|
PRAVASTATIN 20 MG TABLET [11111]
|
Facility
IP
|
$0.31
|
|
|
Service Code
|
NDC 60505-0169-9
|
| Hospital Charge Code |
1711539
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.21
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.21
|
| Rate for Payer: Heritage Provider Network Senior |
$0.21
|
| 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 |
$0.23
|
|
|
PRAVASTATIN 20 MG TABLET [11111]
|
Facility
OP
|
$0.84
|
|
|
Service Code
|
NDC 60687-178-11
|
| Hospital Charge Code |
1711539
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.71 |
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.71
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.46
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.63
|
| Rate for Payer: Blue Shield of California Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.49
|
| Rate for Payer: Cash Price |
$0.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.71
|
| Rate for Payer: Dignity Health Senior |
$0.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.52
|
| Rate for Payer: Heritage Provider Network Senior |
$0.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.71
|
| Rate for Payer: Vantage Medical Group Senior |
$0.71
|
|
|
PRAVASTATIN 20 MG TABLET [11111]
|
Facility
OP
|
$0.68
|
|
|
Service Code
|
NDC 0904-5892-61
|
| Hospital Charge Code |
1711539
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.51
|
| Rate for Payer: Blue Shield of California Commercial |
$0.42
|
| Rate for Payer: Blue Shield of California EPN |
$0.40
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.58
|
| Rate for Payer: Dignity Health Senior |
$0.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.42
|
| Rate for Payer: Heritage Provider Network Senior |
$0.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.58
|
| Rate for Payer: Vantage Medical Group Senior |
$0.58
|
|
|
PRAVASTATIN 40 MG TABLET [11112]
|
Facility
OP
|
$0.85
|
|
|
Service Code
|
NDC 0904-5893-61
|
| Hospital Charge Code |
1712509
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.72 |
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.64
|
| Rate for Payer: Blue Shield of California Commercial |
$0.53
|
| Rate for Payer: Blue Shield of California EPN |
$0.50
|
| Rate for Payer: Cash Price |
$0.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.72
|
| Rate for Payer: Dignity Health Senior |
$0.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.53
|
| Rate for Payer: Heritage Provider Network Senior |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.72
|
| Rate for Payer: Vantage Medical Group Senior |
$0.72
|
|
|
PRAVASTATIN 40 MG TABLET [11112]
|
Facility
OP
|
$0.98
|
|
|
Service Code
|
NDC 51079-782-01
|
| Hospital Charge Code |
1712509
|
|
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 Gatekeeper |
$0.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.54
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.74
|
| Rate for Payer: Blue Shield of California Commercial |
$0.61
|
| Rate for Payer: Blue Shield of California EPN |
$0.58
|
| 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 Senior |
$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 Permanente of CA Commercial |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.83
|
| Rate for Payer: Vantage Medical Group Senior |
$0.83
|
|
|
PRAVASTATIN 40 MG TABLET [11112]
|
Facility
IP
|
$0.46
|
|
|
Service Code
|
NDC 60505-0170-9
|
| Hospital Charge Code |
1712509
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.32
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.31
|
| Rate for Payer: Heritage Provider Network Senior |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
|
|
PRAVASTATIN 40 MG TABLET [11112]
|
Facility
OP
|
$0.86
|
|
|
Service Code
|
NDC 68180-487-09
|
| Hospital Charge Code |
1712509
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.73 |
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.65
|
| Rate for Payer: Blue Shield of California Commercial |
$0.53
|
| Rate for Payer: Blue Shield of California EPN |
$0.50
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.73
|
| Rate for Payer: Dignity Health Senior |
$0.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.53
|
| Rate for Payer: Heritage Provider Network Senior |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.73
|
| Rate for Payer: Vantage Medical Group Senior |
$0.73
|
|
|
PRAVASTATIN 40 MG TABLET [11112]
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
NDC 60687-190-11
|
| Hospital Charge Code |
1712509
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.69
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.68
|
| Rate for Payer: Heritage Provider Network Senior |
$0.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
|
|
PRAVASTATIN 40 MG TABLET [11112]
|
Facility
OP
|
$0.46
|
|
|
Service Code
|
NDC 60505-0170-9
|
| Hospital Charge Code |
1712509
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.39
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.35
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.39
|
| Rate for Payer: Dignity Health Senior |
$0.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.28
|
| Rate for Payer: Heritage Provider Network Senior |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.39
|
| Rate for Payer: Vantage Medical Group Senior |
$0.39
|
|
|
PRAVASTATIN 40 MG TABLET [11112]
|
Facility
IP
|
$0.45
|
|
|
Service Code
|
NDC 68462-197-90
|
| Hospital Charge Code |
1712509
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.31
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.30
|
| Rate for Payer: Heritage Provider Network Senior |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.34
|
|
|
PRAVASTATIN 40 MG TABLET [11112]
|
Facility
IP
|
$0.86
|
|
|
Service Code
|
NDC 68180-487-09
|
| Hospital Charge Code |
1712509
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.59
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.58
|
| Rate for Payer: Heritage Provider Network Senior |
$0.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.65
|
|
|
PRAVASTATIN 40 MG TABLET [11112]
|
Facility
IP
|
$0.85
|
|
|
Service Code
|
NDC 0904-5893-61
|
| Hospital Charge Code |
1712509
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.58
|
| Rate for Payer: Cash Price |
$0.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.58
|
| Rate for Payer: Heritage Provider Network Senior |
$0.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.64
|
|
|
PRAVASTATIN 40 MG TABLET [11112]
|
Facility
OP
|
$0.45
|
|
|
Service Code
|
NDC 68462-197-90
|
| Hospital Charge Code |
1712509
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$0.28
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.38
|
| Rate for Payer: Dignity Health Senior |
$0.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.28
|
| Rate for Payer: Heritage Provider Network Senior |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.38
|
| Rate for Payer: Vantage Medical Group Senior |
$0.38
|
|
|
PRAVASTATIN 40 MG TABLET [11112]
|
Facility
IP
|
$0.98
|
|
|
Service Code
|
NDC 51079-782-20
|
| Hospital Charge Code |
1712509
|
|
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 |
$0.67
|
| 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 Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.74
|
|
|
PRAVASTATIN 40 MG TABLET [11112]
|
Facility
OP
|
$0.98
|
|
|
Service Code
|
NDC 51079-782-20
|
| Hospital Charge Code |
1712509
|
|
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 Gatekeeper |
$0.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.54
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.74
|
| Rate for Payer: Blue Shield of California Commercial |
$0.61
|
| Rate for Payer: Blue Shield of California EPN |
$0.58
|
| 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 Senior |
$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 Permanente of CA Commercial |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.83
|
| Rate for Payer: Vantage Medical Group Senior |
$0.83
|
|
|
PRAVASTATIN 40 MG TABLET [11112]
|
Facility
IP
|
$0.98
|
|
|
Service Code
|
NDC 51079-782-01
|
| Hospital Charge Code |
1712509
|
|
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 |
$0.67
|
| 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 Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.74
|
|
|
PRAVASTATIN 40 MG TABLET [11112]
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
NDC 60687-190-11
|
| Hospital Charge Code |
1712509
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.75
|
| Rate for Payer: Blue Shield of California Commercial |
$0.62
|
| Rate for Payer: Blue Shield of California EPN |
$0.59
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: Dignity Health Senior |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.62
|
| Rate for Payer: Heritage Provider Network Senior |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
PRAZIQUANTEL 600 MG TABLET [11113]
|
Facility
IP
|
$79.72
|
|
|
Service Code
|
NDC 49884-231-83
|
| Hospital Charge Code |
1712212
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.43 |
| Max. Negotiated Rate |
$59.79 |
| Rate for Payer: Adventist Health Commercial |
$15.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.77
|
| Rate for Payer: Cash Price |
$35.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.97
|
| Rate for Payer: Heritage Provider Network Senior |
$53.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.93
|
| Rate for Payer: Multiplan Commercial |
$59.79
|
|
|
PRAZIQUANTEL 600 MG TABLET [11113]
|
Facility
OP
|
$79.72
|
|
|
Service Code
|
NDC 49884-231-83
|
| Hospital Charge Code |
1712212
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.43 |
| Max. Negotiated Rate |
$67.76 |
| Rate for Payer: Adventist Health Commercial |
$15.94
|
| Rate for Payer: Aetna of CA Gatekeeper |
$42.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$67.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$43.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$59.79
|
| Rate for Payer: Blue Shield of California Commercial |
$49.51
|
| Rate for Payer: Blue Shield of California EPN |
$46.80
|
| Rate for Payer: Cash Price |
$35.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$51.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.76
|
| Rate for Payer: Dignity Health Senior |
$67.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$49.35
|
| Rate for Payer: Heritage Provider Network Senior |
$49.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$38.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.93
|
| Rate for Payer: Multiplan Commercial |
$59.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67.76
|
| Rate for Payer: Vantage Medical Group Senior |
$67.76
|
|
|
PRAZIQUANTEL (BULK) 98.5 %-101 % POWDER [23284]
|
Facility
IP
|
$30.69
|
|
|
Service Code
|
NDC 38779-0090-4
|
| Hospital Charge Code |
NDG23284B
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.55 |
| Max. Negotiated Rate |
$23.02 |
| Rate for Payer: Adventist Health Commercial |
$6.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.08
|
| Rate for Payer: Cash Price |
$13.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.78
|
| Rate for Payer: Heritage Provider Network Senior |
$20.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.67
|
| Rate for Payer: Multiplan Commercial |
$23.02
|
|
|
PRAZIQUANTEL (BULK) 98.5 %-101 % POWDER [23284]
|
Facility
OP
|
$30.69
|
|
|
Service Code
|
NDC 38779-0090-4
|
| Hospital Charge Code |
NDG23284B
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.55 |
| Max. Negotiated Rate |
$26.09 |
| Rate for Payer: Adventist Health Commercial |
$6.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$26.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.88
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$23.02
|
| Rate for Payer: Blue Shield of California Commercial |
$19.06
|
| Rate for Payer: Blue Shield of California EPN |
$18.02
|
| Rate for Payer: Cash Price |
$13.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.09
|
| Rate for Payer: Dignity Health Senior |
$26.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.00
|
| Rate for Payer: Heritage Provider Network Senior |
$19.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.67
|
| Rate for Payer: Multiplan Commercial |
$23.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.09
|
| Rate for Payer: Vantage Medical Group Senior |
$26.09
|
|
|
PRAZOSIN 1 MG CAPSULE [6468]
|
Facility
IP
|
$1.81
|
|
|
Service Code
|
NDC 51079-630-01
|
| Hospital Charge Code |
1710580
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.36 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.24
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.23
|
| Rate for Payer: Heritage Provider Network Senior |
$1.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.36
|
|
|
PRAZOSIN 1 MG CAPSULE [6468]
|
Facility
OP
|
$1.81
|
|
|
Service Code
|
NDC 51079-630-01
|
| Hospital Charge Code |
1710580
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.36
|
| Rate for Payer: Blue Shield of California Commercial |
$1.12
|
| Rate for Payer: Blue Shield of California EPN |
$1.06
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.54
|
| Rate for Payer: Dignity Health Senior |
$1.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.12
|
| Rate for Payer: Heritage Provider Network Senior |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.54
|
| Rate for Payer: Vantage Medical Group Senior |
$1.54
|
|
|
PRAZOSIN 1 MG CAPSULE [6468]
|
Facility
OP
|
$1.79
|
|
|
Service Code
|
NDC 68084-996-11
|
| Hospital Charge Code |
1710580
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.52 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1.11
|
| Rate for Payer: Blue Shield of California EPN |
$1.05
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.52
|
| Rate for Payer: Dignity Health Senior |
$1.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.11
|
| Rate for Payer: Heritage Provider Network Senior |
$1.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.52
|
| Rate for Payer: Vantage Medical Group Senior |
$1.52
|
|
|
PRAZOSIN 1 MG CAPSULE [6468]
|
Facility
OP
|
$1.81
|
|
|
Service Code
|
NDC 51079-630-20
|
| Hospital Charge Code |
1710580
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.36
|
| Rate for Payer: Blue Shield of California Commercial |
$1.12
|
| Rate for Payer: Blue Shield of California EPN |
$1.06
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.54
|
| Rate for Payer: Dignity Health Senior |
$1.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.12
|
| Rate for Payer: Heritage Provider Network Senior |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.54
|
| Rate for Payer: Vantage Medical Group Senior |
$1.54
|
|
