|
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
|
$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: AlphaCare Medical Group Commercial/Exchange |
$13.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.29
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$9.36
|
| 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
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: Galaxy Health WC |
$3.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.14
|
| Rate for Payer: BCBS Transplant 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: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$2.16
|
| 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 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: AlphaCare Medical Group Commercial/Exchange |
$13.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.29
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$9.36
|
| 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 % 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
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
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: AlphaCare Medical Group Commercial/Exchange |
$4.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.93
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$2.95
|
| 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: Galaxy Health WC |
$3.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.14
|
| Rate for Payer: BCBS Transplant 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: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$2.16
|
| 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
IP
|
$3.15
|
|
|
Service Code
|
NDC 60505-3276-0
|
| Hospital Charge Code |
1712250
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$2.68 |
| Rate for Payer: Blue Shield of California Commercial |
$2.24
|
| Rate for Payer: Blue Shield of California EPN |
$1.61
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Cigna of CA HMO |
$2.20
|
| Rate for Payer: Cigna of CA PPO |
$2.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.26
|
| Rate for Payer: Galaxy Health WC |
$2.68
|
| Rate for Payer: Global Benefits Group Commercial |
$1.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$2.52
|
| Rate for Payer: Networks By Design Commercial |
$2.05
|
| Rate for Payer: Prime Health Services Commercial |
$2.68
|
|
|
OLANZAPINE 10 MG 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: Vantage Medical Group Medi-Cal |
$1.28
|
| Rate for Payer: Vantage Medical Group Senior |
$1.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.90
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$0.91
|
| 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
|
|
|
OLANZAPINE 10 MG DISINTEGRATING TABLET [28160]
|
Facility
OP
|
$3.15
|
|
|
Service Code
|
NDC 60505-3276-0
|
| Hospital Charge Code |
1712250
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$2.68 |
| Rate for Payer: Galaxy Health WC |
$2.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.73
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.88
|
| Rate for Payer: BCBS Transplant Transplant |
$1.89
|
| Rate for Payer: Blue Shield of California Commercial |
$2.32
|
| Rate for Payer: Blue Shield of California EPN |
$1.84
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Cigna of CA HMO |
$2.20
|
| Rate for Payer: Cigna of CA PPO |
$2.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.68
|
| Rate for Payer: Dignity Health Media |
$2.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.26
|
| Rate for Payer: Global Benefits Group Commercial |
$1.89
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$2.52
|
| Rate for Payer: Networks By Design Commercial |
$2.05
|
| Rate for Payer: Prime Health Services Commercial |
$2.68
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.58
|
| Rate for Payer: United Healthcare All Other HMO |
$1.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2.68
|
|
|
OLANZAPINE 10 MG DISINTEGRATING TABLET [28160]
|
Facility
IP
|
$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: Blue Shield of California Commercial |
$1.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.77
|
| 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: EPIC Health Plan Commercial |
$0.60
|
| Rate for Payer: Galaxy Health WC |
$1.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.91
|
| 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
|
|
|
OLANZAPINE 10 MG DISINTEGRATING TABLET [28160]
|
Facility
IP
|
$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: Blue Shield of California Commercial |
$1.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.77
|
| 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: EPIC Health Plan Commercial |
$0.60
|
| Rate for Payer: Galaxy Health WC |
$1.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.91
|
| 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
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$1.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.90
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$0.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.76
|
| Rate for Payer: United Healthcare All Other HMO |
$0.76
|
| Rate for Payer: United Healthcare HMO Rider |
$0.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.28
|
| Rate for Payer: Vantage Medical Group Senior |
$1.28
|
|
|
OLANZAPINE 10 MG DISINTEGRATING TABLET [28160]
|
Facility
IP
|
$1.51
|
|
|
Service Code
|
NDC 49884-321-55
|
| Hospital Charge Code |
1712250
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.28 |
| Rate for Payer: Blue Shield of California Commercial |
$1.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.77
|
| 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: EPIC Health Plan Commercial |
$0.60
|
| Rate for Payer: Galaxy Health WC |
$1.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.91
|
| 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
|
|
|
OLANZAPINE 10 MG DISINTEGRATING TABLET [28160]
|
Facility
IP
|
$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: Blue Shield of California Commercial |
$1.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.77
|
| 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: EPIC Health Plan Commercial |
$0.60
|
| Rate for Payer: Galaxy Health WC |
$1.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.91
|
| 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
|
|
|
OLANZAPINE 10 MG DISINTEGRATING TABLET [28160]
|
Facility
OP
|
$1.51
|
|
|
Service Code
|
NDC 60505-3276-3
|
| 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: AlphaCare Medical Group Commercial/Exchange |
$1.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.90
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$0.91
|
| 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: AlphaCare Medical Group Commercial/Exchange |
$1.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.90
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$0.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.76
|
| Rate for Payer: United Healthcare All Other HMO |
$0.76
|
| Rate for Payer: United Healthcare HMO Rider |
$0.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.28
|
| Rate for Payer: Vantage Medical Group Senior |
$1.28
|
|
|
OLANZAPINE 10 MG DISINTEGRATING TABLET [28160]
|
Facility
IP
|
$1.51
|
|
|
Service Code
|
NDC 60505-3276-3
|
| Hospital Charge Code |
1712250
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.28 |
| Rate for Payer: Blue Shield of California Commercial |
$1.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.77
|
| 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: EPIC Health Plan Commercial |
$0.60
|
| Rate for Payer: Galaxy Health WC |
$1.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.91
|
| 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
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$1.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.90
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$0.91
|
| 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 INTRAMUSCULAR SOLUTION [38263]
|
Facility
OP
|
$27.89
|
|
|
Service Code
|
CPT J2359
|
| Hospital Charge Code |
1720945
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$23.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.04
|
| 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: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.94
|
| Rate for Payer: BCBS Transplant Transplant |
$16.73
|
| Rate for Payer: BCBS Transplant Transplant |
$27.13
|
| Rate for Payer: Blue Shield of California Commercial |
$20.55
|
| Rate for Payer: Blue Shield of California Commercial |
$33.33
|
| Rate for Payer: Blue Shield of California EPN |
$16.29
|
| Rate for Payer: Blue Shield of California EPN |
$26.41
|
| Rate for Payer: Cash Price |
$20.35
|
| Rate for Payer: Cash Price |
$12.55
|
| Rate for Payer: Cash Price |
$20.35
|
| Rate for Payer: Cash Price |
$12.55
|
| Rate for Payer: Cigna of CA HMO |
$31.65
|
| Rate for Payer: Cigna of CA HMO |
$19.52
|
| Rate for Payer: Cigna of CA PPO |
$19.52
|
| Rate for Payer: Cigna of CA PPO |
$31.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.42
|
| Rate for Payer: Dignity Health Media |
$0.95
|
| Rate for Payer: Dignity Health Media |
$0.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$0.95
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$0.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.95
|
| Rate for Payer: Galaxy Health WC |
$38.44
|
| Rate for Payer: Galaxy Health WC |
$23.71
|
| Rate for Payer: Global Benefits Group Commercial |
$16.73
|
| Rate for Payer: Global Benefits Group Commercial |
$27.13
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$20.92
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$33.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.55
|
| Rate for Payer: Heritage Provider Network Transplant |
$1.55
|
| Rate for Payer: Heritage Provider Network Transplant |
$1.55
|
| Rate for Payer: IEHP Medi-Cal |
$1.53
|
| Rate for Payer: IEHP Medi-Cal |
$1.53
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1.53
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1.53
|
| Rate for Payer: IEHP Medicare Advantage |
$0.95
|
| Rate for Payer: IEHP Medicare Advantage |
$0.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.27
|
| Rate for Payer: Multiplan Commercial |
$22.31
|
| Rate for Payer: Multiplan Commercial |
$36.18
|
| Rate for Payer: Networks By Design Commercial |
$13.94
|
| Rate for Payer: Networks By Design Commercial |
$22.61
|
| Rate for Payer: Prime Health Services Commercial |
$38.44
|
| Rate for Payer: Prime Health Services Commercial |
$23.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.94
|
| Rate for Payer: United Healthcare All Other HMO |
$13.94
|
| Rate for Payer: United Healthcare All Other HMO |
$22.61
|
| Rate for Payer: United Healthcare HMO Rider |
$13.94
|
| Rate for Payer: United Healthcare HMO Rider |
$22.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.95
|
| Rate for Payer: Vantage Medical Group Senior |
$0.95
|
|
|
OLANZAPINE 10 MG INTRAMUSCULAR SOLUTION [38263]
|
Facility
IP
|
$27.89
|
|
|
Service Code
|
CPT J2359
|
| Hospital Charge Code |
1720945
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.69 |
| Max. Negotiated Rate |
$23.71 |
| Rate for Payer: Blue Shield of California Commercial |
$19.86
|
| Rate for Payer: Blue Shield of California Commercial |
$32.20
|
| Rate for Payer: Blue Shield of California EPN |
$23.15
|
| Rate for Payer: Blue Shield of California EPN |
$14.28
|
| Rate for Payer: Cash Price |
$20.35
|
| Rate for Payer: Cash Price |
$12.55
|
| Rate for Payer: Cigna of CA HMO |
$19.52
|
| Rate for Payer: Cigna of CA HMO |
$31.65
|
| Rate for Payer: Cigna of CA PPO |
$19.52
|
| Rate for Payer: Cigna of CA PPO |
$31.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.16
|
| Rate for Payer: Galaxy Health WC |
$38.44
|
| Rate for Payer: Galaxy Health WC |
$23.71
|
| Rate for Payer: Global Benefits Group Commercial |
$27.13
|
| Rate for Payer: Global Benefits Group Commercial |
$16.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.69
|
| Rate for Payer: Multiplan Commercial |
$36.18
|
| Rate for Payer: Multiplan Commercial |
$22.31
|
| Rate for Payer: Networks By Design Commercial |
$22.61
|
| Rate for Payer: Networks By Design Commercial |
$13.94
|
| Rate for Payer: Prime Health Services Commercial |
$23.71
|
| Rate for Payer: Prime Health Services Commercial |
$38.44
|
|
|
OLANZAPINE 10 MG TABLET [17937]
|
Facility
OP
|
$0.29
|
|
|
Service Code
|
NDC 69543-383-30
|
| Hospital Charge Code |
1713143
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: BCBS Transplant Transplant |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.25
|
| Rate for Payer: Dignity Health Media |
$0.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.25
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.19
|
| Rate for Payer: Prime Health Services Commercial |
$0.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.15
|
| Rate for Payer: United Healthcare All Other HMO |
$0.15
|
| Rate for Payer: United Healthcare HMO Rider |
$0.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: Vantage Medical Group Senior |
$0.25
|
|
|
OLANZAPINE 10 MG TABLET [17937]
|
Facility
IP
|
$0.58
|
|
|
Service Code
|
NDC 0904-6376-61
|
| Hospital Charge Code |
1713143
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Blue Shield of California Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.38
|
| Rate for Payer: Prime Health Services Commercial |
$0.49
|
|
