|
OCTREOTIDE,MICROSPHERES 20 MG INTRAMUSCULAR WRAP, LONG-ACTING RELEASE [40824435]
|
Facility
|
OP
|
$5,539.56
|
|
|
Service Code
|
HCPCS J2353
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$207.82 |
| Max. Negotiated Rate |
$4,708.63 |
| Rate for Payer: Adventist Health Commercial |
$1,107.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,286.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$260.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$228.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$228.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$207.82
|
| Rate for Payer: Blue Shield of California Commercial |
$239.10
|
| Rate for Payer: Cash Price |
$2,492.80
|
| Rate for Payer: Cash Price |
$2,492.80
|
| Rate for Payer: Cigna of CA HMO |
$3,877.69
|
| Rate for Payer: Cigna of CA PPO |
$3,877.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$260.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$228.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$228.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,877.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.37
|
| Rate for Payer: EPIC Health Plan Senior |
$228.91
|
| Rate for Payer: Galaxy Health WC |
$4,708.63
|
| Rate for Payer: Global Benefits Group Commercial |
$3,323.74
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$341.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$208.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$208.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,517.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$386.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$291.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,329.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$262.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$278.85
|
| Rate for Payer: Multiplan Commercial |
$4,431.65
|
| Rate for Payer: Networks By Design Commercial |
$2,769.78
|
| Rate for Payer: Prime Health Services Commercial |
$4,708.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,323.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,323.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,079.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,023.60
|
| Rate for Payer: United Healthcare HMO Rider |
$1,979.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,814.21
|
| Rate for Payer: Upland Medical Group Pediatric |
$208.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$260.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$228.91
|
| Rate for Payer: Vantage Medical Group Senior |
$228.91
|
|
|
OCTREOTIDE,MICROSPHERES 30 MG INTRAMUSCULR WRAP, LONG-ACTING RELEASE [40824436]
|
Facility
|
IP
|
$8,295.07
|
|
|
Service Code
|
HCPCS J2353
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,659.01 |
| Max. Negotiated Rate |
$7,050.81 |
| Rate for Payer: Adventist Health Commercial |
$1,659.01
|
| Rate for Payer: Blue Shield of California Commercial |
$4,205.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,378.91
|
| Rate for Payer: Cash Price |
$3,732.78
|
| Rate for Payer: Cigna of CA HMO |
$5,806.55
|
| Rate for Payer: Cigna of CA PPO |
$5,806.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,806.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,318.03
|
| Rate for Payer: EPIC Health Plan Senior |
$3,318.03
|
| Rate for Payer: Galaxy Health WC |
$7,050.81
|
| Rate for Payer: Global Benefits Group Commercial |
$4,977.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,267.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,894.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,990.82
|
| Rate for Payer: Multiplan Commercial |
$6,636.06
|
| Rate for Payer: Networks By Design Commercial |
$4,147.53
|
| Rate for Payer: Prime Health Services Commercial |
$7,050.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,113.14
|
| Rate for Payer: United Healthcare All Other HMO |
$3,030.19
|
| Rate for Payer: United Healthcare HMO Rider |
$2,964.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,716.64
|
|
|
OCTREOTIDE,MICROSPHERES 30 MG INTRAMUSCULR WRAP, LONG-ACTING RELEASE [40824436]
|
Facility
|
OP
|
$8,295.07
|
|
|
Service Code
|
HCPCS J2353
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$207.82 |
| Max. Negotiated Rate |
$7,050.81 |
| Rate for Payer: Adventist Health Commercial |
$1,659.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,286.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$260.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$228.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$228.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$207.82
|
| Rate for Payer: Blue Shield of California Commercial |
$239.10
|
| Rate for Payer: Cash Price |
$3,732.78
|
| Rate for Payer: Cash Price |
$3,732.78
|
| Rate for Payer: Cigna of CA HMO |
$5,806.55
|
| Rate for Payer: Cigna of CA PPO |
$5,806.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$260.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$228.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$228.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,806.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.37
|
| Rate for Payer: EPIC Health Plan Senior |
$228.91
|
| Rate for Payer: Galaxy Health WC |
$7,050.81
|
| Rate for Payer: Global Benefits Group Commercial |
$4,977.04
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$341.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$208.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$208.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,267.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$386.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$291.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,990.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$262.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$278.85
|
| Rate for Payer: Multiplan Commercial |
$6,636.06
|
| Rate for Payer: Networks By Design Commercial |
$4,147.53
|
| Rate for Payer: Prime Health Services Commercial |
$7,050.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,977.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,977.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,113.14
|
| Rate for Payer: United Healthcare All Other HMO |
$3,030.19
|
| Rate for Payer: United Healthcare HMO Rider |
$2,964.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,716.64
|
| Rate for Payer: Upland Medical Group Pediatric |
$208.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$260.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$228.91
|
| Rate for Payer: Vantage Medical Group Senior |
$228.91
|
|
|
OCTREOTIDE,MICROSPHERES ER 10 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE [204871]
|
Facility
|
IP
|
$4,228.12
|
|
|
Service Code
|
HCPCS J2353
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$3,593.90 |
| Rate for Payer: Adventist Health Commercial |
$845.62
|
| Rate for Payer: Blue Shield of California Commercial |
$2,143.66
|
| Rate for Payer: Blue Shield of California Commercial |
$3,251.42
|
| Rate for Payer: Cash Price |
$1,902.65
|
| Rate for Payer: Cigna of CA HMO |
$2,959.68
|
| Rate for Payer: Cigna of CA PPO |
$2,959.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,959.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,691.25
|
| Rate for Payer: EPIC Health Plan Senior |
$1,691.25
|
| Rate for Payer: Galaxy Health WC |
$3,593.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,536.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,684.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,494.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,014.75
|
| Rate for Payer: Multiplan Commercial |
$3,382.50
|
| Rate for Payer: Networks By Design Commercial |
$2,114.06
|
| Rate for Payer: Prime Health Services Commercial |
$3,593.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,586.81
|
| Rate for Payer: United Healthcare All Other HMO |
$1,544.53
|
| Rate for Payer: United Healthcare HMO Rider |
$1,511.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,384.71
|
|
|
OCTREOTIDE,MICROSPHERES ER 10 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE [204871]
|
Facility
|
OP
|
$4,228.12
|
|
|
Service Code
|
HCPCS J2353
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$207.82 |
| Max. Negotiated Rate |
$3,593.90 |
| Rate for Payer: Adventist Health Commercial |
$845.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,286.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$260.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$228.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$228.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$207.82
|
| Rate for Payer: Blue Shield of California Commercial |
$239.10
|
| Rate for Payer: Cash Price |
$1,902.65
|
| Rate for Payer: Cash Price |
$1,902.65
|
| Rate for Payer: Cigna of CA HMO |
$2,959.68
|
| Rate for Payer: Cigna of CA PPO |
$2,959.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$260.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$228.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$228.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,959.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.37
|
| Rate for Payer: EPIC Health Plan Senior |
$228.91
|
| Rate for Payer: Galaxy Health WC |
$3,593.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,536.87
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$341.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$208.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$208.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,684.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$386.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$291.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,014.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$262.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$278.85
|
| Rate for Payer: Multiplan Commercial |
$3,382.50
|
| Rate for Payer: Networks By Design Commercial |
$2,114.06
|
| Rate for Payer: Prime Health Services Commercial |
$3,593.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,536.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,536.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,586.81
|
| Rate for Payer: United Healthcare All Other HMO |
$1,544.53
|
| Rate for Payer: United Healthcare HMO Rider |
$1,511.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,384.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$208.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$260.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$228.91
|
| Rate for Payer: Vantage Medical Group Senior |
$228.91
|
|
|
OCTREOTIDE,MICROSPHERES ER 20 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE [204610]
|
Facility
|
IP
|
$5,539.56
|
|
|
Service Code
|
HCPCS J2353
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,107.91 |
| Max. Negotiated Rate |
$4,708.63 |
| Rate for Payer: Adventist Health Commercial |
$1,107.91
|
| Rate for Payer: Blue Shield of California Commercial |
$2,808.56
|
| Rate for Payer: Blue Shield of California Commercial |
$4,259.92
|
| Rate for Payer: Cash Price |
$2,492.80
|
| Rate for Payer: Cigna of CA HMO |
$3,877.69
|
| Rate for Payer: Cigna of CA PPO |
$3,877.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,877.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,215.82
|
| Rate for Payer: EPIC Health Plan Senior |
$2,215.82
|
| Rate for Payer: Galaxy Health WC |
$4,708.63
|
| Rate for Payer: Global Benefits Group Commercial |
$3,323.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,517.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,268.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,329.49
|
| Rate for Payer: Multiplan Commercial |
$4,431.65
|
| Rate for Payer: Networks By Design Commercial |
$2,769.78
|
| Rate for Payer: Prime Health Services Commercial |
$4,708.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,079.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,023.60
|
| Rate for Payer: United Healthcare HMO Rider |
$1,979.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,814.21
|
|
|
OCTREOTIDE,MICROSPHERES ER 20 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE [204610]
|
Facility
|
OP
|
$5,539.56
|
|
|
Service Code
|
HCPCS J2353
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$207.82 |
| Max. Negotiated Rate |
$4,708.63 |
| Rate for Payer: Adventist Health Commercial |
$1,107.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,286.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$260.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$228.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$228.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$207.82
|
| Rate for Payer: Blue Shield of California Commercial |
$239.10
|
| Rate for Payer: Cash Price |
$2,492.80
|
| Rate for Payer: Cash Price |
$2,492.80
|
| Rate for Payer: Cigna of CA HMO |
$3,877.69
|
| Rate for Payer: Cigna of CA PPO |
$3,877.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$260.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$228.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$228.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,877.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.37
|
| Rate for Payer: EPIC Health Plan Senior |
$228.91
|
| Rate for Payer: Galaxy Health WC |
$4,708.63
|
| Rate for Payer: Global Benefits Group Commercial |
$3,323.74
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$341.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$208.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$208.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,517.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$386.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$291.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,329.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$262.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$278.85
|
| Rate for Payer: Multiplan Commercial |
$4,431.65
|
| Rate for Payer: Networks By Design Commercial |
$2,769.78
|
| Rate for Payer: Prime Health Services Commercial |
$4,708.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,323.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,323.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,079.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,023.60
|
| Rate for Payer: United Healthcare HMO Rider |
$1,979.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,814.21
|
| Rate for Payer: Upland Medical Group Pediatric |
$208.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$260.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$228.91
|
| Rate for Payer: Vantage Medical Group Senior |
$228.91
|
|
|
OCTREOTIDE,MICROSPHERES ER 30 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE [204612]
|
Facility
|
IP
|
$8,295.07
|
|
|
Service Code
|
HCPCS J2353
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,659.01 |
| Max. Negotiated Rate |
$7,050.81 |
| Rate for Payer: Adventist Health Commercial |
$1,659.01
|
| Rate for Payer: Blue Shield of California Commercial |
$4,205.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,378.91
|
| Rate for Payer: Cash Price |
$3,732.78
|
| Rate for Payer: Cigna of CA HMO |
$5,806.55
|
| Rate for Payer: Cigna of CA PPO |
$5,806.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,806.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,318.03
|
| Rate for Payer: EPIC Health Plan Senior |
$3,318.03
|
| Rate for Payer: Galaxy Health WC |
$7,050.81
|
| Rate for Payer: Global Benefits Group Commercial |
$4,977.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,267.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,894.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,990.82
|
| Rate for Payer: Multiplan Commercial |
$6,636.06
|
| Rate for Payer: Networks By Design Commercial |
$4,147.53
|
| Rate for Payer: Prime Health Services Commercial |
$7,050.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,113.14
|
| Rate for Payer: United Healthcare All Other HMO |
$3,030.19
|
| Rate for Payer: United Healthcare HMO Rider |
$2,964.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,716.64
|
|
|
OCTREOTIDE,MICROSPHERES ER 30 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE [204612]
|
Facility
|
OP
|
$8,295.07
|
|
|
Service Code
|
HCPCS J2353
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$207.82 |
| Max. Negotiated Rate |
$7,050.81 |
| Rate for Payer: Adventist Health Commercial |
$1,659.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,286.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$260.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$228.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$228.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$207.82
|
| Rate for Payer: Blue Shield of California Commercial |
$239.10
|
| Rate for Payer: Cash Price |
$3,732.78
|
| Rate for Payer: Cash Price |
$3,732.78
|
| Rate for Payer: Cigna of CA HMO |
$5,806.55
|
| Rate for Payer: Cigna of CA PPO |
$5,806.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$260.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$228.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$228.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,806.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.37
|
| Rate for Payer: EPIC Health Plan Senior |
$228.91
|
| Rate for Payer: Galaxy Health WC |
$7,050.81
|
| Rate for Payer: Global Benefits Group Commercial |
$4,977.04
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$341.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$208.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$208.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,267.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$386.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$291.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,990.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$262.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$278.85
|
| Rate for Payer: Multiplan Commercial |
$6,636.06
|
| Rate for Payer: Networks By Design Commercial |
$4,147.53
|
| Rate for Payer: Prime Health Services Commercial |
$7,050.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,977.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,977.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,113.14
|
| Rate for Payer: United Healthcare All Other HMO |
$3,030.19
|
| Rate for Payer: United Healthcare HMO Rider |
$2,964.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,716.64
|
| Rate for Payer: Upland Medical Group Pediatric |
$208.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$260.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$228.91
|
| Rate for Payer: Vantage Medical Group Senior |
$228.91
|
|
|
OFLOXACIN 0.3 % EAR DROPS [22257]
|
Facility
|
OP
|
$3.60
|
|
|
Service Code
|
NDC 7075660915
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.31
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.52
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Networks By Design Commercial |
$2.34
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other HMO |
$1.80
|
| Rate for Payer: United Healthcare HMO Rider |
$1.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
|
|
OFLOXACIN 0.3 % EAR DROPS [22257]
|
Facility
|
IP
|
$3.60
|
|
|
Service Code
|
NDC 7075660915
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Blue Shield of California Commercial |
$1.83
|
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Networks By Design Commercial |
$2.34
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
|
|
OFLOXACIN 0.3 % EYE DROPS [19746]
|
Facility
|
OP
|
$2.44
|
|
|
Service Code
|
NDC 7248561310
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$2.07 |
| Rate for Payer: Adventist Health Commercial |
$0.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.57
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: Cigna of CA HMO |
$1.71
|
| Rate for Payer: Cigna of CA PPO |
$1.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.98
|
| Rate for Payer: EPIC Health Plan Senior |
$0.98
|
| Rate for Payer: Galaxy Health WC |
$2.07
|
| Rate for Payer: Global Benefits Group Commercial |
$1.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.71
|
| Rate for Payer: Multiplan Commercial |
$1.95
|
| Rate for Payer: Networks By Design Commercial |
$1.59
|
| Rate for Payer: Prime Health Services Commercial |
$2.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.22
|
| Rate for Payer: United Healthcare All Other HMO |
$1.22
|
| Rate for Payer: United Healthcare HMO Rider |
$1.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2.07
|
|
|
OFLOXACIN 0.3 % EYE DROPS [19746]
|
Facility
|
IP
|
$29.77
|
|
|
Service Code
|
NDC 1198077905
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$25.30 |
| Rate for Payer: Adventist Health Commercial |
$5.95
|
| Rate for Payer: Blue Shield of California Commercial |
$15.09
|
| Rate for Payer: Blue Shield of California Commercial |
$22.89
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cigna of CA HMO |
$20.84
|
| Rate for Payer: Cigna of CA PPO |
$20.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.91
|
| Rate for Payer: EPIC Health Plan Senior |
$11.91
|
| Rate for Payer: Galaxy Health WC |
$25.30
|
| Rate for Payer: Global Benefits Group Commercial |
$17.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.14
|
| Rate for Payer: Multiplan Commercial |
$23.82
|
| Rate for Payer: Networks By Design Commercial |
$19.35
|
| Rate for Payer: Prime Health Services Commercial |
$25.30
|
|
|
OFLOXACIN 0.3 % EYE DROPS [19746]
|
Facility
|
IP
|
$3.60
|
|
|
Service Code
|
NDC 7075660730
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Blue Shield of California Commercial |
$1.83
|
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Networks By Design Commercial |
$2.34
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
|
|
OFLOXACIN 0.3 % EYE DROPS [19746]
|
Facility
|
OP
|
$3.60
|
|
|
Service Code
|
NDC 7075660730
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.31
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.52
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Networks By Design Commercial |
$2.34
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other HMO |
$1.80
|
| Rate for Payer: United Healthcare HMO Rider |
$1.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
|
|
OFLOXACIN 0.3 % EYE DROPS [19746]
|
Facility
|
OP
|
$29.77
|
|
|
Service Code
|
NDC 1198077905
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$25.30 |
| Rate for Payer: Adventist Health Commercial |
$5.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.10
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cigna of CA HMO |
$20.84
|
| Rate for Payer: Cigna of CA PPO |
$20.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.91
|
| Rate for Payer: EPIC Health Plan Senior |
$11.91
|
| Rate for Payer: Galaxy Health WC |
$25.30
|
| Rate for Payer: Global Benefits Group Commercial |
$17.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.84
|
| Rate for Payer: Multiplan Commercial |
$23.82
|
| Rate for Payer: Networks By Design Commercial |
$19.35
|
| Rate for Payer: Prime Health Services Commercial |
$25.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.88
|
| Rate for Payer: United Healthcare All Other HMO |
$14.88
|
| Rate for Payer: United Healthcare HMO Rider |
$14.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.30
|
| Rate for Payer: Vantage Medical Group Senior |
$25.30
|
|
|
OFLOXACIN 0.3 % EYE DROPS [19746]
|
Facility
|
IP
|
$2.44
|
|
|
Service Code
|
NDC 7248561310
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$2.07 |
| Rate for Payer: Adventist Health Commercial |
$0.49
|
| Rate for Payer: Blue Shield of California Commercial |
$1.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1.88
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: Cigna of CA HMO |
$1.71
|
| Rate for Payer: Cigna of CA PPO |
$1.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.98
|
| Rate for Payer: EPIC Health Plan Senior |
$0.98
|
| Rate for Payer: Galaxy Health WC |
$2.07
|
| Rate for Payer: Global Benefits Group Commercial |
$1.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: Multiplan Commercial |
$1.95
|
| Rate for Payer: Networks By Design Commercial |
$1.59
|
| Rate for Payer: Prime Health Services Commercial |
$2.07
|
|
|
OLANZAPINE 10 MG DISINTEGRATING TABLET [28160]
|
Facility
|
OP
|
$3.15
|
|
|
Service Code
|
NDC 6050532760
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$2.68 |
| Rate for Payer: Adventist Health Commercial |
$0.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.02
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Cigna of CA HMO |
$2.21
|
| Rate for Payer: Cigna of CA PPO |
$2.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.26
|
| Rate for Payer: EPIC Health Plan Senior |
$1.26
|
| Rate for Payer: Galaxy Health WC |
$2.68
|
| Rate for Payer: Global Benefits Group Commercial |
$1.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.21
|
| Rate for Payer: Multiplan Commercial |
$2.52
|
| Rate for Payer: Networks By Design Commercial |
$2.05
|
| Rate for Payer: Prime Health Services Commercial |
$2.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.57
|
| Rate for Payer: United Healthcare All Other HMO |
$1.57
|
| Rate for Payer: United Healthcare HMO Rider |
$1.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2.68
|
|
|
OLANZAPINE 10 MG DISINTEGRATING TABLET [28160]
|
Facility
|
OP
|
$1.51
|
|
|
Service Code
|
NDC 6050532763
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.28 |
| Rate for Payer: Adventist Health Commercial |
$0.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.97
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cigna of CA HMO |
$1.06
|
| Rate for Payer: Cigna of CA PPO |
$1.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.60
|
| Rate for Payer: EPIC Health Plan Senior |
$0.60
|
| Rate for Payer: Galaxy Health WC |
$1.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.06
|
| Rate for Payer: Multiplan Commercial |
$1.21
|
| Rate for Payer: Networks By Design Commercial |
$0.98
|
| Rate for Payer: Prime Health Services Commercial |
$1.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.76
|
| Rate for Payer: United Healthcare All Other HMO |
$0.76
|
| Rate for Payer: United Healthcare HMO Rider |
$0.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.28
|
| Rate for Payer: Vantage Medical Group Senior |
$1.28
|
|
|
OLANZAPINE 10 MG DISINTEGRATING TABLET [28160]
|
Facility
|
IP
|
$1.51
|
|
|
Service Code
|
NDC 6050532763
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.28 |
| Rate for Payer: Adventist Health Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California Commercial |
$0.77
|
| Rate for Payer: Blue Shield of California Commercial |
$1.16
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cigna of CA HMO |
$1.06
|
| Rate for Payer: Cigna of CA PPO |
$1.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.60
|
| Rate for Payer: EPIC Health Plan Senior |
$0.60
|
| Rate for Payer: Galaxy Health WC |
$1.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.21
|
| Rate for Payer: Networks By Design Commercial |
$0.98
|
| Rate for Payer: Prime Health Services Commercial |
$1.28
|
|
|
OLANZAPINE 10 MG DISINTEGRATING TABLET [28160]
|
Facility
|
IP
|
$3.15
|
|
|
Service Code
|
NDC 6050532760
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$2.68 |
| Rate for Payer: Adventist Health Commercial |
$0.63
|
| Rate for Payer: Blue Shield of California Commercial |
$1.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2.42
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Cigna of CA HMO |
$2.21
|
| Rate for Payer: Cigna of CA PPO |
$2.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.26
|
| Rate for Payer: EPIC Health Plan Senior |
$1.26
|
| Rate for Payer: Galaxy Health WC |
$2.68
|
| Rate for Payer: Global Benefits Group Commercial |
$1.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$2.52
|
| Rate for Payer: Networks By Design Commercial |
$2.05
|
| Rate for Payer: Prime Health Services Commercial |
$2.68
|
|
|
OLANZAPINE 10 MG INTRAMUSCULAR SOLUTION [38263]
|
Facility
|
IP
|
$33.68
|
|
|
Service Code
|
HCPCS J2359
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.74 |
| Max. Negotiated Rate |
$28.63 |
| Rate for Payer: Adventist Health Commercial |
$6.74
|
| Rate for Payer: Adventist Health Commercial |
$4.32
|
| Rate for Payer: Adventist Health Commercial |
$3.36
|
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Adventist Health Commercial |
$9.48
|
| Rate for Payer: Blue Shield of California Commercial |
$16.61
|
| Rate for Payer: Blue Shield of California Commercial |
$10.95
|
| Rate for Payer: Blue Shield of California Commercial |
$8.52
|
| Rate for Payer: Blue Shield of California Commercial |
$12.17
|
| Rate for Payer: Blue Shield of California Commercial |
$24.03
|
| Rate for Payer: Blue Shield of California Commercial |
$36.44
|
| Rate for Payer: Blue Shield of California Commercial |
$18.46
|
| Rate for Payer: Blue Shield of California Commercial |
$25.90
|
| Rate for Payer: Blue Shield of California Commercial |
$12.92
|
| Rate for Payer: Blue Shield of California Commercial |
$17.08
|
| Rate for Payer: Cash Price |
$21.33
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: Cash Price |
$15.16
|
| Rate for Payer: Cigna of CA HMO |
$23.58
|
| Rate for Payer: Cigna of CA HMO |
$16.80
|
| Rate for Payer: Cigna of CA HMO |
$11.76
|
| Rate for Payer: Cigna of CA HMO |
$15.12
|
| Rate for Payer: Cigna of CA HMO |
$33.17
|
| Rate for Payer: Cigna of CA PPO |
$23.58
|
| Rate for Payer: Cigna of CA PPO |
$16.80
|
| Rate for Payer: Cigna of CA PPO |
$11.76
|
| Rate for Payer: Cigna of CA PPO |
$15.12
|
| Rate for Payer: Cigna of CA PPO |
$33.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.72
|
| Rate for Payer: EPIC Health Plan Senior |
$6.72
|
| Rate for Payer: EPIC Health Plan Senior |
$13.47
|
| Rate for Payer: EPIC Health Plan Senior |
$18.96
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$8.64
|
| Rate for Payer: Galaxy Health WC |
$18.36
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Galaxy Health WC |
$40.28
|
| Rate for Payer: Galaxy Health WC |
$28.63
|
| Rate for Payer: Galaxy Health WC |
$14.28
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Global Benefits Group Commercial |
$12.96
|
| Rate for Payer: Global Benefits Group Commercial |
$10.08
|
| Rate for Payer: Global Benefits Group Commercial |
$28.43
|
| Rate for Payer: Global Benefits Group Commercial |
$20.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.03
|
| Rate for Payer: Multiplan Commercial |
$17.28
|
| Rate for Payer: Multiplan Commercial |
$26.94
|
| Rate for Payer: Multiplan Commercial |
$13.44
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Multiplan Commercial |
$37.91
|
| Rate for Payer: Networks By Design Commercial |
$23.70
|
| Rate for Payer: Networks By Design Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$10.80
|
| Rate for Payer: Networks By Design Commercial |
$16.84
|
| Rate for Payer: Networks By Design Commercial |
$8.40
|
| Rate for Payer: Prime Health Services Commercial |
$40.28
|
| Rate for Payer: Prime Health Services Commercial |
$28.63
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Prime Health Services Commercial |
$18.36
|
| Rate for Payer: Prime Health Services Commercial |
$14.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.01
|
| Rate for Payer: United Healthcare All Other HMO |
$17.31
|
| Rate for Payer: United Healthcare All Other HMO |
$12.30
|
| Rate for Payer: United Healthcare All Other HMO |
$7.89
|
| Rate for Payer: United Healthcare All Other HMO |
$6.14
|
| Rate for Payer: United Healthcare All Other HMO |
$8.77
|
| Rate for Payer: United Healthcare HMO Rider |
$6.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8.58
|
| Rate for Payer: United Healthcare HMO Rider |
$16.94
|
| Rate for Payer: United Healthcare HMO Rider |
$12.04
|
| Rate for Payer: United Healthcare HMO Rider |
$7.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.50
|
|
|
OLANZAPINE 10 MG INTRAMUSCULAR SOLUTION [38263]
|
Facility
|
OP
|
$16.80
|
|
|
Service Code
|
HCPCS J2359
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$14.28 |
| Rate for Payer: Adventist Health Commercial |
$3.36
|
| Rate for Payer: Adventist Health Commercial |
$4.32
|
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Adventist Health Commercial |
$6.74
|
| Rate for Payer: Adventist Health Commercial |
$9.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.14
|
| Rate for Payer: Blue Shield of California Commercial |
$1.94
|
| Rate for Payer: Blue Shield of California Commercial |
$1.94
|
| Rate for Payer: Blue Shield of California Commercial |
$1.94
|
| Rate for Payer: Blue Shield of California Commercial |
$1.94
|
| Rate for Payer: Blue Shield of California Commercial |
$1.94
|
| Rate for Payer: Cash Price |
$21.33
|
| Rate for Payer: Cash Price |
$15.16
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$15.16
|
| Rate for Payer: Cash Price |
$21.33
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: Cigna of CA HMO |
$23.58
|
| Rate for Payer: Cigna of CA HMO |
$15.12
|
| Rate for Payer: Cigna of CA HMO |
$16.80
|
| Rate for Payer: Cigna of CA HMO |
$11.76
|
| Rate for Payer: Cigna of CA HMO |
$33.17
|
| Rate for Payer: Cigna of CA PPO |
$16.80
|
| Rate for Payer: Cigna of CA PPO |
$23.58
|
| Rate for Payer: Cigna of CA PPO |
$11.76
|
| Rate for Payer: Cigna of CA PPO |
$33.17
|
| Rate for Payer: Cigna of CA PPO |
$15.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.72
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$18.96
|
| Rate for Payer: EPIC Health Plan Senior |
$13.47
|
| Rate for Payer: EPIC Health Plan Senior |
$6.72
|
| Rate for Payer: EPIC Health Plan Senior |
$8.64
|
| Rate for Payer: Galaxy Health WC |
$28.63
|
| Rate for Payer: Galaxy Health WC |
$40.28
|
| Rate for Payer: Galaxy Health WC |
$14.28
|
| Rate for Payer: Galaxy Health WC |
$18.36
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$12.96
|
| Rate for Payer: Global Benefits Group Commercial |
$10.08
|
| Rate for Payer: Global Benefits Group Commercial |
$28.43
|
| Rate for Payer: Global Benefits Group Commercial |
$20.21
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.17
|
| Rate for Payer: Multiplan Commercial |
$17.28
|
| Rate for Payer: Multiplan Commercial |
$37.91
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Multiplan Commercial |
$26.94
|
| Rate for Payer: Multiplan Commercial |
$13.44
|
| Rate for Payer: Networks By Design Commercial |
$8.40
|
| Rate for Payer: Networks By Design Commercial |
$16.84
|
| Rate for Payer: Networks By Design Commercial |
$10.80
|
| Rate for Payer: Networks By Design Commercial |
$23.70
|
| Rate for Payer: Networks By Design Commercial |
$12.00
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Prime Health Services Commercial |
$40.28
|
| Rate for Payer: Prime Health Services Commercial |
$28.63
|
| Rate for Payer: Prime Health Services Commercial |
$18.36
|
| Rate for Payer: Prime Health Services Commercial |
$14.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.01
|
| Rate for Payer: United Healthcare All Other HMO |
$6.14
|
| Rate for Payer: United Healthcare All Other HMO |
$8.77
|
| Rate for Payer: United Healthcare All Other HMO |
$7.89
|
| Rate for Payer: United Healthcare All Other HMO |
$12.30
|
| Rate for Payer: United Healthcare All Other HMO |
$17.31
|
| Rate for Payer: United Healthcare HMO Rider |
$8.58
|
| Rate for Payer: United Healthcare HMO Rider |
$12.04
|
| Rate for Payer: United Healthcare HMO Rider |
$6.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7.72
|
| Rate for Payer: United Healthcare HMO Rider |
$16.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.28
|
| Rate for Payer: Vantage Medical Group Senior |
$40.28
|
| Rate for Payer: Vantage Medical Group Senior |
$14.28
|
| Rate for Payer: Vantage Medical Group Senior |
$18.36
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$28.63
|
|
|
OLANZAPINE 10 MG TABLET [17937]
|
Facility
|
IP
|
$0.42
|
|
|
Service Code
|
NDC 6050531130
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cigna of CA HMO |
$0.29
|
| Rate for Payer: Cigna of CA PPO |
$0.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: EPIC Health Plan Senior |
$0.17
|
| Rate for Payer: Galaxy Health WC |
$0.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.34
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Prime Health Services Commercial |
$0.36
|
|
|
OLANZAPINE 10 MG TABLET [17937]
|
Facility
|
IP
|
$0.29
|
|
|
Service Code
|
NDC 4359816630
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.25
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.19
|
| Rate for Payer: Prime Health Services Commercial |
$0.25
|
|
