rate for Payer: TriValley Medical Group Senior |
$0.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.22
|
| Rate for Payer: Vantage Medical Group Senior |
$1.22
|
|
|
PREDNISOLONE ACETATE 0.12 % EYE DROPS,SUSPENSION [27038]
|
Facility
|
OP
|
$38.50
|
|
|
Service Code
|
NDC 11980-174-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$32.73 |
| Rate for Payer: Adventist Health Commercial |
$7.70
|
| Rate for Payer: Aetna of CA Gatekeeper |
$20.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.88
|
| Rate for Payer: Blue Shield of California Commercial |
$23.48
|
| Rate for Payer: Blue Shield of California EPN |
$18.79
|
| Rate for Payer: Cash Price |
$21.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.73
|
| Rate for Payer: Dignity Health Senior |
$32.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.83
|
| Rate for Payer: Heritage Provider Network Senior |
$23.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.95
|
| Rate for Payer: Multiplan Commercial |
$28.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.40
|
| Rate for Payer: TriValley Medical Group Senior |
$15.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.73
|
| Rate for Payer: Vantage Medical Group Senior |
$32.73
|
|
|
PREDNISOLONE ACETATE 0.12 % EYE DROPS,SUSPENSION [27038]
|
Facility
|
IP
|
$38.50
|
|
|
Service Code
|
NDC 11980-174-05
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$28.88 |
| Rate for Payer: Adventist Health Commercial |
$7.70
|
| Rate for Payer: Cash Price |
$21.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.06
|
| Rate for Payer: Heritage Provider Network Senior |
$26.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.62
|
| Rate for Payer: Multiplan Commercial |
$28.88
|
|
|
PREDNISOLONE ACETATE 0.12 % EYE DROPS,SUSPENSION [27038]
|
Facility
|
OP
|
$38.50
|
|
|
Service Code
|
NDC 11980-174-05
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$32.73 |
| Rate for Payer: Adventist Health Commercial |
$7.70
|
| Rate for Payer: Aetna of CA Gatekeeper |
$20.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.88
|
| Rate for Payer: Blue Shield of California Commercial |
$23.48
|
| Rate for Payer: Blue Shield of California EPN |
$18.79
|
| Rate for Payer: Cash Price |
$21.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.73
|
| Rate for Payer: Dignity Health Senior |
$32.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.83
|
| Rate for Payer: Heritage Provider Network Senior |
$23.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.95
|
| Rate for Payer: Multiplan Commercial |
$28.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.40
|
| Rate for Payer: TriValley Medical Group Senior |
$15.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.73
|
| Rate for Payer: Vantage Medical Group Senior |
$32.73
|
|
|
PREDNISOLONE ACETATE 0.12 % EYE DROPS,SUSPENSION [27038]
|
Facility
|
IP
|
$38.50
|
|
|
Service Code
|
NDC 11980-174-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$28.88 |
| Rate for Payer: Adventist Health Commercial |
$7.70
|
| Rate for Payer: Cash Price |
$21.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.06
|
| Rate for Payer: Heritage Provider Network Senior |
$26.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.62
|
| Rate for Payer: Multiplan Commercial |
$28.88
|
|
|
PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION [6487]
|
Facility
|
IP
|
$10.56
|
|
|
Service Code
|
NDC 60758-119-05
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$7.92 |
| Rate for Payer: Adventist Health Commercial |
$2.11
|
| Rate for Payer: Cash Price |
$5.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.15
|
| Rate for Payer: Heritage Provider Network Senior |
$7.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$7.92
|
|
|
PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION [6487]
|
Facility
|
OP
|
$38.50
|
|
|
Service Code
|
NDC 11980-180-05
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$32.73 |
| Rate for Payer: Adventist Health Commercial |
$7.70
|
| Rate for Payer: Aetna of CA Gatekeeper |
$20.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.88
|
| Rate for Payer: Blue Shield of California Commercial |
$23.48
|
| Rate for Payer: Blue Shield of California EPN |
$18.79
|
| Rate for Payer: Cash Price |
$21.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.73
|
| Rate for Payer: Dignity Health Senior |
$32.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.83
|
| Rate for Payer: Heritage Provider Network Senior |
$23.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.95
|
| Rate for Payer: Multiplan Commercial |
$28.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.40
|
| Rate for Payer: TriValley Medical Group Senior |
$15.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.73
|
| Rate for Payer: Vantage Medical Group Senior |
$32.73
|
|
|
PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION [6487]
|
Facility
|
OP
|
$10.56
|
|
|
Service Code
|
NDC 60758-119-05
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$8.98 |
| Rate for Payer: Adventist Health Commercial |
$2.11
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.92
|
| Rate for Payer: Blue Shield of California Commercial |
$6.44
|
| Rate for Payer: Blue Shield of California EPN |
$5.15
|
| Rate for Payer: Cash Price |
$5.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.98
|
| Rate for Payer: Dignity Health Senior |
$8.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.54
|
| Rate for Payer: Heritage Provider Network Senior |
$6.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.39
|
| Rate for Payer: Multiplan Commercial |
$7.92
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.22
|
| Rate for Payer: TriValley Medical Group Senior |
$4.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.98
|
| Rate for Payer: Vantage Medical Group Senior |
$8.98
|
|
|
PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION [6487]
|
Facility
|
IP
|
$10.62
|
|
|
Service Code
|
NDC 61314-637-05
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$7.96 |
| Rate for Payer: Adventist Health Commercial |
$2.12
|
| Rate for Payer: Cash Price |
$5.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.19
|
| Rate for Payer: Heritage Provider Network Senior |
$7.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.65
|
| Rate for Payer: Multiplan Commercial |
$7.96
|
|
