PYRIDOXINE (VITAMIN B6) 100 MG TABLET [6745]
|
Facility
|
OP
|
$0.03
|
|
Service Code
|
NDC 8770140730
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.01 |
Max. Negotiated Rate |
$0.03 |
Rate for Payer: Adventist Health Commercial |
$0.01
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.02
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$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 |
$0.02
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.02
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
Rate for Payer: Dignity Health Senior |
$0.03
|
Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
Rate for Payer: Heritage Provider Network Commercial |
$0.02
|
Rate for Payer: Heritage Provider Network Senior |
$0.02
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.01
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.02
|
Rate for Payer: Molina Healthcare of CA Medicare |
$0.02
|
Rate for Payer: Multiplan Commercial |
$0.02
|
Rate for Payer: TriValley Medical Group Commercial |
$0.01
|
Rate for Payer: TriValley Medical Group Senior |
$0.01
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.02
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.02
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
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
|
OP
|
$0.03
|
|
Service Code
|
NDC 0536440601
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.01 |
Max. Negotiated Rate |
$0.03 |
Rate for Payer: Adventist Health Commercial |
$0.01
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.02
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$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: Cigna of CA HMO/PPO |
$0.02
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
Rate for Payer: Dignity Health Senior |
$0.03
|
Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
Rate for Payer: Heritage Provider Network Commercial |
$0.02
|
Rate for Payer: Heritage Provider Network Senior |
$0.02
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.01
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.02
|
Rate for Payer: Molina Healthcare of CA Medicare |
$0.02
|
Rate for Payer: Multiplan Commercial |
$0.02
|
Rate for Payer: TriValley Medical Group Commercial |
$0.01
|
Rate for Payer: TriValley Medical Group Senior |
$0.01
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.02
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.02
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
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 0536440601
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.01 |
Max. Negotiated Rate |
$0.02 |
Rate for Payer: Adventist Health Commercial |
$0.01
|
Rate for Payer: Cash Price |
$0.01
|
Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
Rate for Payer: Heritage Provider Network Commercial |
$0.02
|
Rate for Payer: Heritage Provider Network Senior |
$0.02
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
Rate for Payer: Multiplan Commercial |
$0.02
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET [6748]
|
Facility
|
OP
|
$0.28
|
|
Service Code
|
NDC 5026885811
|
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 |
$0.16
|
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
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET [6748]
|
Facility
|
IP
|
$0.28
|
|
Service Code
|
NDC 5026885815
|
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 |
$0.16
|
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
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET [6748]
|
Facility
|
OP
|
$0.28
|
|
Service Code
|
NDC 5026885815
|
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 |
$0.16
|
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
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET [6748]
|
Facility
|
OP
|
$0.02
|
|
Service Code
|
NDC 5789685301
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Max. Negotiated Rate |
$0.02 |
Rate for Payer: Adventist Health Commercial |
$0.00
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.02
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.02
|
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: Cigna of CA HMO/PPO |
$0.01
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.02
|
Rate for Payer: Dignity Health Medi-Cal |
$0.02
|
Rate for Payer: Dignity Health Senior |
$0.02
|
Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
Rate for Payer: Heritage Provider Network Senior |
$0.01
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.01
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
Rate for Payer: Multiplan Commercial |
$0.02
|
Rate for Payer: TriValley Medical Group Commercial |
$0.01
|
Rate for Payer: TriValley Medical Group Senior |
$0.01
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.01
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.01
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.02
|
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
|
IP
|
$0.28
|
|
Service Code
|
NDC 5026885811
|
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 |
$0.16
|
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
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET [6748]
|
Facility
|
IP
|
$0.02
|
|
Service Code
|
NDC 5789685301
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Max. Negotiated Rate |
$0.02 |
Rate for Payer: Adventist Health Commercial |
$0.00
|
Rate for Payer: Cash Price |
$0.01
|
Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
Rate for Payer: Heritage Provider Network Senior |
$0.01
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
Rate for Payer: Multiplan Commercial |
$0.02
|
|
PYRIDOXINE (VITAMIN B6) ORAL SOLUTION COMPOUND 1 MG/ML [4081140]
|
Facility
|
IP
|
$19.88
|
|
Service Code
|
NDC 9994-0811-40
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$3.60 |
Max. Negotiated Rate |
$14.91 |
Rate for Payer: Adventist Health Commercial |
$3.98
|
Rate for Payer: Cash Price |
$10.94
|
Rate for Payer: EPIC Health Plan Commercial |
$10.74
|
Rate for Payer: Heritage Provider Network Commercial |
$13.46
|
Rate for Payer: Heritage Provider Network Senior |
$13.46
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.60
|
Rate for Payer: LLUH Dept of Risk Management WC |
$4.97
|
Rate for Payer: Multiplan Commercial |
$14.91
|
|
PYRIDOXINE (VITAMIN B6) ORAL SOLUTION COMPOUND 1 MG/ML [4081140]
|
Facility
|
OP
|
$19.88
|
|
Service Code
|
NDC 9994-0811-40
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$3.60 |
Max. Negotiated Rate |
$16.90 |
Rate for Payer: Adventist Health Commercial |
$3.98
|
Rate for Payer: Aetna of CA Gatekeeper |
$10.63
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.66
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.90
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.93
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.91
|
Rate for Payer: Blue Shield of California Commercial |
$12.13
|
Rate for Payer: Blue Shield of California EPN |
$9.70
|
Rate for Payer: Cash Price |
$10.94
|
Rate for Payer: Cigna of CA HMO/PPO |
$12.92
|
Rate for Payer: Dignity Health Commercial/Exchange |
$16.90
|
Rate for Payer: Dignity Health Medi-Cal |
$16.90
|
Rate for Payer: Dignity Health Senior |
$16.90
|
Rate for Payer: EPIC Health Plan Commercial |
$12.72
|
Rate for Payer: Heritage Provider Network Commercial |
$12.31
|
Rate for Payer: Heritage Provider Network Senior |
$12.31
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$9.48
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.60
|
Rate for Payer: LLUH Dept of Risk Management WC |
$4.97
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.92
|
Rate for Payer: Molina Healthcare of CA Medicare |
$13.92
|
Rate for Payer: Multiplan Commercial |
$14.91
|
Rate for Payer: TriValley Medical Group Commercial |
$7.95
|
Rate for Payer: TriValley Medical Group Senior |
$7.95
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.94
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.94
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.90
|
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
|
OP
|
$307.80
|
|
Service Code
|
NDC 0480-3720-56
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$55.71 |
Max. Negotiated Rate |
$261.63 |
Rate for Payer: Adventist Health Commercial |
$61.56
|
Rate for Payer: Aetna of CA Gatekeeper |
$164.52
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$211.46
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$261.63
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$169.29
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$230.85
|
Rate for Payer: Blue Shield of California Commercial |
$187.76
|
Rate for Payer: Blue Shield of California EPN |
$150.21
|
Rate for Payer: Cash Price |
$169.29
|
Rate for Payer: Cigna of CA HMO/PPO |
$200.07
|
Rate for Payer: Dignity Health Commercial/Exchange |
$261.63
|
Rate for Payer: Dignity Health Medi-Cal |
$261.63
|
Rate for Payer: Dignity Health Senior |
$261.63
|
Rate for Payer: EPIC Health Plan Commercial |
$196.99
|
Rate for Payer: Heritage Provider Network Commercial |
$190.53
|
Rate for Payer: Heritage Provider Network Senior |
$190.53
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$146.82
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.71
|
Rate for Payer: LLUH Dept of Risk Management WC |
$76.95
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.46
|
Rate for Payer: Molina Healthcare of CA Medicare |
$215.46
|
Rate for Payer: Multiplan Commercial |
$230.85
|
Rate for Payer: TriValley Medical Group Commercial |
$123.12
|
Rate for Payer: TriValley Medical Group Senior |
$123.12
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$153.90
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$153.90
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$261.63
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$261.63
|
Rate for Payer: Vantage Medical Group Senior |
$261.63
|
|
PYRIMETHAMINE 25 MG TABLET [11246]
|
Facility
|
IP
|
$307.80
|
|
Service Code
|
NDC 0480-3720-56
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$55.71 |
Max. Negotiated Rate |
$230.85 |
Rate for Payer: Adventist Health Commercial |
$61.56
|
Rate for Payer: Cash Price |
$169.29
|
Rate for Payer: EPIC Health Plan Commercial |
$166.21
|
Rate for Payer: Heritage Provider Network Commercial |
$208.38
|
Rate for Payer: Heritage Provider Network Senior |
$208.38
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.71
|
Rate for Payer: LLUH Dept of Risk Management WC |
$76.95
|
Rate for Payer: Multiplan Commercial |
$230.85
|
|
PYRIMETHAMINE ORAL SOLUTION COMPOUND 2 MG/ML [4080328]
|
Facility
|
OP
|
$0.09
|
|
Service Code
|
NDC 9994-0803-28
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.08 |
Rate for Payer: Adventist Health Commercial |
$0.02
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.05
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.06
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.08
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.05
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.07
|
Rate for Payer: Blue Shield of California Commercial |
$0.05
|
Rate for Payer: Blue Shield of California EPN |
$0.04
|
Rate for Payer: Cash Price |
$0.05
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.06
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.08
|
Rate for Payer: Dignity Health Medi-Cal |
$0.08
|
Rate for Payer: Dignity Health Senior |
$0.08
|
Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
Rate for Payer: Heritage Provider Network Commercial |
$0.06
|
Rate for Payer: Heritage Provider Network Senior |
$0.06
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.04
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.06
|
Rate for Payer: Molina Healthcare of CA Medicare |
$0.06
|
Rate for Payer: Multiplan Commercial |
$0.07
|
Rate for Payer: TriValley Medical Group Commercial |
$0.04
|
Rate for Payer: TriValley Medical Group Senior |
$0.04
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.05
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.05
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.08
|
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 |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.07 |
Rate for Payer: Adventist Health Commercial |
$0.02
|
Rate for Payer: Cash Price |
$0.05
|
Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
Rate for Payer: Heritage Provider Network Commercial |
$0.06
|
Rate for Payer: Heritage Provider Network Senior |
$0.06
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
Rate for Payer: Multiplan Commercial |
$0.07
|
|
QUETIAPINE 100 MG TABLET [21824]
|
Facility
|
OP
|
$0.64
|
|
Service Code
|
NDC 60687-349-11
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.12 |
Max. Negotiated Rate |
$0.54 |
Rate for Payer: Adventist Health Commercial |
$0.13
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.34
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.44
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.54
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.35
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.48
|
Rate for Payer: Blue Shield of California Commercial |
$0.39
|
Rate for Payer: Blue Shield of California EPN |
$0.31
|
Rate for Payer: Cash Price |
$0.35
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.42
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.54
|
Rate for Payer: Dignity Health Medi-Cal |
$0.54
|
Rate for Payer: Dignity Health Senior |
$0.54
|
Rate for Payer: EPIC Health Plan Commercial |
$0.41
|
Rate for Payer: Heritage Provider Network Commercial |
$0.40
|
Rate for Payer: Heritage Provider Network Senior |
$0.40
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.31
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.45
|
Rate for Payer: Molina Healthcare of CA Medicare |
$0.45
|
Rate for Payer: Multiplan Commercial |
$0.48
|
Rate for Payer: TriValley Medical Group Commercial |
$0.26
|
Rate for Payer: TriValley Medical Group Senior |
$0.26
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.32
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.32
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.54
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.54
|
Rate for Payer: Vantage Medical Group Senior |
$0.54
|
|
QUETIAPINE 100 MG TABLET [21824]
|
Facility
|
IP
|
$0.64
|
|
Service Code
|
NDC 60687-349-01
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.12 |
Max. Negotiated Rate |
$0.48 |
Rate for Payer: Adventist Health Commercial |
$0.13
|
Rate for Payer: Cash Price |
$0.35
|
Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
Rate for Payer: Heritage Provider Network Commercial |
$0.43
|
Rate for Payer: Heritage Provider Network Senior |
$0.43
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
Rate for Payer: Multiplan Commercial |
$0.48
|
|
QUETIAPINE 100 MG TABLET [21824]
|
Facility
|
OP
|
$0.64
|
|
Service Code
|
NDC 60687-349-01
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.12 |
Max. Negotiated Rate |
$0.54 |
Rate for Payer: Adventist Health Commercial |
$0.13
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.34
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.44
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.54
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.35
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.48
|
Rate for Payer: Blue Shield of California Commercial |
$0.39
|
Rate for Payer: Blue Shield of California EPN |
$0.31
|
Rate for Payer: Cash Price |
$0.35
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.42
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.54
|
Rate for Payer: Dignity Health Medi-Cal |
$0.54
|
Rate for Payer: Dignity Health Senior |
$0.54
|
Rate for Payer: EPIC Health Plan Commercial |
$0.41
|
Rate for Payer: Heritage Provider Network Commercial |
$0.40
|
Rate for Payer: Heritage Provider Network Senior |
$0.40
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.31
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.45
|
Rate for Payer: Molina Healthcare of CA Medicare |
$0.45
|
Rate for Payer: Multiplan Commercial |
$0.48
|
Rate for Payer: TriValley Medical Group Commercial |
$0.26
|
Rate for Payer: TriValley Medical Group Senior |
$0.26
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.32
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.32
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.54
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.54
|
Rate for Payer: Vantage Medical Group Senior |
$0.54
|
|
QUETIAPINE 100 MG TABLET [21824]
|
Facility
|
IP
|
$0.09
|
|
Service Code
|
NDC 67877-250-01
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.07 |
Rate for Payer: Adventist Health Commercial |
$0.02
|
Rate for Payer: Cash Price |
$0.05
|
Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
Rate for Payer: Heritage Provider Network Commercial |
$0.06
|
Rate for Payer: Heritage Provider Network Senior |
$0.06
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
Rate for Payer: Multiplan Commercial |
$0.07
|
|
QUETIAPINE 100 MG TABLET [21824]
|
Facility
|
IP
|
$0.64
|
|
Service Code
|
NDC 60687-349-11
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.12 |
Max. Negotiated Rate |
$0.48 |
Rate for Payer: Adventist Health Commercial |
$0.13
|
Rate for Payer: Cash Price |
$0.35
|
Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
Rate for Payer: Heritage Provider Network Commercial |
$0.43
|
Rate for Payer: Heritage Provider Network Senior |
$0.43
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
Rate for Payer: Multiplan Commercial |
$0.48
|
|
QUETIAPINE 100 MG TABLET [21824]
|
Facility
|
OP
|
$0.38
|
|
Service Code
|
NDC 47335-904-88
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.07 |
Max. Negotiated Rate |
$0.32 |
Rate for Payer: Adventist Health Commercial |
$0.08
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.20
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.26
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.32
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.21
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.29
|
Rate for Payer: Blue Shield of California Commercial |
$0.23
|
Rate for Payer: Blue Shield of California EPN |
$0.19
|
Rate for Payer: Cash Price |
$0.21
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.25
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.32
|
Rate for Payer: Dignity Health Medi-Cal |
$0.32
|
Rate for Payer: Dignity Health Senior |
$0.32
|
Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
Rate for Payer: Heritage Provider Network Commercial |
$0.24
|
Rate for Payer: Heritage Provider Network Senior |
$0.24
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.18
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.27
|
Rate for Payer: Molina Healthcare of CA Medicare |
$0.27
|
Rate for Payer: Multiplan Commercial |
$0.29
|
Rate for Payer: TriValley Medical Group Commercial |
$0.15
|
Rate for Payer: TriValley Medical Group Senior |
$0.15
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.19
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.19
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.32
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.32
|
Rate for Payer: Vantage Medical Group Senior |
$0.32
|
|
QUETIAPINE 100 MG TABLET [21824]
|
Facility
|
IP
|
$0.56
|
|
Service Code
|
NDC 0904-6640-61
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.10 |
Max. Negotiated Rate |
$0.42 |
Rate for Payer: Adventist Health Commercial |
$0.11
|
Rate for Payer: Cash Price |
$0.31
|
Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
Rate for Payer: Heritage Provider Network Commercial |
$0.38
|
Rate for Payer: Heritage Provider Network Senior |
$0.38
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
Rate for Payer: Multiplan Commercial |
$0.42
|
|
QUETIAPINE 100 MG TABLET [21824]
|
Facility
|
OP
|
$0.56
|
|
Service Code
|
NDC 0904-6640-61
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.10 |
Max. Negotiated Rate |
$0.48 |
Rate for Payer: Adventist Health Commercial |
$0.11
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.30
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.38
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.48
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.31
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.42
|
Rate for Payer: Blue Shield of California Commercial |
$0.34
|
Rate for Payer: Blue Shield of California EPN |
$0.27
|
Rate for Payer: Cash Price |
$0.31
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.36
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.48
|
Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
Rate for Payer: Dignity Health Senior |
$0.48
|
Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
Rate for Payer: Heritage Provider Network Commercial |
$0.35
|
Rate for Payer: Heritage Provider Network Senior |
$0.35
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.27
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.39
|
Rate for Payer: Molina Healthcare of CA Medicare |
$0.39
|
Rate for Payer: Multiplan Commercial |
$0.42
|
Rate for Payer: TriValley Medical Group Commercial |
$0.22
|
Rate for Payer: TriValley Medical Group Senior |
$0.22
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.28
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.28
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.48
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
Rate for Payer: Vantage Medical Group Senior |
$0.48
|
|
QUETIAPINE 100 MG TABLET [21824]
|
Facility
|
IP
|
$0.14
|
|
Service Code
|
NDC 16729-147-01
|
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 |
$0.09
|
Rate for Payer: Heritage Provider Network Senior |
$0.09
|
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
|
|
QUETIAPINE 100 MG TABLET [21824]
|
Facility
|
OP
|
$0.14
|
|
Service Code
|
NDC 16729-147-01
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.03 |
Max. Negotiated Rate |
$0.12 |
Rate for Payer: Adventist Health Commercial |
$0.03
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.07
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.10
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.12
|
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 |
$0.09
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.12
|
Rate for Payer: Dignity Health Medi-Cal |
$0.12
|
Rate for Payer: Dignity Health Senior |
$0.12
|
Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
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 |
$0.10
|
Rate for Payer: Molina Healthcare of CA Medicare |
$0.10
|
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 |
$0.07
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.07
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.12
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.12
|
Rate for Payer: Vantage Medical Group Senior |
$0.12
|
|