|
LANTHANUM 1,000 MG CHEWABLE TABLET [43548]
|
Facility
|
IP
|
$12.95
|
|
|
Service Code
|
NDC 66993-424-75
|
| 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 |
$10.01
|
| Rate for Payer: Blue Shield of California EPN |
$6.53
|
| Rate for Payer: Cash Price |
$7.12
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$8.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.02
|
| 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
|
$6.67
|
|
|
Service Code
|
NDC 68180-821-47
|
| 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 |
$5.16
|
| Rate for Payer: Blue Shield of California EPN |
$3.36
|
| Rate for Payer: Cash Price |
$3.67
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$4.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.13
|
| 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 68180-821-47
|
| 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 |
$3.92
|
| Rate for Payer: Blue Shield of California Commercial |
$4.08
|
| Rate for Payer: Blue Shield of California EPN |
$2.66
|
| Rate for Payer: Cash Price |
$3.67
|
| 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: 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: InnovAge PACE Commercial |
$3.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.67
|
| Rate for Payer: Molina Healthcare of CA 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
|
$6.67
|
|
|
Service Code
|
NDC 68180-821-10
|
| 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 |
$5.16
|
| Rate for Payer: Blue Shield of California EPN |
$3.36
|
| Rate for Payer: Cash Price |
$3.67
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$4.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.13
|
| 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
|
IP
|
$12.95
|
|
|
Service Code
|
NDC 66993-424-85
|
| 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 |
$10.01
|
| Rate for Payer: Blue Shield of California EPN |
$6.53
|
| Rate for Payer: Cash Price |
$7.12
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$8.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.02
|
| 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
|
OP
|
$6.67
|
|
|
Service Code
|
NDC 68180-821-10
|
| 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 |
$3.92
|
| Rate for Payer: Blue Shield of California Commercial |
$4.08
|
| Rate for Payer: Blue Shield of California EPN |
$2.66
|
| Rate for Payer: Cash Price |
$3.67
|
| 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: 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: InnovAge PACE Commercial |
$3.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.67
|
| Rate for Payer: Molina Healthcare of CA 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 500 MG CHEWABLE TABLET [39975]
|
Facility
|
IP
|
$14.41
|
|
|
Service Code
|
NDC 54092-252-45
|
| 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 |
$11.14
|
| Rate for Payer: Blue Shield of California EPN |
$7.26
|
| Rate for Payer: Cash Price |
$7.92
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$9.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.92
|
| 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 54092-252-45
|
| 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 |
$8.46
|
| Rate for Payer: Blue Shield of California Commercial |
$8.80
|
| Rate for Payer: Blue Shield of California EPN |
$5.75
|
| Rate for Payer: Cash Price |
$7.92
|
| 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: 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: InnovAge PACE Commercial |
$7.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.09
|
| Rate for Payer: Molina Healthcare of CA 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
|
|
|
LARONIDASE 2.9 MG/5 ML INTRAVENOUS SOLUTION [35779]
|
Facility
|
IP
|
$267.21
|
|
|
Service Code
|
HCPCS J1931
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.44 |
| Max. Negotiated Rate |
$240.49 |
| Rate for Payer: Adventist Health Commercial |
$53.44
|
| Rate for Payer: Blue Shield of California Commercial |
$206.55
|
| Rate for Payer: Blue Shield of California EPN |
$134.67
|
| Rate for Payer: Cash Price |
$146.97
|
| Rate for Payer: Central Health Plan Commercial |
$213.77
|
| Rate for Payer: Cigna of CA HMO |
$187.05
|
| Rate for Payer: Cigna of CA PPO |
$187.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.88
|
| Rate for Payer: EPIC Health Plan Senior |
$106.88
|
| Rate for Payer: Galaxy Health WC |
$227.13
|
| Rate for Payer: Global Benefits Group Commercial |
$160.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$240.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.44
|
| Rate for Payer: Multiplan Commercial |
$200.41
|
| Rate for Payer: Networks By Design Commercial |
$133.60
|
| Rate for Payer: Prime Health Services Commercial |
$227.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.28
|
| Rate for Payer: United Healthcare All Other HMO |
$97.61
|
| Rate for Payer: United Healthcare HMO Rider |
$95.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$87.51
|
|
|
LARONIDASE 2.9 MG/5 ML INTRAVENOUS SOLUTION [35779]
|
Facility
|
OP
|
$267.21
|
|
|
Service Code
|
HCPCS J1931
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.91 |
| Max. Negotiated Rate |
$240.49 |
| Rate for Payer: Adventist Health Commercial |
$53.44
|
| Rate for Payer: Adventist Health Medi-Cal |
$39.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$162.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$49.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$43.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$84.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.91
|
| Rate for Payer: Blue Shield of California Commercial |
$48.73
|
| Rate for Payer: Blue Shield of California EPN |
$44.30
|
| Rate for Payer: Cash Price |
$146.97
|
| Rate for Payer: Cash Price |
$146.97
|
| Rate for Payer: Central Health Plan Commercial |
$213.77
|
| Rate for Payer: Cigna of CA HMO |
$187.05
|
| Rate for Payer: Cigna of CA PPO |
$187.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$49.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$43.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.84
|
| Rate for Payer: EPIC Health Plan Senior |
$39.88
|
| Rate for Payer: Galaxy Health WC |
$227.13
|
| Rate for Payer: Global Benefits Group Commercial |
$160.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$240.49
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$65.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$38.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$39.88
|
| Rate for Payer: InnovAge PACE Commercial |
$59.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.44
|
| Rate for Payer: Multiplan Commercial |
$200.41
|
| Rate for Payer: Networks By Design Commercial |
$133.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$39.88
|
| Rate for Payer: Prime Health Services Commercial |
$227.13
|
| Rate for Payer: Prime Health Services Medicare |
$42.27
|
| Rate for Payer: Riverside University Health System MISP |
$43.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.28
|
| Rate for Payer: United Healthcare All Other HMO |
$97.61
|
| Rate for Payer: United Healthcare HMO Rider |
$95.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$87.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$39.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$49.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.87
|
| Rate for Payer: Vantage Medical Group Senior |
$43.87
|
|
|
LATANOPROST 0.005 % EYE DROPS [18621]
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
NDC 59762-0333-2
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California Commercial |
$0.93
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Central Health Plan Commercial |
$0.96
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Senior |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: Networks By Design Commercial |
$0.78
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
|
|
LATANOPROST 0.005 % EYE DROPS [18621]
|
Facility
|
OP
|
$8.64
|
|
|
Service Code
|
NDC 24208-463-25
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$7.78 |
| Rate for Payer: Adventist Health Commercial |
$1.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.07
|
| Rate for Payer: Blue Shield of California Commercial |
$5.28
|
| Rate for Payer: Blue Shield of California EPN |
$3.45
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Central Health Plan Commercial |
$6.91
|
| Rate for Payer: Cigna of CA HMO |
$6.05
|
| Rate for Payer: Cigna of CA PPO |
$6.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.46
|
| Rate for Payer: EPIC Health Plan Senior |
$3.46
|
| Rate for Payer: Galaxy Health WC |
$7.34
|
| Rate for Payer: Global Benefits Group Commercial |
$5.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.78
|
| Rate for Payer: InnovAge PACE Commercial |
$4.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.05
|
| Rate for Payer: Multiplan Commercial |
$6.48
|
| Rate for Payer: Networks By Design Commercial |
$5.62
|
| Rate for Payer: Prime Health Services Commercial |
$7.34
|
| Rate for Payer: Riverside University Health System MISP |
$3.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.32
|
| Rate for Payer: United Healthcare All Other HMO |
$4.32
|
| Rate for Payer: United Healthcare HMO Rider |
$4.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.34
|
| Rate for Payer: Vantage Medical Group Senior |
$7.34
|
|
|
LATANOPROST 0.005 % EYE DROPS [18621]
|
Facility
|
OP
|
$2.38
|
|
|
Service Code
|
NDC 70069-421-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.14 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.95
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Central Health Plan Commercial |
$1.90
|
| 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 Medi-Cal |
$2.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.95
|
| Rate for Payer: EPIC Health Plan Senior |
$0.95
|
| Rate for Payer: Galaxy Health WC |
$2.02
|
| Rate for Payer: Global Benefits Group Commercial |
$1.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.14
|
| Rate for Payer: InnovAge PACE Commercial |
$1.19
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$1.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.67
|
| Rate for Payer: Multiplan Commercial |
$1.78
|
| Rate for Payer: Networks By Design Commercial |
$1.55
|
| Rate for Payer: Prime Health Services Commercial |
$2.02
|
| Rate for Payer: Riverside University Health System MISP |
$0.95
|
| 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
|
|
|
LATANOPROST 0.005 % EYE DROPS [18621]
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
NDC 59762-0333-2
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.70
|
| Rate for Payer: Blue Shield of California Commercial |
$0.73
|
| Rate for Payer: Blue Shield of California EPN |
$0.48
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Central Health Plan Commercial |
$0.96
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Senior |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.08
|
| Rate for Payer: InnovAge PACE Commercial |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.84
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: Networks By Design Commercial |
$0.78
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
| Rate for Payer: Riverside University Health System MISP |
$0.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.60
|
| Rate for Payer: United Healthcare All Other HMO |
$0.60
|
| Rate for Payer: United Healthcare HMO Rider |
$0.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: Vantage Medical Group Senior |
$1.02
|
|
|
LATANOPROST 0.005 % EYE DROPS [18621]
|
Facility
|
IP
|
$8.64
|
|
|
Service Code
|
NDC 24208-463-25
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$7.78 |
| Rate for Payer: Adventist Health Commercial |
$1.73
|
| Rate for Payer: Blue Shield of California Commercial |
$6.68
|
| Rate for Payer: Blue Shield of California EPN |
$4.35
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Central Health Plan Commercial |
$6.91
|
| Rate for Payer: Cigna of CA HMO |
$6.05
|
| Rate for Payer: Cigna of CA PPO |
$6.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.46
|
| Rate for Payer: EPIC Health Plan Senior |
$3.46
|
| Rate for Payer: Galaxy Health WC |
$7.34
|
| Rate for Payer: Global Benefits Group Commercial |
$5.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: Multiplan Commercial |
$6.48
|
| Rate for Payer: Networks By Design Commercial |
$5.62
|
| Rate for Payer: Prime Health Services Commercial |
$7.34
|
|
|
LATANOPROST 0.005 % EYE DROPS [18621]
|
Facility
|
OP
|
$5.14
|
|
|
Service Code
|
NDC 61314-547-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$4.63 |
| Rate for Payer: Adventist Health Commercial |
$1.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.02
|
| Rate for Payer: Blue Shield of California Commercial |
$3.14
|
| Rate for Payer: Blue Shield of California EPN |
$2.05
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Central Health Plan Commercial |
$4.11
|
| Rate for Payer: Cigna of CA HMO |
$3.60
|
| Rate for Payer: Cigna of CA PPO |
$3.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.06
|
| Rate for Payer: EPIC Health Plan Senior |
$2.06
|
| Rate for Payer: Galaxy Health WC |
$4.37
|
| Rate for Payer: Global Benefits Group Commercial |
$3.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.63
|
| Rate for Payer: InnovAge PACE Commercial |
$2.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$3.85
|
| Rate for Payer: Networks By Design Commercial |
$3.34
|
| Rate for Payer: Prime Health Services Commercial |
$4.37
|
| Rate for Payer: Riverside University Health System MISP |
$2.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.57
|
| Rate for Payer: United Healthcare All Other HMO |
$2.57
|
| Rate for Payer: United Healthcare HMO Rider |
$2.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.37
|
| Rate for Payer: Vantage Medical Group Senior |
$4.37
|
|
|
LATANOPROST 0.005 % EYE DROPS [18621]
|
Facility
|
IP
|
$5.14
|
|
|
Service Code
|
NDC 61314-547-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$4.63 |
| Rate for Payer: Adventist Health Commercial |
$1.03
|
| Rate for Payer: Blue Shield of California Commercial |
$3.97
|
| Rate for Payer: Blue Shield of California EPN |
$2.59
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Central Health Plan Commercial |
$4.11
|
| Rate for Payer: Cigna of CA HMO |
$3.60
|
| Rate for Payer: Cigna of CA PPO |
$3.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.06
|
| Rate for Payer: EPIC Health Plan Senior |
$2.06
|
| Rate for Payer: Galaxy Health WC |
$4.37
|
| Rate for Payer: Global Benefits Group Commercial |
$3.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.03
|
| Rate for Payer: Multiplan Commercial |
$3.85
|
| Rate for Payer: Networks By Design Commercial |
$3.34
|
| Rate for Payer: Prime Health Services Commercial |
$4.37
|
|
|
LATANOPROST 0.005 % EYE DROPS [18621]
|
Facility
|
IP
|
$2.38
|
|
|
Service Code
|
NDC 70069-421-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.14 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California Commercial |
$1.84
|
| Rate for Payer: Blue Shield of California EPN |
$1.20
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Central Health Plan Commercial |
$1.90
|
| 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: EPIC Health Plan Senior |
$0.95
|
| Rate for Payer: Galaxy Health WC |
$2.02
|
| Rate for Payer: Global Benefits Group Commercial |
$1.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.14
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$1.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.78
|
| Rate for Payer: Networks By Design Commercial |
$1.55
|
| Rate for Payer: Prime Health Services Commercial |
$2.02
|
|
|
LECANEMAB-IRMB IN 0.9 % SODIUM CHLORIDE IV INFUSION [40820177]
|
Facility
|
OP
|
$152.88
|
|
|
Service Code
|
NDC 9940-8201-77
|
| Min. Negotiated Rate |
$30.58 |
| Max. Negotiated Rate |
$137.59 |
| Rate for Payer: Adventist Health Commercial |
$30.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$92.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$129.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$114.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$74.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.79
|
| Rate for Payer: Blue Shield of California Commercial |
$93.41
|
| Rate for Payer: Blue Shield of California EPN |
$61.00
|
| Rate for Payer: Cash Price |
$84.09
|
| Rate for Payer: Central Health Plan Commercial |
$122.30
|
| Rate for Payer: Cigna of CA HMO |
$97.84
|
| Rate for Payer: Cigna of CA PPO |
$113.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$129.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$129.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.15
|
| Rate for Payer: EPIC Health Plan Senior |
$61.15
|
| Rate for Payer: Galaxy Health WC |
$129.95
|
| Rate for Payer: Global Benefits Group Commercial |
$91.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$137.59
|
| Rate for Payer: InnovAge PACE Commercial |
$76.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$107.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$107.02
|
| Rate for Payer: Multiplan Commercial |
$114.66
|
| Rate for Payer: Networks By Design Commercial |
$99.37
|
| Rate for Payer: Prime Health Services Commercial |
$129.95
|
| Rate for Payer: Riverside University Health System MISP |
$61.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.44
|
| Rate for Payer: United Healthcare All Other HMO |
$76.44
|
| Rate for Payer: United Healthcare HMO Rider |
$76.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$129.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.95
|
| Rate for Payer: Vantage Medical Group Senior |
$129.95
|
|
|
LECANEMAB-IRMB IN 0.9 % SODIUM CHLORIDE IV INFUSION [40820177]
|
Facility
|
IP
|
$152.88
|
|
|
Service Code
|
NDC 9940-8201-77
|
| Min. Negotiated Rate |
$30.58 |
| Max. Negotiated Rate |
$137.59 |
| Rate for Payer: Adventist Health Commercial |
$30.58
|
| Rate for Payer: Cash Price |
$84.09
|
| Rate for Payer: Central Health Plan Commercial |
$122.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.15
|
| Rate for Payer: EPIC Health Plan Senior |
$61.15
|
| Rate for Payer: Galaxy Health WC |
$129.95
|
| Rate for Payer: Global Benefits Group Commercial |
$91.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$137.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.58
|
| Rate for Payer: Multiplan Commercial |
$114.66
|
| Rate for Payer: Networks By Design Commercial |
$99.37
|
| Rate for Payer: Prime Health Services Commercial |
$129.95
|
|
|
LEFLUNOMIDE 10 MG TABLET [23872]
|
Facility
|
IP
|
$1.31
|
|
|
Service Code
|
NDC 70710-1157-3
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.18 |
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.66
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Central Health Plan Commercial |
$1.05
|
| Rate for Payer: Cigna of CA HMO |
$0.92
|
| Rate for Payer: Cigna of CA PPO |
$0.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: EPIC Health Plan Senior |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.98
|
| Rate for Payer: Networks By Design Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.11
|
|
|
LEFLUNOMIDE 10 MG TABLET [23872]
|
Facility
|
OP
|
$3.20
|
|
|
Service Code
|
NDC 60505-2502-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.88 |
| Rate for Payer: Adventist Health Commercial |
$0.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.96
|
| Rate for Payer: Blue Shield of California EPN |
$1.28
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Central Health Plan Commercial |
$2.56
|
| Rate for Payer: Cigna of CA HMO |
$2.24
|
| Rate for Payer: Cigna of CA PPO |
$2.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: EPIC Health Plan Senior |
$1.28
|
| Rate for Payer: Galaxy Health WC |
$2.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.88
|
| Rate for Payer: InnovAge PACE Commercial |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.24
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$2.08
|
| Rate for Payer: Prime Health Services Commercial |
$2.72
|
| Rate for Payer: Riverside University Health System MISP |
$1.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1.60
|
| Rate for Payer: United Healthcare HMO Rider |
$1.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.72
|
| Rate for Payer: Vantage Medical Group Senior |
$2.72
|
|
|
LEFLUNOMIDE 10 MG TABLET [23872]
|
Facility
|
IP
|
$3.20
|
|
|
Service Code
|
NDC 60505-2502-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.88 |
| Rate for Payer: Adventist Health Commercial |
$0.64
|
| Rate for Payer: Blue Shield of California Commercial |
$2.47
|
| Rate for Payer: Blue Shield of California EPN |
$1.61
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Central Health Plan Commercial |
$2.56
|
| Rate for Payer: Cigna of CA HMO |
$2.24
|
| Rate for Payer: Cigna of CA PPO |
$2.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: EPIC Health Plan Senior |
$1.28
|
| Rate for Payer: Galaxy Health WC |
$2.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$2.08
|
| Rate for Payer: Prime Health Services Commercial |
$2.72
|
|
|
LEFLUNOMIDE 10 MG TABLET [23872]
|
Facility
|
OP
|
$1.31
|
|
|
Service Code
|
NDC 70710-1157-3
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.18 |
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.77
|
| Rate for Payer: Blue Shield of California Commercial |
$0.80
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Central Health Plan Commercial |
$1.05
|
| Rate for Payer: Cigna of CA HMO |
$0.92
|
| Rate for Payer: Cigna of CA PPO |
$0.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: EPIC Health Plan Senior |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.18
|
| Rate for Payer: InnovAge PACE Commercial |
$0.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.92
|
| Rate for Payer: Multiplan Commercial |
$0.98
|
| Rate for Payer: Networks By Design Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.11
|
| Rate for Payer: Riverside University Health System MISP |
$0.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.66
|
| Rate for Payer: United Healthcare All Other HMO |
$0.66
|
| Rate for Payer: United Healthcare HMO Rider |
$0.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.11
|
| Rate for Payer: Vantage Medical Group Senior |
$1.11
|
|
|
LEFLUNOMIDE 20 MG TABLET [23873]
|
Facility
|
OP
|
$0.88
|
|
|
Service Code
|
NDC 23155-044-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.79 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.52
|
| Rate for Payer: Blue Shield of California Commercial |
$0.54
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: Central Health Plan Commercial |
$0.70
|
| Rate for Payer: Cigna of CA HMO |
$0.62
|
| Rate for Payer: Cigna of CA PPO |
$0.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: EPIC Health Plan Senior |
$0.35
|
| Rate for Payer: Galaxy Health WC |
$0.75
|
| Rate for Payer: Global Benefits Group Commercial |
$0.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.79
|
| Rate for Payer: InnovAge PACE Commercial |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.62
|
| Rate for Payer: Multiplan Commercial |
$0.66
|
| Rate for Payer: Networks By Design Commercial |
$0.57
|
| Rate for Payer: Prime Health Services Commercial |
$0.75
|
| Rate for Payer: Riverside University Health System MISP |
$0.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.44
|
| Rate for Payer: United Healthcare All Other HMO |
$0.44
|
| Rate for Payer: United Healthcare HMO Rider |
$0.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.75
|
| Rate for Payer: Vantage Medical Group Senior |
$0.75
|
|
