|
ATENOLOL ORAL SUSPENSION COMPOUND 2 MG/ML [4080244]
|
Facility
IP
|
$0.89
|
|
|
Service Code
|
NDC 9994-0802-44
|
| Hospital Charge Code |
1715013
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Blue Shield of California Commercial |
$0.67
|
| Rate for Payer: Blue Shield of California EPN |
$0.48
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Central Health Plan Commercial |
$0.71
|
| Rate for Payer: Cigna of CA HMO |
$0.62
|
| Rate for Payer: Cigna of CA PPO |
$0.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: Galaxy Health WC |
$0.76
|
| Rate for Payer: Global Benefits Group Commercial |
$0.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.67
|
| Rate for Payer: Networks By Design Commercial |
$0.58
|
| Rate for Payer: Prime Health Services Commercial |
$0.76
|
|
|
ATENOLOL ORAL SUSPENSION COMPOUND 2 MG/ML [4080244]
|
Facility
OP
|
$0.89
|
|
|
Service Code
|
NDC 9994-0802-44
|
| Hospital Charge Code |
1715013
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.49
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.53
|
| Rate for Payer: BCBS Transplant Transplant |
$0.53
|
| Rate for Payer: Blue Shield of California Commercial |
$0.56
|
| Rate for Payer: Blue Shield of California EPN |
$0.44
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Central Health Plan Commercial |
$0.71
|
| Rate for Payer: Cigna of CA HMO |
$0.62
|
| Rate for Payer: Cigna of CA PPO |
$0.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.36
|
| Rate for Payer: Galaxy Health WC |
$0.76
|
| Rate for Payer: Global Benefits Group Commercial |
$0.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.67
|
| Rate for Payer: IEHP medi-cal |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.67
|
| Rate for Payer: Networks By Design Commercial |
$0.58
|
| Rate for Payer: Prime Health Services Commercial |
$0.76
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.53
|
| Rate for Payer: Riverside University Health MISP |
$0.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.45
|
| Rate for Payer: United Healthcare All Other HMO |
$0.45
|
| Rate for Payer: United Healthcare HMO Rider |
$0.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.76
|
| Rate for Payer: Vantage Medical Group Senior |
$0.76
|
|
|
ATEZOLIZUMAB 1,200 MG/20 ML (60 MG/ML) INTRAVENOUS SOLUTION [214353]
|
Facility
IP
|
$620.83
|
|
|
Service Code
|
CPT J9022
|
| Hospital Charge Code |
NDG214353
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$124.17 |
| Max. Negotiated Rate |
$558.75 |
| Rate for Payer: Blue Shield of California Commercial |
$465.62
|
| Rate for Payer: Blue Shield of California EPN |
$331.52
|
| Rate for Payer: Cash Price |
$279.37
|
| Rate for Payer: Central Health Plan Commercial |
$496.66
|
| Rate for Payer: Cigna of CA HMO |
$434.58
|
| Rate for Payer: Cigna of CA PPO |
$434.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$248.33
|
| Rate for Payer: Galaxy Health WC |
$527.71
|
| Rate for Payer: Global Benefits Group Commercial |
$372.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$558.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$414.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.17
|
| Rate for Payer: Multiplan Commercial |
$465.62
|
| Rate for Payer: Networks By Design Commercial |
$310.42
|
| Rate for Payer: Prime Health Services Commercial |
$527.71
|
|
|
ATEZOLIZUMAB 1,200 MG/20 ML (60 MG/ML) INTRAVENOUS SOLUTION [214353]
|
Facility
OP
|
$620.83
|
|
|
Service Code
|
CPT J9022
|
| Hospital Charge Code |
NDG214353
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$85.01 |
| Max. Negotiated Rate |
$558.75 |
| Rate for Payer: Adventist Health Medi-Cal |
$85.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$167.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$106.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$93.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$93.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$142.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.62
|
| Rate for Payer: BCBS Transplant Transplant |
$372.50
|
| Rate for Payer: Blue Shield of California Commercial |
$101.13
|
| Rate for Payer: Blue Shield of California EPN |
$91.94
|
| Rate for Payer: Caremore Medicare Advantage |
$85.01
|
| Rate for Payer: Cash Price |
$279.37
|
| Rate for Payer: Cash Price |
$279.37
|
| Rate for Payer: Central Health Plan Commercial |
$496.66
|
| Rate for Payer: Cigna of CA HMO |
$434.58
|
| Rate for Payer: Cigna of CA PPO |
$434.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$85.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$85.01
|
| Rate for Payer: Galaxy Health WC |
$527.71
|
| Rate for Payer: Global Benefits Group Commercial |
$372.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$558.75
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$465.62
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$139.42
|
| Rate for Payer: IEHP medi-cal |
$140.27
|
| Rate for Payer: IEHP Medicare Advantage |
$85.01
|
| Rate for Payer: Innovage PACE Commercial |
$127.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$414.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$85.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$113.91
|
| Rate for Payer: Multiplan Commercial |
$465.62
|
| Rate for Payer: Networks By Design Commercial |
$310.42
|
| Rate for Payer: Prime Health Services Commercial |
$527.71
|
| Rate for Payer: Prime Health Services Medicare |
$90.11
|
| Rate for Payer: Riverside University Health MISP |
$93.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$372.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$372.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$310.42
|
| Rate for Payer: United Healthcare All Other HMO |
$310.42
|
| Rate for Payer: United Healthcare HMO Rider |
$310.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$310.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$127.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.51
|
| Rate for Payer: Vantage Medical Group Senior |
$85.01
|
|
|
ATEZOLIZUMAB 840 MG/14 ML (60 MG/ML) INTRAVENOUS SOLUTION [224360]
|
Facility
OP
|
$620.83
|
|
|
Service Code
|
CPT J9022
|
| Hospital Charge Code |
NDG224360
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$85.01 |
| Max. Negotiated Rate |
$558.75 |
| Rate for Payer: Adventist Health Medi-Cal |
$85.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$167.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$106.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$93.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$93.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$142.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.62
|
| Rate for Payer: BCBS Transplant Transplant |
$372.50
|
| Rate for Payer: Blue Shield of California Commercial |
$101.13
|
| Rate for Payer: Blue Shield of California EPN |
$91.94
|
| Rate for Payer: Caremore Medicare Advantage |
$85.01
|
| Rate for Payer: Cash Price |
$279.37
|
| Rate for Payer: Cash Price |
$279.37
|
| Rate for Payer: Central Health Plan Commercial |
$496.66
|
| Rate for Payer: Cigna of CA HMO |
$434.58
|
| Rate for Payer: Cigna of CA PPO |
$434.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$85.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$85.01
|
| Rate for Payer: Galaxy Health WC |
$527.71
|
| Rate for Payer: Global Benefits Group Commercial |
$372.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$558.75
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$465.62
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$139.42
|
| Rate for Payer: IEHP medi-cal |
$140.27
|
| Rate for Payer: IEHP Medicare Advantage |
$85.01
|
| Rate for Payer: Innovage PACE Commercial |
$127.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$414.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$85.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$113.91
|
| Rate for Payer: Multiplan Commercial |
$465.62
|
| Rate for Payer: Networks By Design Commercial |
$310.42
|
| Rate for Payer: Prime Health Services Commercial |
$527.71
|
| Rate for Payer: Prime Health Services Medicare |
$90.11
|
| Rate for Payer: Riverside University Health MISP |
$93.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$372.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$372.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$310.42
|
| Rate for Payer: United Healthcare All Other HMO |
$310.42
|
| Rate for Payer: United Healthcare HMO Rider |
$310.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$310.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$127.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.51
|
| Rate for Payer: Vantage Medical Group Senior |
$85.01
|
|
|
ATEZOLIZUMAB 840 MG/14 ML (60 MG/ML) INTRAVENOUS SOLUTION [224360]
|
Facility
IP
|
$620.83
|
|
|
Service Code
|
CPT J9022
|
| Hospital Charge Code |
NDG224360
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$124.17 |
| Max. Negotiated Rate |
$558.75 |
| Rate for Payer: Blue Shield of California Commercial |
$465.62
|
| Rate for Payer: Blue Shield of California EPN |
$331.52
|
| Rate for Payer: Cash Price |
$279.37
|
| Rate for Payer: Central Health Plan Commercial |
$496.66
|
| Rate for Payer: Cigna of CA HMO |
$434.58
|
| Rate for Payer: Cigna of CA PPO |
$434.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$248.33
|
| Rate for Payer: Galaxy Health WC |
$527.71
|
| Rate for Payer: Global Benefits Group Commercial |
$372.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$558.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$414.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.17
|
| Rate for Payer: Multiplan Commercial |
$465.62
|
| Rate for Payer: Networks By Design Commercial |
$310.42
|
| Rate for Payer: Prime Health Services Commercial |
$527.71
|
|
|
ATOMOXETINE 10 MG CAPSULE [34444]
|
Facility
IP
|
$1.95
|
|
|
Service Code
|
NDC 64980-373-03
|
| Hospital Charge Code |
1711821
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.76 |
| Rate for Payer: Blue Shield of California Commercial |
$1.46
|
| Rate for Payer: Blue Shield of California EPN |
$1.04
|
| Rate for Payer: Cash Price |
$0.88
|
| Rate for Payer: Central Health Plan Commercial |
$1.56
|
| Rate for Payer: Cigna of CA HMO |
$1.36
|
| Rate for Payer: Cigna of CA PPO |
$1.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.78
|
| Rate for Payer: Galaxy Health WC |
$1.66
|
| Rate for Payer: Global Benefits Group Commercial |
$1.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$1.46
|
| Rate for Payer: Networks By Design Commercial |
$1.27
|
| Rate for Payer: Prime Health Services Commercial |
$1.66
|
|
|
ATOMOXETINE 10 MG CAPSULE [34444]
|
Facility
OP
|
$1.95
|
|
|
Service Code
|
NDC 64980-373-03
|
| Hospital Charge Code |
1711821
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.15
|
| Rate for Payer: BCBS Transplant Transplant |
$1.17
|
| Rate for Payer: Blue Shield of California Commercial |
$1.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.95
|
| Rate for Payer: Cash Price |
$0.88
|
| Rate for Payer: Central Health Plan Commercial |
$1.56
|
| Rate for Payer: Cigna of CA HMO |
$1.36
|
| Rate for Payer: Cigna of CA PPO |
$1.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.78
|
| Rate for Payer: Galaxy Health WC |
$1.66
|
| Rate for Payer: Global Benefits Group Commercial |
$1.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.76
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.46
|
| Rate for Payer: IEHP medi-cal |
$0.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$1.46
|
| Rate for Payer: Networks By Design Commercial |
$1.27
|
| Rate for Payer: Prime Health Services Commercial |
$1.66
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.17
|
| Rate for Payer: Riverside University Health MISP |
$0.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.98
|
| Rate for Payer: United Healthcare All Other HMO |
$0.98
|
| Rate for Payer: United Healthcare HMO Rider |
$0.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.66
|
| Rate for Payer: Vantage Medical Group Senior |
$1.66
|
|
|
ATOMOXETINE 10 MG CAPSULE [34444]
|
Facility
IP
|
$4.44
|
|
|
Service Code
|
NDC 0093-3542-56
|
| Hospital Charge Code |
1711821
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Blue Shield of California Commercial |
$3.33
|
| Rate for Payer: Blue Shield of California EPN |
$2.37
|
| Rate for Payer: Cash Price |
$2.00
|
| Rate for Payer: Central Health Plan Commercial |
$3.55
|
| Rate for Payer: Cigna of CA HMO |
$3.11
|
| Rate for Payer: Cigna of CA PPO |
$3.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.78
|
| Rate for Payer: Galaxy Health WC |
$3.77
|
| Rate for Payer: Global Benefits Group Commercial |
$2.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.89
|
| Rate for Payer: Multiplan Commercial |
$3.33
|
| Rate for Payer: Networks By Design Commercial |
$2.89
|
| Rate for Payer: Prime Health Services Commercial |
$3.77
|
|
|
ATOMOXETINE 10 MG CAPSULE [34444]
|
Facility
OP
|
$15.82
|
|
|
Service Code
|
NDC 0002-3227-30
|
| Hospital Charge Code |
1711821
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$14.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.35
|
| Rate for Payer: BCBS Transplant Transplant |
$9.49
|
| Rate for Payer: Blue Shield of California Commercial |
$9.95
|
| Rate for Payer: Blue Shield of California EPN |
$7.74
|
| Rate for Payer: Cash Price |
$7.12
|
| Rate for Payer: Central Health Plan Commercial |
$12.66
|
| Rate for Payer: Cigna of CA HMO |
$11.07
|
| Rate for Payer: Cigna of CA PPO |
$11.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.33
|
| Rate for Payer: Galaxy Health WC |
$13.45
|
| Rate for Payer: Global Benefits Group Commercial |
$9.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.86
|
| Rate for Payer: IEHP medi-cal |
$5.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.16
|
| Rate for Payer: Multiplan Commercial |
$11.86
|
| Rate for Payer: Networks By Design Commercial |
$10.28
|
| Rate for Payer: Prime Health Services Commercial |
$13.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.49
|
| Rate for Payer: Riverside University Health MISP |
$6.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.91
|
| Rate for Payer: United Healthcare All Other HMO |
$7.91
|
| Rate for Payer: United Healthcare HMO Rider |
$7.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.45
|
| Rate for Payer: Vantage Medical Group Senior |
$13.45
|
|
|
ATOMOXETINE 10 MG CAPSULE [34444]
|
Facility
IP
|
$2.20
|
|
|
Service Code
|
NDC 31722-714-30
|
| Hospital Charge Code |
1711821
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Blue Shield of California Commercial |
$1.65
|
| Rate for Payer: Blue Shield of California EPN |
$1.17
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Central Health Plan Commercial |
$1.76
|
| Rate for Payer: Cigna of CA HMO |
$1.54
|
| Rate for Payer: Cigna of CA PPO |
$1.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.88
|
| Rate for Payer: Galaxy Health WC |
$1.87
|
| Rate for Payer: Global Benefits Group Commercial |
$1.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: Multiplan Commercial |
$1.65
|
| Rate for Payer: Networks By Design Commercial |
$1.43
|
| Rate for Payer: Prime Health Services Commercial |
$1.87
|
|
|
ATOMOXETINE 10 MG CAPSULE [34444]
|
Facility
IP
|
$1.90
|
|
|
Service Code
|
NDC 68462-265-30
|
| Hospital Charge Code |
1711821
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.71 |
| Rate for Payer: Blue Shield of California Commercial |
$1.42
|
| Rate for Payer: Blue Shield of California EPN |
$1.01
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Central Health Plan Commercial |
$1.52
|
| Rate for Payer: Cigna of CA HMO |
$1.33
|
| Rate for Payer: Cigna of CA PPO |
$1.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.76
|
| Rate for Payer: Galaxy Health WC |
$1.62
|
| Rate for Payer: Global Benefits Group Commercial |
$1.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$1.42
|
| Rate for Payer: Networks By Design Commercial |
$1.24
|
| Rate for Payer: Prime Health Services Commercial |
$1.62
|
|
|
ATOMOXETINE 10 MG CAPSULE [34444]
|
Facility
OP
|
$1.95
|
|
|
Service Code
|
NDC 55111-519-30
|
| Hospital Charge Code |
1711821
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.15
|
| Rate for Payer: BCBS Transplant Transplant |
$1.17
|
| Rate for Payer: Blue Shield of California Commercial |
$1.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.95
|
| Rate for Payer: Cash Price |
$0.88
|
| Rate for Payer: Central Health Plan Commercial |
$1.56
|
| Rate for Payer: Cigna of CA HMO |
$1.36
|
| Rate for Payer: Cigna of CA PPO |
$1.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.78
|
| Rate for Payer: Galaxy Health WC |
$1.66
|
| Rate for Payer: Global Benefits Group Commercial |
$1.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.76
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.46
|
| Rate for Payer: IEHP medi-cal |
$0.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$1.46
|
| Rate for Payer: Networks By Design Commercial |
$1.27
|
| Rate for Payer: Prime Health Services Commercial |
$1.66
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.17
|
| Rate for Payer: Riverside University Health MISP |
$0.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.98
|
| Rate for Payer: United Healthcare All Other HMO |
$0.98
|
| Rate for Payer: United Healthcare HMO Rider |
$0.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.66
|
| Rate for Payer: Vantage Medical Group Senior |
$1.66
|
|
|
ATOMOXETINE 10 MG CAPSULE [34444]
|
Facility
OP
|
$4.44
|
|
|
Service Code
|
NDC 0093-3542-56
|
| Hospital Charge Code |
1711821
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.62
|
| Rate for Payer: BCBS Transplant Transplant |
$2.66
|
| Rate for Payer: Blue Shield of California Commercial |
$2.79
|
| Rate for Payer: Blue Shield of California EPN |
$2.17
|
| Rate for Payer: Cash Price |
$2.00
|
| Rate for Payer: Central Health Plan Commercial |
$3.55
|
| Rate for Payer: Cigna of CA HMO |
$3.11
|
| Rate for Payer: Cigna of CA PPO |
$3.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.78
|
| Rate for Payer: Galaxy Health WC |
$3.77
|
| Rate for Payer: Global Benefits Group Commercial |
$2.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.33
|
| Rate for Payer: IEHP medi-cal |
$1.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.89
|
| Rate for Payer: Multiplan Commercial |
$3.33
|
| Rate for Payer: Networks By Design Commercial |
$2.89
|
| Rate for Payer: Prime Health Services Commercial |
$3.77
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.66
|
| Rate for Payer: Riverside University Health MISP |
$1.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.22
|
| Rate for Payer: United Healthcare All Other HMO |
$2.22
|
| Rate for Payer: United Healthcare HMO Rider |
$2.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.77
|
| Rate for Payer: Vantage Medical Group Senior |
$3.77
|
|
|
ATOMOXETINE 10 MG CAPSULE [34444]
|
Facility
OP
|
$2.20
|
|
|
Service Code
|
NDC 31722-714-30
|
| Hospital Charge Code |
1711821
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.87
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.30
|
| Rate for Payer: BCBS Transplant Transplant |
$1.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1.38
|
| Rate for Payer: Blue Shield of California EPN |
$1.08
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Central Health Plan Commercial |
$1.76
|
| Rate for Payer: Cigna of CA HMO |
$1.54
|
| Rate for Payer: Cigna of CA PPO |
$1.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.88
|
| Rate for Payer: Galaxy Health WC |
$1.87
|
| Rate for Payer: Global Benefits Group Commercial |
$1.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.98
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.65
|
| Rate for Payer: IEHP medi-cal |
$0.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: Multiplan Commercial |
$1.65
|
| Rate for Payer: Networks By Design Commercial |
$1.43
|
| Rate for Payer: Prime Health Services Commercial |
$1.87
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.32
|
| Rate for Payer: Riverside University Health MISP |
$0.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1.10
|
| Rate for Payer: United Healthcare HMO Rider |
$1.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.87
|
| Rate for Payer: Vantage Medical Group Senior |
$1.87
|
|
|
ATOMOXETINE 10 MG CAPSULE [34444]
|
Facility
IP
|
$1.95
|
|
|
Service Code
|
NDC 55111-519-30
|
| Hospital Charge Code |
1711821
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.76 |
| Rate for Payer: Blue Shield of California Commercial |
$1.46
|
| Rate for Payer: Blue Shield of California EPN |
$1.04
|
| Rate for Payer: Cash Price |
$0.88
|
| Rate for Payer: Central Health Plan Commercial |
$1.56
|
| Rate for Payer: Cigna of CA HMO |
$1.36
|
| Rate for Payer: Cigna of CA PPO |
$1.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.78
|
| Rate for Payer: Galaxy Health WC |
$1.66
|
| Rate for Payer: Global Benefits Group Commercial |
$1.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$1.46
|
| Rate for Payer: Networks By Design Commercial |
$1.27
|
| Rate for Payer: Prime Health Services Commercial |
$1.66
|
|
|
ATOMOXETINE 10 MG CAPSULE [34444]
|
Facility
IP
|
$15.82
|
|
|
Service Code
|
NDC 0002-3227-30
|
| Hospital Charge Code |
1711821
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$14.24 |
| Rate for Payer: Blue Shield of California Commercial |
$11.86
|
| Rate for Payer: Blue Shield of California EPN |
$8.45
|
| Rate for Payer: Cash Price |
$7.12
|
| Rate for Payer: Central Health Plan Commercial |
$12.66
|
| Rate for Payer: Cigna of CA HMO |
$11.07
|
| Rate for Payer: Cigna of CA PPO |
$11.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.33
|
| Rate for Payer: Galaxy Health WC |
$13.45
|
| Rate for Payer: Global Benefits Group Commercial |
$9.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.16
|
| Rate for Payer: Multiplan Commercial |
$11.86
|
| Rate for Payer: Networks By Design Commercial |
$10.28
|
| Rate for Payer: Prime Health Services Commercial |
$13.45
|
|
|
ATOMOXETINE 10 MG CAPSULE [34444]
|
Facility
OP
|
$1.90
|
|
|
Service Code
|
NDC 68462-265-30
|
| Hospital Charge Code |
1711821
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.12
|
| Rate for Payer: BCBS Transplant Transplant |
$1.14
|
| Rate for Payer: Blue Shield of California Commercial |
$1.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.93
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Central Health Plan Commercial |
$1.52
|
| Rate for Payer: Cigna of CA HMO |
$1.33
|
| Rate for Payer: Cigna of CA PPO |
$1.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.76
|
| Rate for Payer: Galaxy Health WC |
$1.62
|
| Rate for Payer: Global Benefits Group Commercial |
$1.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.71
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.42
|
| Rate for Payer: IEHP medi-cal |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$1.42
|
| Rate for Payer: Networks By Design Commercial |
$1.24
|
| Rate for Payer: Prime Health Services Commercial |
$1.62
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.14
|
| Rate for Payer: Riverside University Health MISP |
$0.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.95
|
| Rate for Payer: United Healthcare All Other HMO |
$0.95
|
| Rate for Payer: United Healthcare HMO Rider |
$0.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.62
|
| Rate for Payer: Vantage Medical Group Senior |
$1.62
|
|
|
ATOMOXETINE 18 MG CAPSULE [34445]
|
Facility
IP
|
$15.82
|
|
|
Service Code
|
NDC 0002-3238-30
|
| Hospital Charge Code |
1711822
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$14.24 |
| Rate for Payer: Blue Shield of California Commercial |
$11.86
|
| Rate for Payer: Blue Shield of California EPN |
$8.45
|
| Rate for Payer: Cash Price |
$7.12
|
| Rate for Payer: Central Health Plan Commercial |
$12.66
|
| Rate for Payer: Cigna of CA HMO |
$11.07
|
| Rate for Payer: Cigna of CA PPO |
$11.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.33
|
| Rate for Payer: Galaxy Health WC |
$13.45
|
| Rate for Payer: Global Benefits Group Commercial |
$9.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.16
|
| Rate for Payer: Multiplan Commercial |
$11.86
|
| Rate for Payer: Networks By Design Commercial |
$10.28
|
| Rate for Payer: Prime Health Services Commercial |
$13.45
|
|
|
ATOMOXETINE 18 MG CAPSULE [34445]
|
Facility
OP
|
$15.82
|
|
|
Service Code
|
NDC 0002-3238-30
|
| Hospital Charge Code |
1711822
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$14.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.35
|
| Rate for Payer: BCBS Transplant Transplant |
$9.49
|
| Rate for Payer: Blue Shield of California Commercial |
$9.95
|
| Rate for Payer: Blue Shield of California EPN |
$7.74
|
| Rate for Payer: Cash Price |
$7.12
|
| Rate for Payer: Central Health Plan Commercial |
$12.66
|
| Rate for Payer: Cigna of CA HMO |
$11.07
|
| Rate for Payer: Cigna of CA PPO |
$11.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.33
|
| Rate for Payer: Galaxy Health WC |
$13.45
|
| Rate for Payer: Global Benefits Group Commercial |
$9.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.86
|
| Rate for Payer: IEHP medi-cal |
$5.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.16
|
| Rate for Payer: Multiplan Commercial |
$11.86
|
| Rate for Payer: Networks By Design Commercial |
$10.28
|
| Rate for Payer: Prime Health Services Commercial |
$13.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.49
|
| Rate for Payer: Riverside University Health MISP |
$6.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.91
|
| Rate for Payer: United Healthcare All Other HMO |
$7.91
|
| Rate for Payer: United Healthcare HMO Rider |
$7.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.45
|
| Rate for Payer: Vantage Medical Group Senior |
$13.45
|
|
|
ATOMOXETINE 25 MG CAPSULE [34446]
|
Facility
IP
|
$4.40
|
|
|
Service Code
|
NDC 60687-567-21
|
| Hospital Charge Code |
1711823
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: Blue Shield of California Commercial |
$3.30
|
| Rate for Payer: Blue Shield of California EPN |
$2.35
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Central Health Plan Commercial |
$3.52
|
| Rate for Payer: Cigna of CA HMO |
$3.08
|
| Rate for Payer: Cigna of CA PPO |
$3.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.76
|
| Rate for Payer: Galaxy Health WC |
$3.74
|
| Rate for Payer: Global Benefits Group Commercial |
$2.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.88
|
| Rate for Payer: Multiplan Commercial |
$3.30
|
| Rate for Payer: Networks By Design Commercial |
$2.86
|
| Rate for Payer: Prime Health Services Commercial |
$3.74
|
|
|
ATOMOXETINE 25 MG CAPSULE [34446]
|
Facility
IP
|
$4.40
|
|
|
Service Code
|
NDC 60687-567-11
|
| Hospital Charge Code |
1711823
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: Blue Shield of California Commercial |
$3.30
|
| Rate for Payer: Blue Shield of California EPN |
$2.35
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Central Health Plan Commercial |
$3.52
|
| Rate for Payer: Cigna of CA HMO |
$3.08
|
| Rate for Payer: Cigna of CA PPO |
$3.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.76
|
| Rate for Payer: Galaxy Health WC |
$3.74
|
| Rate for Payer: Global Benefits Group Commercial |
$2.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.88
|
| Rate for Payer: Multiplan Commercial |
$3.30
|
| Rate for Payer: Networks By Design Commercial |
$2.86
|
| Rate for Payer: Prime Health Services Commercial |
$3.74
|
|
|
ATOMOXETINE 25 MG CAPSULE [34446]
|
Facility
OP
|
$4.40
|
|
|
Service Code
|
NDC 60687-567-21
|
| Hospital Charge Code |
1711823
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.42
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.60
|
| Rate for Payer: BCBS Transplant Transplant |
$2.64
|
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Blue Shield of California EPN |
$2.15
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Central Health Plan Commercial |
$3.52
|
| Rate for Payer: Cigna of CA HMO |
$3.08
|
| Rate for Payer: Cigna of CA PPO |
$3.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.76
|
| Rate for Payer: Galaxy Health WC |
$3.74
|
| Rate for Payer: Global Benefits Group Commercial |
$2.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.96
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.30
|
| Rate for Payer: IEHP medi-cal |
$1.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.88
|
| Rate for Payer: Multiplan Commercial |
$3.30
|
| Rate for Payer: Networks By Design Commercial |
$2.86
|
| Rate for Payer: Prime Health Services Commercial |
$3.74
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.64
|
| Rate for Payer: Riverside University Health MISP |
$1.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.20
|
| Rate for Payer: United Healthcare All Other HMO |
$2.20
|
| Rate for Payer: United Healthcare HMO Rider |
$2.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.74
|
| Rate for Payer: Vantage Medical Group Senior |
$3.74
|
|
|
ATOMOXETINE 25 MG CAPSULE [34446]
|
Facility
OP
|
$4.40
|
|
|
Service Code
|
NDC 60687-567-11
|
| Hospital Charge Code |
1711823
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.42
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.60
|
| Rate for Payer: BCBS Transplant Transplant |
$2.64
|
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Blue Shield of California EPN |
$2.15
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Central Health Plan Commercial |
$3.52
|
| Rate for Payer: Cigna of CA HMO |
$3.08
|
| Rate for Payer: Cigna of CA PPO |
$3.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.76
|
| Rate for Payer: Galaxy Health WC |
$3.74
|
| Rate for Payer: Global Benefits Group Commercial |
$2.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.96
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.30
|
| Rate for Payer: IEHP medi-cal |
$1.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.88
|
| Rate for Payer: Multiplan Commercial |
$3.30
|
| Rate for Payer: Networks By Design Commercial |
$2.86
|
| Rate for Payer: Prime Health Services Commercial |
$3.74
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.64
|
| Rate for Payer: Riverside University Health MISP |
$1.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.20
|
| Rate for Payer: United Healthcare All Other HMO |
$2.20
|
| Rate for Payer: United Healthcare HMO Rider |
$2.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.74
|
| Rate for Payer: Vantage Medical Group Senior |
$3.74
|
|
|
ATOMOXETINE 40 MG CAPSULE [34447]
|
Facility
OP
|
$7.59
|
|
|
Service Code
|
NDC 60687-326-95
|
| Hospital Charge Code |
1711824
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$6.83 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.48
|
| Rate for Payer: BCBS Transplant Transplant |
$4.55
|
| Rate for Payer: Blue Shield of California Commercial |
$4.77
|
| Rate for Payer: Blue Shield of California EPN |
$3.71
|
| Rate for Payer: Cash Price |
$3.42
|
| Rate for Payer: Central Health Plan Commercial |
$6.07
|
| Rate for Payer: Cigna of CA HMO |
$5.31
|
| Rate for Payer: Cigna of CA PPO |
$5.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.04
|
| Rate for Payer: Galaxy Health WC |
$6.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.83
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.69
|
| Rate for Payer: IEHP medi-cal |
$2.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.52
|
| Rate for Payer: Multiplan Commercial |
$5.69
|
| Rate for Payer: Networks By Design Commercial |
$4.93
|
| Rate for Payer: Prime Health Services Commercial |
$6.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.55
|
| Rate for Payer: Riverside University Health MISP |
$3.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.80
|
| Rate for Payer: United Healthcare All Other HMO |
$3.80
|
| Rate for Payer: United Healthcare HMO Rider |
$3.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.45
|
| Rate for Payer: Vantage Medical Group Senior |
$6.45
|
|
