|
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
|
|
|
OMEPRAZOLE MAGNESIUM 20 MG TABLET,DELAYED RELEASE [36205]
|
Facility
|
IP
|
$0.86
|
|
|
Service Code
|
NDC 3700045902
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.55
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.58
|
| Rate for Payer: Heritage Provider Network Senior |
$0.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.65
|
|
|
OMEPRAZOLE MAGNESIUM 20 MG TABLET,DELAYED RELEASE [36205]
|
Facility
|
OP
|
$0.86
|
|
|
Service Code
|
NDC 3700045902
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.73 |
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.42
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.53
|
| Rate for Payer: Heritage Provider Network Senior |
$0.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.60
|
| Rate for Payer: Multiplan Commercial |
$0.65
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.34
|
| Rate for Payer: TriValley Medical Group Senior |
$0.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.73
|
| Rate for Payer: Vantage Medical Group Senior |
$0.73
|
|
|
ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION [32700]
|
Facility
|
OP
|
$781.20
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$585.90 |
| Rate for Payer: Adventist Health Commercial |
$156.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$482.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.68
|
| Rate for Payer: Blue Shield of California Commercial |
$6.59
|
| Rate for Payer: Blue Shield of California EPN |
$6.59
|
| Rate for Payer: Cash Price |
$351.54
|
| Rate for Payer: Cash Price |
$351.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$359.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.97
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$361.70
|
| Rate for Payer: Heritage Provider Network Senior |
$361.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$372.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$141.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.72
|
| Rate for Payer: Multiplan Commercial |
$585.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$312.48
|
| Rate for Payer: TriValley Medical Group Senior |
$312.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$282.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$258.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.16
|
| Rate for Payer: Vantage Medical Group Senior |
$7.16
|
|
|
ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION [32700]
|
Facility
|
IP
|
$781.20
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$141.40 |
| Max. Negotiated Rate |
$585.90 |
| Rate for Payer: Adventist Health Commercial |
$156.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$503.09
|
| Rate for Payer: Cash Price |
$351.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$359.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$421.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$361.70
|
| Rate for Payer: Heritage Provider Network Senior |
$361.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$141.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.30
|
| Rate for Payer: Multiplan Commercial |
$585.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$282.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$258.66
|
|
|
ONABOTULINUMTOXINA (COSMETIC) 50 UNIT INTRAMUSCULAR SOLUTION [95794]
|
Facility
|
IP
|
$434.40
|
|
|
Service Code
|
NDC 0023391950
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$78.63 |
| Max. Negotiated Rate |
$325.80 |
| Rate for Payer: Adventist Health Commercial |
$86.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$279.75
|
| Rate for Payer: Cash Price |
$195.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$199.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$201.13
|
| Rate for Payer: Heritage Provider Network Senior |
$201.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$78.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.60
|
| Rate for Payer: Multiplan Commercial |
$325.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$156.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$143.83
|
|
|
ONABOTULINUMTOXINA (COSMETIC) 50 UNIT INTRAMUSCULAR SOLUTION [95794]
|
Facility
|
OP
|
$434.40
|
|
|
Service Code
|
NDC 0023391950
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$78.63 |
| Max. Negotiated Rate |
$369.24 |
| Rate for Payer: Adventist Health Commercial |
$86.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$268.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$369.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$238.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$325.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$217.29
|
| Rate for Payer: Blue Shield of California Commercial |
$264.98
|
| Rate for Payer: Blue Shield of California EPN |
$211.99
|
| Rate for Payer: Cash Price |
$195.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$199.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$369.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$369.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$369.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$201.13
|
| Rate for Payer: Heritage Provider Network Senior |
$201.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$207.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$78.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$304.08
|
| Rate for Payer: Multiplan Commercial |
$325.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$173.76
|
| Rate for Payer: TriValley Medical Group Senior |
$173.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$156.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$143.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$369.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.24
|
| Rate for Payer: Vantage Medical Group Senior |
$369.24
|
|
|
ONASEMNOGENE ABEPARVOVEC-XIOI 2 X 10EXP13 VG/ML IV SUSPENSION,KIT [224879]
|
Facility
|
OP
|
$35,465.93
|
|
|
Service Code
|
HCPCS J3399
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,419.33 |
| Max. Negotiated Rate |
$3,591,250.09 |
| Rate for Payer: Adventist Health Commercial |
$7,093.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21,917.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,350,046.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,948,041.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,948,041.12
|
| Rate for Payer: Blue Shield of California Commercial |
$2,368,485.25
|
| Rate for Payer: Blue Shield of California EPN |
$2,368,485.25
|
| Rate for Payer: Cash Price |
$15,959.67
|
| Rate for Payer: Cash Price |
$15,959.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16,314.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,350,046.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,948,041.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,948,041.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,698.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,680,037.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,420.73
|
| Rate for Payer: Heritage Provider Network Senior |
$16,420.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,680,037.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16,917.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,419.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,082,042.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,866.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,591,250.09
|
| Rate for Payer: Multiplan Commercial |
$26,599.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$14,186.37
|
| Rate for Payer: TriValley Medical Group Senior |
$14,186.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,813.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,742.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,350,046.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,948,041.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,948,041.12
|
|
|
ONASEMNOGENE ABEPARVOVEC-XIOI 2 X 10EXP13 VG/ML IV SUSPENSION,KIT [224879]
|
Facility
|
IP
|
$35,465.93
|
|
|
Service Code
|
HCPCS J3399
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,419.33 |
| Max. Negotiated Rate |
$26,599.45 |
| Rate for Payer: Adventist Health Commercial |
$7,093.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22,840.06
|
| Rate for Payer: Cash Price |
$15,959.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16,314.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,151.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,420.73
|
| Rate for Payer: Heritage Provider Network Senior |
$16,420.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,419.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,866.48
|
| Rate for Payer: Multiplan Commercial |
$26,599.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,813.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,742.77
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET [27697]
|
Facility
|
IP
|
$0.30
|
|
|
Service Code
|
NDC 5723707710
|
| 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
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET [27697]
|
Facility
|
OP
|
$0.55
|
|
|
Service Code
|
NDC 6846215740
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.47 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.28
|
| Rate for Payer: Blue Shield of California Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.34
|
| Rate for Payer: Heritage Provider Network Senior |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.22
|
| Rate for Payer: TriValley Medical Group Senior |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.47
|
| Rate for Payer: Vantage Medical Group Senior |
$0.47
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET [27697]
|
Facility
|
IP
|
$0.73
|
|
|
Service Code
|
NDC 6586239010
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.47
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.49
|
| Rate for Payer: Heritage Provider Network Senior |
$0.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.55
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET [27697]
|
Facility
|
IP
|
$0.73
|
|
|
Service Code
|
NDC 6275624064
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.47
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.49
|
| Rate for Payer: Heritage Provider Network Senior |
$0.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.55
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET [27697]
|
Facility
|
IP
|
$0.55
|
|
|
Service Code
|
NDC 6846215713
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.35
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.37
|
| Rate for Payer: Heritage Provider Network Senior |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET [27697]
|
Facility
|
OP
|
$0.83
|
|
|
Service Code
|
NDC 6800124617
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.71 |
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.42
|
| Rate for Payer: Blue Shield of California Commercial |
$0.51
|
| Rate for Payer: Blue Shield of California EPN |
$0.41
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.51
|
| Rate for Payer: Heritage Provider Network Senior |
$0.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.58
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.33
|
| Rate for Payer: TriValley Medical Group Senior |
$0.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.71
|
| Rate for Payer: Vantage Medical Group Senior |
$0.71
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET [27697]
|
Facility
|
IP
|
$0.73
|
|
|
Service Code
|
NDC 6800124604
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.47
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.49
|
| Rate for Payer: Heritage Provider Network Senior |
$0.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.55
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET [27697]
|
Facility
|
OP
|
$0.73
|
|
|
Service Code
|
NDC 6586239010
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.45
|
| Rate for Payer: Heritage Provider Network Senior |
$0.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.51
|
| Rate for Payer: Multiplan Commercial |
$0.55
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Senior |
$0.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.62
|
| Rate for Payer: Vantage Medical Group Senior |
$0.62
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET [27697]
|
Facility
|
OP
|
$0.55
|
|
|
Service Code
|
NDC 6846215713
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.47 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.28
|
| Rate for Payer: Blue Shield of California Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.34
|
| Rate for Payer: Heritage Provider Network Senior |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.22
|
| Rate for Payer: TriValley Medical Group Senior |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.47
|
| Rate for Payer: Vantage Medical Group Senior |
$0.47
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET [27697]
|
Facility
|
OP
|
$0.73
|
|
|
Service Code
|
NDC 6275624060
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.45
|
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.45
|
| Rate for Payer: Heritage Provider Network Senior |
$0.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.51
|
| Rate for Payer: Multiplan Commercial |
$0.55
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Senior |
$0.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.62
|
| Rate for Payer: Vantage Medical Group Senior |
$0.62
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET [27697]
|
Facility
|
IP
|
$0.83
|
|
|
Service Code
|
NDC 6800124616
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.53
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.56
|
| Rate for Payer: Heritage Provider Network Senior |
$0.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET [27697]
|
Facility
|
IP
|
$0.55
|
|
|
Service Code
|
NDC 6846215740
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.35
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.37
|
| Rate for Payer: Heritage Provider Network Senior |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET [27697]
|
Facility
|
OP
|
$0.83
|
|
|
Service Code
|
NDC 6800124616
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.71 |
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.42
|
| Rate for Payer: Blue Shield of California Commercial |
$0.51
|
| Rate for Payer: Blue Shield of California EPN |
$0.41
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.51
|
| Rate for Payer: Heritage Provider Network Senior |
$0.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.58
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.33
|
| Rate for Payer: TriValley Medical Group Senior |
$0.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.71
|
| Rate for Payer: Vantage Medical Group Senior |
$0.71
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET [27697]
|
Facility
|
OP
|
$0.73
|
|
|
Service Code
|
NDC 6800124604
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.45
|
| Rate for Payer: Heritage Provider Network Senior |
$0.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.51
|
| Rate for Payer: Multiplan Commercial |
$0.55
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Senior |
$0.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.62
|
| Rate for Payer: Vantage Medical Group Senior |
$0.62
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET [27697]
|
Facility
|
OP
|
$0.29
|
|
|
Service Code
|
NDC 5723707730
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.22
|
| 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 |
$0.14
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Senior |
$0.18
|
| 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 |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| 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 |
$0.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: Vantage Medical Group Senior |
$0.25
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET [27697]
|
Facility
|
IP
|
$0.83
|
|
|
Service Code
|
NDC 6800124617
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.53
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.56
|
| Rate for Payer: Heritage Provider Network Senior |
$0.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
|
