|
LAMOTRIGINE 50 MG DISINTEGRATING TABLET [96940]
|
Facility
|
OP
|
$4.24
|
|
|
Service Code
|
NDC 2724118430
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Adventist Health Commercial |
$0.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.72
|
| Rate for Payer: Cash Price |
$1.91
|
| Rate for Payer: Cigna of CA HMO |
$2.97
|
| Rate for Payer: Cigna of CA PPO |
$2.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.70
|
| Rate for Payer: EPIC Health Plan Senior |
$1.70
|
| Rate for Payer: Galaxy Health WC |
$3.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.97
|
| Rate for Payer: Multiplan Commercial |
$3.39
|
| Rate for Payer: Networks By Design Commercial |
$2.76
|
| Rate for Payer: Prime Health Services Commercial |
$3.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.12
|
| Rate for Payer: United Healthcare All Other HMO |
$2.12
|
| Rate for Payer: United Healthcare HMO Rider |
$2.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.60
|
| Rate for Payer: Vantage Medical Group Senior |
$3.60
|
|
|
LAMOTRIGINE 50 MG DISINTEGRATING TABLET [96940]
|
Facility
|
IP
|
$4.24
|
|
|
Service Code
|
NDC 2724118430
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Adventist Health Commercial |
$0.85
|
| Rate for Payer: Blue Shield of California Commercial |
$2.15
|
| Rate for Payer: Blue Shield of California Commercial |
$3.26
|
| Rate for Payer: Cash Price |
$1.91
|
| Rate for Payer: Cigna of CA HMO |
$2.97
|
| Rate for Payer: Cigna of CA PPO |
$2.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.70
|
| Rate for Payer: EPIC Health Plan Senior |
$1.70
|
| Rate for Payer: Galaxy Health WC |
$3.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: Multiplan Commercial |
$3.39
|
| Rate for Payer: Networks By Design Commercial |
$2.76
|
| Rate for Payer: Prime Health Services Commercial |
$3.60
|
|
|
LAMOTRIGINE 50 MG DISINTEGRATING TABLET [96940]
|
Facility
|
IP
|
$6.41
|
|
|
Service Code
|
NDC 4359855130
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$5.45 |
| Rate for Payer: Adventist Health Commercial |
$1.28
|
| Rate for Payer: Blue Shield of California Commercial |
$3.25
|
| Rate for Payer: Blue Shield of California Commercial |
$4.93
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: Cigna of CA HMO |
$4.49
|
| Rate for Payer: Cigna of CA PPO |
$4.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.56
|
| Rate for Payer: EPIC Health Plan Senior |
$2.56
|
| Rate for Payer: Galaxy Health WC |
$5.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.54
|
| Rate for Payer: Multiplan Commercial |
$5.13
|
| Rate for Payer: Networks By Design Commercial |
$4.17
|
| Rate for Payer: Prime Health Services Commercial |
$5.45
|
|
|
LAMOTRIGINE 50 MG DISINTEGRATING TABLET [96940]
|
Facility
|
OP
|
$6.41
|
|
|
Service Code
|
NDC 4359855130
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$5.45 |
| Rate for Payer: Adventist Health Commercial |
$1.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.11
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: Cigna of CA HMO |
$4.49
|
| Rate for Payer: Cigna of CA PPO |
$4.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.56
|
| Rate for Payer: EPIC Health Plan Senior |
$2.56
|
| Rate for Payer: Galaxy Health WC |
$5.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.49
|
| Rate for Payer: Multiplan Commercial |
$5.13
|
| Rate for Payer: Networks By Design Commercial |
$4.17
|
| Rate for Payer: Prime Health Services Commercial |
$5.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.21
|
| Rate for Payer: United Healthcare All Other HMO |
$3.21
|
| Rate for Payer: United Healthcare HMO Rider |
$3.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.45
|
| Rate for Payer: Vantage Medical Group Senior |
$5.45
|
|
|
LAMOTRIGINE 5 MG CHEWABLE DISPERSIBLE TABLET [104568]
|
Facility
|
IP
|
$11.42
|
|
|
Service Code
|
NDC 0173052600
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$9.71 |
| Rate for Payer: Adventist Health Commercial |
$2.28
|
| Rate for Payer: Blue Shield of California Commercial |
$5.79
|
| Rate for Payer: Blue Shield of California Commercial |
$8.78
|
| Rate for Payer: Cash Price |
$5.14
|
| Rate for Payer: Cigna of CA HMO |
$7.99
|
| Rate for Payer: Cigna of CA PPO |
$7.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.57
|
| Rate for Payer: EPIC Health Plan Senior |
$4.57
|
| Rate for Payer: Galaxy Health WC |
$9.71
|
| Rate for Payer: Global Benefits Group Commercial |
$6.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.74
|
| Rate for Payer: Multiplan Commercial |
$9.14
|
| Rate for Payer: Networks By Design Commercial |
$7.42
|
| Rate for Payer: Prime Health Services Commercial |
$9.71
|
|
|
LAMOTRIGINE 5 MG CHEWABLE DISPERSIBLE TABLET [104568]
|
Facility
|
OP
|
$11.42
|
|
|
Service Code
|
NDC 0173052600
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$9.71 |
| Rate for Payer: Adventist Health Commercial |
$2.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.33
|
| Rate for Payer: Cash Price |
$5.14
|
| Rate for Payer: Cigna of CA HMO |
$7.99
|
| Rate for Payer: Cigna of CA PPO |
$7.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.57
|
| Rate for Payer: EPIC Health Plan Senior |
$4.57
|
| Rate for Payer: Galaxy Health WC |
$9.71
|
| Rate for Payer: Global Benefits Group Commercial |
$6.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.99
|
| Rate for Payer: Multiplan Commercial |
$9.14
|
| Rate for Payer: Networks By Design Commercial |
$7.42
|
| Rate for Payer: Prime Health Services Commercial |
$9.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.71
|
| Rate for Payer: United Healthcare All Other HMO |
$5.71
|
| Rate for Payer: United Healthcare HMO Rider |
$5.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.71
|
| Rate for Payer: Vantage Medical Group Senior |
$9.71
|
|
|
LANOLIN ALCOHOLS-MINERAL OIL-W.PETROLATUM-CERESIN TOPICAL CREAM [120012]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
NDC 7214003868
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
LANOLIN ALCOHOLS-MINERAL OIL-W.PETROLATUM-CERESIN TOPICAL CREAM [120012]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 7214003868
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
LANOLIN-MINERAL OIL LOTION [2787]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 7214011019
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
LANOLIN-MINERAL OIL LOTION [2787]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 7214011019
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
LANREOTIDE 60 MG/0.2 ML SUBCUTANEOUS SYRINGE [88570]
|
Facility
|
IP
|
$40,158.00
|
|
|
Service Code
|
HCPCS J1930
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8,031.60 |
| Max. Negotiated Rate |
$34,134.30 |
| Rate for Payer: Adventist Health Commercial |
$8,031.60
|
| Rate for Payer: Blue Shield of California Commercial |
$20,360.11
|
| Rate for Payer: Blue Shield of California Commercial |
$30,881.50
|
| Rate for Payer: Cash Price |
$18,071.10
|
| Rate for Payer: Cigna of CA HMO |
$28,110.60
|
| Rate for Payer: Cigna of CA PPO |
$28,110.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28,110.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,063.20
|
| Rate for Payer: EPIC Health Plan Senior |
$16,063.20
|
| Rate for Payer: Galaxy Health WC |
$34,134.30
|
| Rate for Payer: Global Benefits Group Commercial |
$24,094.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25,500.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23,693.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,637.92
|
| Rate for Payer: Multiplan Commercial |
$32,126.40
|
| Rate for Payer: Networks By Design Commercial |
$20,079.00
|
| Rate for Payer: Prime Health Services Commercial |
$34,134.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,071.30
|
| Rate for Payer: United Healthcare All Other HMO |
$14,669.72
|
| Rate for Payer: United Healthcare HMO Rider |
$14,352.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13,151.75
|
|
|
LANREOTIDE 60 MG/0.2 ML SUBCUTANEOUS SYRINGE [88570]
|
Facility
|
OP
|
$40,158.00
|
|
|
Service Code
|
HCPCS J1930
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.43 |
| Max. Negotiated Rate |
$34,134.30 |
| Rate for Payer: Adventist Health Commercial |
$8,031.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$248.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.90
|
| Rate for Payer: Blue Shield of California Commercial |
$49.21
|
| Rate for Payer: Cash Price |
$18,071.10
|
| Rate for Payer: Cash Price |
$18,071.10
|
| Rate for Payer: Cigna of CA HMO |
$28,110.60
|
| Rate for Payer: Cigna of CA PPO |
$28,110.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28,110.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.76
|
| Rate for Payer: EPIC Health Plan Senior |
$41.17
|
| Rate for Payer: Galaxy Health WC |
$34,134.30
|
| Rate for Payer: Global Benefits Group Commercial |
$24,094.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25,500.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$75.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,637.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.16
|
| Rate for Payer: Multiplan Commercial |
$32,126.40
|
| Rate for Payer: Networks By Design Commercial |
$20,079.00
|
| Rate for Payer: Prime Health Services Commercial |
$34,134.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24,094.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24,094.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,071.30
|
| Rate for Payer: United Healthcare All Other HMO |
$14,669.72
|
| Rate for Payer: United Healthcare HMO Rider |
$14,352.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13,151.75
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.17
|
| Rate for Payer: Vantage Medical Group Senior |
$41.17
|
|
|
LANREOTIDE 90 MG/0.3 ML SUBCUTANEOUS SYRINGE [87860]
|
Facility
|
OP
|
$35,652.00
|
|
|
Service Code
|
HCPCS J1930
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.43 |
| Max. Negotiated Rate |
$30,304.20 |
| Rate for Payer: Adventist Health Commercial |
$7,130.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$248.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.90
|
| Rate for Payer: Blue Shield of California Commercial |
$49.21
|
| Rate for Payer: Cash Price |
$16,043.40
|
| Rate for Payer: Cash Price |
$16,043.40
|
| Rate for Payer: Cigna of CA HMO |
$24,956.40
|
| Rate for Payer: Cigna of CA PPO |
$24,956.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24,956.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.76
|
| Rate for Payer: EPIC Health Plan Senior |
$41.17
|
| Rate for Payer: Galaxy Health WC |
$30,304.20
|
| Rate for Payer: Global Benefits Group Commercial |
$21,391.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22,639.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$75.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,556.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.16
|
| Rate for Payer: Multiplan Commercial |
$28,521.60
|
| Rate for Payer: Networks By Design Commercial |
$17,826.00
|
| Rate for Payer: Prime Health Services Commercial |
$30,304.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21,391.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21,391.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,380.20
|
| Rate for Payer: United Healthcare All Other HMO |
$13,023.68
|
| Rate for Payer: United Healthcare HMO Rider |
$12,742.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,676.03
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.17
|
| Rate for Payer: Vantage Medical Group Senior |
$41.17
|
|
|
LANREOTIDE 90 MG/0.3 ML SUBCUTANEOUS SYRINGE [87860]
|
Facility
|
IP
|
$35,652.00
|
|
|
Service Code
|
HCPCS J1930
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,130.40 |
| Max. Negotiated Rate |
$30,304.20 |
| Rate for Payer: Adventist Health Commercial |
$7,130.40
|
| Rate for Payer: Blue Shield of California Commercial |
$18,075.56
|
| Rate for Payer: Blue Shield of California Commercial |
$27,416.39
|
| Rate for Payer: Cash Price |
$16,043.40
|
| Rate for Payer: Cigna of CA HMO |
$24,956.40
|
| Rate for Payer: Cigna of CA PPO |
$24,956.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24,956.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,260.80
|
| Rate for Payer: EPIC Health Plan Senior |
$14,260.80
|
| Rate for Payer: Galaxy Health WC |
$30,304.20
|
| Rate for Payer: Global Benefits Group Commercial |
$21,391.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22,639.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21,034.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,556.48
|
| Rate for Payer: Multiplan Commercial |
$28,521.60
|
| Rate for Payer: Networks By Design Commercial |
$17,826.00
|
| Rate for Payer: Prime Health Services Commercial |
$30,304.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,380.20
|
| Rate for Payer: United Healthcare All Other HMO |
$13,023.68
|
| Rate for Payer: United Healthcare HMO Rider |
$12,742.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,676.03
|
|
|
LANSOPRAZOLE 15 MG CAPSULE,DELAYED RELEASE [27691]
|
Facility
|
IP
|
$3.65
|
|
|
Service Code
|
NDC 6068711111
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$3.10 |
| Rate for Payer: Adventist Health Commercial |
$0.73
|
| Rate for Payer: Blue Shield of California Commercial |
$1.85
|
| Rate for Payer: Blue Shield of California Commercial |
$2.81
|
| Rate for Payer: Cash Price |
$1.64
|
| Rate for Payer: Cigna of CA HMO |
$2.56
|
| Rate for Payer: Cigna of CA PPO |
$2.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.46
|
| Rate for Payer: EPIC Health Plan Senior |
$1.46
|
| Rate for Payer: Galaxy Health WC |
$3.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.88
|
| Rate for Payer: Multiplan Commercial |
$2.92
|
| Rate for Payer: Networks By Design Commercial |
$2.37
|
| Rate for Payer: Prime Health Services Commercial |
$3.10
|
|
|
LANSOPRAZOLE 15 MG CAPSULE,DELAYED RELEASE [27691]
|
Facility
|
OP
|
$3.65
|
|
|
Service Code
|
NDC 6068711121
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$3.10 |
| Rate for Payer: Adventist Health Commercial |
$0.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.39
|
| 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 |
$2.34
|
| Rate for Payer: Cash Price |
$1.64
|
| Rate for Payer: Cigna of CA HMO |
$2.56
|
| Rate for Payer: Cigna of CA PPO |
$2.56
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.46
|
| Rate for Payer: EPIC Health Plan Senior |
$1.46
|
| Rate for Payer: Galaxy Health WC |
$3.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.56
|
| Rate for Payer: Multiplan Commercial |
$2.92
|
| Rate for Payer: Networks By Design Commercial |
$2.37
|
| Rate for Payer: Prime Health Services Commercial |
$3.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.82
|
| Rate for Payer: United Healthcare All Other HMO |
$1.82
|
| Rate for Payer: United Healthcare HMO Rider |
$1.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$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
|
|
|
LANSOPRAZOLE 15 MG CAPSULE,DELAYED RELEASE [27691]
|
Facility
|
IP
|
$3.65
|
|
|
Service Code
|
NDC 6068711121
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$3.10 |
| Rate for Payer: Adventist Health Commercial |
$0.73
|
| Rate for Payer: Blue Shield of California Commercial |
$1.85
|
| Rate for Payer: Blue Shield of California Commercial |
$2.81
|
| Rate for Payer: Cash Price |
$1.64
|
| Rate for Payer: Cigna of CA HMO |
$2.56
|
| Rate for Payer: Cigna of CA PPO |
$2.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.46
|
| Rate for Payer: EPIC Health Plan Senior |
$1.46
|
| Rate for Payer: Galaxy Health WC |
$3.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.88
|
| Rate for Payer: Multiplan Commercial |
$2.92
|
| Rate for Payer: Networks By Design Commercial |
$2.37
|
| Rate for Payer: Prime Health Services Commercial |
$3.10
|
|
|
LANSOPRAZOLE 15 MG CAPSULE,DELAYED RELEASE [27691]
|
Facility
|
OP
|
$3.65
|
|
|
Service Code
|
NDC 6068711111
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$3.10 |
| Rate for Payer: Adventist Health Commercial |
$0.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.39
|
| 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 |
$2.34
|
| Rate for Payer: Cash Price |
$1.64
|
| Rate for Payer: Cigna of CA HMO |
$2.56
|
| Rate for Payer: Cigna of CA PPO |
$2.56
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.46
|
| Rate for Payer: EPIC Health Plan Senior |
$1.46
|
| Rate for Payer: Galaxy Health WC |
$3.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.56
|
| Rate for Payer: Multiplan Commercial |
$2.92
|
| Rate for Payer: Networks By Design Commercial |
$2.37
|
| Rate for Payer: Prime Health Services Commercial |
$3.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.82
|
| Rate for Payer: United Healthcare All Other HMO |
$1.82
|
| Rate for Payer: United Healthcare HMO Rider |
$1.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$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
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET [34595]
|
Facility
|
OP
|
$16.60
|
|
|
Service Code
|
NDC 6476454411
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.32 |
| Max. Negotiated Rate |
$14.11 |
| Rate for Payer: Adventist Health Commercial |
$3.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.65
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Cigna of CA HMO |
$11.62
|
| Rate for Payer: Cigna of CA PPO |
$11.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.64
|
| Rate for Payer: EPIC Health Plan Senior |
$6.64
|
| Rate for Payer: Galaxy Health WC |
$14.11
|
| Rate for Payer: Global Benefits Group Commercial |
$9.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.62
|
| Rate for Payer: Multiplan Commercial |
$13.28
|
| Rate for Payer: Networks By Design Commercial |
$10.79
|
| Rate for Payer: Prime Health Services Commercial |
$14.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.30
|
| Rate for Payer: United Healthcare All Other HMO |
$8.30
|
| Rate for Payer: United Healthcare HMO Rider |
$8.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.11
|
| Rate for Payer: Vantage Medical Group Senior |
$14.11
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET [34595]
|
Facility
|
IP
|
$16.60
|
|
|
Service Code
|
NDC 6476454411
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.32 |
| Max. Negotiated Rate |
$14.11 |
| Rate for Payer: Adventist Health Commercial |
$3.32
|
| Rate for Payer: Blue Shield of California Commercial |
$12.77
|
| Rate for Payer: Blue Shield of California Commercial |
$8.42
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Cigna of CA HMO |
$11.62
|
| Rate for Payer: Cigna of CA PPO |
$11.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.64
|
| Rate for Payer: EPIC Health Plan Senior |
$6.64
|
| Rate for Payer: Galaxy Health WC |
$14.11
|
| Rate for Payer: Global Benefits Group Commercial |
$9.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.98
|
| Rate for Payer: Multiplan Commercial |
$13.28
|
| Rate for Payer: Networks By Design Commercial |
$10.79
|
| Rate for Payer: Prime Health Services Commercial |
$14.11
|
|
|
LANSOPRAZOLE ORAL SUSPENSION COMPOUND 3 MG/ML [4080290]
|
Facility
|
OP
|
$0.57
|
|
|
Service Code
|
NDC 9994080290
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.37
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.40
|
| Rate for Payer: Cigna of CA PPO |
$0.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Senior |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.37
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.29
|
| Rate for Payer: United Healthcare All Other HMO |
$0.29
|
| Rate for Payer: United Healthcare HMO Rider |
$0.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
|
|
LANSOPRAZOLE ORAL SUSPENSION COMPOUND 3 MG/ML [4080290]
|
Facility
|
IP
|
$0.57
|
|
|
Service Code
|
NDC 9994080290
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.40
|
| Rate for Payer: Cigna of CA PPO |
$0.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Senior |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.37
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
|
|
LANTHANUM 1,000 MG CHEWABLE TABLET [43548]
|
Facility
|
IP
|
$12.95
|
|
|
Service Code
|
NDC 6699342485
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$11.01 |
| Rate for Payer: Adventist Health Commercial |
$2.59
|
| Rate for Payer: Blue Shield of California Commercial |
$6.57
|
| Rate for Payer: Blue Shield of California Commercial |
$9.96
|
| Rate for Payer: Cash Price |
$5.83
|
| Rate for Payer: Cigna of CA HMO |
$9.06
|
| Rate for Payer: Cigna of CA PPO |
$9.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.18
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$11.01
|
| Rate for Payer: Global Benefits Group Commercial |
$7.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.11
|
| Rate for Payer: Multiplan Commercial |
$10.36
|
| Rate for Payer: Networks By Design Commercial |
$6.47
|
| Rate for Payer: Prime Health Services Commercial |
$11.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.86
|
| Rate for Payer: United Healthcare All Other HMO |
$4.73
|
| Rate for Payer: United Healthcare HMO Rider |
$4.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.24
|
|
|
LANTHANUM 1,000 MG CHEWABLE TABLET [43548]
|
Facility
|
IP
|
$12.95
|
|
|
Service Code
|
NDC 6699342475
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$11.01 |
| Rate for Payer: Adventist Health Commercial |
$2.59
|
| Rate for Payer: Blue Shield of California Commercial |
$6.57
|
| Rate for Payer: Blue Shield of California Commercial |
$9.96
|
| Rate for Payer: Cash Price |
$5.83
|
| Rate for Payer: Cigna of CA HMO |
$9.06
|
| Rate for Payer: Cigna of CA PPO |
$9.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.18
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$11.01
|
| Rate for Payer: Global Benefits Group Commercial |
$7.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.11
|
| Rate for Payer: Multiplan Commercial |
$10.36
|
| Rate for Payer: Networks By Design Commercial |
$6.47
|
| Rate for Payer: Prime Health Services Commercial |
$11.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.86
|
| Rate for Payer: United Healthcare All Other HMO |
$4.73
|
| Rate for Payer: United Healthcare HMO Rider |
$4.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.24
|
|
|
LANTHANUM 1,000 MG CHEWABLE TABLET [43548]
|
Facility
|
IP
|
$6.67
|
|
|
Service Code
|
NDC 6818082147
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$5.67 |
| Rate for Payer: Adventist Health Commercial |
$1.33
|
| Rate for Payer: Blue Shield of California Commercial |
$3.38
|
| Rate for Payer: Blue Shield of California Commercial |
$5.13
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna of CA HMO |
$4.67
|
| Rate for Payer: Cigna of CA PPO |
$4.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.67
|
| Rate for Payer: EPIC Health Plan Senior |
$2.67
|
| Rate for Payer: Galaxy Health WC |
$5.67
|
| Rate for Payer: Global Benefits Group Commercial |
$4.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.60
|
| Rate for Payer: Multiplan Commercial |
$5.34
|
| Rate for Payer: Networks By Design Commercial |
$3.33
|
| Rate for Payer: Prime Health Services Commercial |
$5.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2.44
|
| Rate for Payer: United Healthcare HMO Rider |
$2.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.18
|
|
