|
OCTREOTIDE,MICROSPHERES 20 MG INTRAMUSCULAR WRAP, LONG-ACTING RELEASE [40824435]
|
Facility
|
OP
|
$5,324.45
|
|
|
Service Code
|
CPT J2353
|
| Hospital Charge Code |
ERX24435
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$173.38 |
| Max. Negotiated Rate |
$4,525.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,326.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$263.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$231.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$231.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$173.38
|
| Rate for Payer: Blue Distinction Transplant |
$3,194.67
|
| Rate for Payer: Blue Shield of California Commercial |
$3,924.12
|
| Rate for Payer: Blue Shield of California EPN |
$255.88
|
| Rate for Payer: Cash Price |
$2,396.00
|
| Rate for Payer: Cash Price |
$2,396.00
|
| Rate for Payer: Cigna of CA HMO |
$3,727.12
|
| Rate for Payer: Cigna of CA PPO |
$3,727.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$316.24
|
| Rate for Payer: Dignity Health Media |
$210.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$231.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$210.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$210.83
|
| Rate for Payer: Galaxy Health WC |
$4,525.78
|
| Rate for Payer: Global Benefits Group Commercial |
$3,194.67
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,993.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$345.76
|
| Rate for Payer: Heritage Provider Network Transplant |
$345.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$341.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$341.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$210.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,551.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$409.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$210.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,277.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$265.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$282.51
|
| Rate for Payer: Multiplan Commercial |
$4,259.56
|
| Rate for Payer: Networks By Design Commercial |
$2,662.22
|
| Rate for Payer: Prime Health Services Commercial |
$4,525.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,194.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,194.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,662.22
|
| Rate for Payer: United Healthcare All Other HMO |
$2,662.22
|
| Rate for Payer: United Healthcare HMO Rider |
$2,662.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,662.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$316.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$231.91
|
| Rate for Payer: Vantage Medical Group Senior |
$210.83
|
|
|
OCTREOTIDE,MICROSPHERES 30 MG INTRAMUSCULR WRAP, LONG-ACTING RELEASE [40824436]
|
Facility
|
OP
|
$7,972.97
|
|
|
Service Code
|
CPT J2353
|
| Hospital Charge Code |
ERX24436
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$173.38 |
| Max. Negotiated Rate |
$6,777.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,326.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$263.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$231.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$231.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$173.38
|
| Rate for Payer: Blue Distinction Transplant |
$4,783.78
|
| Rate for Payer: Blue Shield of California Commercial |
$5,876.08
|
| Rate for Payer: Blue Shield of California EPN |
$255.88
|
| Rate for Payer: Cash Price |
$3,587.84
|
| Rate for Payer: Cash Price |
$3,587.84
|
| Rate for Payer: Cigna of CA HMO |
$5,581.08
|
| Rate for Payer: Cigna of CA PPO |
$5,581.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$316.24
|
| Rate for Payer: Dignity Health Media |
$210.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$231.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$210.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$210.83
|
| Rate for Payer: Galaxy Health WC |
$6,777.02
|
| Rate for Payer: Global Benefits Group Commercial |
$4,783.78
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,979.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$345.76
|
| Rate for Payer: Heritage Provider Network Transplant |
$345.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$341.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$341.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$210.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,317.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$409.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$210.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,913.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$265.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$282.51
|
| Rate for Payer: Multiplan Commercial |
$6,378.38
|
| Rate for Payer: Networks By Design Commercial |
$3,986.48
|
| Rate for Payer: Prime Health Services Commercial |
$6,777.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,783.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,783.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,986.48
|
| Rate for Payer: United Healthcare All Other HMO |
$3,986.48
|
| Rate for Payer: United Healthcare HMO Rider |
$3,986.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,986.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$316.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$231.91
|
| Rate for Payer: Vantage Medical Group Senior |
$210.83
|
|
|
OCTREOTIDE,MICROSPHERES 30 MG INTRAMUSCULR WRAP, LONG-ACTING RELEASE [40824436]
|
Facility
|
IP
|
$7,972.97
|
|
|
Service Code
|
CPT J2353
|
| Hospital Charge Code |
ERX24436
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,913.51 |
| Max. Negotiated Rate |
$6,777.02 |
| Rate for Payer: Blue Shield of California Commercial |
$5,676.75
|
| Rate for Payer: Blue Shield of California EPN |
$4,082.16
|
| Rate for Payer: Cash Price |
$3,587.84
|
| Rate for Payer: Cigna of CA HMO |
$5,581.08
|
| Rate for Payer: Cigna of CA PPO |
$5,581.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,189.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,189.19
|
| Rate for Payer: Galaxy Health WC |
$6,777.02
|
| Rate for Payer: Global Benefits Group Commercial |
$4,783.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,317.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,037.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,913.51
|
| Rate for Payer: Multiplan Commercial |
$6,378.38
|
| Rate for Payer: Networks By Design Commercial |
$3,986.48
|
| Rate for Payer: Prime Health Services Commercial |
$6,777.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,010.59
|
| Rate for Payer: United Healthcare All Other HMO |
$2,940.43
|
| Rate for Payer: United Healthcare HMO Rider |
$2,876.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,631.08
|
|
|
OCTREOTIDE,MICROSPHERES ER 10 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE [204871]
|
Facility
|
IP
|
$4,063.93
|
|
|
Service Code
|
CPT J2353
|
| Hospital Charge Code |
ERX204871
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$975.34 |
| Max. Negotiated Rate |
$3,454.34 |
| Rate for Payer: Blue Shield of California Commercial |
$2,893.52
|
| Rate for Payer: Blue Shield of California EPN |
$2,080.73
|
| Rate for Payer: Cash Price |
$1,828.77
|
| Rate for Payer: Cigna of CA HMO |
$2,844.75
|
| Rate for Payer: Cigna of CA PPO |
$2,844.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,625.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,625.57
|
| Rate for Payer: Galaxy Health WC |
$3,454.34
|
| Rate for Payer: Global Benefits Group Commercial |
$2,438.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,710.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,548.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.34
|
| Rate for Payer: Multiplan Commercial |
$3,251.14
|
| Rate for Payer: Networks By Design Commercial |
$2,031.96
|
| Rate for Payer: Prime Health Services Commercial |
$3,454.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,534.54
|
| Rate for Payer: United Healthcare All Other HMO |
$1,498.78
|
| Rate for Payer: United Healthcare HMO Rider |
$1,466.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,341.10
|
|
|
OCTREOTIDE,MICROSPHERES ER 10 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE [204871]
|
Facility
|
OP
|
$4,063.93
|
|
|
Service Code
|
CPT J2353
|
| Hospital Charge Code |
ERX204871
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$173.38 |
| Max. Negotiated Rate |
$3,454.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,326.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$263.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$231.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$231.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$173.38
|
| Rate for Payer: Blue Distinction Transplant |
$2,438.36
|
| Rate for Payer: Blue Shield of California Commercial |
$2,995.12
|
| Rate for Payer: Blue Shield of California EPN |
$255.88
|
| Rate for Payer: Cash Price |
$1,828.77
|
| Rate for Payer: Cash Price |
$1,828.77
|
| Rate for Payer: Cigna of CA HMO |
$2,844.75
|
| Rate for Payer: Cigna of CA PPO |
$2,844.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$316.24
|
| Rate for Payer: Dignity Health Media |
$210.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$231.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$210.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$210.83
|
| Rate for Payer: Galaxy Health WC |
$3,454.34
|
| Rate for Payer: Global Benefits Group Commercial |
$2,438.36
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,047.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$345.76
|
| Rate for Payer: Heritage Provider Network Transplant |
$345.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$341.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$341.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$210.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,710.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$409.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$210.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$265.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$282.51
|
| Rate for Payer: Multiplan Commercial |
$3,251.14
|
| Rate for Payer: Networks By Design Commercial |
$2,031.96
|
| Rate for Payer: Prime Health Services Commercial |
$3,454.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,438.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,438.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,031.96
|
| Rate for Payer: United Healthcare All Other HMO |
$2,031.96
|
| Rate for Payer: United Healthcare HMO Rider |
$2,031.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,031.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$316.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$231.91
|
| Rate for Payer: Vantage Medical Group Senior |
$210.83
|
|
|
OCTREOTIDE,MICROSPHERES ER 20 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE [204610]
|
Facility
|
IP
|
$5,324.45
|
|
|
Service Code
|
CPT J2353
|
| Hospital Charge Code |
1720927
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,277.87 |
| Max. Negotiated Rate |
$4,525.78 |
| Rate for Payer: Blue Shield of California Commercial |
$3,791.01
|
| Rate for Payer: Blue Shield of California EPN |
$2,726.12
|
| Rate for Payer: Cash Price |
$2,396.00
|
| Rate for Payer: Cigna of CA HMO |
$3,727.12
|
| Rate for Payer: Cigna of CA PPO |
$3,727.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,129.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,129.78
|
| Rate for Payer: Galaxy Health WC |
$4,525.78
|
| Rate for Payer: Global Benefits Group Commercial |
$3,194.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,551.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,028.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,277.87
|
| Rate for Payer: Multiplan Commercial |
$4,259.56
|
| Rate for Payer: Networks By Design Commercial |
$2,662.22
|
| Rate for Payer: Prime Health Services Commercial |
$4,525.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,010.51
|
| Rate for Payer: United Healthcare All Other HMO |
$1,963.66
|
| Rate for Payer: United Healthcare HMO Rider |
$1,921.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,757.07
|
|
|
OCTREOTIDE,MICROSPHERES ER 20 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE [204610]
|
Facility
|
OP
|
$5,324.45
|
|
|
Service Code
|
CPT J2353
|
| Hospital Charge Code |
1720927
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$173.38 |
| Max. Negotiated Rate |
$4,525.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,326.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$263.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$231.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$231.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$173.38
|
| Rate for Payer: Blue Distinction Transplant |
$3,194.67
|
| Rate for Payer: Blue Shield of California Commercial |
$3,924.12
|
| Rate for Payer: Blue Shield of California EPN |
$255.88
|
| Rate for Payer: Cash Price |
$2,396.00
|
| Rate for Payer: Cash Price |
$2,396.00
|
| Rate for Payer: Cigna of CA HMO |
$3,727.12
|
| Rate for Payer: Cigna of CA PPO |
$3,727.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$316.24
|
| Rate for Payer: Dignity Health Media |
$210.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$231.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$210.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$210.83
|
| Rate for Payer: Galaxy Health WC |
$4,525.78
|
| Rate for Payer: Global Benefits Group Commercial |
$3,194.67
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,993.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$345.76
|
| Rate for Payer: Heritage Provider Network Transplant |
$345.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$341.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$341.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$210.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,551.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$409.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$210.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,277.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$265.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$282.51
|
| Rate for Payer: Multiplan Commercial |
$4,259.56
|
| Rate for Payer: Networks By Design Commercial |
$2,662.22
|
| Rate for Payer: Prime Health Services Commercial |
$4,525.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,194.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,194.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,662.22
|
| Rate for Payer: United Healthcare All Other HMO |
$2,662.22
|
| Rate for Payer: United Healthcare HMO Rider |
$2,662.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,662.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$316.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$231.91
|
| Rate for Payer: Vantage Medical Group Senior |
$210.83
|
|
|
OCTREOTIDE,MICROSPHERES ER 30 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE [204612]
|
Facility
|
OP
|
$7,972.97
|
|
|
Service Code
|
CPT J2353
|
| Hospital Charge Code |
ERX204612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$173.38 |
| Max. Negotiated Rate |
$6,777.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,326.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$263.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$231.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$231.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$173.38
|
| Rate for Payer: Blue Distinction Transplant |
$4,783.78
|
| Rate for Payer: Blue Shield of California Commercial |
$5,876.08
|
| Rate for Payer: Blue Shield of California EPN |
$255.88
|
| Rate for Payer: Cash Price |
$3,587.84
|
| Rate for Payer: Cash Price |
$3,587.84
|
| Rate for Payer: Cigna of CA HMO |
$5,581.08
|
| Rate for Payer: Cigna of CA PPO |
$5,581.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$316.24
|
| Rate for Payer: Dignity Health Media |
$210.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$231.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$210.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$210.83
|
| Rate for Payer: Galaxy Health WC |
$6,777.02
|
| Rate for Payer: Global Benefits Group Commercial |
$4,783.78
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,979.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$345.76
|
| Rate for Payer: Heritage Provider Network Transplant |
$345.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$341.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$341.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$210.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,317.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$409.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$210.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,913.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$265.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$282.51
|
| Rate for Payer: Multiplan Commercial |
$6,378.38
|
| Rate for Payer: Networks By Design Commercial |
$3,986.48
|
| Rate for Payer: Prime Health Services Commercial |
$6,777.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,783.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,783.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,986.48
|
| Rate for Payer: United Healthcare All Other HMO |
$3,986.48
|
| Rate for Payer: United Healthcare HMO Rider |
$3,986.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,986.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$316.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$231.91
|
| Rate for Payer: Vantage Medical Group Senior |
$210.83
|
|
|
OCTREOTIDE,MICROSPHERES ER 30 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE [204612]
|
Facility
|
IP
|
$7,972.97
|
|
|
Service Code
|
CPT J2353
|
| Hospital Charge Code |
ERX204612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,913.51 |
| Max. Negotiated Rate |
$6,777.02 |
| Rate for Payer: Blue Shield of California Commercial |
$5,676.75
|
| Rate for Payer: Blue Shield of California EPN |
$4,082.16
|
| Rate for Payer: Cash Price |
$3,587.84
|
| Rate for Payer: Cigna of CA HMO |
$5,581.08
|
| Rate for Payer: Cigna of CA PPO |
$5,581.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,189.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,189.19
|
| Rate for Payer: Galaxy Health WC |
$6,777.02
|
| Rate for Payer: Global Benefits Group Commercial |
$4,783.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,317.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,037.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,913.51
|
| Rate for Payer: Multiplan Commercial |
$6,378.38
|
| Rate for Payer: Networks By Design Commercial |
$3,986.48
|
| Rate for Payer: Prime Health Services Commercial |
$6,777.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,010.59
|
| Rate for Payer: United Healthcare All Other HMO |
$2,940.43
|
| Rate for Payer: United Healthcare HMO Rider |
$2,876.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,631.08
|
|
|
OFLOXACIN 0.3 % EAR DROPS [22257]
|
Facility
|
OP
|
$3.60
|
|
|
Service Code
|
NDC 69238-1615-3
|
| Hospital Charge Code |
1740311
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.14
|
| Rate for Payer: Blue Distinction Transplant |
$2.16
|
| Rate for Payer: Blue Shield of California Commercial |
$2.65
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Media |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Networks By Design Commercial |
$2.34
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other HMO |
$1.80
|
| Rate for Payer: United Healthcare HMO Rider |
$1.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
|
|
OFLOXACIN 0.3 % EAR DROPS [22257]
|
Facility
|
OP
|
$15.60
|
|
|
Service Code
|
NDC 50383-025-05
|
| Hospital Charge Code |
1740311
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$13.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.29
|
| Rate for Payer: Blue Distinction Transplant |
$9.36
|
| Rate for Payer: Blue Shield of California Commercial |
$11.50
|
| Rate for Payer: Blue Shield of California EPN |
$9.11
|
| Rate for Payer: Cash Price |
$7.02
|
| Rate for Payer: Cigna of CA HMO |
$10.92
|
| Rate for Payer: Cigna of CA PPO |
$10.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.26
|
| Rate for Payer: Dignity Health Media |
$13.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.24
|
| Rate for Payer: Galaxy Health WC |
$13.26
|
| Rate for Payer: Global Benefits Group Commercial |
$9.36
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.74
|
| Rate for Payer: Multiplan Commercial |
$12.48
|
| Rate for Payer: Networks By Design Commercial |
$10.14
|
| Rate for Payer: Prime Health Services Commercial |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.80
|
| Rate for Payer: United Healthcare All Other HMO |
$7.80
|
| Rate for Payer: United Healthcare HMO Rider |
$7.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$13.26
|
|
|
OFLOXACIN 0.3 % EAR DROPS [22257]
|
Facility
|
IP
|
$3.60
|
|
|
Service Code
|
NDC 69238-1615-3
|
| Hospital Charge Code |
1740311
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Blue Shield of California Commercial |
$2.56
|
| Rate for Payer: Blue Shield of California EPN |
$1.84
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Networks By Design Commercial |
$2.34
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
|
|
OFLOXACIN 0.3 % EAR DROPS [22257]
|
Facility
|
OP
|
$15.60
|
|
|
Service Code
|
NDC 60505-0363-1
|
| Hospital Charge Code |
1740311
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$13.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.29
|
| Rate for Payer: Blue Distinction Transplant |
$9.36
|
| Rate for Payer: Blue Shield of California Commercial |
$11.50
|
| Rate for Payer: Blue Shield of California EPN |
$9.11
|
| Rate for Payer: Cash Price |
$7.02
|
| Rate for Payer: Cigna of CA HMO |
$10.92
|
| Rate for Payer: Cigna of CA PPO |
$10.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.26
|
| Rate for Payer: Dignity Health Media |
$13.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.24
|
| Rate for Payer: Galaxy Health WC |
$13.26
|
| Rate for Payer: Global Benefits Group Commercial |
$9.36
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.74
|
| Rate for Payer: Multiplan Commercial |
$12.48
|
| Rate for Payer: Networks By Design Commercial |
$10.14
|
| Rate for Payer: Prime Health Services Commercial |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.80
|
| Rate for Payer: United Healthcare All Other HMO |
$7.80
|
| Rate for Payer: United Healthcare HMO Rider |
$7.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$13.26
|
|
|
OFLOXACIN 0.3 % EAR DROPS [22257]
|
Facility
|
IP
|
$15.60
|
|
|
Service Code
|
NDC 60505-0363-1
|
| Hospital Charge Code |
1740311
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$13.26 |
| Rate for Payer: Blue Shield of California Commercial |
$11.11
|
| Rate for Payer: Blue Shield of California EPN |
$7.99
|
| Rate for Payer: Cash Price |
$7.02
|
| Rate for Payer: Cigna of CA HMO |
$10.92
|
| Rate for Payer: Cigna of CA PPO |
$10.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.24
|
| Rate for Payer: Galaxy Health WC |
$13.26
|
| Rate for Payer: Global Benefits Group Commercial |
$9.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.74
|
| Rate for Payer: Multiplan Commercial |
$12.48
|
| Rate for Payer: Networks By Design Commercial |
$10.14
|
| Rate for Payer: Prime Health Services Commercial |
$13.26
|
|
|
OFLOXACIN 0.3 % EAR DROPS [22257]
|
Facility
|
IP
|
$15.60
|
|
|
Service Code
|
NDC 50383-025-05
|
| Hospital Charge Code |
1740311
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$13.26 |
| Rate for Payer: Blue Shield of California Commercial |
$11.11
|
| Rate for Payer: Blue Shield of California EPN |
$7.99
|
| Rate for Payer: Cash Price |
$7.02
|
| Rate for Payer: Cigna of CA HMO |
$10.92
|
| Rate for Payer: Cigna of CA PPO |
$10.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.24
|
| Rate for Payer: Galaxy Health WC |
$13.26
|
| Rate for Payer: Global Benefits Group Commercial |
$9.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.74
|
| Rate for Payer: Multiplan Commercial |
$12.48
|
| Rate for Payer: Networks By Design Commercial |
$10.14
|
| Rate for Payer: Prime Health Services Commercial |
$13.26
|
|
|
OFLOXACIN 0.3 % EAR DROPS [22257]
|
Facility
|
OP
|
$30.86
|
|
|
Service Code
|
NDC 24208-410-05
|
| Hospital Charge Code |
1740311
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$26.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$20.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.39
|
| Rate for Payer: Blue Distinction Transplant |
$18.52
|
| Rate for Payer: Blue Shield of California Commercial |
$22.74
|
| Rate for Payer: Blue Shield of California EPN |
$18.02
|
| Rate for Payer: Cash Price |
$13.89
|
| Rate for Payer: Cigna of CA HMO |
$21.60
|
| Rate for Payer: Cigna of CA PPO |
$21.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.23
|
| Rate for Payer: Dignity Health Media |
$26.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.34
|
| Rate for Payer: Galaxy Health WC |
$26.23
|
| Rate for Payer: Global Benefits Group Commercial |
$18.52
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$23.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.41
|
| Rate for Payer: Multiplan Commercial |
$24.69
|
| Rate for Payer: Networks By Design Commercial |
$20.06
|
| Rate for Payer: Prime Health Services Commercial |
$26.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.43
|
| Rate for Payer: United Healthcare All Other HMO |
$15.43
|
| Rate for Payer: United Healthcare HMO Rider |
$15.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.23
|
| Rate for Payer: Vantage Medical Group Senior |
$26.23
|
|
|
OFLOXACIN 0.3 % EAR DROPS [22257]
|
Facility
|
IP
|
$30.86
|
|
|
Service Code
|
NDC 24208-410-05
|
| Hospital Charge Code |
1740311
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$26.23 |
| Rate for Payer: Blue Shield of California Commercial |
$21.97
|
| Rate for Payer: Blue Shield of California EPN |
$15.80
|
| Rate for Payer: Cash Price |
$13.89
|
| Rate for Payer: Cigna of CA HMO |
$21.60
|
| Rate for Payer: Cigna of CA PPO |
$21.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.34
|
| Rate for Payer: Galaxy Health WC |
$26.23
|
| Rate for Payer: Global Benefits Group Commercial |
$18.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.41
|
| Rate for Payer: Multiplan Commercial |
$24.69
|
| Rate for Payer: Networks By Design Commercial |
$20.06
|
| Rate for Payer: Prime Health Services Commercial |
$26.23
|
|
|
OFLOXACIN 0.3 % EYE DROPS [19746]
|
Facility
|
IP
|
$4.91
|
|
|
Service Code
|
NDC 24208-434-05
|
| Hospital Charge Code |
1740303
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$4.17 |
| Rate for Payer: Blue Shield of California Commercial |
$3.50
|
| Rate for Payer: Blue Shield of California EPN |
$2.51
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cigna of CA HMO |
$3.44
|
| Rate for Payer: Cigna of CA PPO |
$3.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.96
|
| Rate for Payer: Galaxy Health WC |
$4.17
|
| Rate for Payer: Global Benefits Group Commercial |
$2.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$3.93
|
| Rate for Payer: Networks By Design Commercial |
$3.19
|
| Rate for Payer: Prime Health Services Commercial |
$4.17
|
|
|
OFLOXACIN 0.3 % EYE DROPS [19746]
|
Facility
|
IP
|
$3.60
|
|
|
Service Code
|
NDC 64980-515-05
|
| Hospital Charge Code |
1740303
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Blue Shield of California Commercial |
$2.56
|
| Rate for Payer: Blue Shield of California EPN |
$1.84
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Networks By Design Commercial |
$2.34
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
|
|
OFLOXACIN 0.3 % EYE DROPS [19746]
|
Facility
|
OP
|
$4.91
|
|
|
Service Code
|
NDC 24208-434-05
|
| Hospital Charge Code |
1740303
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$4.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.93
|
| Rate for Payer: Blue Distinction Transplant |
$2.95
|
| Rate for Payer: Blue Shield of California Commercial |
$3.62
|
| Rate for Payer: Blue Shield of California EPN |
$2.87
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cigna of CA HMO |
$3.44
|
| Rate for Payer: Cigna of CA PPO |
$3.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.17
|
| Rate for Payer: Dignity Health Media |
$4.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.96
|
| Rate for Payer: Galaxy Health WC |
$4.17
|
| Rate for Payer: Global Benefits Group Commercial |
$2.95
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$3.93
|
| Rate for Payer: Networks By Design Commercial |
$3.19
|
| Rate for Payer: Prime Health Services Commercial |
$4.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.46
|
| Rate for Payer: United Healthcare All Other HMO |
$2.46
|
| Rate for Payer: United Healthcare HMO Rider |
$2.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4.17
|
|
|
OFLOXACIN 0.3 % EYE DROPS [19746]
|
Facility
|
OP
|
$3.60
|
|
|
Service Code
|
NDC 64980-515-05
|
| Hospital Charge Code |
1740303
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.14
|
| Rate for Payer: Blue Distinction Transplant |
$2.16
|
| Rate for Payer: Blue Shield of California Commercial |
$2.65
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Media |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Networks By Design Commercial |
$2.34
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other HMO |
$1.80
|
| Rate for Payer: United Healthcare HMO Rider |
$1.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
|
|
OLANZAPINE 10 MG DISINTEGRATING TABLET [28160]
|
Facility
|
OP
|
$1.51
|
|
|
Service Code
|
NDC 49884-321-52
|
| Hospital Charge Code |
1712250
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.90
|
| Rate for Payer: Blue Distinction Transplant |
$0.91
|
| Rate for Payer: Blue Shield of California Commercial |
$1.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.88
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cigna of CA HMO |
$1.06
|
| Rate for Payer: Cigna of CA PPO |
$1.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.28
|
| Rate for Payer: Dignity Health Media |
$1.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.60
|
| Rate for Payer: Galaxy Health WC |
$1.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.91
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.21
|
| Rate for Payer: Networks By Design Commercial |
$0.98
|
| Rate for Payer: Prime Health Services Commercial |
$1.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.76
|
| Rate for Payer: United Healthcare All Other HMO |
$0.76
|
| Rate for Payer: United Healthcare HMO Rider |
$0.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.28
|
| Rate for Payer: Vantage Medical Group Senior |
$1.28
|
|
|
OLANZAPINE 10 MG DISINTEGRATING TABLET [28160]
|
Facility
|
OP
|
$1.51
|
|
|
Service Code
|
NDC 49884-321-55
|
| Hospital Charge Code |
1712250
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.90
|
| Rate for Payer: Blue Distinction Transplant |
$0.91
|
| Rate for Payer: Blue Shield of California Commercial |
$1.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.88
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cigna of CA HMO |
$1.06
|
| Rate for Payer: Cigna of CA PPO |
$1.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.28
|
| Rate for Payer: Dignity Health Media |
$1.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.60
|
| Rate for Payer: Galaxy Health WC |
$1.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.91
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.21
|
| Rate for Payer: Networks By Design Commercial |
$0.98
|
| Rate for Payer: Prime Health Services Commercial |
$1.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.76
|
| Rate for Payer: United Healthcare All Other HMO |
$0.76
|
| Rate for Payer: United Healthcare HMO Rider |
$0.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.28
|
| Rate for Payer: Vantage Medical Group Senior |
$1.28
|
|
|
OLANZAPINE 10 MG DISINTEGRATING TABLET [28160]
|
Facility
|
OP
|
$1.51
|
|
|
Service Code
|
NDC 59746-307-32
|
| Hospital Charge Code |
1712250
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.90
|
| Rate for Payer: Blue Distinction Transplant |
$0.91
|
| Rate for Payer: Blue Shield of California Commercial |
$1.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.88
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cigna of CA HMO |
$1.06
|
| Rate for Payer: Cigna of CA PPO |
$1.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.28
|
| Rate for Payer: Dignity Health Media |
$1.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.60
|
| Rate for Payer: Galaxy Health WC |
$1.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.91
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.21
|
| Rate for Payer: Networks By Design Commercial |
$0.98
|
| Rate for Payer: Prime Health Services Commercial |
$1.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.76
|
| Rate for Payer: United Healthcare All Other HMO |
$0.76
|
| Rate for Payer: United Healthcare HMO Rider |
$0.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.28
|
| Rate for Payer: Vantage Medical Group Senior |
$1.28
|
|
|
OLANZAPINE 10 MG DISINTEGRATING TABLET [28160]
|
Facility
|
OP
|
$1.51
|
|
|
Service Code
|
NDC 59746-307-12
|
| Hospital Charge Code |
1712250
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.90
|
| Rate for Payer: Blue Distinction Transplant |
$0.91
|
| Rate for Payer: Blue Shield of California Commercial |
$1.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.88
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cigna of CA HMO |
$1.06
|
| Rate for Payer: Cigna of CA PPO |
$1.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.28
|
| Rate for Payer: Dignity Health Media |
$1.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.60
|
| Rate for Payer: Galaxy Health WC |
$1.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.91
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.21
|
| Rate for Payer: Networks By Design Commercial |
$0.98
|
| Rate for Payer: Prime Health Services Commercial |
$1.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.76
|
| Rate for Payer: United Healthcare All Other HMO |
$0.76
|
| Rate for Payer: United Healthcare HMO Rider |
$0.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.28
|
| Rate for Payer: Vantage Medical Group Senior |
$1.28
|
|
