|
LIPASE-PROTEASE-AMYLASE 12,000-38,000-60,000 UNIT CAPSULE,DELAYED REL [98035]
|
Facility
OP
|
$4.75
|
|
|
Service Code
|
NDC 0032-1212-07
|
| Hospital Charge Code |
1712413
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$4.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.83
|
| Rate for Payer: BCBS Transplant Transplant |
$2.85
|
| Rate for Payer: Blue Shield of California Commercial |
$3.50
|
| Rate for Payer: Blue Shield of California EPN |
$2.77
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cigna of CA HMO |
$3.32
|
| Rate for Payer: Cigna of CA PPO |
$3.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.04
|
| Rate for Payer: Dignity Health Media |
$4.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.90
|
| Rate for Payer: Galaxy Health WC |
$4.04
|
| Rate for Payer: Global Benefits Group Commercial |
$2.85
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.14
|
| Rate for Payer: Multiplan Commercial |
$3.80
|
| Rate for Payer: Networks By Design Commercial |
$3.09
|
| Rate for Payer: Prime Health Services Commercial |
$4.04
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.38
|
| Rate for Payer: United Healthcare All Other HMO |
$2.38
|
| Rate for Payer: United Healthcare HMO Rider |
$2.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Vantage Medical Group Senior |
$4.04
|
|
|
LIPASE-PROTEASE-AMYLASE 20,880-78,300-78,300 UNIT TABLET [196333]
|
Facility
OP
|
$9.14
|
|
|
Service Code
|
NDC 73562-208-10
|
| Hospital Charge Code |
1712582
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$7.77 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.45
|
| Rate for Payer: BCBS Transplant Transplant |
$5.48
|
| Rate for Payer: Blue Shield of California Commercial |
$6.74
|
| Rate for Payer: Blue Shield of California EPN |
$5.34
|
| Rate for Payer: Cash Price |
$4.11
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Cigna of CA PPO |
$6.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Media |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.66
|
| Rate for Payer: Galaxy Health WC |
$7.77
|
| Rate for Payer: Global Benefits Group Commercial |
$5.48
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.19
|
| Rate for Payer: Multiplan Commercial |
$7.31
|
| Rate for Payer: Networks By Design Commercial |
$5.94
|
| Rate for Payer: Prime Health Services Commercial |
$7.77
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.57
|
| Rate for Payer: United Healthcare All Other HMO |
$4.57
|
| Rate for Payer: United Healthcare HMO Rider |
$4.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.77
|
| Rate for Payer: Vantage Medical Group Senior |
$7.77
|
|
|
LIPASE-PROTEASE-AMYLASE 20,880-78,300-78,300 UNIT TABLET [196333]
|
Facility
IP
|
$9.14
|
|
|
Service Code
|
NDC 73562-208-10
|
| Hospital Charge Code |
1712582
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$7.77 |
| Rate for Payer: Blue Shield of California Commercial |
$6.51
|
| Rate for Payer: Blue Shield of California EPN |
$4.68
|
| Rate for Payer: Cash Price |
$4.11
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Cigna of CA PPO |
$6.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.66
|
| Rate for Payer: Galaxy Health WC |
$7.77
|
| Rate for Payer: Global Benefits Group Commercial |
$5.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.19
|
| Rate for Payer: Multiplan Commercial |
$7.31
|
| Rate for Payer: Networks By Design Commercial |
$5.94
|
| Rate for Payer: Prime Health Services Commercial |
$7.77
|
|
|
LIPASE-PROTEASE-AMYLASE 24,000-76,000-120,000 UNIT CAPSULE,DELAYED REL [98036]
|
Facility
OP
|
$9.41
|
|
|
Service Code
|
NDC 0032-1224-01
|
| Hospital Charge Code |
1712414
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.61
|
| Rate for Payer: BCBS Transplant Transplant |
$5.65
|
| Rate for Payer: Blue Shield of California Commercial |
$6.94
|
| Rate for Payer: Blue Shield of California EPN |
$5.50
|
| Rate for Payer: Cash Price |
$4.23
|
| Rate for Payer: Cigna of CA HMO |
$6.59
|
| Rate for Payer: Cigna of CA PPO |
$6.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.00
|
| Rate for Payer: Dignity Health Media |
$8.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.76
|
| Rate for Payer: Galaxy Health WC |
$8.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5.65
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.26
|
| Rate for Payer: Multiplan Commercial |
$7.53
|
| Rate for Payer: Networks By Design Commercial |
$6.12
|
| Rate for Payer: Prime Health Services Commercial |
$8.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.70
|
| Rate for Payer: United Healthcare All Other HMO |
$4.70
|
| Rate for Payer: United Healthcare HMO Rider |
$4.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.00
|
| Rate for Payer: Vantage Medical Group Senior |
$8.00
|
|
|
LIPASE-PROTEASE-AMYLASE 24,000-76,000-120,000 UNIT CAPSULE,DELAYED REL [98036]
|
Facility
OP
|
$9.26
|
|
|
Service Code
|
NDC 0032-1224-07
|
| Hospital Charge Code |
1712414
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$7.87 |
| Rate for Payer: BCBS Transplant Transplant |
$5.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.87
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.52
|
| Rate for Payer: Blue Shield of California Commercial |
$6.82
|
| Rate for Payer: Blue Shield of California EPN |
$5.41
|
| Rate for Payer: Cash Price |
$4.17
|
| Rate for Payer: Cigna of CA HMO |
$6.48
|
| Rate for Payer: Cigna of CA PPO |
$6.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.87
|
| Rate for Payer: Dignity Health Media |
$7.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.70
|
| Rate for Payer: Galaxy Health WC |
$7.87
|
| Rate for Payer: Global Benefits Group Commercial |
$5.56
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.22
|
| Rate for Payer: Multiplan Commercial |
$7.41
|
| Rate for Payer: Networks By Design Commercial |
$6.02
|
| Rate for Payer: Prime Health Services Commercial |
$7.87
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.63
|
| Rate for Payer: United Healthcare All Other HMO |
$4.63
|
| Rate for Payer: United Healthcare HMO Rider |
$4.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.87
|
| Rate for Payer: Vantage Medical Group Senior |
$7.87
|
|
|
LIPASE-PROTEASE-AMYLASE 24,000-76,000-120,000 UNIT CAPSULE,DELAYED REL [98036]
|
Facility
IP
|
$9.41
|
|
|
Service Code
|
NDC 0032-1224-01
|
| Hospital Charge Code |
1712414
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Blue Shield of California Commercial |
$6.70
|
| Rate for Payer: Blue Shield of California EPN |
$4.82
|
| Rate for Payer: Cash Price |
$4.23
|
| Rate for Payer: Cigna of CA HMO |
$6.59
|
| Rate for Payer: Cigna of CA PPO |
$6.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.76
|
| Rate for Payer: Galaxy Health WC |
$8.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.26
|
| Rate for Payer: Multiplan Commercial |
$7.53
|
| Rate for Payer: Networks By Design Commercial |
$6.12
|
| Rate for Payer: Prime Health Services Commercial |
$8.00
|
|
|
LIPASE-PROTEASE-AMYLASE 24,000-76,000-120,000 UNIT CAPSULE,DELAYED REL [98036]
|
Facility
IP
|
$9.26
|
|
|
Service Code
|
NDC 0032-1224-07
|
| Hospital Charge Code |
1712414
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$7.87 |
| Rate for Payer: Blue Shield of California Commercial |
$6.59
|
| Rate for Payer: Blue Shield of California EPN |
$4.74
|
| Rate for Payer: Cash Price |
$4.17
|
| Rate for Payer: Cigna of CA HMO |
$6.48
|
| Rate for Payer: Cigna of CA PPO |
$6.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.70
|
| Rate for Payer: Galaxy Health WC |
$7.87
|
| Rate for Payer: Global Benefits Group Commercial |
$5.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.22
|
| Rate for Payer: Multiplan Commercial |
$7.41
|
| Rate for Payer: Networks By Design Commercial |
$6.02
|
| Rate for Payer: Prime Health Services Commercial |
$7.87
|
|
|
LIPASE-PROTEASE-AMYLASE 3,000-9,500-15,000 UNIT CAPSULE, DELAYED REL [187996]
|
Facility
OP
|
$2.01
|
|
|
Service Code
|
NDC 0032-1203-70
|
| Hospital Charge Code |
1712583
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.71 |
| Rate for Payer: Galaxy Health WC |
$1.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.71
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.20
|
| Rate for Payer: BCBS Transplant Transplant |
$1.21
|
| Rate for Payer: Blue Shield of California Commercial |
$1.48
|
| Rate for Payer: Blue Shield of California EPN |
$1.17
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO |
$1.41
|
| Rate for Payer: Cigna of CA PPO |
$1.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.71
|
| Rate for Payer: Dignity Health Media |
$1.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1.21
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.61
|
| Rate for Payer: Networks By Design Commercial |
$1.31
|
| Rate for Payer: Prime Health Services Commercial |
$1.71
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1.71
|
|
|
LIPASE-PROTEASE-AMYLASE 3,000-9,500-15,000 UNIT CAPSULE, DELAYED REL [187996]
|
Facility
IP
|
$2.01
|
|
|
Service Code
|
NDC 0032-1203-70
|
| Hospital Charge Code |
1712583
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.71 |
| Rate for Payer: Blue Shield of California Commercial |
$1.43
|
| Rate for Payer: Blue Shield of California EPN |
$1.03
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO |
$1.41
|
| Rate for Payer: Cigna of CA PPO |
$1.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.71
|
| Rate for Payer: Global Benefits Group Commercial |
$1.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.61
|
| Rate for Payer: Networks By Design Commercial |
$1.31
|
| Rate for Payer: Prime Health Services Commercial |
$1.71
|
|
|
LIPASE-PROTEASE-AMYLASE 36,000-114,000-180,000 UNIT CAPSULE,DELAY REL [201958]
|
Facility
OP
|
$14.28
|
|
|
Service Code
|
NDC 0032-3016-28
|
| Hospital Charge Code |
ERX201958
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$12.14 |
| Rate for Payer: Blue Shield of California EPN |
$8.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.51
|
| Rate for Payer: BCBS Transplant Transplant |
$8.57
|
| Rate for Payer: Blue Shield of California Commercial |
$10.52
|
| Rate for Payer: Cash Price |
$6.43
|
| Rate for Payer: Cigna of CA HMO |
$10.00
|
| Rate for Payer: Cigna of CA PPO |
$10.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.14
|
| Rate for Payer: Dignity Health Media |
$12.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.71
|
| Rate for Payer: Galaxy Health WC |
$12.14
|
| Rate for Payer: Global Benefits Group Commercial |
$8.57
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.43
|
| Rate for Payer: Multiplan Commercial |
$11.42
|
| Rate for Payer: Networks By Design Commercial |
$9.28
|
| Rate for Payer: Prime Health Services Commercial |
$12.14
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.14
|
| Rate for Payer: United Healthcare All Other HMO |
$7.14
|
| Rate for Payer: United Healthcare HMO Rider |
$7.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.14
|
| Rate for Payer: Vantage Medical Group Senior |
$12.14
|
|
|
LIPASE-PROTEASE-AMYLASE 36,000-114,000-180,000 UNIT CAPSULE,DELAY REL [201958]
|
Facility
IP
|
$14.28
|
|
|
Service Code
|
NDC 0032-3016-28
|
| Hospital Charge Code |
ERX201958
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$12.14 |
| Rate for Payer: Blue Shield of California Commercial |
$10.17
|
| Rate for Payer: Blue Shield of California EPN |
$7.31
|
| Rate for Payer: Cash Price |
$6.43
|
| Rate for Payer: Cigna of CA HMO |
$10.00
|
| Rate for Payer: Cigna of CA PPO |
$10.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.71
|
| Rate for Payer: Galaxy Health WC |
$12.14
|
| Rate for Payer: Global Benefits Group Commercial |
$8.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.43
|
| Rate for Payer: Multiplan Commercial |
$11.42
|
| Rate for Payer: Networks By Design Commercial |
$9.28
|
| Rate for Payer: Prime Health Services Commercial |
$12.14
|
|
|
LIPASE-PROTEASE-AMYLASE 6,000-19,000-30,000 UNIT CAPSULE,DELAYED REL [98034]
|
Facility
IP
|
$2.38
|
|
|
Service Code
|
NDC 0032-1206-01
|
| Hospital Charge Code |
1712412
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.02 |
| Rate for Payer: Blue Shield of California Commercial |
$1.69
|
| Rate for Payer: Blue Shield of California EPN |
$1.22
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: Cigna of CA HMO |
$1.67
|
| Rate for Payer: Cigna of CA PPO |
$1.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.95
|
| Rate for Payer: Galaxy Health WC |
$2.02
|
| Rate for Payer: Global Benefits Group Commercial |
$1.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$1.90
|
| Rate for Payer: Networks By Design Commercial |
$1.55
|
| Rate for Payer: Prime Health Services Commercial |
$2.02
|
|
|
LIPASE-PROTEASE-AMYLASE 6,000-19,000-30,000 UNIT CAPSULE,DELAYED REL [98034]
|
Facility
OP
|
$2.38
|
|
|
Service Code
|
NDC 0032-1206-07
|
| Hospital Charge Code |
1712412
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.42
|
| Rate for Payer: BCBS Transplant Transplant |
$1.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1.75
|
| Rate for Payer: Blue Shield of California EPN |
$1.39
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: Cigna of CA HMO |
$1.67
|
| Rate for Payer: Cigna of CA PPO |
$1.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.02
|
| Rate for Payer: Dignity Health Media |
$2.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.95
|
| Rate for Payer: Galaxy Health WC |
$2.02
|
| Rate for Payer: Global Benefits Group Commercial |
$1.43
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$1.90
|
| Rate for Payer: Networks By Design Commercial |
$1.55
|
| Rate for Payer: Prime Health Services Commercial |
$2.02
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.19
|
| Rate for Payer: United Healthcare All Other HMO |
$1.19
|
| Rate for Payer: United Healthcare HMO Rider |
$1.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.02
|
| Rate for Payer: Vantage Medical Group Senior |
$2.02
|
|
|
LIPASE-PROTEASE-AMYLASE 6,000-19,000-30,000 UNIT CAPSULE,DELAYED REL [98034]
|
Facility
IP
|
$2.38
|
|
|
Service Code
|
NDC 0032-1206-07
|
| Hospital Charge Code |
1712412
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.02 |
| Rate for Payer: Blue Shield of California Commercial |
$1.69
|
| Rate for Payer: Blue Shield of California EPN |
$1.22
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: Cigna of CA HMO |
$1.67
|
| Rate for Payer: Cigna of CA PPO |
$1.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.95
|
| Rate for Payer: Galaxy Health WC |
$2.02
|
| Rate for Payer: Global Benefits Group Commercial |
$1.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$1.90
|
| Rate for Payer: Networks By Design Commercial |
$1.55
|
| Rate for Payer: Prime Health Services Commercial |
$2.02
|
|
|
LIPASE-PROTEASE-AMYLASE 6,000-19,000-30,000 UNIT CAPSULE,DELAYED REL [98034]
|
Facility
OP
|
$2.38
|
|
|
Service Code
|
NDC 0032-1206-01
|
| Hospital Charge Code |
1712412
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.02 |
| Rate for Payer: Galaxy Health WC |
$2.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.42
|
| Rate for Payer: BCBS Transplant Transplant |
$1.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1.75
|
| Rate for Payer: Blue Shield of California EPN |
$1.39
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: Cigna of CA HMO |
$1.67
|
| Rate for Payer: Cigna of CA PPO |
$1.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.02
|
| Rate for Payer: Dignity Health Media |
$2.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1.43
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$1.90
|
| Rate for Payer: Networks By Design Commercial |
$1.55
|
| Rate for Payer: Prime Health Services Commercial |
$2.02
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.19
|
| Rate for Payer: United Healthcare All Other HMO |
$1.19
|
| Rate for Payer: United Healthcare HMO Rider |
$1.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.02
|
| Rate for Payer: Vantage Medical Group Senior |
$2.02
|
|
|
LIRAGLUTIDE 0.6 MG/0.1 ML (18 MG/3 ML) SUBCUTANEOUS PEN INJECTOR [100803]
|
Facility
OP
|
$148.91
|
|
|
Service Code
|
NDC 0169-4060-12
|
| Hospital Charge Code |
NDG100803
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.74 |
| Max. Negotiated Rate |
$126.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$97.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$126.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$81.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$81.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.72
|
| Rate for Payer: BCBS Transplant Transplant |
$89.35
|
| Rate for Payer: Blue Shield of California Commercial |
$109.75
|
| Rate for Payer: Blue Shield of California EPN |
$86.96
|
| Rate for Payer: Cash Price |
$67.01
|
| Rate for Payer: Cigna of CA HMO |
$104.24
|
| Rate for Payer: Cigna of CA PPO |
$104.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$126.57
|
| Rate for Payer: Dignity Health Media |
$126.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$126.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.56
|
| Rate for Payer: Galaxy Health WC |
$126.57
|
| Rate for Payer: Global Benefits Group Commercial |
$89.35
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$111.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.74
|
| Rate for Payer: Multiplan Commercial |
$119.13
|
| Rate for Payer: Networks By Design Commercial |
$96.79
|
| Rate for Payer: Prime Health Services Commercial |
$126.57
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$89.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$89.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$89.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.46
|
| Rate for Payer: United Healthcare All Other HMO |
$74.46
|
| Rate for Payer: United Healthcare HMO Rider |
$74.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$74.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$126.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$126.57
|
| Rate for Payer: Vantage Medical Group Senior |
$126.57
|
|
|
LIRAGLUTIDE 0.6 MG/0.1 ML (18 MG/3 ML) SUBCUTANEOUS PEN INJECTOR [100803]
|
Facility
IP
|
$148.91
|
|
|
Service Code
|
NDC 0169-4060-12
|
| Hospital Charge Code |
NDG100803
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.74 |
| Max. Negotiated Rate |
$126.57 |
| Rate for Payer: Blue Shield of California Commercial |
$106.02
|
| Rate for Payer: Blue Shield of California EPN |
$76.24
|
| Rate for Payer: Cash Price |
$67.01
|
| Rate for Payer: Cigna of CA HMO |
$104.24
|
| Rate for Payer: Cigna of CA PPO |
$104.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.56
|
| Rate for Payer: Galaxy Health WC |
$126.57
|
| Rate for Payer: Global Benefits Group Commercial |
$89.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.74
|
| Rate for Payer: Multiplan Commercial |
$119.13
|
| Rate for Payer: Networks By Design Commercial |
$96.79
|
| Rate for Payer: Prime Health Services Commercial |
$126.57
|
|
|
LISINOPRIL 10 MG TABLET [10449]
|
Facility
OP
|
$0.05
|
|
|
Service Code
|
NDC 68001-334-00
|
| Hospital Charge Code |
1712062
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: BCBS Transplant Transplant |
$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 |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.04
|
| Rate for Payer: Dignity Health Media |
$0.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.04
|
|
|
LISINOPRIL 10 MG TABLET [10449]
|
Facility
IP
|
$0.05
|
|
|
Service Code
|
NDC 68001-334-00
|
| Hospital Charge Code |
1712062
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| 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 |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
|
|
LISSAMINE GREEN 1.5 MG EYE STRIPS [77167]
|
Facility
IP
|
$0.24
|
|
|
Service Code
|
NDC 17238-920-11
|
| Hospital Charge Code |
ERX77167
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Blue Shield of California Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
|
|
LISSAMINE GREEN 1.5 MG EYE STRIPS [77167]
|
Facility
IP
|
$0.24
|
|
|
Service Code
|
NDC 17238-920-98
|
| Hospital Charge Code |
ERX77167
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Blue Shield of California Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
|
|
LISSAMINE GREEN 1.5 MG EYE STRIPS [77167]
|
Facility
OP
|
$0.24
|
|
|
Service Code
|
NDC 17238-920-11
|
| Hospital Charge Code |
ERX77167
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
| Rate for Payer: BCBS Transplant Transplant |
$0.14
|
| 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 |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Media |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO |
$0.12
|
| Rate for Payer: United Healthcare HMO Rider |
$0.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
LISSAMINE GREEN 1.5 MG EYE STRIPS [77167]
|
Facility
OP
|
$0.24
|
|
|
Service Code
|
NDC 17238-920-98
|
| Hospital Charge Code |
ERX77167
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
| Rate for Payer: BCBS Transplant Transplant |
$0.14
|
| 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 |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Media |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO |
$0.12
|
| Rate for Payer: United Healthcare HMO Rider |
$0.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
LITHIUM CARBONATE 150 MG CAPSULE [4528]
|
Facility
IP
|
$0.18
|
|
|
Service Code
|
NDC 0054-8526-25
|
| Hospital Charge Code |
1711740
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
|
|
LITHIUM CARBONATE 150 MG CAPSULE [4528]
|
Facility
OP
|
$0.18
|
|
|
Service Code
|
NDC 0054-8526-25
|
| Hospital Charge Code |
1711740
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.11
|
| Rate for Payer: BCBS Transplant Transplant |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.15
|
| Rate for Payer: Dignity Health Media |
$0.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Vantage Medical Group Senior |
$0.15
|
|
