|
OLANZAPINE 5 MG TABLET [17936]
|
Facility
|
IP
|
$0.28
|
|
|
Service Code
|
NDC 6050531110
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| 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 |
$0.11
|
| Rate for Payer: EPIC Health Plan Senior |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.24
|
| 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 |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.24
|
|
|
OLANZAPINE 7.5 MG TABLET [17938]
|
Facility
|
IP
|
$0.34
|
|
|
Service Code
|
NDC 6050531120
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.24
|
| Rate for Payer: Cigna of CA PPO |
$0.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Networks By Design Commercial |
$0.22
|
| Rate for Payer: Prime Health Services Commercial |
$0.29
|
|
|
OLANZAPINE 7.5 MG TABLET [17938]
|
Facility
|
IP
|
$0.24
|
|
|
Service Code
|
NDC 4359816530
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
|
|
OLANZAPINE 7.5 MG TABLET [17938]
|
Facility
|
OP
|
$0.34
|
|
|
Service Code
|
NDC 6050531120
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.22
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.24
|
| Rate for Payer: Cigna of CA PPO |
$0.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Networks By Design Commercial |
$0.22
|
| Rate for Payer: Prime Health Services Commercial |
$0.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Vantage Medical Group Senior |
$0.29
|
|
|
OLANZAPINE 7.5 MG TABLET [17938]
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
NDC 4359816530
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO |
$0.12
|
| Rate for Payer: United Healthcare HMO Rider |
$0.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
OLOPATADINE 0.1 % EYE DROPS [19452]
|
Facility
|
OP
|
$1.81
|
|
|
Service Code
|
NDC 4612267264
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cigna of CA HMO |
$1.27
|
| Rate for Payer: Cigna of CA PPO |
$1.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Senior |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$1.54
|
| Rate for Payer: Global Benefits Group Commercial |
$1.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.27
|
| Rate for Payer: Multiplan Commercial |
$1.45
|
| Rate for Payer: Networks By Design Commercial |
$1.18
|
| Rate for Payer: Prime Health Services Commercial |
$1.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.91
|
| Rate for Payer: United Healthcare All Other HMO |
$0.91
|
| Rate for Payer: United Healthcare HMO Rider |
$0.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.54
|
| Rate for Payer: Vantage Medical Group Senior |
$1.54
|
|
|
OLOPATADINE 0.1 % EYE DROPS [19452]
|
Facility
|
IP
|
$1.81
|
|
|
Service Code
|
NDC 7006901701
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$0.92
|
| Rate for Payer: Blue Shield of California Commercial |
$1.39
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cigna of CA HMO |
$1.27
|
| Rate for Payer: Cigna of CA PPO |
$1.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Senior |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$1.54
|
| Rate for Payer: Global Benefits Group Commercial |
$1.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$1.45
|
| Rate for Payer: Networks By Design Commercial |
$1.18
|
| Rate for Payer: Prime Health Services Commercial |
$1.54
|
|
|
OLOPATADINE 0.1 % EYE DROPS [19452]
|
Facility
|
OP
|
$1.81
|
|
|
Service Code
|
NDC 7006901701
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cigna of CA HMO |
$1.27
|
| Rate for Payer: Cigna of CA PPO |
$1.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Senior |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$1.54
|
| Rate for Payer: Global Benefits Group Commercial |
$1.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.27
|
| Rate for Payer: Multiplan Commercial |
$1.45
|
| Rate for Payer: Networks By Design Commercial |
$1.18
|
| Rate for Payer: Prime Health Services Commercial |
$1.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.91
|
| Rate for Payer: United Healthcare All Other HMO |
$0.91
|
| Rate for Payer: United Healthcare HMO Rider |
$0.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.54
|
| Rate for Payer: Vantage Medical Group Senior |
$1.54
|
|
|
OLOPATADINE 0.1 % EYE DROPS [19452]
|
Facility
|
IP
|
$1.81
|
|
|
Service Code
|
NDC 4612267264
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$0.92
|
| Rate for Payer: Blue Shield of California Commercial |
$1.39
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cigna of CA HMO |
$1.27
|
| Rate for Payer: Cigna of CA PPO |
$1.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Senior |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$1.54
|
| Rate for Payer: Global Benefits Group Commercial |
$1.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$1.45
|
| Rate for Payer: Networks By Design Commercial |
$1.18
|
| Rate for Payer: Prime Health Services Commercial |
$1.54
|
|
|
OLUTASIDENIB 150 MG CAPSULE [236323]
|
Facility
|
IP
|
$717.40
|
|
|
Service Code
|
NDC 7133200501
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$143.48 |
| Max. Negotiated Rate |
$609.79 |
| Rate for Payer: Adventist Health Commercial |
$143.48
|
| Rate for Payer: Blue Shield of California Commercial |
$363.72
|
| Rate for Payer: Blue Shield of California Commercial |
$551.68
|
| Rate for Payer: Cash Price |
$322.83
|
| Rate for Payer: Cigna of CA HMO |
$502.18
|
| Rate for Payer: Cigna of CA PPO |
$502.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$502.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$286.96
|
| Rate for Payer: EPIC Health Plan Senior |
$286.96
|
| Rate for Payer: Galaxy Health WC |
$609.79
|
| Rate for Payer: Global Benefits Group Commercial |
$430.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$455.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$423.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.18
|
| Rate for Payer: Multiplan Commercial |
$573.92
|
| Rate for Payer: Networks By Design Commercial |
$466.31
|
| Rate for Payer: Prime Health Services Commercial |
$609.79
|
|
|
OLUTASIDENIB 150 MG CAPSULE [236323]
|
Facility
|
OP
|
$717.40
|
|
|
Service Code
|
NDC 7133200501
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$143.48 |
| Max. Negotiated Rate |
$609.79 |
| Rate for Payer: Adventist Health Commercial |
$143.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$470.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$609.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$394.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$538.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$460.36
|
| Rate for Payer: Cash Price |
$322.83
|
| Rate for Payer: Cigna of CA HMO |
$502.18
|
| Rate for Payer: Cigna of CA PPO |
$502.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$609.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$609.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$609.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$502.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$286.96
|
| Rate for Payer: EPIC Health Plan Senior |
$286.96
|
| Rate for Payer: Galaxy Health WC |
$609.79
|
| Rate for Payer: Global Benefits Group Commercial |
$430.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$455.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$260.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$423.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$502.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$502.18
|
| Rate for Payer: Multiplan Commercial |
$573.92
|
| Rate for Payer: Networks By Design Commercial |
$466.31
|
| Rate for Payer: Prime Health Services Commercial |
$609.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$430.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$430.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$358.70
|
| Rate for Payer: United Healthcare All Other HMO |
$358.70
|
| Rate for Payer: United Healthcare HMO Rider |
$358.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$358.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$609.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$609.79
|
| Rate for Payer: Vantage Medical Group Senior |
$609.79
|
|
|
OMADACYCLINE 100 MG INTRAVENOUS SOLUTION [223621]
|
Facility
|
IP
|
$607.97
|
|
|
Service Code
|
HCPCS J0121
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$121.59 |
| Max. Negotiated Rate |
$516.77 |
| Rate for Payer: Adventist Health Commercial |
$121.59
|
| Rate for Payer: Blue Shield of California Commercial |
$308.24
|
| Rate for Payer: Blue Shield of California Commercial |
$467.53
|
| Rate for Payer: Cash Price |
$273.59
|
| Rate for Payer: Cigna of CA HMO |
$425.58
|
| Rate for Payer: Cigna of CA PPO |
$425.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$425.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.19
|
| Rate for Payer: EPIC Health Plan Senior |
$243.19
|
| Rate for Payer: Galaxy Health WC |
$516.77
|
| Rate for Payer: Global Benefits Group Commercial |
$364.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$386.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$358.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.91
|
| Rate for Payer: Multiplan Commercial |
$486.38
|
| Rate for Payer: Networks By Design Commercial |
$303.99
|
| Rate for Payer: Prime Health Services Commercial |
$516.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$228.17
|
| Rate for Payer: United Healthcare All Other HMO |
$222.09
|
| Rate for Payer: United Healthcare HMO Rider |
$217.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$199.11
|
|
|
OMADACYCLINE 100 MG INTRAVENOUS SOLUTION [223621]
|
Facility
|
OP
|
$607.97
|
|
|
Service Code
|
HCPCS J0121
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$516.77 |
| Rate for Payer: Adventist Health Commercial |
$121.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.34
|
| Rate for Payer: Blue Shield of California Commercial |
$5.40
|
| Rate for Payer: Cash Price |
$273.59
|
| Rate for Payer: Cash Price |
$273.59
|
| Rate for Payer: Cigna of CA HMO |
$425.58
|
| Rate for Payer: Cigna of CA PPO |
$425.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$425.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.91
|
| Rate for Payer: EPIC Health Plan Senior |
$4.61
|
| Rate for Payer: Galaxy Health WC |
$516.77
|
| Rate for Payer: Global Benefits Group Commercial |
$364.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$386.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.61
|
| Rate for Payer: Multiplan Commercial |
$486.38
|
| Rate for Payer: Networks By Design Commercial |
$303.99
|
| Rate for Payer: Prime Health Services Commercial |
$516.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$364.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$364.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$228.17
|
| Rate for Payer: United Healthcare All Other HMO |
$222.09
|
| Rate for Payer: United Healthcare HMO Rider |
$217.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$199.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.61
|
| Rate for Payer: Vantage Medical Group Senior |
$4.61
|
|
|
OMALIZUMAB 150 MG/ML SUBCUTANEOUS SYRINGE [223366]
|
Facility
|
OP
|
$1,864.51
|
|
|
Service Code
|
HCPCS J2357
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$1,584.83 |
| Rate for Payer: Adventist Health Commercial |
$372.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$252.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$58.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.40
|
| Rate for Payer: Blue Shield of California Commercial |
$55.40
|
| Rate for Payer: Cash Price |
$839.03
|
| Rate for Payer: Cash Price |
$839.03
|
| Rate for Payer: Cigna of CA HMO |
$1,305.16
|
| Rate for Payer: Cigna of CA PPO |
$1,305.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,305.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.87
|
| Rate for Payer: EPIC Health Plan Senior |
$51.25
|
| Rate for Payer: Galaxy Health WC |
$1,584.83
|
| Rate for Payer: Global Benefits Group Commercial |
$1,118.71
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$76.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$46.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$46.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,183.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$94.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$65.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$447.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$58.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$62.43
|
| Rate for Payer: Multiplan Commercial |
$1,491.61
|
| Rate for Payer: Networks By Design Commercial |
$932.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,584.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,118.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,118.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$699.75
|
| Rate for Payer: United Healthcare All Other HMO |
$681.11
|
| Rate for Payer: United Healthcare HMO Rider |
$666.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$610.63
|
| Rate for Payer: Upland Medical Group Pediatric |
$46.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$58.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.25
|
| Rate for Payer: Vantage Medical Group Senior |
$51.25
|
|
|
OMALIZUMAB 150 MG/ML SUBCUTANEOUS SYRINGE [223366]
|
Facility
|
IP
|
$1,864.51
|
|
|
Service Code
|
HCPCS J2357
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$372.90 |
| Max. Negotiated Rate |
$1,584.83 |
| Rate for Payer: Adventist Health Commercial |
$372.90
|
| Rate for Payer: Blue Shield of California Commercial |
$1,433.81
|
| Rate for Payer: Blue Shield of California Commercial |
$945.31
|
| Rate for Payer: Cash Price |
$839.03
|
| Rate for Payer: Cigna of CA HMO |
$1,305.16
|
| Rate for Payer: Cigna of CA PPO |
$1,305.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,305.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$745.80
|
| Rate for Payer: EPIC Health Plan Senior |
$745.80
|
| Rate for Payer: Galaxy Health WC |
$1,584.83
|
| Rate for Payer: Global Benefits Group Commercial |
$1,118.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,183.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,100.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$447.48
|
| Rate for Payer: Multiplan Commercial |
$1,491.61
|
| Rate for Payer: Networks By Design Commercial |
$932.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,584.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$699.75
|
| Rate for Payer: United Healthcare All Other HMO |
$681.11
|
| Rate for Payer: United Healthcare HMO Rider |
$666.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$610.63
|
|
|
OMALIZUMAB 150 MG SUBCUTANEOUS SOLUTION [36151]
|
Facility
|
IP
|
$1,864.51
|
|
|
Service Code
|
HCPCS J2357
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$372.90 |
| Max. Negotiated Rate |
$1,584.83 |
| Rate for Payer: Adventist Health Commercial |
$372.90
|
| Rate for Payer: Blue Shield of California Commercial |
$1,433.81
|
| Rate for Payer: Blue Shield of California Commercial |
$945.31
|
| Rate for Payer: Cash Price |
$839.03
|
| Rate for Payer: Cigna of CA HMO |
$1,305.16
|
| Rate for Payer: Cigna of CA PPO |
$1,305.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,305.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$745.80
|
| Rate for Payer: EPIC Health Plan Senior |
$745.80
|
| Rate for Payer: Galaxy Health WC |
$1,584.83
|
| Rate for Payer: Global Benefits Group Commercial |
$1,118.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,183.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,100.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$447.48
|
| Rate for Payer: Multiplan Commercial |
$1,491.61
|
| Rate for Payer: Networks By Design Commercial |
$932.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,584.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$699.75
|
| Rate for Payer: United Healthcare All Other HMO |
$681.11
|
| Rate for Payer: United Healthcare HMO Rider |
$666.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$610.63
|
|
|
OMALIZUMAB 150 MG SUBCUTANEOUS SOLUTION [36151]
|
Facility
|
OP
|
$1,864.51
|
|
|
Service Code
|
HCPCS J2357
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$1,584.83 |
| Rate for Payer: Adventist Health Commercial |
$372.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$252.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$58.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.40
|
| Rate for Payer: Blue Shield of California Commercial |
$55.40
|
| Rate for Payer: Cash Price |
$839.03
|
| Rate for Payer: Cash Price |
$839.03
|
| Rate for Payer: Cigna of CA HMO |
$1,305.16
|
| Rate for Payer: Cigna of CA PPO |
$1,305.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,305.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.87
|
| Rate for Payer: EPIC Health Plan Senior |
$51.25
|
| Rate for Payer: Galaxy Health WC |
$1,584.83
|
| Rate for Payer: Global Benefits Group Commercial |
$1,118.71
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$76.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$46.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$46.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,183.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$94.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$65.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$447.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$58.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$62.43
|
| Rate for Payer: Multiplan Commercial |
$1,491.61
|
| Rate for Payer: Networks By Design Commercial |
$932.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,584.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,118.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,118.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$699.75
|
| Rate for Payer: United Healthcare All Other HMO |
$681.11
|
| Rate for Payer: United Healthcare HMO Rider |
$666.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$610.63
|
| Rate for Payer: Upland Medical Group Pediatric |
$46.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$58.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.25
|
| Rate for Payer: Vantage Medical Group Senior |
$51.25
|
|
|
OMALIZUMAB 75 MG/0.5 ML SUBCUTANEOUS SYRINGE [223364]
|
Facility
|
OP
|
$1,864.51
|
|
|
Service Code
|
HCPCS J2357
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$1,584.83 |
| Rate for Payer: Adventist Health Commercial |
$372.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$252.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$58.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.40
|
| Rate for Payer: Blue Shield of California Commercial |
$55.40
|
| Rate for Payer: Cash Price |
$839.03
|
| Rate for Payer: Cash Price |
$839.03
|
| Rate for Payer: Cigna of CA HMO |
$1,305.16
|
| Rate for Payer: Cigna of CA PPO |
$1,305.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,305.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.87
|
| Rate for Payer: EPIC Health Plan Senior |
$51.25
|
| Rate for Payer: Galaxy Health WC |
$1,584.83
|
| Rate for Payer: Global Benefits Group Commercial |
$1,118.71
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$76.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$46.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$46.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,183.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$94.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$65.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$447.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$58.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$62.43
|
| Rate for Payer: Multiplan Commercial |
$1,491.61
|
| Rate for Payer: Networks By Design Commercial |
$932.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,584.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,118.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,118.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$699.75
|
| Rate for Payer: United Healthcare All Other HMO |
$681.11
|
| Rate for Payer: United Healthcare HMO Rider |
$666.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$610.63
|
| Rate for Payer: Upland Medical Group Pediatric |
$46.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$58.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.25
|
| Rate for Payer: Vantage Medical Group Senior |
$51.25
|
|
|
OMALIZUMAB 75 MG/0.5 ML SUBCUTANEOUS SYRINGE [223364]
|
Facility
|
IP
|
$1,864.51
|
|
|
Service Code
|
HCPCS J2357
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$372.90 |
| Max. Negotiated Rate |
$1,584.83 |
| Rate for Payer: Adventist Health Commercial |
$372.90
|
| Rate for Payer: Blue Shield of California Commercial |
$1,433.81
|
| Rate for Payer: Blue Shield of California Commercial |
$945.31
|
| Rate for Payer: Cash Price |
$839.03
|
| Rate for Payer: Cigna of CA HMO |
$1,305.16
|
| Rate for Payer: Cigna of CA PPO |
$1,305.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,305.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$745.80
|
| Rate for Payer: EPIC Health Plan Senior |
$745.80
|
| Rate for Payer: Galaxy Health WC |
$1,584.83
|
| Rate for Payer: Global Benefits Group Commercial |
$1,118.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,183.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,100.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$447.48
|
| Rate for Payer: Multiplan Commercial |
$1,491.61
|
| Rate for Payer: Networks By Design Commercial |
$932.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,584.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$699.75
|
| Rate for Payer: United Healthcare All Other HMO |
$681.11
|
| Rate for Payer: United Healthcare HMO Rider |
$666.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$610.63
|
|
|
OMEGA-3 300 MG-DHA 120 MG-EPA 180 MG-FISH OIL 1,000 MG CAPSULE [231730]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 0904723860
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
|
|
OMEGA-3 300 MG-DHA 120 MG-EPA 180 MG-FISH OIL 1,000 MG CAPSULE [231730]
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 0904723860
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE [41822]
|
Facility
|
OP
|
$0.25
|
|
|
Service Code
|
NDC 4280655212
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Vantage Medical Group Senior |
$0.21
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE [41822]
|
Facility
|
OP
|
$3.65
|
|
|
Service Code
|
NDC 6068712765
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$3.10 |
| Rate for Payer: Adventist Health Commercial |
$0.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.34
|
| Rate for Payer: Cash Price |
$1.64
|
| Rate for Payer: Cigna of CA HMO |
$2.56
|
| Rate for Payer: Cigna of CA PPO |
$2.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.46
|
| Rate for Payer: EPIC Health Plan Senior |
$1.46
|
| Rate for Payer: Galaxy Health WC |
$3.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.56
|
| Rate for Payer: Multiplan Commercial |
$2.92
|
| Rate for Payer: Networks By Design Commercial |
$2.37
|
| Rate for Payer: Prime Health Services Commercial |
$3.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.82
|
| Rate for Payer: United Healthcare All Other HMO |
$1.82
|
| Rate for Payer: United Healthcare HMO Rider |
$1.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.10
|
| Rate for Payer: Vantage Medical Group Senior |
$3.10
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE [41822]
|
Facility
|
OP
|
$0.30
|
|
|
Service Code
|
NDC 7075642322
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.19
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.24
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.15
|
| Rate for Payer: United Healthcare All Other HMO |
$0.15
|
| Rate for Payer: United Healthcare HMO Rider |
$0.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE [41822]
|
Facility
|
OP
|
$0.45
|
|
|
Service Code
|
NDC 3172293612
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.29
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cigna of CA HMO |
$0.32
|
| Rate for Payer: Cigna of CA PPO |
$0.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Senior |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.38
|
| Rate for Payer: Global Benefits Group Commercial |
$0.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$0.36
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.23
|
| Rate for Payer: United Healthcare All Other HMO |
$0.23
|
| Rate for Payer: United Healthcare HMO Rider |
$0.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.38
|
| Rate for Payer: Vantage Medical Group Senior |
$0.38
|
|
