|
ATOMOXETINE 10 MG CAPSULE [34444]
|
Facility
IP
|
$1.95
|
|
|
Service Code
|
NDC 55111-519-30
|
| Hospital Charge Code |
1711821
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$1.66 |
| Rate for Payer: Networks By Design Commercial |
$1.27
|
| Rate for Payer: Blue Shield of California Commercial |
$1.39
|
| Rate for Payer: Blue Shield of California EPN |
$1.00
|
| Rate for Payer: Cash Price |
$0.88
|
| Rate for Payer: Cigna of CA HMO |
$1.36
|
| Rate for Payer: Cigna of CA PPO |
$1.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.78
|
| Rate for Payer: Galaxy Health WC |
$1.66
|
| Rate for Payer: Global Benefits Group Commercial |
$1.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.47
|
| Rate for Payer: Multiplan Commercial |
$1.56
|
| Rate for Payer: Prime Health Services Commercial |
$1.66
|
|
|
ATOMOXETINE 10 MG CAPSULE [34444]
|
Facility
OP
|
$2.20
|
|
|
Service Code
|
NDC 31722-714-30
|
| Hospital Charge Code |
1711821
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$1.87 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.87
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.31
|
| Rate for Payer: BCBS Transplant Transplant |
$1.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1.62
|
| Rate for Payer: Blue Shield of California EPN |
$1.28
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cigna of CA HMO |
$1.54
|
| Rate for Payer: Cigna of CA PPO |
$1.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.87
|
| Rate for Payer: Dignity Health Media |
$1.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.88
|
| Rate for Payer: Galaxy Health WC |
$1.87
|
| Rate for Payer: Global Benefits Group Commercial |
$1.32
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: Multiplan Commercial |
$1.76
|
| Rate for Payer: Networks By Design Commercial |
$1.43
|
| Rate for Payer: Prime Health Services Commercial |
$1.87
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1.10
|
| Rate for Payer: United Healthcare HMO Rider |
$1.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.87
|
| Rate for Payer: Vantage Medical Group Senior |
$1.87
|
|
|
ATOMOXETINE 10 MG CAPSULE [34444]
|
Facility
OP
|
$15.82
|
|
|
Service Code
|
NDC 0002-3227-30
|
| Hospital Charge Code |
1711821
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$13.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.43
|
| Rate for Payer: BCBS Transplant Transplant |
$9.49
|
| Rate for Payer: Blue Shield of California Commercial |
$11.66
|
| Rate for Payer: Blue Shield of California EPN |
$9.24
|
| Rate for Payer: Cash Price |
$7.12
|
| Rate for Payer: Cigna of CA HMO |
$11.07
|
| Rate for Payer: Cigna of CA PPO |
$11.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.45
|
| Rate for Payer: Dignity Health Media |
$13.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.33
|
| Rate for Payer: Galaxy Health WC |
$13.45
|
| Rate for Payer: Global Benefits Group Commercial |
$9.49
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.80
|
| Rate for Payer: Multiplan Commercial |
$12.66
|
| Rate for Payer: Networks By Design Commercial |
$10.28
|
| Rate for Payer: Prime Health Services Commercial |
$13.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.91
|
| Rate for Payer: United Healthcare All Other HMO |
$7.91
|
| Rate for Payer: United Healthcare HMO Rider |
$7.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.45
|
| Rate for Payer: Vantage Medical Group Senior |
$13.45
|
|
|
ATOMOXETINE 10 MG CAPSULE [34444]
|
Facility
IP
|
$4.44
|
|
|
Service Code
|
NDC 0093-3542-56
|
| Hospital Charge Code |
1711821
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$3.77 |
| Rate for Payer: Blue Shield of California Commercial |
$3.16
|
| Rate for Payer: Blue Shield of California EPN |
$2.27
|
| Rate for Payer: Cash Price |
$2.00
|
| Rate for Payer: Cigna of CA HMO |
$3.11
|
| Rate for Payer: Cigna of CA PPO |
$3.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.78
|
| Rate for Payer: Galaxy Health WC |
$3.77
|
| Rate for Payer: Global Benefits Group Commercial |
$2.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.07
|
| Rate for Payer: Multiplan Commercial |
$3.55
|
| Rate for Payer: Networks By Design Commercial |
$2.89
|
| Rate for Payer: Prime Health Services Commercial |
$3.77
|
|
|
ATOMOXETINE 10 MG CAPSULE [34444]
|
Facility
IP
|
$2.20
|
|
|
Service Code
|
NDC 31722-714-30
|
| Hospital Charge Code |
1711821
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$1.87 |
| Rate for Payer: Blue Shield of California Commercial |
$1.57
|
| Rate for Payer: Blue Shield of California EPN |
$1.13
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cigna of CA HMO |
$1.54
|
| Rate for Payer: Cigna of CA PPO |
$1.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.88
|
| Rate for Payer: Galaxy Health WC |
$1.87
|
| Rate for Payer: Global Benefits Group Commercial |
$1.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: Multiplan Commercial |
$1.76
|
| Rate for Payer: Networks By Design Commercial |
$1.43
|
| Rate for Payer: Prime Health Services Commercial |
$1.87
|
|
|
ATOMOXETINE 10 MG CAPSULE [34444]
|
Facility
IP
|
$15.82
|
|
|
Service Code
|
NDC 0002-3227-30
|
| Hospital Charge Code |
1711821
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$13.45 |
| Rate for Payer: Blue Shield of California Commercial |
$11.26
|
| Rate for Payer: Blue Shield of California EPN |
$8.10
|
| Rate for Payer: Cash Price |
$7.12
|
| Rate for Payer: Cigna of CA HMO |
$11.07
|
| Rate for Payer: Cigna of CA PPO |
$11.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.33
|
| Rate for Payer: Galaxy Health WC |
$13.45
|
| Rate for Payer: Global Benefits Group Commercial |
$9.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.80
|
| Rate for Payer: Multiplan Commercial |
$12.66
|
| Rate for Payer: Networks By Design Commercial |
$10.28
|
| Rate for Payer: Prime Health Services Commercial |
$13.45
|
|
|
ATOMOXETINE 10 MG CAPSULE [34444]
|
Facility
OP
|
$1.90
|
|
|
Service Code
|
NDC 68462-265-30
|
| Hospital Charge Code |
1711821
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.13
|
| Rate for Payer: BCBS Transplant Transplant |
$1.14
|
| Rate for Payer: Blue Shield of California Commercial |
$1.40
|
| Rate for Payer: Blue Shield of California EPN |
$1.11
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cigna of CA HMO |
$1.33
|
| Rate for Payer: Cigna of CA PPO |
$1.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.62
|
| Rate for Payer: Dignity Health Media |
$1.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.76
|
| Rate for Payer: Galaxy Health WC |
$1.62
|
| Rate for Payer: Global Benefits Group Commercial |
$1.14
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.46
|
| Rate for Payer: Multiplan Commercial |
$1.52
|
| Rate for Payer: Networks By Design Commercial |
$1.24
|
| Rate for Payer: Prime Health Services Commercial |
$1.62
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.95
|
| Rate for Payer: United Healthcare All Other HMO |
$0.95
|
| Rate for Payer: United Healthcare HMO Rider |
$0.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.62
|
| Rate for Payer: Vantage Medical Group Senior |
$1.62
|
|
|
ATOMOXETINE 10 MG CAPSULE [34444]
|
Facility
IP
|
$1.95
|
|
|
Service Code
|
NDC 64980-373-03
|
| Hospital Charge Code |
1711821
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$1.66 |
| Rate for Payer: Blue Shield of California Commercial |
$1.39
|
| Rate for Payer: Blue Shield of California EPN |
$1.00
|
| Rate for Payer: Cash Price |
$0.88
|
| Rate for Payer: Cigna of CA HMO |
$1.36
|
| Rate for Payer: Cigna of CA PPO |
$1.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.78
|
| Rate for Payer: Galaxy Health WC |
$1.66
|
| Rate for Payer: Global Benefits Group Commercial |
$1.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.47
|
| Rate for Payer: Multiplan Commercial |
$1.56
|
| Rate for Payer: Networks By Design Commercial |
$1.27
|
| Rate for Payer: Prime Health Services Commercial |
$1.66
|
|
|
ATOMOXETINE 10 MG CAPSULE [34444]
|
Facility
OP
|
$4.44
|
|
|
Service Code
|
NDC 0093-3542-56
|
| Hospital Charge Code |
1711821
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$3.77 |
| Rate for Payer: Galaxy Health WC |
$3.77
|
| Rate for Payer: Global Benefits Group Commercial |
$2.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.65
|
| Rate for Payer: BCBS Transplant Transplant |
$2.66
|
| Rate for Payer: Blue Shield of California Commercial |
$3.27
|
| Rate for Payer: Blue Shield of California EPN |
$2.59
|
| Rate for Payer: Cash Price |
$2.00
|
| Rate for Payer: Cigna of CA HMO |
$3.11
|
| Rate for Payer: Cigna of CA PPO |
$3.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.77
|
| Rate for Payer: Dignity Health Media |
$3.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.78
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.07
|
| Rate for Payer: Multiplan Commercial |
$3.55
|
| Rate for Payer: Networks By Design Commercial |
$2.89
|
| Rate for Payer: Prime Health Services Commercial |
$3.77
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.22
|
| Rate for Payer: United Healthcare All Other HMO |
$2.22
|
| Rate for Payer: United Healthcare HMO Rider |
$2.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.77
|
| Rate for Payer: Vantage Medical Group Senior |
$3.77
|
|
|
ATOMOXETINE 10 MG CAPSULE [34444]
|
Facility
IP
|
$1.90
|
|
|
Service Code
|
NDC 68462-265-30
|
| Hospital Charge Code |
1711821
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: Blue Shield of California Commercial |
$1.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.97
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cigna of CA HMO |
$1.33
|
| Rate for Payer: Cigna of CA PPO |
$1.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.76
|
| Rate for Payer: Galaxy Health WC |
$1.62
|
| Rate for Payer: Global Benefits Group Commercial |
$1.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.46
|
| Rate for Payer: Multiplan Commercial |
$1.52
|
| Rate for Payer: Networks By Design Commercial |
$1.24
|
| Rate for Payer: Prime Health Services Commercial |
$1.62
|
|
|
ATOMOXETINE 10 MG CAPSULE [34444]
|
Facility
OP
|
$1.95
|
|
|
Service Code
|
NDC 55111-519-30
|
| Hospital Charge Code |
1711821
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$1.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: BCBS Transplant Transplant |
$1.17
|
| Rate for Payer: Blue Shield of California Commercial |
$1.44
|
| Rate for Payer: Blue Shield of California EPN |
$1.14
|
| Rate for Payer: Cash Price |
$0.88
|
| Rate for Payer: Cigna of CA HMO |
$1.36
|
| Rate for Payer: Cigna of CA PPO |
$1.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.66
|
| Rate for Payer: Dignity Health Media |
$1.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.78
|
| Rate for Payer: Galaxy Health WC |
$1.66
|
| Rate for Payer: Global Benefits Group Commercial |
$1.17
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.47
|
| Rate for Payer: Multiplan Commercial |
$1.56
|
| Rate for Payer: Networks By Design Commercial |
$1.27
|
| Rate for Payer: Prime Health Services Commercial |
$1.66
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.98
|
| Rate for Payer: United Healthcare All Other HMO |
$0.98
|
| Rate for Payer: United Healthcare HMO Rider |
$0.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.66
|
| Rate for Payer: Vantage Medical Group Senior |
$1.66
|
|
|
ATOMOXETINE 10 MG CAPSULE [34444]
|
Facility
OP
|
$1.95
|
|
|
Service Code
|
NDC 64980-373-03
|
| Hospital Charge Code |
1711821
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$1.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: BCBS Transplant Transplant |
$1.17
|
| Rate for Payer: Blue Shield of California Commercial |
$1.44
|
| Rate for Payer: Blue Shield of California EPN |
$1.14
|
| Rate for Payer: Cash Price |
$0.88
|
| Rate for Payer: Cigna of CA HMO |
$1.36
|
| Rate for Payer: Cigna of CA PPO |
$1.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.66
|
| Rate for Payer: Dignity Health Media |
$1.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.78
|
| Rate for Payer: Galaxy Health WC |
$1.66
|
| Rate for Payer: Global Benefits Group Commercial |
$1.17
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.47
|
| Rate for Payer: Multiplan Commercial |
$1.56
|
| Rate for Payer: Networks By Design Commercial |
$1.27
|
| Rate for Payer: Prime Health Services Commercial |
$1.66
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.98
|
| Rate for Payer: United Healthcare All Other HMO |
$0.98
|
| Rate for Payer: United Healthcare HMO Rider |
$0.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.66
|
| Rate for Payer: Vantage Medical Group Senior |
$1.66
|
|
|
ATOMOXETINE 18 MG CAPSULE [34445]
|
Facility
OP
|
$15.82
|
|
|
Service Code
|
NDC 0002-3238-30
|
| Hospital Charge Code |
1711822
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$13.45 |
| Rate for Payer: Cash Price |
$7.12
|
| Rate for Payer: Cigna of CA HMO |
$11.07
|
| Rate for Payer: Cigna of CA PPO |
$11.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.43
|
| Rate for Payer: BCBS Transplant Transplant |
$9.49
|
| Rate for Payer: Blue Shield of California Commercial |
$11.66
|
| Rate for Payer: Blue Shield of California EPN |
$9.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.45
|
| Rate for Payer: Dignity Health Media |
$13.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.33
|
| Rate for Payer: Galaxy Health WC |
$13.45
|
| Rate for Payer: Global Benefits Group Commercial |
$9.49
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.80
|
| Rate for Payer: Multiplan Commercial |
$12.66
|
| Rate for Payer: Networks By Design Commercial |
$10.28
|
| Rate for Payer: Prime Health Services Commercial |
$13.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.91
|
| Rate for Payer: United Healthcare All Other HMO |
$7.91
|
| Rate for Payer: United Healthcare HMO Rider |
$7.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.45
|
| Rate for Payer: Vantage Medical Group Senior |
$13.45
|
|
|
ATOMOXETINE 18 MG CAPSULE [34445]
|
Facility
IP
|
$15.82
|
|
|
Service Code
|
NDC 0002-3238-30
|
| Hospital Charge Code |
1711822
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$13.45 |
| Rate for Payer: Blue Shield of California Commercial |
$11.26
|
| Rate for Payer: Blue Shield of California EPN |
$8.10
|
| Rate for Payer: Cash Price |
$7.12
|
| Rate for Payer: Cigna of CA HMO |
$11.07
|
| Rate for Payer: Cigna of CA PPO |
$11.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.33
|
| Rate for Payer: Galaxy Health WC |
$13.45
|
| Rate for Payer: Global Benefits Group Commercial |
$9.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.80
|
| Rate for Payer: Multiplan Commercial |
$12.66
|
| Rate for Payer: Networks By Design Commercial |
$10.28
|
| Rate for Payer: Prime Health Services Commercial |
$13.45
|
|
|
ATOMOXETINE 25 MG CAPSULE [34446]
|
Facility
OP
|
$4.40
|
|
|
Service Code
|
NDC 60687-567-21
|
| Hospital Charge Code |
1711823
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.42
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.62
|
| Rate for Payer: BCBS Transplant Transplant |
$2.64
|
| Rate for Payer: Blue Shield of California Commercial |
$3.24
|
| Rate for Payer: Blue Shield of California EPN |
$2.57
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cigna of CA HMO |
$3.08
|
| Rate for Payer: Cigna of CA PPO |
$3.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.74
|
| Rate for Payer: Dignity Health Media |
$3.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.76
|
| Rate for Payer: Galaxy Health WC |
$3.74
|
| Rate for Payer: Global Benefits Group Commercial |
$2.64
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Multiplan Commercial |
$3.52
|
| Rate for Payer: Networks By Design Commercial |
$2.86
|
| Rate for Payer: Prime Health Services Commercial |
$3.74
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.20
|
| Rate for Payer: United Healthcare All Other HMO |
$2.20
|
| Rate for Payer: United Healthcare HMO Rider |
$2.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.74
|
| Rate for Payer: Vantage Medical Group Senior |
$3.74
|
|
|
ATOMOXETINE 25 MG CAPSULE [34446]
|
Facility
OP
|
$4.40
|
|
|
Service Code
|
NDC 60687-567-11
|
| Hospital Charge Code |
1711823
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.42
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.62
|
| Rate for Payer: BCBS Transplant Transplant |
$2.64
|
| Rate for Payer: Blue Shield of California Commercial |
$3.24
|
| Rate for Payer: Blue Shield of California EPN |
$2.57
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cigna of CA HMO |
$3.08
|
| Rate for Payer: Cigna of CA PPO |
$3.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.74
|
| Rate for Payer: Dignity Health Media |
$3.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.76
|
| Rate for Payer: Galaxy Health WC |
$3.74
|
| Rate for Payer: Global Benefits Group Commercial |
$2.64
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Multiplan Commercial |
$3.52
|
| Rate for Payer: Networks By Design Commercial |
$2.86
|
| Rate for Payer: Prime Health Services Commercial |
$3.74
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.20
|
| Rate for Payer: United Healthcare All Other HMO |
$2.20
|
| Rate for Payer: United Healthcare HMO Rider |
$2.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.74
|
| Rate for Payer: Vantage Medical Group Senior |
$3.74
|
|
|
ATOMOXETINE 25 MG CAPSULE [34446]
|
Facility
IP
|
$4.40
|
|
|
Service Code
|
NDC 60687-567-21
|
| Hospital Charge Code |
1711823
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: EPIC Health Plan Commercial |
$1.76
|
| Rate for Payer: Galaxy Health WC |
$3.74
|
| Rate for Payer: Blue Shield of California Commercial |
$3.13
|
| Rate for Payer: Blue Shield of California EPN |
$2.25
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cigna of CA HMO |
$3.08
|
| Rate for Payer: Cigna of CA PPO |
$3.08
|
| Rate for Payer: Global Benefits Group Commercial |
$2.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Multiplan Commercial |
$3.52
|
| Rate for Payer: Networks By Design Commercial |
$2.86
|
| Rate for Payer: Prime Health Services Commercial |
$3.74
|
|
|
ATOMOXETINE 25 MG CAPSULE [34446]
|
Facility
IP
|
$4.40
|
|
|
Service Code
|
NDC 60687-567-11
|
| Hospital Charge Code |
1711823
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Blue Shield of California Commercial |
$3.13
|
| Rate for Payer: Blue Shield of California EPN |
$2.25
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cigna of CA HMO |
$3.08
|
| Rate for Payer: Cigna of CA PPO |
$3.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.76
|
| Rate for Payer: Galaxy Health WC |
$3.74
|
| Rate for Payer: Global Benefits Group Commercial |
$2.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Multiplan Commercial |
$3.52
|
| Rate for Payer: Networks By Design Commercial |
$2.86
|
| Rate for Payer: Prime Health Services Commercial |
$3.74
|
|
|
ATOMOXETINE 40 MG CAPSULE [34447]
|
Facility
OP
|
$4.83
|
|
|
Service Code
|
NDC 35573-418-30
|
| Hospital Charge Code |
1711824
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$4.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.88
|
| Rate for Payer: BCBS Transplant Transplant |
$2.90
|
| Rate for Payer: Blue Shield of California Commercial |
$3.56
|
| Rate for Payer: Blue Shield of California EPN |
$2.82
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna of CA HMO |
$3.38
|
| Rate for Payer: Cigna of CA PPO |
$3.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.11
|
| Rate for Payer: Dignity Health Media |
$4.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.93
|
| Rate for Payer: Galaxy Health WC |
$4.11
|
| Rate for Payer: Global Benefits Group Commercial |
$2.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.16
|
| Rate for Payer: Multiplan Commercial |
$3.86
|
| Rate for Payer: Networks By Design Commercial |
$3.14
|
| Rate for Payer: Prime Health Services Commercial |
$4.11
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.42
|
| Rate for Payer: United Healthcare All Other HMO |
$2.42
|
| Rate for Payer: United Healthcare HMO Rider |
$2.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.11
|
| Rate for Payer: Vantage Medical Group Senior |
$4.11
|
|
|
ATOMOXETINE 40 MG CAPSULE [34447]
|
Facility
IP
|
$7.59
|
|
|
Service Code
|
NDC 60687-326-25
|
| Hospital Charge Code |
1711824
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$6.45 |
| Rate for Payer: Blue Shield of California Commercial |
$5.40
|
| Rate for Payer: Blue Shield of California EPN |
$3.89
|
| Rate for Payer: Cash Price |
$3.42
|
| Rate for Payer: Cigna of CA HMO |
$5.31
|
| Rate for Payer: Cigna of CA PPO |
$5.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.04
|
| Rate for Payer: Galaxy Health WC |
$6.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.82
|
| Rate for Payer: Multiplan Commercial |
$6.07
|
| Rate for Payer: Networks By Design Commercial |
$4.93
|
| Rate for Payer: Prime Health Services Commercial |
$6.45
|
|
|
ATOMOXETINE 40 MG CAPSULE [34447]
|
Facility
IP
|
$2.12
|
|
|
Service Code
|
NDC 64980-376-03
|
| Hospital Charge Code |
1711824
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Blue Shield of California Commercial |
$1.51
|
| Rate for Payer: Blue Shield of California EPN |
$1.09
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Cigna of CA HMO |
$1.48
|
| Rate for Payer: Cigna of CA PPO |
$1.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.85
|
| Rate for Payer: Galaxy Health WC |
$1.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.51
|
| Rate for Payer: Multiplan Commercial |
$1.70
|
| Rate for Payer: Networks By Design Commercial |
$1.38
|
| Rate for Payer: Prime Health Services Commercial |
$1.80
|
|
|
ATOMOXETINE 40 MG CAPSULE [34447]
|
Facility
OP
|
$17.18
|
|
|
Service Code
|
NDC 0002-3229-30
|
| Hospital Charge Code |
1711824
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$14.60 |
| Rate for Payer: Multiplan Commercial |
$13.74
|
| Rate for Payer: Networks By Design Commercial |
$11.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.24
|
| Rate for Payer: BCBS Transplant Transplant |
$10.31
|
| Rate for Payer: Blue Shield of California Commercial |
$12.66
|
| Rate for Payer: Blue Shield of California EPN |
$10.03
|
| Rate for Payer: Cash Price |
$7.73
|
| Rate for Payer: Cigna of CA HMO |
$12.03
|
| Rate for Payer: Cigna of CA PPO |
$12.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.60
|
| Rate for Payer: Dignity Health Media |
$14.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.87
|
| Rate for Payer: Galaxy Health WC |
$14.60
|
| Rate for Payer: Global Benefits Group Commercial |
$10.31
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.12
|
| Rate for Payer: Prime Health Services Commercial |
$14.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.59
|
| Rate for Payer: United Healthcare All Other HMO |
$8.59
|
| Rate for Payer: United Healthcare HMO Rider |
$8.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.60
|
| Rate for Payer: Vantage Medical Group Senior |
$14.60
|
|
|
ATOMOXETINE 40 MG CAPSULE [34447]
|
Facility
OP
|
$7.59
|
|
|
Service Code
|
NDC 60687-326-95
|
| Hospital Charge Code |
1711824
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$6.45 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.45
|
| Rate for Payer: Vantage Medical Group Senior |
$6.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.52
|
| Rate for Payer: BCBS Transplant Transplant |
$4.55
|
| Rate for Payer: Blue Shield of California Commercial |
$5.59
|
| Rate for Payer: Blue Shield of California EPN |
$4.43
|
| Rate for Payer: Cash Price |
$3.42
|
| Rate for Payer: Cigna of CA HMO |
$5.31
|
| Rate for Payer: Cigna of CA PPO |
$5.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.45
|
| Rate for Payer: Dignity Health Media |
$6.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.04
|
| Rate for Payer: Galaxy Health WC |
$6.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4.55
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.82
|
| Rate for Payer: Multiplan Commercial |
$6.07
|
| Rate for Payer: Networks By Design Commercial |
$4.93
|
| Rate for Payer: Prime Health Services Commercial |
$6.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.80
|
| Rate for Payer: United Healthcare All Other HMO |
$3.80
|
| Rate for Payer: United Healthcare HMO Rider |
$3.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.45
|
|
|
ATOMOXETINE 40 MG CAPSULE [34447]
|
Facility
OP
|
$7.59
|
|
|
Service Code
|
NDC 60687-326-25
|
| Hospital Charge Code |
1711824
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$6.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.52
|
| Rate for Payer: BCBS Transplant Transplant |
$4.55
|
| Rate for Payer: Blue Shield of California Commercial |
$5.59
|
| Rate for Payer: Blue Shield of California EPN |
$4.43
|
| Rate for Payer: Cash Price |
$3.42
|
| Rate for Payer: Cigna of CA HMO |
$5.31
|
| Rate for Payer: Cigna of CA PPO |
$5.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.45
|
| Rate for Payer: Dignity Health Media |
$6.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.04
|
| Rate for Payer: Galaxy Health WC |
$6.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4.55
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.82
|
| Rate for Payer: Multiplan Commercial |
$6.07
|
| Rate for Payer: Networks By Design Commercial |
$4.93
|
| Rate for Payer: Prime Health Services Commercial |
$6.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.80
|
| Rate for Payer: United Healthcare All Other HMO |
$3.80
|
| Rate for Payer: United Healthcare HMO Rider |
$3.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.45
|
| Rate for Payer: Vantage Medical Group Senior |
$6.45
|
|
|
ATOMOXETINE 40 MG CAPSULE [34447]
|
Facility
IP
|
$17.18
|
|
|
Service Code
|
NDC 0002-3229-30
|
| Hospital Charge Code |
1711824
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$14.60 |
| Rate for Payer: Blue Shield of California Commercial |
$12.23
|
| Rate for Payer: Blue Shield of California EPN |
$8.80
|
| Rate for Payer: Cash Price |
$7.73
|
| Rate for Payer: Cigna of CA HMO |
$12.03
|
| Rate for Payer: Cigna of CA PPO |
$12.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.87
|
| Rate for Payer: Galaxy Health WC |
$14.60
|
| Rate for Payer: Global Benefits Group Commercial |
$10.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.12
|
| Rate for Payer: Multiplan Commercial |
$13.74
|
| Rate for Payer: Networks By Design Commercial |
$11.17
|
| Rate for Payer: Prime Health Services Commercial |
$14.60
|
|
