|
ATEZOLIZUMAB 1,200 MG/20 ML (60 MG/ML) INTRAVENOUS SOLUTION [214353]
|
Facility
|
IP
|
$716.22
|
|
|
Service Code
|
HCPCS J9022
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$143.24 |
| Max. Negotiated Rate |
$644.60 |
| Rate for Payer: Adventist Health Commercial |
$143.24
|
| Rate for Payer: Blue Shield of California Commercial |
$574.41
|
| Rate for Payer: Blue Shield of California EPN |
$360.97
|
| Rate for Payer: Cash Price |
$322.30
|
| Rate for Payer: Central Health Plan Commercial |
$572.98
|
| Rate for Payer: Cigna of CA HMO |
$501.35
|
| Rate for Payer: Cigna of CA PPO |
$501.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$501.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$286.49
|
| Rate for Payer: EPIC Health Plan Senior |
$286.49
|
| Rate for Payer: Galaxy Health WC |
$608.79
|
| Rate for Payer: Global Benefits Group Commercial |
$429.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$644.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$454.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$422.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.24
|
| Rate for Payer: Multiplan Commercial |
$537.16
|
| Rate for Payer: Networks By Design Commercial |
$358.11
|
| Rate for Payer: Prime Health Services Commercial |
$608.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$268.80
|
| Rate for Payer: United Healthcare All Other HMO |
$261.64
|
| Rate for Payer: United Healthcare HMO Rider |
$255.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$234.56
|
|
|
ATEZOLIZUMAB 1,200 MG/20 ML (60 MG/ML) INTRAVENOUS SOLUTION [214353]
|
Facility
|
OP
|
$716.22
|
|
|
Service Code
|
HCPCS J9022
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$96.55 |
| Max. Negotiated Rate |
$644.60 |
| Rate for Payer: Adventist Health Commercial |
$143.24
|
| Rate for Payer: Adventist Health Medi-Cal |
$96.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$144.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$106.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$96.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$142.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.36
|
| Rate for Payer: Blue Shield of California Commercial |
$120.16
|
| Rate for Payer: Blue Shield of California EPN |
$109.24
|
| Rate for Payer: Cash Price |
$322.30
|
| Rate for Payer: Cash Price |
$322.30
|
| Rate for Payer: Central Health Plan Commercial |
$572.98
|
| Rate for Payer: Cigna of CA HMO |
$501.35
|
| Rate for Payer: Cigna of CA PPO |
$501.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$120.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$106.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$106.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$501.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.31
|
| Rate for Payer: EPIC Health Plan Senior |
$106.20
|
| Rate for Payer: Galaxy Health WC |
$608.79
|
| Rate for Payer: Global Benefits Group Commercial |
$429.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$644.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$158.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$96.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$96.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$454.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$178.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$135.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$129.38
|
| Rate for Payer: Multiplan Commercial |
$537.16
|
| Rate for Payer: Networks By Design Commercial |
$358.11
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$96.55
|
| Rate for Payer: Prime Health Services Commercial |
$608.79
|
| Rate for Payer: Prime Health Services Medicare |
$102.34
|
| Rate for Payer: Riverside University Health System MISP |
$106.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$429.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$429.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$268.80
|
| Rate for Payer: United Healthcare All Other HMO |
$261.64
|
| Rate for Payer: United Healthcare HMO Rider |
$255.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$234.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$96.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$120.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$106.20
|
| Rate for Payer: Vantage Medical Group Senior |
$106.20
|
|
|
ATEZOLIZUMAB 840 MG/14 ML (60 MG/ML) INTRAVENOUS SOLUTION [224360]
|
Facility
|
OP
|
$716.22
|
|
|
Service Code
|
HCPCS J9022
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$96.55 |
| Max. Negotiated Rate |
$644.60 |
| Rate for Payer: Adventist Health Commercial |
$143.24
|
| Rate for Payer: Adventist Health Medi-Cal |
$96.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$144.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$106.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$96.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$142.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.36
|
| Rate for Payer: Blue Shield of California Commercial |
$120.16
|
| Rate for Payer: Blue Shield of California EPN |
$109.24
|
| Rate for Payer: Cash Price |
$322.30
|
| Rate for Payer: Cash Price |
$322.30
|
| Rate for Payer: Central Health Plan Commercial |
$572.98
|
| Rate for Payer: Cigna of CA HMO |
$501.35
|
| Rate for Payer: Cigna of CA PPO |
$501.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$120.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$106.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$106.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$501.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.31
|
| Rate for Payer: EPIC Health Plan Senior |
$106.20
|
| Rate for Payer: Galaxy Health WC |
$608.79
|
| Rate for Payer: Global Benefits Group Commercial |
$429.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$644.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$158.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$96.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$96.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$454.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$178.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$135.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$129.38
|
| Rate for Payer: Multiplan Commercial |
$537.16
|
| Rate for Payer: Networks By Design Commercial |
$358.11
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$96.55
|
| Rate for Payer: Prime Health Services Commercial |
$608.79
|
| Rate for Payer: Prime Health Services Medicare |
$102.34
|
| Rate for Payer: Riverside University Health System MISP |
$106.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$429.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$429.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$268.80
|
| Rate for Payer: United Healthcare All Other HMO |
$261.64
|
| Rate for Payer: United Healthcare HMO Rider |
$255.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$234.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$96.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$120.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$106.20
|
| Rate for Payer: Vantage Medical Group Senior |
$106.20
|
|
|
ATEZOLIZUMAB 840 MG/14 ML (60 MG/ML) INTRAVENOUS SOLUTION [224360]
|
Facility
|
IP
|
$716.22
|
|
|
Service Code
|
HCPCS J9022
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$143.24 |
| Max. Negotiated Rate |
$644.60 |
| Rate for Payer: Adventist Health Commercial |
$143.24
|
| Rate for Payer: Blue Shield of California Commercial |
$574.41
|
| Rate for Payer: Blue Shield of California EPN |
$360.97
|
| Rate for Payer: Cash Price |
$322.30
|
| Rate for Payer: Central Health Plan Commercial |
$572.98
|
| Rate for Payer: Cigna of CA HMO |
$501.35
|
| Rate for Payer: Cigna of CA PPO |
$501.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$501.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$286.49
|
| Rate for Payer: EPIC Health Plan Senior |
$286.49
|
| Rate for Payer: Galaxy Health WC |
$608.79
|
| Rate for Payer: Global Benefits Group Commercial |
$429.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$644.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$454.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$422.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.24
|
| Rate for Payer: Multiplan Commercial |
$537.16
|
| Rate for Payer: Networks By Design Commercial |
$358.11
|
| Rate for Payer: Prime Health Services Commercial |
$608.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$268.80
|
| Rate for Payer: United Healthcare All Other HMO |
$261.64
|
| Rate for Payer: United Healthcare HMO Rider |
$255.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$234.56
|
|
|
ATHEROSCLEROSIS WITH MCC
|
Facility
|
IP
|
$31,493.32
|
|
|
Service Code
|
MSDRG 302
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$31,493.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$31,493.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20,343.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28,481.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$28,718.51
|
| Rate for Payer: EPIC Health Plan Senior |
$19,145.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17,405.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24,367.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23,322.91
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17,405.16
|
| Rate for Payer: Prime Health Services Medicare |
$18,449.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
ATHEROSCLEROSIS WITHOUT MCC
|
Facility
|
IP
|
$17,717.95
|
|
|
Service Code
|
MSDRG 303
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$17,717.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17,717.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,445.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,023.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,807.58
|
| Rate for Payer: EPIC Health Plan Senior |
$11,205.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,186.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,260.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13,649.79
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10,186.41
|
| Rate for Payer: Prime Health Services Medicare |
$10,797.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
ATOMOXETINE 10 MG CAPSULE [34444]
|
Facility
|
OP
|
$1.95
|
|
|
Service Code
|
NDC 6498037303
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.75 |
| Rate for Payer: Adventist Health Commercial |
$0.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.13
|
| Rate for Payer: Blue Shield of California Commercial |
$1.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.78
|
| 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: Dignity Health Medi-Cal |
$1.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.78
|
| Rate for Payer: EPIC Health Plan Senior |
$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 |
$1.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.36
|
| 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: Riverside University Health System 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 Commercial/Exchange |
$1.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.66
|
| Rate for Payer: Vantage Medical Group Senior |
$1.66
|
|
|
ATOMOXETINE 10 MG CAPSULE [34444]
|
Facility
|
OP
|
$1.17
|
|
|
Service Code
|
NDC 5511151930
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.68
|
| Rate for Payer: Blue Shield of California Commercial |
$0.74
|
| Rate for Payer: Blue Shield of California EPN |
$0.47
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: Central Health Plan Commercial |
$0.94
|
| Rate for Payer: Cigna of CA HMO |
$0.82
|
| Rate for Payer: Cigna of CA PPO |
$0.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.47
|
| Rate for Payer: EPIC Health Plan Senior |
$0.47
|
| Rate for Payer: Galaxy Health WC |
$0.99
|
| Rate for Payer: Global Benefits Group Commercial |
$0.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.82
|
| Rate for Payer: Multiplan Commercial |
$0.88
|
| Rate for Payer: Networks By Design Commercial |
$0.76
|
| Rate for Payer: Prime Health Services Commercial |
$0.99
|
| Rate for Payer: Riverside University Health System MISP |
$0.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.59
|
| Rate for Payer: United Healthcare All Other HMO |
$0.59
|
| Rate for Payer: United Healthcare HMO Rider |
$0.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: Vantage Medical Group Senior |
$0.99
|
|
|
ATOMOXETINE 10 MG CAPSULE [34444]
|
Facility
|
IP
|
$1.90
|
|
|
Service Code
|
NDC 6846226530
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.71 |
| Rate for Payer: Adventist Health Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California Commercial |
$1.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.96
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.76
|
| Rate for Payer: EPIC Health Plan Senior |
$0.76
|
| Rate for Payer: Galaxy Health WC |
$1.61
|
| Rate for Payer: Global Benefits Group Commercial |
$1.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$1.43
|
| Rate for Payer: Networks By Design Commercial |
$1.24
|
| Rate for Payer: Prime Health Services Commercial |
$1.61
|
|
|
ATOMOXETINE 10 MG CAPSULE [34444]
|
Facility
|
IP
|
$1.17
|
|
|
Service Code
|
NDC 3172271430
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California Commercial |
$0.94
|
| Rate for Payer: Blue Shield of California EPN |
$0.59
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: Central Health Plan Commercial |
$0.94
|
| Rate for Payer: Cigna of CA HMO |
$0.82
|
| Rate for Payer: Cigna of CA PPO |
$0.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.47
|
| Rate for Payer: EPIC Health Plan Senior |
$0.47
|
| Rate for Payer: Galaxy Health WC |
$0.99
|
| Rate for Payer: Global Benefits Group Commercial |
$0.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.88
|
| Rate for Payer: Networks By Design Commercial |
$0.76
|
| Rate for Payer: Prime Health Services Commercial |
$0.99
|
|
|
ATOMOXETINE 10 MG CAPSULE [34444]
|
Facility
|
OP
|
$1.17
|
|
|
Service Code
|
NDC 3172271430
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.68
|
| Rate for Payer: Blue Shield of California Commercial |
$0.74
|
| Rate for Payer: Blue Shield of California EPN |
$0.47
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: Central Health Plan Commercial |
$0.94
|
| Rate for Payer: Cigna of CA HMO |
$0.82
|
| Rate for Payer: Cigna of CA PPO |
$0.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.47
|
| Rate for Payer: EPIC Health Plan Senior |
$0.47
|
| Rate for Payer: Galaxy Health WC |
$0.99
|
| Rate for Payer: Global Benefits Group Commercial |
$0.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.82
|
| Rate for Payer: Multiplan Commercial |
$0.88
|
| Rate for Payer: Networks By Design Commercial |
$0.76
|
| Rate for Payer: Prime Health Services Commercial |
$0.99
|
| Rate for Payer: Riverside University Health System MISP |
$0.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.59
|
| Rate for Payer: United Healthcare All Other HMO |
$0.59
|
| Rate for Payer: United Healthcare HMO Rider |
$0.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: Vantage Medical Group Senior |
$0.99
|
|
|
ATOMOXETINE 10 MG CAPSULE [34444]
|
Facility
|
IP
|
$1.95
|
|
|
Service Code
|
NDC 6498037303
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.75 |
| Rate for Payer: Adventist Health Commercial |
$0.39
|
| Rate for Payer: Blue Shield of California Commercial |
$1.56
|
| Rate for Payer: Blue Shield of California EPN |
$0.98
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.78
|
| Rate for Payer: EPIC Health Plan Senior |
$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 |
$1.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.15
|
| 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
|
$4.44
|
|
|
Service Code
|
NDC 0093354256
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Adventist Health Commercial |
$0.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.58
|
| Rate for Payer: Blue Shield of California Commercial |
$2.81
|
| Rate for Payer: Blue Shield of California EPN |
$1.77
|
| 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: Dignity Health Medi-Cal |
$3.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.78
|
| Rate for Payer: EPIC Health Plan Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$2.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.11
|
| 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: Riverside University Health System 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 Commercial/Exchange |
$3.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.77
|
| Rate for Payer: Vantage Medical Group Senior |
$3.77
|
|
|
ATOMOXETINE 10 MG CAPSULE [34444]
|
Facility
|
IP
|
$1.17
|
|
|
Service Code
|
NDC 5511151930
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California Commercial |
$0.94
|
| Rate for Payer: Blue Shield of California EPN |
$0.59
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: Central Health Plan Commercial |
$0.94
|
| Rate for Payer: Cigna of CA HMO |
$0.82
|
| Rate for Payer: Cigna of CA PPO |
$0.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.47
|
| Rate for Payer: EPIC Health Plan Senior |
$0.47
|
| Rate for Payer: Galaxy Health WC |
$0.99
|
| Rate for Payer: Global Benefits Group Commercial |
$0.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.88
|
| Rate for Payer: Networks By Design Commercial |
$0.76
|
| Rate for Payer: Prime Health Services Commercial |
$0.99
|
|
|
ATOMOXETINE 10 MG CAPSULE [34444]
|
Facility
|
OP
|
$1.90
|
|
|
Service Code
|
NDC 6846226530
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.71 |
| Rate for Payer: Adventist Health Commercial |
$0.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.11
|
| Rate for Payer: Blue Shield of California Commercial |
$1.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.76
|
| 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 |
$1.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.76
|
| Rate for Payer: EPIC Health Plan Senior |
$0.76
|
| Rate for Payer: Galaxy Health WC |
$1.61
|
| Rate for Payer: Global Benefits Group Commercial |
$1.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.33
|
| Rate for Payer: Multiplan Commercial |
$1.43
|
| Rate for Payer: Networks By Design Commercial |
$1.24
|
| Rate for Payer: Prime Health Services Commercial |
$1.61
|
| Rate for Payer: Riverside University Health System 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 Commercial/Exchange |
$1.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1.61
|
|
|
ATOMOXETINE 10 MG CAPSULE [34444]
|
Facility
|
IP
|
$4.44
|
|
|
Service Code
|
NDC 0093354256
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Adventist Health Commercial |
$0.89
|
| Rate for Payer: Blue Shield of California Commercial |
$3.56
|
| Rate for Payer: Blue Shield of California EPN |
$2.24
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.78
|
| Rate for Payer: EPIC Health Plan Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$2.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.62
|
| 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 25 MG CAPSULE [34446]
|
Facility
|
IP
|
$4.40
|
|
|
Service Code
|
NDC 6068756721
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: Adventist Health Commercial |
$0.88
|
| Rate for Payer: Blue Shield of California Commercial |
$3.53
|
| Rate for Payer: Blue Shield of California EPN |
$2.22
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.76
|
| Rate for Payer: EPIC Health Plan Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$2.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.60
|
| 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 6068756721
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: Adventist Health Commercial |
$0.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.56
|
| Rate for Payer: Blue Shield of California Commercial |
$2.79
|
| Rate for Payer: Blue Shield of California EPN |
$1.76
|
| 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: Dignity Health Medi-Cal |
$3.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.76
|
| Rate for Payer: EPIC Health Plan Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$2.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.08
|
| 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: Riverside University Health System 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 Commercial/Exchange |
$3.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.74
|
| Rate for Payer: Vantage Medical Group Senior |
$3.74
|
|
|
ATOMOXETINE 25 MG CAPSULE [34446]
|
Facility
|
IP
|
$4.40
|
|
|
Service Code
|
NDC 6068756711
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: Adventist Health Commercial |
$0.88
|
| Rate for Payer: Blue Shield of California Commercial |
$3.53
|
| Rate for Payer: Blue Shield of California EPN |
$2.22
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.76
|
| Rate for Payer: EPIC Health Plan Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$2.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.60
|
| 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 6068756711
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: Adventist Health Commercial |
$0.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.56
|
| Rate for Payer: Blue Shield of California Commercial |
$2.79
|
| Rate for Payer: Blue Shield of California EPN |
$1.76
|
| 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: Dignity Health Medi-Cal |
$3.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.76
|
| Rate for Payer: EPIC Health Plan Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$2.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.08
|
| 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: Riverside University Health System 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 Commercial/Exchange |
$3.74
|
| 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
|
IP
|
$2.12
|
|
|
Service Code
|
NDC 6498037603
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Adventist Health Commercial |
$0.42
|
| Rate for Payer: Blue Shield of California Commercial |
$1.70
|
| Rate for Payer: Blue Shield of California EPN |
$1.07
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Central Health Plan Commercial |
$1.70
|
| Rate for Payer: Cigna of CA HMO |
$1.48
|
| Rate for Payer: Cigna of CA PPO |
$1.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.85
|
| Rate for Payer: EPIC Health Plan Senior |
$0.85
|
| Rate for Payer: Galaxy Health WC |
$1.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$1.59
|
| Rate for Payer: Networks By Design Commercial |
$1.38
|
| Rate for Payer: Prime Health Services Commercial |
$1.80
|
|
|
ATOMOXETINE 40 MG CAPSULE [34447]
|
Facility
|
IP
|
$7.59
|
|
|
Service Code
|
NDC 6068732625
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$6.83 |
| Rate for Payer: Adventist Health Commercial |
$1.52
|
| Rate for Payer: Blue Shield of California Commercial |
$6.09
|
| Rate for Payer: Blue Shield of California EPN |
$3.83
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.04
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.48
|
| 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
|
|
|
ATOMOXETINE 40 MG CAPSULE [34447]
|
Facility
|
OP
|
$7.59
|
|
|
Service Code
|
NDC 6068732625
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$6.83 |
| Rate for Payer: Adventist Health Commercial |
$1.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.42
|
| Rate for Payer: Blue Shield of California Commercial |
$4.81
|
| Rate for Payer: Blue Shield of California EPN |
$3.03
|
| 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: Dignity Health Medi-Cal |
$6.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.04
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.31
|
| 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: Riverside University Health System 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 |
$3.79
|
| Rate for Payer: United Healthcare All Other HMO |
$3.79
|
| Rate for Payer: United Healthcare HMO Rider |
$3.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.45
|
| Rate for Payer: Vantage Medical Group Senior |
$6.45
|
|
|
ATOMOXETINE 40 MG CAPSULE [34447]
|
Facility
|
IP
|
$7.59
|
|
|
Service Code
|
NDC 6068732695
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$6.83 |
| Rate for Payer: Adventist Health Commercial |
$1.52
|
| Rate for Payer: Blue Shield of California Commercial |
$6.09
|
| Rate for Payer: Blue Shield of California EPN |
$3.83
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.04
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.48
|
| 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
|
|
|
ATOMOXETINE 40 MG CAPSULE [34447]
|
Facility
|
OP
|
$7.59
|
|
|
Service Code
|
NDC 6068732695
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$6.83 |
| Rate for Payer: Adventist Health Commercial |
$1.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.42
|
| Rate for Payer: Blue Shield of California Commercial |
$4.81
|
| Rate for Payer: Blue Shield of California EPN |
$3.03
|
| 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: Dignity Health Medi-Cal |
$6.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.04
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.31
|
| 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: Riverside University Health System 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 |
$3.79
|
| Rate for Payer: United Healthcare All Other HMO |
$3.79
|
| Rate for Payer: United Healthcare HMO Rider |
$3.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.45
|
| Rate for Payer: Vantage Medical Group Senior |
$6.45
|
|
