|
OLANZAPINE 5 MG TABLET [17936]
|
Facility
OP
|
$0.43
|
|
|
Service Code
|
NDC 65862-562-30
|
| Hospital Charge Code |
1713141
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.25
|
| Rate for Payer: BCBS Transplant Transplant |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Central Health Plan Commercial |
$0.34
|
| Rate for Payer: Cigna of CA HMO |
$0.30
|
| Rate for Payer: Cigna of CA PPO |
$0.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.17
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.39
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.32
|
| Rate for Payer: IEHP medi-cal |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.32
|
| Rate for Payer: Networks By Design Commercial |
$0.28
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.26
|
| Rate for Payer: Riverside University Health MISP |
$0.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO |
$0.22
|
| Rate for Payer: United Healthcare HMO Rider |
$0.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Vantage Medical Group Senior |
$0.37
|
|
|
OLANZAPINE 5 MG TABLET [17936]
|
Facility
IP
|
$0.43
|
|
|
Service Code
|
NDC 65862-562-30
|
| Hospital Charge Code |
1713141
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Central Health Plan Commercial |
$0.34
|
| Rate for Payer: Cigna of CA HMO |
$0.30
|
| Rate for Payer: Cigna of CA PPO |
$0.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.32
|
| Rate for Payer: Networks By Design Commercial |
$0.28
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
|
|
OLANZAPINE 7.5 MG TABLET [17938]
|
Facility
OP
|
$0.34
|
|
|
Service Code
|
NDC 43598-165-30
|
| Hospital Charge Code |
1713142
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.29
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.20
|
| Rate for Payer: BCBS Transplant Transplant |
$0.20
|
| 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 |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.24
|
| Rate for Payer: Cigna of CA PPO |
$0.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.31
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.26
|
| Rate for Payer: IEHP medi-cal |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Networks By Design Commercial |
$0.22
|
| Rate for Payer: Prime Health Services Commercial |
$0.29
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: Riverside University Health MISP |
$0.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Vantage Medical Group Senior |
$0.29
|
|
|
OLANZAPINE 7.5 MG TABLET [17938]
|
Facility
IP
|
$0.34
|
|
|
Service Code
|
NDC 60505-3112-0
|
| Hospital Charge Code |
1713142
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.24
|
| Rate for Payer: Cigna of CA PPO |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Networks By Design Commercial |
$0.22
|
| Rate for Payer: Prime Health Services Commercial |
$0.29
|
|
|
OLANZAPINE 7.5 MG TABLET [17938]
|
Facility
IP
|
$0.34
|
|
|
Service Code
|
NDC 43598-165-30
|
| Hospital Charge Code |
1713142
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.24
|
| Rate for Payer: Cigna of CA PPO |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Networks By Design Commercial |
$0.22
|
| Rate for Payer: Prime Health Services Commercial |
$0.29
|
|
|
OLANZAPINE 7.5 MG TABLET [17938]
|
Facility
OP
|
$0.34
|
|
|
Service Code
|
NDC 60505-3112-0
|
| Hospital Charge Code |
1713142
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.29
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.20
|
| Rate for Payer: BCBS Transplant Transplant |
$0.20
|
| 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 |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.24
|
| Rate for Payer: Cigna of CA PPO |
$0.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.31
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.26
|
| Rate for Payer: IEHP medi-cal |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Networks By Design Commercial |
$0.22
|
| Rate for Payer: Prime Health Services Commercial |
$0.29
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: Riverside University Health MISP |
$0.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Vantage Medical Group Senior |
$0.29
|
|
|
OLOPATADINE 0.1 % EYE DROPS [19452]
|
Facility
IP
|
$9.49
|
|
|
Service Code
|
NDC 60505-0575-1
|
| Hospital Charge Code |
1740310
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$7.12
|
| Rate for Payer: Blue Shield of California EPN |
$5.07
|
| Rate for Payer: Cash Price |
$4.27
|
| Rate for Payer: Cash Price |
$4.27
|
| Rate for Payer: Central Health Plan Commercial |
$7.59
|
| Rate for Payer: Cigna of CA HMO |
$6.64
|
| Rate for Payer: Cigna of CA PPO |
$6.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.80
|
| Rate for Payer: Galaxy Health WC |
$8.07
|
| Rate for Payer: Global Benefits Group Commercial |
$5.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.90
|
| Rate for Payer: Multiplan Commercial |
$7.12
|
| Rate for Payer: Networks By Design Commercial |
$6.17
|
| Rate for Payer: Prime Health Services Commercial |
$8.07
|
|
|
OLOPATADINE 0.1 % EYE DROPS [19452]
|
Facility
IP
|
$6.00
|
|
|
Service Code
|
NDC 70069-007-01
|
| Hospital Charge Code |
1740310
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$4.50
|
| Rate for Payer: Blue Shield of California EPN |
$3.20
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Central Health Plan Commercial |
$4.80
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
|
|
OLOPATADINE 0.1 % EYE DROPS [19452]
|
Facility
OP
|
$9.49
|
|
|
Service Code
|
NDC 60505-0575-1
|
| Hospital Charge Code |
1740310
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$8.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.07
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.61
|
| Rate for Payer: BCBS Transplant Transplant |
$5.69
|
| Rate for Payer: Blue Shield of California Commercial |
$5.97
|
| Rate for Payer: Blue Shield of California EPN |
$4.64
|
| Rate for Payer: Cash Price |
$4.27
|
| Rate for Payer: Central Health Plan Commercial |
$7.59
|
| Rate for Payer: Cigna of CA HMO |
$6.64
|
| Rate for Payer: Cigna of CA PPO |
$6.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.80
|
| Rate for Payer: Galaxy Health WC |
$8.07
|
| Rate for Payer: Global Benefits Group Commercial |
$5.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.54
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.12
|
| Rate for Payer: IEHP medi-cal |
$3.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.90
|
| Rate for Payer: Multiplan Commercial |
$7.12
|
| Rate for Payer: Networks By Design Commercial |
$6.17
|
| Rate for Payer: Prime Health Services Commercial |
$8.07
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.69
|
| Rate for Payer: Riverside University Health MISP |
$3.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.74
|
| Rate for Payer: United Healthcare All Other HMO |
$4.74
|
| Rate for Payer: United Healthcare HMO Rider |
$4.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.07
|
| Rate for Payer: Vantage Medical Group Senior |
$8.07
|
|
|
OLOPATADINE 0.1 % EYE DROPS [19452]
|
Facility
OP
|
$6.00
|
|
|
Service Code
|
NDC 70069-007-01
|
| Hospital Charge Code |
1740310
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.54
|
| Rate for Payer: BCBS Transplant Transplant |
$3.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3.77
|
| Rate for Payer: Blue Shield of California EPN |
$2.93
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Central Health Plan Commercial |
$4.80
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.50
|
| Rate for Payer: IEHP medi-cal |
$2.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.60
|
| Rate for Payer: Riverside University Health MISP |
$2.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$5.10
|
|
|
OLOPATADINE 0.1 % EYE DROPS [19452]
|
Facility
OP
|
$1.81
|
|
|
Service Code
|
NDC 46122-672-64
|
| Hospital Charge Code |
1740310
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.07
|
| Rate for Payer: BCBS Transplant Transplant |
$1.09
|
| Rate for Payer: Blue Shield of California Commercial |
$1.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.89
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Central Health Plan Commercial |
$1.45
|
| Rate for Payer: Cigna of CA HMO |
$1.27
|
| Rate for Payer: Cigna of CA PPO |
$1.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$1.54
|
| Rate for Payer: Global Benefits Group Commercial |
$1.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.63
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.36
|
| Rate for Payer: IEHP medi-cal |
$0.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.36
|
| Rate for Payer: Networks By Design Commercial |
$1.18
|
| Rate for Payer: Prime Health Services Commercial |
$1.54
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.09
|
| Rate for Payer: Riverside University Health MISP |
$0.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.91
|
| Rate for Payer: United Healthcare All Other HMO |
$0.91
|
| Rate for Payer: United Healthcare HMO Rider |
$0.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.54
|
| Rate for Payer: Vantage Medical Group Senior |
$1.54
|
|
|
OLOPATADINE 0.1 % EYE DROPS [19452]
|
Facility
IP
|
$1.81
|
|
|
Service Code
|
NDC 46122-672-64
|
| Hospital Charge Code |
1740310
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.36
|
| Rate for Payer: Blue Shield of California EPN |
$0.97
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Central Health Plan Commercial |
$1.45
|
| Rate for Payer: Cigna of CA HMO |
$1.27
|
| Rate for Payer: Cigna of CA PPO |
$1.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$1.54
|
| Rate for Payer: Global Benefits Group Commercial |
$1.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.36
|
| Rate for Payer: Networks By Design Commercial |
$1.18
|
| Rate for Payer: Prime Health Services Commercial |
$1.54
|
|
|
OLUTASIDENIB 150 MG CAPSULE [236323]
|
Facility
IP
|
$644.00
|
|
|
Service Code
|
NDC 71332-005-01
|
| Hospital Charge Code |
ERX236323
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$128.80 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$483.00
|
| Rate for Payer: Blue Shield of California EPN |
$343.90
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Central Health Plan Commercial |
$515.20
|
| Rate for Payer: Cigna of CA HMO |
$450.80
|
| Rate for Payer: Cigna of CA PPO |
$450.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.60
|
| Rate for Payer: Galaxy Health WC |
$547.40
|
| Rate for Payer: Global Benefits Group Commercial |
$386.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$579.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$429.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.80
|
| Rate for Payer: Multiplan Commercial |
$483.00
|
| Rate for Payer: Networks By Design Commercial |
$418.60
|
| Rate for Payer: Prime Health Services Commercial |
$547.40
|
|
|
OLUTASIDENIB 150 MG CAPSULE [236323]
|
Facility
OP
|
$644.00
|
|
|
Service Code
|
NDC 71332-005-01
|
| Hospital Charge Code |
ERX236323
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$128.80 |
| Max. Negotiated Rate |
$579.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$391.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$547.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$354.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$354.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$311.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$380.48
|
| Rate for Payer: BCBS Transplant Transplant |
$386.40
|
| Rate for Payer: Blue Shield of California Commercial |
$405.08
|
| Rate for Payer: Blue Shield of California EPN |
$314.92
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Central Health Plan Commercial |
$515.20
|
| Rate for Payer: Cigna of CA HMO |
$450.80
|
| Rate for Payer: Cigna of CA PPO |
$450.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$547.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$257.60
|
| Rate for Payer: Galaxy Health WC |
$547.40
|
| Rate for Payer: Global Benefits Group Commercial |
$386.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$579.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$483.00
|
| Rate for Payer: IEHP medi-cal |
$225.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$429.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.80
|
| Rate for Payer: Multiplan Commercial |
$483.00
|
| Rate for Payer: Networks By Design Commercial |
$418.60
|
| Rate for Payer: Prime Health Services Commercial |
$547.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$386.40
|
| Rate for Payer: Riverside University Health MISP |
$257.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$386.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$386.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$322.00
|
| Rate for Payer: United Healthcare All Other HMO |
$322.00
|
| Rate for Payer: United Healthcare HMO Rider |
$322.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$322.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$547.40
|
| Rate for Payer: Vantage Medical Group Senior |
$547.40
|
|
|
OMALIZUMAB 150 MG/ML SUBCUTANEOUS SYRINGE [223366]
|
Facility
IP
|
$1,567.88
|
|
|
Service Code
|
CPT J2357
|
| Hospital Charge Code |
NDG223366
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$313.58 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1,175.91
|
| Rate for Payer: Blue Shield of California EPN |
$837.25
|
| Rate for Payer: Cash Price |
$705.55
|
| Rate for Payer: Cash Price |
$705.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,254.30
|
| Rate for Payer: Cigna of CA HMO |
$1,097.52
|
| Rate for Payer: Cigna of CA PPO |
$1,097.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$627.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$627.15
|
| Rate for Payer: Galaxy Health WC |
$1,332.70
|
| Rate for Payer: Global Benefits Group Commercial |
$940.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,411.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,045.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.58
|
| Rate for Payer: Multiplan Commercial |
$1,175.91
|
| Rate for Payer: Networks By Design Commercial |
$783.94
|
| Rate for Payer: Prime Health Services Commercial |
$1,332.70
|
|
|
OMALIZUMAB 150 MG/ML SUBCUTANEOUS SYRINGE [223366]
|
Facility
OP
|
$1,567.88
|
|
|
Service Code
|
CPT J2357
|
| Hospital Charge Code |
NDG223366
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.30 |
| Max. Negotiated Rate |
$1,411.09 |
| Rate for Payer: Adventist Health Medi-Cal |
$39.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$244.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$49.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$43.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$43.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.27
|
| Rate for Payer: BCBS Transplant Transplant |
$940.73
|
| Rate for Payer: Blue Shield of California Commercial |
$49.65
|
| Rate for Payer: Blue Shield of California EPN |
$45.14
|
| Rate for Payer: Caremore Medicare Advantage |
$39.46
|
| Rate for Payer: Cash Price |
$705.55
|
| Rate for Payer: Cash Price |
$705.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,254.30
|
| Rate for Payer: Cigna of CA HMO |
$1,097.52
|
| Rate for Payer: Cigna of CA PPO |
$1,097.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$39.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$39.46
|
| Rate for Payer: Galaxy Health WC |
$1,332.70
|
| Rate for Payer: Global Benefits Group Commercial |
$940.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,411.09
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,175.91
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$64.71
|
| Rate for Payer: IEHP medi-cal |
$65.11
|
| Rate for Payer: IEHP Medicare Advantage |
$39.46
|
| Rate for Payer: Innovage PACE Commercial |
$59.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,045.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$52.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$52.88
|
| Rate for Payer: Multiplan Commercial |
$1,175.91
|
| Rate for Payer: Networks By Design Commercial |
$783.94
|
| Rate for Payer: Prime Health Services Commercial |
$1,332.70
|
| Rate for Payer: Prime Health Services Medicare |
$41.83
|
| Rate for Payer: Riverside University Health MISP |
$43.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$940.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$940.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$783.94
|
| Rate for Payer: United Healthcare All Other HMO |
$783.94
|
| Rate for Payer: United Healthcare HMO Rider |
$783.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$783.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.40
|
| Rate for Payer: Vantage Medical Group Senior |
$39.46
|
|
|
OMALIZUMAB 150 MG SUBCUTANEOUS SOLUTION [36151]
|
Facility
IP
|
$1,567.88
|
|
|
Service Code
|
CPT J2357
|
| Hospital Charge Code |
ERX36151
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$313.58 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1,175.91
|
| Rate for Payer: Blue Shield of California EPN |
$837.25
|
| Rate for Payer: Cash Price |
$705.55
|
| Rate for Payer: Cash Price |
$705.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,254.30
|
| Rate for Payer: Cigna of CA HMO |
$1,097.52
|
| Rate for Payer: Cigna of CA PPO |
$1,097.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$627.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$627.15
|
| Rate for Payer: Galaxy Health WC |
$1,332.70
|
| Rate for Payer: Global Benefits Group Commercial |
$940.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,411.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,045.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.58
|
| Rate for Payer: Multiplan Commercial |
$1,175.91
|
| Rate for Payer: Networks By Design Commercial |
$783.94
|
| Rate for Payer: Prime Health Services Commercial |
$1,332.70
|
|
|
OMALIZUMAB 150 MG SUBCUTANEOUS SOLUTION [36151]
|
Facility
OP
|
$1,567.88
|
|
|
Service Code
|
CPT J2357
|
| Hospital Charge Code |
ERX36151
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.30 |
| Max. Negotiated Rate |
$1,411.09 |
| Rate for Payer: Adventist Health Medi-Cal |
$39.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$244.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$49.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$43.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$43.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.27
|
| Rate for Payer: BCBS Transplant Transplant |
$940.73
|
| Rate for Payer: Blue Shield of California Commercial |
$49.65
|
| Rate for Payer: Blue Shield of California EPN |
$45.14
|
| Rate for Payer: Caremore Medicare Advantage |
$39.46
|
| Rate for Payer: Cash Price |
$705.55
|
| Rate for Payer: Cash Price |
$705.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,254.30
|
| Rate for Payer: Cigna of CA HMO |
$1,097.52
|
| Rate for Payer: Cigna of CA PPO |
$1,097.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$39.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$39.46
|
| Rate for Payer: Galaxy Health WC |
$1,332.70
|
| Rate for Payer: Global Benefits Group Commercial |
$940.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,411.09
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,175.91
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$64.71
|
| Rate for Payer: IEHP medi-cal |
$65.11
|
| Rate for Payer: IEHP Medicare Advantage |
$39.46
|
| Rate for Payer: Innovage PACE Commercial |
$59.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,045.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$52.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$52.88
|
| Rate for Payer: Multiplan Commercial |
$1,175.91
|
| Rate for Payer: Networks By Design Commercial |
$783.94
|
| Rate for Payer: Prime Health Services Commercial |
$1,332.70
|
| Rate for Payer: Prime Health Services Medicare |
$41.83
|
| Rate for Payer: Riverside University Health MISP |
$43.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$940.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$940.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$783.94
|
| Rate for Payer: United Healthcare All Other HMO |
$783.94
|
| Rate for Payer: United Healthcare HMO Rider |
$783.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$783.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.40
|
| Rate for Payer: Vantage Medical Group Senior |
$39.46
|
|
|
OMALIZUMAB 75 MG/0.5 ML SUBCUTANEOUS SYRINGE [223364]
|
Facility
OP
|
$1,567.87
|
|
|
Service Code
|
CPT J2357
|
| Hospital Charge Code |
NDG223364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.30 |
| Max. Negotiated Rate |
$1,411.08 |
| Rate for Payer: Adventist Health Medi-Cal |
$39.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$244.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$49.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$43.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$43.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.27
|
| Rate for Payer: BCBS Transplant Transplant |
$940.72
|
| Rate for Payer: Blue Shield of California Commercial |
$49.65
|
| Rate for Payer: Blue Shield of California EPN |
$45.14
|
| Rate for Payer: Caremore Medicare Advantage |
$39.46
|
| Rate for Payer: Cash Price |
$705.54
|
| Rate for Payer: Cash Price |
$705.54
|
| Rate for Payer: Central Health Plan Commercial |
$1,254.30
|
| Rate for Payer: Cigna of CA HMO |
$1,097.51
|
| Rate for Payer: Cigna of CA PPO |
$1,097.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$39.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$39.46
|
| Rate for Payer: Galaxy Health WC |
$1,332.69
|
| Rate for Payer: Global Benefits Group Commercial |
$940.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,411.08
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,175.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$64.71
|
| Rate for Payer: IEHP medi-cal |
$65.11
|
| Rate for Payer: IEHP Medicare Advantage |
$39.46
|
| Rate for Payer: Innovage PACE Commercial |
$59.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,045.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$52.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$52.88
|
| Rate for Payer: Multiplan Commercial |
$1,175.90
|
| Rate for Payer: Networks By Design Commercial |
$783.94
|
| Rate for Payer: Prime Health Services Commercial |
$1,332.69
|
| Rate for Payer: Prime Health Services Medicare |
$41.83
|
| Rate for Payer: Riverside University Health MISP |
$43.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$940.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$940.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$783.94
|
| Rate for Payer: United Healthcare All Other HMO |
$783.94
|
| Rate for Payer: United Healthcare HMO Rider |
$783.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$783.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.40
|
| Rate for Payer: Vantage Medical Group Senior |
$39.46
|
|
|
OMALIZUMAB 75 MG/0.5 ML SUBCUTANEOUS SYRINGE [223364]
|
Facility
IP
|
$1,567.87
|
|
|
Service Code
|
CPT J2357
|
| Hospital Charge Code |
NDG223364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$313.57 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1,175.90
|
| Rate for Payer: Blue Shield of California EPN |
$837.24
|
| Rate for Payer: Cash Price |
$705.54
|
| Rate for Payer: Cash Price |
$705.54
|
| Rate for Payer: Central Health Plan Commercial |
$1,254.30
|
| Rate for Payer: Cigna of CA HMO |
$1,097.51
|
| Rate for Payer: Cigna of CA PPO |
$1,097.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$627.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$627.15
|
| Rate for Payer: Galaxy Health WC |
$1,332.69
|
| Rate for Payer: Global Benefits Group Commercial |
$940.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,411.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,045.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.57
|
| Rate for Payer: Multiplan Commercial |
$1,175.90
|
| Rate for Payer: Networks By Design Commercial |
$783.94
|
| Rate for Payer: Prime Health Services Commercial |
$1,332.69
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE [41822]
|
Facility
IP
|
$3.65
|
|
|
Service Code
|
NDC 60687-127-11
|
| Hospital Charge Code |
1712384
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2.74
|
| Rate for Payer: Blue Shield of California EPN |
$1.95
|
| Rate for Payer: Cash Price |
$1.64
|
| Rate for Payer: Cash Price |
$1.64
|
| Rate for Payer: Central Health Plan Commercial |
$2.92
|
| Rate for Payer: Cigna of CA HMO |
$2.56
|
| Rate for Payer: Cigna of CA PPO |
$2.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.46
|
| Rate for Payer: Galaxy Health WC |
$3.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.73
|
| Rate for Payer: Multiplan Commercial |
$2.74
|
| Rate for Payer: Networks By Design Commercial |
$2.37
|
| Rate for Payer: Prime Health Services Commercial |
$3.10
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE [41822]
|
Facility
OP
|
$0.97
|
|
|
Service Code
|
NDC 60505-3170-7
|
| Hospital Charge Code |
1712384
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.87 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.57
|
| Rate for Payer: BCBS Transplant Transplant |
$0.58
|
| Rate for Payer: Blue Shield of California Commercial |
$0.61
|
| Rate for Payer: Blue Shield of California EPN |
$0.47
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Central Health Plan Commercial |
$0.78
|
| Rate for Payer: Cigna of CA HMO |
$0.68
|
| Rate for Payer: Cigna of CA PPO |
$0.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.39
|
| Rate for Payer: Galaxy Health WC |
$0.82
|
| Rate for Payer: Global Benefits Group Commercial |
$0.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.87
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.73
|
| Rate for Payer: IEHP medi-cal |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.73
|
| Rate for Payer: Networks By Design Commercial |
$0.63
|
| Rate for Payer: Prime Health Services Commercial |
$0.82
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.58
|
| Rate for Payer: Riverside University Health MISP |
$0.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.49
|
| Rate for Payer: United Healthcare All Other HMO |
$0.49
|
| Rate for Payer: United Healthcare HMO Rider |
$0.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.82
|
| Rate for Payer: Vantage Medical Group Senior |
$0.82
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE [41822]
|
Facility
OP
|
$3.65
|
|
|
Service Code
|
NDC 60687-127-11
|
| Hospital Charge Code |
1712384
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$3.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.16
|
| Rate for Payer: BCBS Transplant Transplant |
$2.19
|
| Rate for Payer: Blue Shield of California Commercial |
$2.30
|
| Rate for Payer: Blue Shield of California EPN |
$1.78
|
| Rate for Payer: Cash Price |
$1.64
|
| Rate for Payer: Central Health Plan Commercial |
$2.92
|
| Rate for Payer: Cigna of CA HMO |
$2.56
|
| Rate for Payer: Cigna of CA PPO |
$2.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.46
|
| Rate for Payer: Galaxy Health WC |
$3.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.28
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.74
|
| Rate for Payer: IEHP medi-cal |
$1.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.73
|
| Rate for Payer: Multiplan Commercial |
$2.74
|
| Rate for Payer: Networks By Design Commercial |
$2.37
|
| Rate for Payer: Prime Health Services Commercial |
$3.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.19
|
| Rate for Payer: Riverside University Health MISP |
$1.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.82
|
| Rate for Payer: United Healthcare All Other HMO |
$1.82
|
| Rate for Payer: United Healthcare HMO Rider |
$1.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.10
|
| Rate for Payer: Vantage Medical Group Senior |
$3.10
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE [41822]
|
Facility
OP
|
$3.65
|
|
|
Service Code
|
NDC 60687-127-65
|
| Hospital Charge Code |
1712384
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$3.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.16
|
| Rate for Payer: BCBS Transplant Transplant |
$2.19
|
| Rate for Payer: Blue Shield of California Commercial |
$2.30
|
| Rate for Payer: Blue Shield of California EPN |
$1.78
|
| Rate for Payer: Cash Price |
$1.64
|
| Rate for Payer: Central Health Plan Commercial |
$2.92
|
| Rate for Payer: Cigna of CA HMO |
$2.56
|
| Rate for Payer: Cigna of CA PPO |
$2.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.46
|
| Rate for Payer: Galaxy Health WC |
$3.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.28
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.74
|
| Rate for Payer: IEHP medi-cal |
$1.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.73
|
| Rate for Payer: Multiplan Commercial |
$2.74
|
| Rate for Payer: Networks By Design Commercial |
$2.37
|
| Rate for Payer: Prime Health Services Commercial |
$3.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.19
|
| Rate for Payer: Riverside University Health MISP |
$1.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.82
|
| Rate for Payer: United Healthcare All Other HMO |
$1.82
|
| Rate for Payer: United Healthcare HMO Rider |
$1.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.10
|
| Rate for Payer: Vantage Medical Group Senior |
$3.10
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE [41822]
|
Facility
IP
|
$0.27
|
|
|
Service Code
|
NDC 64380-761-11
|
| Hospital Charge Code |
1712384
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Central Health Plan Commercial |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
|
