|
ATEZOLIZUMAB 1,200 MG/20 ML (60 MG/ML) INTRAVENOUS SOLUTION [214353]
|
Facility
|
IP
|
$695.36
|
|
|
Service Code
|
HCPCS J9022
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$139.07 |
| Max. Negotiated Rate |
$625.82 |
| Rate for Payer: Adventist Health Commercial |
$139.07
|
| Rate for Payer: Blue Shield of California Commercial |
$537.51
|
| Rate for Payer: Blue Shield of California EPN |
$350.46
|
| Rate for Payer: Cash Price |
$382.45
|
| Rate for Payer: Central Health Plan Commercial |
$556.29
|
| Rate for Payer: Cigna of CA HMO |
$486.75
|
| Rate for Payer: Cigna of CA PPO |
$486.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.14
|
| Rate for Payer: EPIC Health Plan Senior |
$278.14
|
| Rate for Payer: Galaxy Health WC |
$591.06
|
| Rate for Payer: Global Benefits Group Commercial |
$417.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$625.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$463.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$264.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$430.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.07
|
| Rate for Payer: Multiplan Commercial |
$521.52
|
| Rate for Payer: Networks By Design Commercial |
$347.68
|
| Rate for Payer: Prime Health Services Commercial |
$591.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$260.97
|
| Rate for Payer: United Healthcare All Other HMO |
$254.02
|
| Rate for Payer: United Healthcare HMO Rider |
$248.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$227.73
|
|
|
ATEZOLIZUMAB 1,200 MG/20 ML (60 MG/ML) INTRAVENOUS SOLUTION [214353]
|
Facility
|
OP
|
$695.36
|
|
|
Service Code
|
HCPCS J9022
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.28 |
| Max. Negotiated Rate |
$625.82 |
| Rate for Payer: Adventist Health Commercial |
$139.07
|
| Rate for Payer: Adventist Health Medi-Cal |
$91.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$422.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$136.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$100.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$91.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$206.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.28
|
| 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 |
$382.45
|
| Rate for Payer: Cash Price |
$382.45
|
| Rate for Payer: Central Health Plan Commercial |
$556.29
|
| Rate for Payer: Cigna of CA HMO |
$486.75
|
| Rate for Payer: Cigna of CA PPO |
$486.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$100.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$100.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.88
|
| Rate for Payer: EPIC Health Plan Senior |
$91.02
|
| Rate for Payer: Galaxy Health WC |
$591.06
|
| Rate for Payer: Global Benefits Group Commercial |
$417.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$625.82
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$149.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$89.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$91.02
|
| Rate for Payer: InnovAge PACE Commercial |
$136.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$463.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$91.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$121.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$121.97
|
| Rate for Payer: Multiplan Commercial |
$521.52
|
| Rate for Payer: Networks By Design Commercial |
$347.68
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$91.02
|
| Rate for Payer: Prime Health Services Commercial |
$591.06
|
| Rate for Payer: Prime Health Services Medicare |
$96.48
|
| Rate for Payer: Riverside University Health System MISP |
$100.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$417.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$417.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$260.97
|
| Rate for Payer: United Healthcare All Other HMO |
$254.02
|
| Rate for Payer: United Healthcare HMO Rider |
$248.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$227.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$91.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$100.12
|
| Rate for Payer: Vantage Medical Group Senior |
$100.12
|
|
|
ATEZOLIZUMAB 840 MG/14 ML (60 MG/ML) INTRAVENOUS SOLUTION [224360]
|
Facility
|
IP
|
$695.36
|
|
|
Service Code
|
HCPCS J9022
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$139.07 |
| Max. Negotiated Rate |
$625.82 |
| Rate for Payer: Adventist Health Commercial |
$139.07
|
| Rate for Payer: Blue Shield of California Commercial |
$537.51
|
| Rate for Payer: Blue Shield of California EPN |
$350.46
|
| Rate for Payer: Cash Price |
$382.45
|
| Rate for Payer: Central Health Plan Commercial |
$556.29
|
| Rate for Payer: Cigna of CA HMO |
$486.75
|
| Rate for Payer: Cigna of CA PPO |
$486.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.14
|
| Rate for Payer: EPIC Health Plan Senior |
$278.14
|
| Rate for Payer: Galaxy Health WC |
$591.06
|
| Rate for Payer: Global Benefits Group Commercial |
$417.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$625.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$463.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$264.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$430.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.07
|
| Rate for Payer: Multiplan Commercial |
$521.52
|
| Rate for Payer: Networks By Design Commercial |
$347.68
|
| Rate for Payer: Prime Health Services Commercial |
$591.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$260.97
|
| Rate for Payer: United Healthcare All Other HMO |
$254.02
|
| Rate for Payer: United Healthcare HMO Rider |
$248.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$227.73
|
|
|
ATEZOLIZUMAB 840 MG/14 ML (60 MG/ML) INTRAVENOUS SOLUTION [224360]
|
Facility
|
OP
|
$695.36
|
|
|
Service Code
|
HCPCS J9022
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.28 |
| Max. Negotiated Rate |
$625.82 |
| Rate for Payer: Adventist Health Commercial |
$139.07
|
| Rate for Payer: Adventist Health Medi-Cal |
$91.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$422.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$136.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$100.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$91.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$206.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.28
|
| 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 |
$382.45
|
| Rate for Payer: Cash Price |
$382.45
|
| Rate for Payer: Central Health Plan Commercial |
$556.29
|
| Rate for Payer: Cigna of CA HMO |
$486.75
|
| Rate for Payer: Cigna of CA PPO |
$486.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$100.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$100.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.88
|
| Rate for Payer: EPIC Health Plan Senior |
$91.02
|
| Rate for Payer: Galaxy Health WC |
$591.06
|
| Rate for Payer: Global Benefits Group Commercial |
$417.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$625.82
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$149.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$89.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$91.02
|
| Rate for Payer: InnovAge PACE Commercial |
$136.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$463.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$91.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$121.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$121.97
|
| Rate for Payer: Multiplan Commercial |
$521.52
|
| Rate for Payer: Networks By Design Commercial |
$347.68
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$91.02
|
| Rate for Payer: Prime Health Services Commercial |
$591.06
|
| Rate for Payer: Prime Health Services Medicare |
$96.48
|
| Rate for Payer: Riverside University Health System MISP |
$100.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$417.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$417.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$260.97
|
| Rate for Payer: United Healthcare All Other HMO |
$254.02
|
| Rate for Payer: United Healthcare HMO Rider |
$248.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$227.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$91.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$100.12
|
| Rate for Payer: Vantage Medical Group Senior |
$100.12
|
|
|
ATOMOXETINE 10 MG CAPSULE [34444]
|
Facility
|
IP
|
$1.95
|
|
|
Service Code
|
NDC 31722-714-30
|
| 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 |
$1.51
|
| Rate for Payer: Blue Shield of California EPN |
$0.98
|
| Rate for Payer: Cash Price |
$1.07
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.21
|
| 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
|
$1.95
|
|
|
Service Code
|
NDC 64980-373-03
|
| 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 |
$1.51
|
| Rate for Payer: Blue Shield of California EPN |
$0.98
|
| Rate for Payer: Cash Price |
$1.07
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.21
|
| 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 31722-714-30
|
| 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 |
$1.15
|
| Rate for Payer: Blue Shield of California Commercial |
$1.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.78
|
| Rate for Payer: Cash Price |
$1.07
|
| 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: 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: InnovAge PACE Commercial |
$0.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.36
|
| Rate for Payer: Molina Healthcare of CA 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
|
$4.44
|
|
|
Service Code
|
NDC 0093-3542-56
|
| 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 |
$2.61
|
| Rate for Payer: Blue Shield of California Commercial |
$2.71
|
| Rate for Payer: Blue Shield of California EPN |
$1.77
|
| Rate for Payer: Cash Price |
$2.44
|
| 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: 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: InnovAge PACE Commercial |
$2.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.11
|
| Rate for Payer: Molina Healthcare of CA 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
|
$1.95
|
|
|
Service Code
|
NDC 55111-519-30
|
| 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 |
$1.51
|
| Rate for Payer: Blue Shield of California EPN |
$0.98
|
| Rate for Payer: Cash Price |
$1.07
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.21
|
| 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 |
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 |
$1.15
|
| Rate for Payer: Blue Shield of California Commercial |
$1.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.78
|
| Rate for Payer: Cash Price |
$1.07
|
| 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: 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: InnovAge PACE Commercial |
$0.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.36
|
| Rate for Payer: Molina Healthcare of CA 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
|
$1.95
|
|
|
Service Code
|
NDC 55111-519-30
|
| 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 |
$1.15
|
| Rate for Payer: Blue Shield of California Commercial |
$1.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.78
|
| Rate for Payer: Cash Price |
$1.07
|
| 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: 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: InnovAge PACE Commercial |
$0.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.36
|
| Rate for Payer: Molina Healthcare of CA 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
|
$1.90
|
|
|
Service Code
|
NDC 68462-265-30
|
| 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 |
$1.12
|
| Rate for Payer: Blue Shield of California Commercial |
$1.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.76
|
| Rate for Payer: Cash Price |
$1.05
|
| 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: 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: InnovAge PACE Commercial |
$0.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.33
|
| Rate for Payer: Molina Healthcare of CA 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
|
$1.90
|
|
|
Service Code
|
NDC 68462-265-30
|
| 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 |
$1.47
|
| Rate for Payer: Blue Shield of California EPN |
$0.96
|
| Rate for Payer: Cash Price |
$1.05
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$1.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.18
|
| 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
|
$4.44
|
|
|
Service Code
|
NDC 0093-3542-56
|
| 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 |
$3.43
|
| Rate for Payer: Blue Shield of California EPN |
$2.24
|
| Rate for Payer: Cash Price |
$2.44
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$2.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.75
|
| 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 60687-567-11
|
| 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 |
$3.40
|
| Rate for Payer: Blue Shield of California EPN |
$2.22
|
| Rate for Payer: Cash Price |
$2.42
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$2.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.72
|
| 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 |
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 |
$2.58
|
| Rate for Payer: Blue Shield of California Commercial |
$2.69
|
| Rate for Payer: Blue Shield of California EPN |
$1.76
|
| Rate for Payer: Cash Price |
$2.42
|
| 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: 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: InnovAge PACE Commercial |
$2.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.08
|
| Rate for Payer: Molina Healthcare of CA 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 60687-567-21
|
| 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 |
$3.40
|
| Rate for Payer: Blue Shield of California EPN |
$2.22
|
| Rate for Payer: Cash Price |
$2.42
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$2.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.72
|
| 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 60687-567-11
|
| 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 |
$2.58
|
| Rate for Payer: Blue Shield of California Commercial |
$2.69
|
| Rate for Payer: Blue Shield of California EPN |
$1.76
|
| Rate for Payer: Cash Price |
$2.42
|
| 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: 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: InnovAge PACE Commercial |
$2.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.08
|
| Rate for Payer: Molina Healthcare of CA 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
|
$7.59
|
|
|
Service Code
|
NDC 60687-326-25
|
| 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 |
$5.87
|
| Rate for Payer: Blue Shield of California EPN |
$3.83
|
| Rate for Payer: Cash Price |
$4.17
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$5.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.70
|
| 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
|
$2.12
|
|
|
Service Code
|
NDC 64980-376-03
|
| 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: Aetna of CA HMO/PPO |
$1.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.85
|
| Rate for Payer: Cash Price |
$1.17
|
| 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: Dignity Health Commercial/Exchange |
$1.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.80
|
| 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: InnovAge PACE Commercial |
$1.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.48
|
| 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
|
| Rate for Payer: Riverside University Health System MISP |
$0.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.06
|
| Rate for Payer: United Healthcare All Other HMO |
$1.06
|
| Rate for Payer: United Healthcare HMO Rider |
$1.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1.80
|
|
|
ATOMOXETINE 40 MG CAPSULE [34447]
|
Facility
|
OP
|
$7.59
|
|
|
Service Code
|
NDC 60687-326-25
|
| 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 |
$4.46
|
| Rate for Payer: Blue Shield of California Commercial |
$4.64
|
| Rate for Payer: Blue Shield of California EPN |
$3.03
|
| Rate for Payer: Cash Price |
$4.17
|
| 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: 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: InnovAge PACE Commercial |
$3.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.31
|
| Rate for Payer: Molina Healthcare of CA 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
|
$2.12
|
|
|
Service Code
|
NDC 64980-376-03
|
| 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 |
$1.64
|
| Rate for Payer: Blue Shield of California EPN |
$1.07
|
| Rate for Payer: Cash Price |
$1.17
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$1.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.31
|
| 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
|
OP
|
$7.59
|
|
|
Service Code
|
NDC 60687-326-95
|
| 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 |
$4.46
|
| Rate for Payer: Blue Shield of California Commercial |
$4.64
|
| Rate for Payer: Blue Shield of California EPN |
$3.03
|
| Rate for Payer: Cash Price |
$4.17
|
| 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: 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: InnovAge PACE Commercial |
$3.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.31
|
| Rate for Payer: Molina Healthcare of CA 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 60687-326-95
|
| 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 |
$5.87
|
| Rate for Payer: Blue Shield of California EPN |
$3.83
|
| Rate for Payer: Cash Price |
$4.17
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$5.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.70
|
| 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
|
|
|
ATORVASTATIN 10 MG TABLET [19176]
|
Facility
|
OP
|
$0.13
|
|
|
Service Code
|
NDC 0378-3950-77
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Central Health Plan Commercial |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.09
|
| Rate for Payer: Cigna of CA PPO |
$0.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.12
|
| Rate for Payer: InnovAge PACE Commercial |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.11
|
| Rate for Payer: Riverside University Health System MISP |
$0.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: Vantage Medical Group Senior |
$0.11
|
|
