|
PULMONARY EMBOLISM WITHOUT MCC
|
Facility
|
IP
|
$13,062.76
|
|
|
Service Code
|
MSDRG 176
|
| Min. Negotiated Rate |
$9,748.33 |
| Max. Negotiated Rate |
$13,062.76 |
| Rate for Payer: EPIC Health Plan Medicare |
$9,748.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,748.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,210.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13,062.76
|
|
|
PUNCH BIOPSY OF SKIN (INCLUDING SIMPLE CLOSURE, WHEN PERFORMED); EACH SEPARATE/ADDITIONAL LESION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 11105
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$918.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
|
|
PUNCH BIOPSY OF SKIN (INCLUDING SIMPLE CLOSURE, WHEN PERFORMED); SINGLE LESION
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 11104
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$522.85 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$522.85
|
| Rate for Payer: Heritage Provider Network Senior |
$643.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$993.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$601.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$575.13
|
| Rate for Payer: TriValley Medical Group Senior |
$575.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
PYRAZINAMIDE 500 MG TABLET [6738]
|
Facility
|
OP
|
$6.96
|
|
|
Service Code
|
NDC 6068778901
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.92 |
| Rate for Payer: Adventist Health Commercial |
$1.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.48
|
| Rate for Payer: Blue Shield of California Commercial |
$4.25
|
| Rate for Payer: Blue Shield of California EPN |
$3.40
|
| Rate for Payer: Cash Price |
$3.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.31
|
| Rate for Payer: Heritage Provider Network Senior |
$4.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.87
|
| Rate for Payer: Multiplan Commercial |
$5.22
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.78
|
| Rate for Payer: TriValley Medical Group Senior |
$2.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.92
|
| Rate for Payer: Vantage Medical Group Senior |
$5.92
|
|
|
PYRAZINAMIDE 500 MG TABLET [6738]
|
Facility
|
OP
|
$6.96
|
|
|
Service Code
|
NDC 6068778911
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.92 |
| Rate for Payer: Adventist Health Commercial |
$1.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.48
|
| Rate for Payer: Blue Shield of California Commercial |
$4.25
|
| Rate for Payer: Blue Shield of California EPN |
$3.40
|
| Rate for Payer: Cash Price |
$3.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.31
|
| Rate for Payer: Heritage Provider Network Senior |
$4.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.87
|
| Rate for Payer: Multiplan Commercial |
$5.22
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.78
|
| Rate for Payer: TriValley Medical Group Senior |
$2.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.92
|
| Rate for Payer: Vantage Medical Group Senior |
$5.92
|
|
|
PYRAZINAMIDE 500 MG TABLET [6738]
|
Facility
|
IP
|
$6.96
|
|
|
Service Code
|
NDC 6068778901
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.22 |
| Rate for Payer: Adventist Health Commercial |
$1.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.48
|
| Rate for Payer: Cash Price |
$3.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.71
|
| Rate for Payer: Heritage Provider Network Senior |
$4.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.74
|
| Rate for Payer: Multiplan Commercial |
$5.22
|
|
|
PYRAZINAMIDE 500 MG TABLET [6738]
|
Facility
|
IP
|
$4.40
|
|
|
Service Code
|
NDC 1013573560
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.30 |
| Rate for Payer: Adventist Health Commercial |
$0.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.83
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.98
|
| Rate for Payer: Heritage Provider Network Senior |
$2.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.10
|
| Rate for Payer: Multiplan Commercial |
$3.30
|
|
|
PYRAZINAMIDE 500 MG TABLET [6738]
|
Facility
|
IP
|
$5.46
|
|
|
Service Code
|
NDC 7095448410
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Adventist Health Commercial |
$1.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.52
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.70
|
| Rate for Payer: Heritage Provider Network Senior |
$3.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.36
|
| Rate for Payer: Multiplan Commercial |
$4.09
|
|
|
PYRAZINAMIDE 500 MG TABLET [6738]
|
Facility
|
OP
|
$4.40
|
|
|
Service Code
|
NDC 1013573560
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Adventist Health Commercial |
$0.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2.68
|
| Rate for Payer: Blue Shield of California EPN |
$2.15
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.72
|
| Rate for Payer: Heritage Provider Network Senior |
$2.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.08
|
| Rate for Payer: Multiplan Commercial |
$3.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.76
|
| Rate for Payer: TriValley Medical Group Senior |
$1.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.74
|
| Rate for Payer: Vantage Medical Group Senior |
$3.74
|
|
|
PYRAZINAMIDE 500 MG TABLET [6738]
|
Facility
|
OP
|
$5.32
|
|
|
Service Code
|
NDC 3334244711
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$4.52 |
| Rate for Payer: Adventist Health Commercial |
$1.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.66
|
| Rate for Payer: Blue Shield of California Commercial |
$3.25
|
| Rate for Payer: Blue Shield of California EPN |
$2.60
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.29
|
| Rate for Payer: Heritage Provider Network Senior |
$3.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.72
|
| Rate for Payer: Multiplan Commercial |
$3.99
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.13
|
| Rate for Payer: TriValley Medical Group Senior |
$2.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.52
|
| Rate for Payer: Vantage Medical Group Senior |
$4.52
|
|
|
PYRAZINAMIDE 500 MG TABLET [6738]
|
Facility
|
OP
|
$5.46
|
|
|
Service Code
|
NDC 7095448410
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$4.64 |
| Rate for Payer: Adventist Health Commercial |
$1.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.73
|
| Rate for Payer: Blue Shield of California Commercial |
$3.33
|
| Rate for Payer: Blue Shield of California EPN |
$2.66
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.38
|
| Rate for Payer: Heritage Provider Network Senior |
$3.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.82
|
| Rate for Payer: Multiplan Commercial |
$4.09
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.18
|
| Rate for Payer: TriValley Medical Group Senior |
$2.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.64
|
| Rate for Payer: Vantage Medical Group Senior |
$4.64
|
|
|
PYRAZINAMIDE 500 MG TABLET [6738]
|
Facility
|
IP
|
$6.96
|
|
|
Service Code
|
NDC 6068778911
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.22 |
| Rate for Payer: Adventist Health Commercial |
$1.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.48
|
| Rate for Payer: Cash Price |
$3.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.71
|
| Rate for Payer: Heritage Provider Network Senior |
$4.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.74
|
| Rate for Payer: Multiplan Commercial |
$5.22
|
|
|
PYRAZINAMIDE 500 MG TABLET [6738]
|
Facility
|
IP
|
$5.42
|
|
|
Service Code
|
NDC 7095448420
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$4.07 |
| Rate for Payer: Adventist Health Commercial |
$1.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.49
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.67
|
| Rate for Payer: Heritage Provider Network Senior |
$3.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.35
|
| Rate for Payer: Multiplan Commercial |
$4.07
|
|
|
PYRAZINAMIDE 500 MG TABLET [6738]
|
Facility
|
OP
|
$5.42
|
|
|
Service Code
|
NDC 7095448420
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$4.61 |
| Rate for Payer: Adventist Health Commercial |
$1.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.71
|
| Rate for Payer: Blue Shield of California Commercial |
$3.31
|
| Rate for Payer: Blue Shield of California EPN |
$2.64
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.35
|
| Rate for Payer: Heritage Provider Network Senior |
$3.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.79
|
| Rate for Payer: Multiplan Commercial |
$4.07
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.17
|
| Rate for Payer: TriValley Medical Group Senior |
$2.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.61
|
| Rate for Payer: Vantage Medical Group Senior |
$4.61
|
|
|
PYRAZINAMIDE 500 MG TABLET [6738]
|
Facility
|
IP
|
$5.32
|
|
|
Service Code
|
NDC 3334244711
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$3.99 |
| Rate for Payer: Adventist Health Commercial |
$1.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.43
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.60
|
| Rate for Payer: Heritage Provider Network Senior |
$3.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.33
|
| Rate for Payer: Multiplan Commercial |
$3.99
|
|
|
PYRAZINAMIDE ORAL SUSPENSION COMPOUND 100 MG/ML [4080326]
|
Facility
|
OP
|
$6.32
|
|
|
Service Code
|
NDC 9994080326
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$5.37 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.91
|
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.16
|
| Rate for Payer: Blue Shield of California Commercial |
$3.86
|
| Rate for Payer: Blue Shield of California EPN |
$3.08
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.91
|
| Rate for Payer: Heritage Provider Network Senior |
$3.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.42
|
| Rate for Payer: Multiplan Commercial |
$4.74
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.53
|
| Rate for Payer: TriValley Medical Group Senior |
$2.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.37
|
| Rate for Payer: Vantage Medical Group Senior |
$5.37
|
|
|
PYRAZINAMIDE ORAL SUSPENSION COMPOUND 100 MG/ML [4080326]
|
Facility
|
IP
|
$6.32
|
|
|
Service Code
|
NDC 9994080326
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$4.74 |
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.07
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.28
|
| Rate for Payer: Heritage Provider Network Senior |
$4.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.58
|
| Rate for Payer: Multiplan Commercial |
$4.74
|
|
|
PYRIDOSTIGMINE BROMIDE 5 MG/ML INJECTION SOLUTION [11237]
|
Facility
|
OP
|
$20.26
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$17.22 |
| Rate for Payer: Adventist Health Commercial |
$4.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.20
|
| Rate for Payer: Blue Shield of California Commercial |
$12.36
|
| Rate for Payer: Blue Shield of California EPN |
$9.89
|
| Rate for Payer: Cash Price |
$9.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.38
|
| Rate for Payer: Heritage Provider Network Senior |
$9.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.18
|
| Rate for Payer: Multiplan Commercial |
$15.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.10
|
| Rate for Payer: TriValley Medical Group Senior |
$8.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.22
|
| Rate for Payer: Vantage Medical Group Senior |
$17.22
|
|
|
PYRIDOSTIGMINE BROMIDE 5 MG/ML INJECTION SOLUTION [11237]
|
Facility
|
IP
|
$20.26
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$15.20 |
| Rate for Payer: Adventist Health Commercial |
$4.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.05
|
| Rate for Payer: Cash Price |
$9.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.38
|
| Rate for Payer: Heritage Provider Network Senior |
$9.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.07
|
| Rate for Payer: Multiplan Commercial |
$15.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.71
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG/5 ML ORAL SYRUP [11238]
|
Facility
|
OP
|
$4.90
|
|
|
Service Code
|
NDC 0187301220
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$4.17 |
| Rate for Payer: Adventist Health Commercial |
$0.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.45
|
| Rate for Payer: Blue Shield of California Commercial |
$2.99
|
| Rate for Payer: Blue Shield of California EPN |
$2.39
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.03
|
| Rate for Payer: Heritage Provider Network Senior |
$3.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.43
|
| Rate for Payer: Multiplan Commercial |
$3.67
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.96
|
| Rate for Payer: TriValley Medical Group Senior |
$1.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4.17
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG/5 ML ORAL SYRUP [11238]
|
Facility
|
IP
|
$4.90
|
|
|
Service Code
|
NDC 0187301220
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Adventist Health Commercial |
$0.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.16
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.32
|
| Rate for Payer: Heritage Provider Network Senior |
$3.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.23
|
| Rate for Payer: Multiplan Commercial |
$3.67
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG TABLET [11239]
|
Facility
|
OP
|
$1.22
|
|
|
Service Code
|
NDC 7193002890
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.61
|
| Rate for Payer: Blue Shield of California Commercial |
$0.74
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.76
|
| Rate for Payer: Heritage Provider Network Senior |
$0.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.85
|
| Rate for Payer: Multiplan Commercial |
$0.92
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.49
|
| Rate for Payer: TriValley Medical Group Senior |
$0.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.04
|
| Rate for Payer: Vantage Medical Group Senior |
$1.04
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG TABLET [11239]
|
Facility
|
OP
|
$1.22
|
|
|
Service Code
|
NDC 6838265906
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.61
|
| Rate for Payer: Blue Shield of California Commercial |
$0.74
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.76
|
| Rate for Payer: Heritage Provider Network Senior |
$0.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.85
|
| Rate for Payer: Multiplan Commercial |
$0.92
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.49
|
| Rate for Payer: TriValley Medical Group Senior |
$0.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.04
|
| Rate for Payer: Vantage Medical Group Senior |
$1.04
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG TABLET [11239]
|
Facility
|
IP
|
$0.98
|
|
|
Service Code
|
NDC 0115351101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.74 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.63
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.66
|
| Rate for Payer: Heritage Provider Network Senior |
$0.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.74
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG TABLET [11239]
|
Facility
|
OP
|
$0.98
|
|
|
Service Code
|
NDC 0115351101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.83 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.49
|
| Rate for Payer: Blue Shield of California Commercial |
$0.60
|
| Rate for Payer: Blue Shield of California EPN |
$0.48
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.61
|
| Rate for Payer: Heritage Provider Network Senior |
$0.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$0.74
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.39
|
| Rate for Payer: TriValley Medical Group Senior |
$0.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.83
|
| Rate for Payer: Vantage Medical Group Senior |
$0.83
|
|
