|
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 |
$14.94 |
| Rate for Payer: Adventist Health Commercial |
$3.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.08
|
| 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 Exchange |
$8.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.66
|
| Rate for Payer: Blue Shield of California Commercial |
$10.52
|
| Rate for Payer: Blue Shield of California EPN |
$6.62
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Central Health Plan Commercial |
$13.28
|
| 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: Health Management Network EPO/PPO |
$14.94
|
| 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 |
$3.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.62
|
| Rate for Payer: Multiplan Commercial |
$12.45
|
| Rate for Payer: Networks By Design Commercial |
$10.79
|
| Rate for Payer: Prime Health Services Commercial |
$14.11
|
| Rate for Payer: Riverside University Health System MISP |
$6.64
|
| 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 |
$14.94 |
| Rate for Payer: Adventist Health Commercial |
$3.32
|
| Rate for Payer: Blue Shield of California Commercial |
$13.31
|
| Rate for Payer: Blue Shield of California EPN |
$8.37
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Central Health Plan Commercial |
$13.28
|
| 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: Health Management Network EPO/PPO |
$14.94
|
| 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 |
$3.32
|
| Rate for Payer: Multiplan Commercial |
$12.45
|
| 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
|
IP
|
$0.57
|
|
|
Service Code
|
NDC 9994080290
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Central Health Plan Commercial |
$0.46
|
| 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: Health Management Network EPO/PPO |
$0.51
|
| 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 |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.43
|
| Rate for Payer: Networks By Design Commercial |
$0.37
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
|
|
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 |
$0.51 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.35
|
| 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 Exchange |
$0.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.33
|
| Rate for Payer: Blue Shield of California Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Central Health Plan Commercial |
$0.46
|
| 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: Health Management Network EPO/PPO |
$0.51
|
| 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 |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$0.43
|
| Rate for Payer: Networks By Design Commercial |
$0.37
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
| Rate for Payer: Riverside University Health System MISP |
$0.23
|
| 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
|
|
|
LANTHANUM 1,000 MG CHEWABLE TABLET [43548]
|
Facility
|
IP
|
$6.67
|
|
|
Service Code
|
NDC 6818082110
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Adventist Health Commercial |
$1.33
|
| Rate for Payer: Blue Shield of California Commercial |
$5.35
|
| Rate for Payer: Blue Shield of California EPN |
$3.36
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Central Health Plan Commercial |
$5.34
|
| 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: Health Management Network EPO/PPO |
$6.00
|
| 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 |
$1.33
|
| Rate for Payer: Multiplan Commercial |
$5.00
|
| 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
|
|
|
LANTHANUM 1,000 MG CHEWABLE TABLET [43548]
|
Facility
|
OP
|
$12.95
|
|
|
Service Code
|
NDC 6699342475
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$11.65 |
| Rate for Payer: Adventist Health Commercial |
$2.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.53
|
| Rate for Payer: Blue Shield of California Commercial |
$8.21
|
| Rate for Payer: Blue Shield of California EPN |
$5.17
|
| Rate for Payer: Cash Price |
$5.83
|
| Rate for Payer: Central Health Plan Commercial |
$10.36
|
| Rate for Payer: Cigna of CA HMO |
$9.06
|
| Rate for Payer: Cigna of CA PPO |
$9.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.01
|
| 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: Health Management Network EPO/PPO |
$11.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.06
|
| Rate for Payer: Multiplan Commercial |
$9.71
|
| Rate for Payer: Networks By Design Commercial |
$6.47
|
| Rate for Payer: Prime Health Services Commercial |
$11.01
|
| Rate for Payer: Riverside University Health System MISP |
$5.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.77
|
| 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
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.01
|
| Rate for Payer: Vantage Medical Group Senior |
$11.01
|
|
|
LANTHANUM 1,000 MG CHEWABLE TABLET [43548]
|
Facility
|
OP
|
$12.95
|
|
|
Service Code
|
NDC 6699342485
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$11.65 |
| Rate for Payer: Adventist Health Commercial |
$2.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.53
|
| Rate for Payer: Blue Shield of California Commercial |
$8.21
|
| Rate for Payer: Blue Shield of California EPN |
$5.17
|
| Rate for Payer: Cash Price |
$5.83
|
| Rate for Payer: Central Health Plan Commercial |
$10.36
|
| Rate for Payer: Cigna of CA HMO |
$9.06
|
| Rate for Payer: Cigna of CA PPO |
$9.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.01
|
| 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: Health Management Network EPO/PPO |
$11.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.06
|
| Rate for Payer: Multiplan Commercial |
$9.71
|
| Rate for Payer: Networks By Design Commercial |
$6.47
|
| Rate for Payer: Prime Health Services Commercial |
$11.01
|
| Rate for Payer: Riverside University Health System MISP |
$5.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.77
|
| 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
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.01
|
| Rate for Payer: Vantage Medical Group Senior |
$11.01
|
|
|
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 |
$6.00 |
| Rate for Payer: Adventist Health Commercial |
$1.33
|
| Rate for Payer: Blue Shield of California Commercial |
$5.35
|
| Rate for Payer: Blue Shield of California EPN |
$3.36
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Central Health Plan Commercial |
$5.34
|
| 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: Health Management Network EPO/PPO |
$6.00
|
| 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 |
$1.33
|
| Rate for Payer: Multiplan Commercial |
$5.00
|
| 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
|
|
|
LANTHANUM 1,000 MG CHEWABLE TABLET [43548]
|
Facility
|
OP
|
$6.67
|
|
|
Service Code
|
NDC 6818082147
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Adventist Health Commercial |
$1.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.88
|
| Rate for Payer: Blue Shield of California Commercial |
$4.23
|
| Rate for Payer: Blue Shield of California EPN |
$2.66
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Central Health Plan Commercial |
$5.34
|
| Rate for Payer: Cigna of CA HMO |
$4.67
|
| Rate for Payer: Cigna of CA PPO |
$4.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.67
|
| 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: Health Management Network EPO/PPO |
$6.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.67
|
| Rate for Payer: Multiplan Commercial |
$5.00
|
| Rate for Payer: Networks By Design Commercial |
$3.33
|
| Rate for Payer: Prime Health Services Commercial |
$5.67
|
| Rate for Payer: Riverside University Health System MISP |
$2.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.00
|
| 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
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.67
|
| Rate for Payer: Vantage Medical Group Senior |
$5.67
|
|
|
LANTHANUM 1,000 MG CHEWABLE TABLET [43548]
|
Facility
|
OP
|
$6.67
|
|
|
Service Code
|
NDC 6818082110
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Adventist Health Commercial |
$1.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.88
|
| Rate for Payer: Blue Shield of California Commercial |
$4.23
|
| Rate for Payer: Blue Shield of California EPN |
$2.66
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Central Health Plan Commercial |
$5.34
|
| Rate for Payer: Cigna of CA HMO |
$4.67
|
| Rate for Payer: Cigna of CA PPO |
$4.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.67
|
| 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: Health Management Network EPO/PPO |
$6.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.67
|
| Rate for Payer: Multiplan Commercial |
$5.00
|
| Rate for Payer: Networks By Design Commercial |
$3.33
|
| Rate for Payer: Prime Health Services Commercial |
$5.67
|
| Rate for Payer: Riverside University Health System MISP |
$2.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.00
|
| 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
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.67
|
| Rate for Payer: Vantage Medical Group Senior |
$5.67
|
|
|
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 |
$11.65 |
| Rate for Payer: Adventist Health Commercial |
$2.59
|
| Rate for Payer: Blue Shield of California Commercial |
$10.39
|
| Rate for Payer: Blue Shield of California EPN |
$6.53
|
| Rate for Payer: Cash Price |
$5.83
|
| Rate for Payer: Central Health Plan Commercial |
$10.36
|
| 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: Health Management Network EPO/PPO |
$11.65
|
| 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 |
$2.59
|
| Rate for Payer: Multiplan Commercial |
$9.71
|
| 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 |
$11.65 |
| Rate for Payer: Adventist Health Commercial |
$2.59
|
| Rate for Payer: Blue Shield of California Commercial |
$10.39
|
| Rate for Payer: Blue Shield of California EPN |
$6.53
|
| Rate for Payer: Cash Price |
$5.83
|
| Rate for Payer: Central Health Plan Commercial |
$10.36
|
| 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: Health Management Network EPO/PPO |
$11.65
|
| 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 |
$2.59
|
| Rate for Payer: Multiplan Commercial |
$9.71
|
| 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 500 MG CHEWABLE TABLET [39975]
|
Facility
|
IP
|
$14.41
|
|
|
Service Code
|
NDC 5409225245
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$12.97 |
| Rate for Payer: Adventist Health Commercial |
$2.88
|
| Rate for Payer: Blue Shield of California Commercial |
$11.56
|
| Rate for Payer: Blue Shield of California EPN |
$7.26
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Central Health Plan Commercial |
$11.53
|
| Rate for Payer: Cigna of CA HMO |
$10.09
|
| Rate for Payer: Cigna of CA PPO |
$10.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Senior |
$5.76
|
| Rate for Payer: Galaxy Health WC |
$12.25
|
| Rate for Payer: Global Benefits Group Commercial |
$8.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$10.81
|
| Rate for Payer: Networks By Design Commercial |
$7.21
|
| Rate for Payer: Prime Health Services Commercial |
$12.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.41
|
| Rate for Payer: United Healthcare All Other HMO |
$5.26
|
| Rate for Payer: United Healthcare HMO Rider |
$5.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.72
|
|
|
LANTHANUM 500 MG CHEWABLE TABLET [39975]
|
Facility
|
OP
|
$14.41
|
|
|
Service Code
|
NDC 5409225245
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$12.97 |
| Rate for Payer: Adventist Health Commercial |
$2.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.38
|
| Rate for Payer: Blue Shield of California Commercial |
$9.14
|
| Rate for Payer: Blue Shield of California EPN |
$5.75
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Central Health Plan Commercial |
$11.53
|
| Rate for Payer: Cigna of CA HMO |
$10.09
|
| Rate for Payer: Cigna of CA PPO |
$10.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Senior |
$5.76
|
| Rate for Payer: Galaxy Health WC |
$12.25
|
| Rate for Payer: Global Benefits Group Commercial |
$8.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.09
|
| Rate for Payer: Multiplan Commercial |
$10.81
|
| Rate for Payer: Networks By Design Commercial |
$7.21
|
| Rate for Payer: Prime Health Services Commercial |
$12.25
|
| Rate for Payer: Riverside University Health System MISP |
$5.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.41
|
| Rate for Payer: United Healthcare All Other HMO |
$5.26
|
| Rate for Payer: United Healthcare HMO Rider |
$5.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.25
|
| Rate for Payer: Vantage Medical Group Senior |
$12.25
|
|
|
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC
|
Facility
|
IP
|
$44,521.22
|
|
|
Service Code
|
MSDRG 418
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$44,521.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$44,521.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28,758.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40,263.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$39,983.15
|
| Rate for Payer: EPIC Health Plan Senior |
$26,655.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,232.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,925.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32,471.16
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24,232.21
|
| Rate for Payer: Prime Health Services Medicare |
$25,686.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC
|
Facility
|
IP
|
$62,807.66
|
|
|
Service Code
|
MSDRG 417
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$62,807.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$62,807.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$40,571.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56,801.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$55,794.63
|
| Rate for Payer: EPIC Health Plan Senior |
$37,196.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33,814.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47,340.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$45,312.01
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$33,814.93
|
| Rate for Payer: Prime Health Services Medicare |
$35,843.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC
|
Facility
|
IP
|
$35,946.49
|
|
|
Service Code
|
MSDRG 419
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$35,946.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$35,946.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23,219.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32,508.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,568.97
|
| Rate for Payer: EPIC Health Plan Senior |
$21,712.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19,738.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27,634.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26,449.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$19,738.77
|
| Rate for Payer: Prime Health Services Medicare |
$20,923.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
LAPAROSCOPY, ABDOMEN, PERITONEUM, AND OMENTUM, DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 49320
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$80.69 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,775.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,553.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,775.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,811.52
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,553.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,775.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,829.67
|
| Rate for Payer: EPIC Health Plan Senior |
$8,553.12
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,751.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$80.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,775.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,885.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,419.25
|
| Rate for Payer: Multiplan WC |
$11,811.52
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,775.56
|
| Rate for Payer: Preferred Health Network WC |
$12,052.57
|
| Rate for Payer: Prime Health Services Medicare |
$8,242.09
|
| Rate for Payer: Prime Health Services WC |
$11,690.99
|
| Rate for Payer: Riverside University Health System MISP |
$8,553.12
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,775.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,553.12
|
| Rate for Payer: Vantage Medical Group Senior |
$7,775.56
|
|
|
LAPAROSCOPY, SURGICAL, APPENDECTOMY
|
Facility
|
OP
|
$28,817.00
|
|
|
Service Code
|
CPT 44970
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$94.14 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,775.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,553.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,775.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,811.52
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,553.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,775.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,829.67
|
| Rate for Payer: EPIC Health Plan Senior |
$8,553.12
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,751.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$94.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,775.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$103.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,885.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,419.25
|
| Rate for Payer: Multiplan WC |
$11,811.52
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,775.56
|
| Rate for Payer: Preferred Health Network WC |
$12,052.57
|
| Rate for Payer: Prime Health Services Medicare |
$8,242.09
|
| Rate for Payer: Prime Health Services WC |
$11,690.99
|
| Rate for Payer: Riverside University Health System MISP |
$8,553.12
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,775.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,553.12
|
| Rate for Payer: Vantage Medical Group Senior |
$7,775.56
|
|
|
LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY
|
Facility
|
OP
|
$28,817.00
|
|
|
Service Code
|
CPT 47562
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$801.73 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,775.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,553.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,775.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,933.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,811.52
|
| Rate for Payer: Blue Shield of California Commercial |
$9,831.25
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,553.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,775.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,829.67
|
| Rate for Payer: EPIC Health Plan Senior |
$8,553.12
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,751.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$801.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,775.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$885.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,885.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,419.25
|
| Rate for Payer: Multiplan WC |
$11,811.52
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,775.56
|
| Rate for Payer: Preferred Health Network WC |
$12,052.57
|
| Rate for Payer: Prime Health Services Medicare |
$8,242.09
|
| Rate for Payer: Prime Health Services WC |
$11,690.99
|
| Rate for Payer: Riverside University Health System MISP |
$8,553.12
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,775.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,553.12
|
| Rate for Payer: Vantage Medical Group Senior |
$7,775.56
|
|
|
LAPAROSCOPY, SURGICAL, COLPOPEXY (SUSPENSION OF VAGINAL APEX)
|
Facility
|
OP
|
$28,817.00
|
|
|
Service Code
|
CPT 57425
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$176.04 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,671.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,507.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,038.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,671.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,138.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$21,077.25
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,507.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,038.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,671.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,558.37
|
| Rate for Payer: EPIC Health Plan Senior |
$15,038.91
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22,421.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$176.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,671.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$194.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19,140.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18,320.13
|
| Rate for Payer: Multiplan WC |
$21,077.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13,671.74
|
| Rate for Payer: Preferred Health Network WC |
$21,507.40
|
| Rate for Payer: Prime Health Services Medicare |
$14,492.04
|
| Rate for Payer: Prime Health Services WC |
$20,862.18
|
| Rate for Payer: Riverside University Health System MISP |
$15,038.91
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$13,671.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,507.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,038.91
|
| Rate for Payer: Vantage Medical Group Senior |
$13,671.74
|
|
|
LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCEDURE; REMOVAL OF ADJUSTABLE GASTRIC RESTRICTIVE DEVICE AND SUBCUTANEOUS PORT COMPONENTS
|
Facility
|
OP
|
$50,447.00
|
|
|
Service Code
|
CPT 43774
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,217.31 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Upland Medical Group Pediatric |
$4,958.78
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,958.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,958.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,702.17
|
| Rate for Payer: Blue Shield of California Commercial |
$6,228.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,454.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,958.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,181.99
|
| Rate for Payer: EPIC Health Plan Senior |
$5,454.66
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8,132.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,217.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,958.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,344.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,942.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,644.77
|
| Rate for Payer: Multiplan WC |
$7,702.17
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,958.78
|
| Rate for Payer: Preferred Health Network WC |
$7,859.36
|
| Rate for Payer: Prime Health Services Medicare |
$5,256.31
|
| Rate for Payer: Prime Health Services WC |
$7,623.58
|
| Rate for Payer: Riverside University Health System MISP |
$5,454.66
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Vantage Medical Group Senior |
$4,958.78
|
|
|
LAPAROSCOPY, SURGICAL; NEPHRECTOMY WITH TOTAL URETERECTOMY
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 50548
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,494.59 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,138.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,494.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,651.01
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
|
|
LAPAROSCOPY, SURGICAL; PARTIAL NEPHRECTOMY
|
Facility
|
OP
|
$28,817.00
|
|
|
Service Code
|
CPT 50543
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$220.28 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,671.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,507.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,038.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,671.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,687.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$21,077.25
|
| Rate for Payer: Blue Shield of California Commercial |
$9,831.25
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,507.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,038.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,671.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,558.37
|
| Rate for Payer: EPIC Health Plan Senior |
$15,038.91
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22,421.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$220.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,671.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$243.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19,140.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18,320.13
|
| Rate for Payer: Multiplan WC |
$21,077.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13,671.74
|
| Rate for Payer: Preferred Health Network WC |
$21,507.40
|
| Rate for Payer: Prime Health Services Medicare |
$14,492.04
|
| Rate for Payer: Prime Health Services WC |
$20,862.18
|
| Rate for Payer: Riverside University Health System MISP |
$15,038.91
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$13,671.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,507.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,038.91
|
| Rate for Payer: Vantage Medical Group Senior |
$13,671.74
|
|
|
LAPAROSCOPY, SURGICAL PROSTATECTOMY, RETROPUBIC RADICAL, INCLUDING NERVE SPARING, INCLUDES ROBOTIC ASSISTANCE, WHEN PERFORMED;
|
Facility
|
OP
|
$50,447.00
|
|
|
Service Code
|
CPT 55866
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,639.31 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,671.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,507.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,038.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,671.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,687.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$21,077.25
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,507.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,038.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,671.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,558.37
|
| Rate for Payer: EPIC Health Plan Senior |
$15,038.91
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22,421.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,639.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,671.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,810.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19,140.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18,320.13
|
| Rate for Payer: Multiplan WC |
$21,077.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13,671.74
|
| Rate for Payer: Preferred Health Network WC |
$21,507.40
|
| Rate for Payer: Prime Health Services Medicare |
$14,492.04
|
| Rate for Payer: Prime Health Services WC |
$20,862.18
|
| Rate for Payer: Riverside University Health System MISP |
$15,038.91
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$13,671.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,507.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,038.91
|
| Rate for Payer: Vantage Medical Group Senior |
$13,671.74
|
|
