|
OMADACYCLINE 100 MG INTRAVENOUS SOLUTION [223621]
|
Facility
|
IP
|
$607.97
|
|
|
Service Code
|
HCPCS J0121
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$110.04 |
| Max. Negotiated Rate |
$455.98 |
| Rate for Payer: Adventist Health Commercial |
$121.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$391.53
|
| Rate for Payer: Cash Price |
$273.59
|
| Rate for Payer: Cigna of CA HMO/PPO |
$279.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$328.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$281.49
|
| Rate for Payer: Heritage Provider Network Senior |
$281.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$110.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.99
|
| Rate for Payer: Multiplan Commercial |
$455.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$219.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$201.30
|
|
|
OMADACYCLINE 100 MG INTRAVENOUS SOLUTION [223621]
|
Facility
|
OP
|
$607.97
|
|
|
Service Code
|
HCPCS J0121
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$455.98 |
| Rate for Payer: Adventist Health Commercial |
$121.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$375.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.87
|
| Rate for Payer: Blue Shield of California Commercial |
$4.59
|
| Rate for Payer: Blue Shield of California EPN |
$4.59
|
| Rate for Payer: Cash Price |
$273.59
|
| Rate for Payer: Cash Price |
$273.59
|
| Rate for Payer: Cigna of CA HMO/PPO |
$279.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$389.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$281.49
|
| Rate for Payer: Heritage Provider Network Senior |
$281.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$290.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$110.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.61
|
| Rate for Payer: Multiplan Commercial |
$455.98
|
| Rate for Payer: TriValley Medical Group Commercial |
$243.19
|
| Rate for Payer: TriValley Medical Group Senior |
$243.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$219.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$201.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.61
|
| Rate for Payer: Vantage Medical Group Senior |
$4.61
|
|
|
OMALIZUMAB 150 MG/ML SUBCUTANEOUS SYRINGE [223366]
|
Facility
|
IP
|
$1,864.51
|
|
|
Service Code
|
HCPCS J2357
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$337.48 |
| Max. Negotiated Rate |
$1,398.38 |
| Rate for Payer: Adventist Health Commercial |
$372.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,200.74
|
| Rate for Payer: Cash Price |
$839.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$857.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,006.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$863.27
|
| Rate for Payer: Heritage Provider Network Senior |
$863.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$337.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$466.13
|
| Rate for Payer: Multiplan Commercial |
$1,398.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$673.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$617.34
|
|
|
OMALIZUMAB 150 MG/ML SUBCUTANEOUS SYRINGE [223366]
|
Facility
|
OP
|
$1,864.51
|
|
|
Service Code
|
HCPCS J2357
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.34 |
| Max. Negotiated Rate |
$1,398.38 |
| Rate for Payer: Adventist Health Commercial |
$372.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,152.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$58.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.34
|
| Rate for Payer: Blue Shield of California Commercial |
$47.09
|
| Rate for Payer: Blue Shield of California EPN |
$47.09
|
| Rate for Payer: Cash Price |
$839.03
|
| Rate for Payer: Cash Price |
$839.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$857.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,193.29
|
| Rate for Payer: EPIC Health Plan Medicare |
$46.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$863.27
|
| Rate for Payer: Heritage Provider Network Senior |
$863.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$46.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$889.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$337.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$466.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$62.43
|
| Rate for Payer: Multiplan Commercial |
$1,398.38
|
| Rate for Payer: TriValley Medical Group Commercial |
$745.80
|
| Rate for Payer: TriValley Medical Group Senior |
$745.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$673.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$617.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$58.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.25
|
| Rate for Payer: Vantage Medical Group Senior |
$51.25
|
|
|
OMALIZUMAB 150 MG SUBCUTANEOUS SOLUTION [36151]
|
Facility
|
OP
|
$1,864.51
|
|
|
Service Code
|
HCPCS J2357
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.34 |
| Max. Negotiated Rate |
$1,398.38 |
| Rate for Payer: Adventist Health Commercial |
$372.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,152.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$58.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.34
|
| Rate for Payer: Blue Shield of California Commercial |
$47.09
|
| Rate for Payer: Blue Shield of California EPN |
$47.09
|
| Rate for Payer: Cash Price |
$839.03
|
| Rate for Payer: Cash Price |
$839.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$857.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,193.29
|
| Rate for Payer: EPIC Health Plan Medicare |
$46.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$863.27
|
| Rate for Payer: Heritage Provider Network Senior |
$863.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$46.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$889.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$337.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$466.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$62.43
|
| Rate for Payer: Multiplan Commercial |
$1,398.38
|
| Rate for Payer: TriValley Medical Group Commercial |
$745.80
|
| Rate for Payer: TriValley Medical Group Senior |
$745.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$673.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$617.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$58.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.25
|
| Rate for Payer: Vantage Medical Group Senior |
$51.25
|
|
|
OMALIZUMAB 150 MG SUBCUTANEOUS SOLUTION [36151]
|
Facility
|
IP
|
$1,864.51
|
|
|
Service Code
|
HCPCS J2357
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$337.48 |
| Max. Negotiated Rate |
$1,398.38 |
| Rate for Payer: Adventist Health Commercial |
$372.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,200.74
|
| Rate for Payer: Cash Price |
$839.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$857.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,006.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$863.27
|
| Rate for Payer: Heritage Provider Network Senior |
$863.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$337.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$466.13
|
| Rate for Payer: Multiplan Commercial |
$1,398.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$673.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$617.34
|
|
|
OMALIZUMAB 75 MG/0.5 ML SUBCUTANEOUS SYRINGE [223364]
|
Facility
|
IP
|
$1,864.51
|
|
|
Service Code
|
HCPCS J2357
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$337.48 |
| Max. Negotiated Rate |
$1,398.38 |
| Rate for Payer: Adventist Health Commercial |
$372.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,200.74
|
| Rate for Payer: Cash Price |
$839.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$857.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,006.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$863.27
|
| Rate for Payer: Heritage Provider Network Senior |
$863.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$337.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$466.13
|
| Rate for Payer: Multiplan Commercial |
$1,398.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$673.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$617.34
|
|
|
OMALIZUMAB 75 MG/0.5 ML SUBCUTANEOUS SYRINGE [223364]
|
Facility
|
OP
|
$1,864.51
|
|
|
Service Code
|
HCPCS J2357
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.34 |
| Max. Negotiated Rate |
$1,398.38 |
| Rate for Payer: Adventist Health Commercial |
$372.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,152.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$58.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.34
|
| Rate for Payer: Blue Shield of California Commercial |
$47.09
|
| Rate for Payer: Blue Shield of California EPN |
$47.09
|
| Rate for Payer: Cash Price |
$839.03
|
| Rate for Payer: Cash Price |
$839.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$857.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,193.29
|
| Rate for Payer: EPIC Health Plan Medicare |
$46.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$863.27
|
| Rate for Payer: Heritage Provider Network Senior |
$863.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$46.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$889.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$337.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$466.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$62.43
|
| Rate for Payer: Multiplan Commercial |
$1,398.38
|
| Rate for Payer: TriValley Medical Group Commercial |
$745.80
|
| Rate for Payer: TriValley Medical Group Senior |
$745.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$673.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$617.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$58.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.25
|
| Rate for Payer: Vantage Medical Group Senior |
$51.25
|
|
|
OMEGA-3 300 MG-DHA 120 MG-EPA 180 MG-FISH OIL 1,000 MG CAPSULE [231730]
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 0904723860
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Senior |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
|
OMEGA-3 300 MG-DHA 120 MG-EPA 180 MG-FISH OIL 1,000 MG CAPSULE [231730]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 0904723860
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Senior |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE [41822]
|
Facility
|
IP
|
$0.97
|
|
|
Service Code
|
NDC 6050531707
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.73 |
| Rate for Payer: Adventist Health Commercial |
$0.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.62
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.66
|
| Rate for Payer: Heritage Provider Network Senior |
$0.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.73
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE [41822]
|
Facility
|
IP
|
$0.30
|
|
|
Service Code
|
NDC 7075642322
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.19
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.20
|
| Rate for Payer: Heritage Provider Network Senior |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE [41822]
|
Facility
|
OP
|
$0.97
|
|
|
Service Code
|
NDC 6050531707
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: Adventist Health Commercial |
$0.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.49
|
| Rate for Payer: Blue Shield of California Commercial |
$0.59
|
| Rate for Payer: Blue Shield of California EPN |
$0.47
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.60
|
| Rate for Payer: Heritage Provider Network Senior |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.68
|
| Rate for Payer: Multiplan Commercial |
$0.73
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.39
|
| Rate for Payer: TriValley Medical Group Senior |
$0.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.82
|
| Rate for Payer: Vantage Medical Group Senior |
$0.82
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE [41822]
|
Facility
|
OP
|
$0.27
|
|
|
Service Code
|
NDC 6438076111
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Senior |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Vantage Medical Group Senior |
$0.23
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE [41822]
|
Facility
|
IP
|
$0.45
|
|
|
Service Code
|
NDC 3172293612
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.29
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.30
|
| Rate for Payer: Heritage Provider Network Senior |
$0.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.34
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE [41822]
|
Facility
|
OP
|
$0.30
|
|
|
Service Code
|
NDC 7075642322
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Senior |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.12
|
| Rate for Payer: TriValley Medical Group Senior |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE [41822]
|
Facility
|
OP
|
$3.65
|
|
|
Service Code
|
NDC 6068712765
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$3.10 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.10
|
| Rate for Payer: Adventist Health Commercial |
$0.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.83
|
| Rate for Payer: Blue Shield of California Commercial |
$2.23
|
| Rate for Payer: Blue Shield of California EPN |
$1.78
|
| Rate for Payer: Cash Price |
$1.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.26
|
| Rate for Payer: Heritage Provider Network Senior |
$2.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.56
|
| Rate for Payer: Multiplan Commercial |
$2.74
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.46
|
| Rate for Payer: TriValley Medical Group Senior |
$1.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.10
|
| Rate for Payer: Vantage Medical Group Senior |
$3.10
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE [41822]
|
Facility
|
IP
|
$3.65
|
|
|
Service Code
|
NDC 6068712711
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.74 |
| Rate for Payer: Adventist Health Commercial |
$0.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.35
|
| Rate for Payer: Cash Price |
$1.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.47
|
| Rate for Payer: Heritage Provider Network Senior |
$2.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.91
|
| Rate for Payer: Multiplan Commercial |
$2.74
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE [41822]
|
Facility
|
OP
|
$3.65
|
|
|
Service Code
|
NDC 6068712711
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$3.10 |
| Rate for Payer: Adventist Health Commercial |
$0.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.83
|
| Rate for Payer: Blue Shield of California Commercial |
$2.23
|
| Rate for Payer: Blue Shield of California EPN |
$1.78
|
| Rate for Payer: Cash Price |
$1.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.26
|
| Rate for Payer: Heritage Provider Network Senior |
$2.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.56
|
| Rate for Payer: Multiplan Commercial |
$2.74
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.46
|
| Rate for Payer: TriValley Medical Group Senior |
$1.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.10
|
| Rate for Payer: Vantage Medical Group Senior |
$3.10
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE [41822]
|
Facility
|
OP
|
$0.45
|
|
|
Service Code
|
NDC 3172293612
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.23
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.28
|
| Rate for Payer: Heritage Provider Network Senior |
$0.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$0.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.18
|
| Rate for Payer: TriValley Medical Group Senior |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.38
|
| Rate for Payer: Vantage Medical Group Senior |
$0.38
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE [41822]
|
Facility
|
OP
|
$0.25
|
|
|
Service Code
|
NDC 4280655212
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Senior |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Vantage Medical Group Senior |
$0.21
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE [41822]
|
Facility
|
IP
|
$0.25
|
|
|
Service Code
|
NDC 4280655212
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.16
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Senior |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE [41822]
|
Facility
|
IP
|
$3.65
|
|
|
Service Code
|
NDC 6068712765
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.74 |
| Rate for Payer: Adventist Health Commercial |
$0.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.35
|
| Rate for Payer: Cash Price |
$1.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.47
|
| Rate for Payer: Heritage Provider Network Senior |
$2.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.91
|
| Rate for Payer: Multiplan Commercial |
$2.74
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE [41822]
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
NDC 6438076111
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.17
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Senior |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
|
|
OMEGA 3-DHA-EPA-FISH OIL 300 MG-1,000 MG CAPSULE [10774]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 1191710202
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Senior |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
|
