|
LINEZOLID 600 MG TABLET [28224]
|
Facility
|
IP
|
$7.40
|
|
|
Service Code
|
NDC 60687-309-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$6.66 |
| Rate for Payer: Adventist Health Commercial |
$1.48
|
| Rate for Payer: Blue Shield of California Commercial |
$5.72
|
| Rate for Payer: Blue Shield of California EPN |
$3.73
|
| Rate for Payer: Cash Price |
$4.07
|
| Rate for Payer: Central Health Plan Commercial |
$5.92
|
| Rate for Payer: Cigna of CA HMO |
$5.18
|
| Rate for Payer: Cigna of CA PPO |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.96
|
| Rate for Payer: EPIC Health Plan Senior |
$2.96
|
| Rate for Payer: Galaxy Health WC |
$6.29
|
| Rate for Payer: Global Benefits Group Commercial |
$4.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.48
|
| Rate for Payer: Multiplan Commercial |
$5.55
|
| Rate for Payer: Networks By Design Commercial |
$4.81
|
| Rate for Payer: Prime Health Services Commercial |
$6.29
|
|
|
LINEZOLID 600 MG TABLET [28224]
|
Facility
|
OP
|
$4.20
|
|
|
Service Code
|
NDC 67877-419-84
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$3.78 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.47
|
| Rate for Payer: Blue Shield of California Commercial |
$2.57
|
| Rate for Payer: Blue Shield of California EPN |
$1.68
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Central Health Plan Commercial |
$3.36
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.78
|
| Rate for Payer: InnovAge PACE Commercial |
$2.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.94
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: Networks By Design Commercial |
$2.73
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
| Rate for Payer: Riverside University Health System MISP |
$1.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.10
|
| Rate for Payer: United Healthcare All Other HMO |
$2.10
|
| Rate for Payer: United Healthcare HMO Rider |
$2.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.57
|
| Rate for Payer: Vantage Medical Group Senior |
$3.57
|
|
|
LINEZOLID 600 MG TABLET [28224]
|
Facility
|
IP
|
$4.20
|
|
|
Service Code
|
NDC 67877-419-84
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$3.78 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Blue Shield of California Commercial |
$3.25
|
| Rate for Payer: Blue Shield of California EPN |
$2.12
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Central Health Plan Commercial |
$3.36
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: Networks By Design Commercial |
$2.73
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
|
|
LINEZOLID 600 MG TABLET [28224]
|
Facility
|
OP
|
$7.05
|
|
|
Service Code
|
NDC 31722-749-20
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$6.34 |
| Rate for Payer: Adventist Health Commercial |
$1.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.14
|
| Rate for Payer: Blue Shield of California Commercial |
$4.31
|
| Rate for Payer: Blue Shield of California EPN |
$2.81
|
| Rate for Payer: Cash Price |
$3.88
|
| Rate for Payer: Central Health Plan Commercial |
$5.64
|
| Rate for Payer: Cigna of CA HMO |
$4.93
|
| Rate for Payer: Cigna of CA PPO |
$4.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.82
|
| Rate for Payer: EPIC Health Plan Senior |
$2.82
|
| Rate for Payer: Galaxy Health WC |
$5.99
|
| Rate for Payer: Global Benefits Group Commercial |
$4.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.34
|
| Rate for Payer: InnovAge PACE Commercial |
$3.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.93
|
| Rate for Payer: Multiplan Commercial |
$5.29
|
| Rate for Payer: Networks By Design Commercial |
$4.58
|
| Rate for Payer: Prime Health Services Commercial |
$5.99
|
| Rate for Payer: Riverside University Health System MISP |
$2.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.52
|
| Rate for Payer: United Healthcare All Other HMO |
$3.52
|
| Rate for Payer: United Healthcare HMO Rider |
$3.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.99
|
| Rate for Payer: Vantage Medical Group Senior |
$5.99
|
|
|
LINEZOLID 600 MG TABLET [28224]
|
Facility
|
IP
|
$4.20
|
|
|
Service Code
|
NDC 67877-419-33
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$3.78 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Blue Shield of California Commercial |
$3.25
|
| Rate for Payer: Blue Shield of California EPN |
$2.12
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Central Health Plan Commercial |
$3.36
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: Networks By Design Commercial |
$2.73
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
|
|
LINEZOLID 600 MG TABLET [28224]
|
Facility
|
IP
|
$7.05
|
|
|
Service Code
|
NDC 31722-749-20
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$6.34 |
| Rate for Payer: Adventist Health Commercial |
$1.41
|
| Rate for Payer: Blue Shield of California Commercial |
$5.45
|
| Rate for Payer: Blue Shield of California EPN |
$3.55
|
| Rate for Payer: Cash Price |
$3.88
|
| Rate for Payer: Central Health Plan Commercial |
$5.64
|
| Rate for Payer: Cigna of CA HMO |
$4.93
|
| Rate for Payer: Cigna of CA PPO |
$4.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.82
|
| Rate for Payer: EPIC Health Plan Senior |
$2.82
|
| Rate for Payer: Galaxy Health WC |
$5.99
|
| Rate for Payer: Global Benefits Group Commercial |
$4.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.41
|
| Rate for Payer: Multiplan Commercial |
$5.29
|
| Rate for Payer: Networks By Design Commercial |
$4.58
|
| Rate for Payer: Prime Health Services Commercial |
$5.99
|
|
|
LINEZOLID 600 MG TABLET [28224]
|
Facility
|
OP
|
$7.43
|
|
|
Service Code
|
NDC 0904-6553-04
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$6.69 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.36
|
| Rate for Payer: Blue Shield of California Commercial |
$4.54
|
| Rate for Payer: Blue Shield of California EPN |
$2.96
|
| Rate for Payer: Cash Price |
$4.09
|
| Rate for Payer: Central Health Plan Commercial |
$5.94
|
| Rate for Payer: Cigna of CA HMO |
$5.20
|
| Rate for Payer: Cigna of CA PPO |
$5.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.97
|
| Rate for Payer: EPIC Health Plan Senior |
$2.97
|
| Rate for Payer: Galaxy Health WC |
$6.32
|
| Rate for Payer: Global Benefits Group Commercial |
$4.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.69
|
| Rate for Payer: InnovAge PACE Commercial |
$3.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.20
|
| Rate for Payer: Multiplan Commercial |
$5.57
|
| Rate for Payer: Networks By Design Commercial |
$4.83
|
| Rate for Payer: Prime Health Services Commercial |
$6.32
|
| Rate for Payer: Riverside University Health System MISP |
$2.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.71
|
| Rate for Payer: United Healthcare All Other HMO |
$3.71
|
| Rate for Payer: United Healthcare HMO Rider |
$3.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.32
|
| Rate for Payer: Vantage Medical Group Senior |
$6.32
|
|
|
LINEZOLID 600 MG TABLET [28224]
|
Facility
|
OP
|
$7.40
|
|
|
Service Code
|
NDC 60687-309-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$6.66 |
| Rate for Payer: Adventist Health Commercial |
$1.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.35
|
| Rate for Payer: Blue Shield of California Commercial |
$4.52
|
| Rate for Payer: Blue Shield of California EPN |
$2.95
|
| Rate for Payer: Cash Price |
$4.07
|
| Rate for Payer: Central Health Plan Commercial |
$5.92
|
| Rate for Payer: Cigna of CA HMO |
$5.18
|
| Rate for Payer: Cigna of CA PPO |
$5.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.96
|
| Rate for Payer: EPIC Health Plan Senior |
$2.96
|
| Rate for Payer: Galaxy Health WC |
$6.29
|
| Rate for Payer: Global Benefits Group Commercial |
$4.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.66
|
| Rate for Payer: InnovAge PACE Commercial |
$3.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.18
|
| Rate for Payer: Multiplan Commercial |
$5.55
|
| Rate for Payer: Networks By Design Commercial |
$4.81
|
| Rate for Payer: Prime Health Services Commercial |
$6.29
|
| Rate for Payer: Riverside University Health System MISP |
$2.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.70
|
| Rate for Payer: United Healthcare All Other HMO |
$3.70
|
| Rate for Payer: United Healthcare HMO Rider |
$3.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.29
|
| Rate for Payer: Vantage Medical Group Senior |
$6.29
|
|
|
LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK [114051]
|
Facility
|
IP
|
$0.25
|
|
|
Service Code
|
HCPCS J2020
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.08
|
| Rate for Payer: Central Health Plan Commercial |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.20
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
|
|
LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK [114051]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
HCPCS J2020
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$8.36 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.89
|
| Rate for Payer: Blue Shield of California Commercial |
$8.36
|
| Rate for Payer: Blue Shield of California Commercial |
$8.36
|
| Rate for Payer: Blue Shield of California Commercial |
$8.36
|
| Rate for Payer: Blue Shield of California EPN |
$7.60
|
| Rate for Payer: Blue Shield of California EPN |
$7.60
|
| Rate for Payer: Blue Shield of California EPN |
$7.60
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Central Health Plan Commercial |
$0.20
|
| Rate for Payer: Central Health Plan Commercial |
$0.08
|
| Rate for Payer: Central Health Plan Commercial |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.47
|
| Rate for Payer: InnovAge PACE Commercial |
$0.13
|
| Rate for Payer: InnovAge PACE Commercial |
$0.05
|
| Rate for Payer: InnovAge PACE Commercial |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
| Rate for Payer: Riverside University Health System MISP |
$0.10
|
| Rate for Payer: Riverside University Health System MISP |
$0.04
|
| Rate for Payer: Riverside University Health System MISP |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.21
|
|
|
LIOTHYRONINE 25 MCG TABLET [4504]
|
Facility
|
IP
|
$0.87
|
|
|
Service Code
|
NDC 62756-590-88
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.78 |
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.67
|
| Rate for Payer: Blue Shield of California EPN |
$0.44
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: Central Health Plan Commercial |
$0.70
|
| Rate for Payer: Cigna of CA HMO |
$0.61
|
| Rate for Payer: Cigna of CA PPO |
$0.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: EPIC Health Plan Senior |
$0.35
|
| Rate for Payer: Galaxy Health WC |
$0.74
|
| Rate for Payer: Global Benefits Group Commercial |
$0.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.65
|
| Rate for Payer: Networks By Design Commercial |
$0.57
|
| Rate for Payer: Prime Health Services Commercial |
$0.74
|
|
|
LIOTHYRONINE 25 MCG TABLET [4504]
|
Facility
|
OP
|
$1.06
|
|
|
Service Code
|
NDC 42794-019-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.62
|
| Rate for Payer: Blue Shield of California Commercial |
$0.65
|
| Rate for Payer: Blue Shield of California EPN |
$0.42
|
| Rate for Payer: Cash Price |
$0.58
|
| Rate for Payer: Central Health Plan Commercial |
$0.85
|
| Rate for Payer: Cigna of CA HMO |
$0.74
|
| Rate for Payer: Cigna of CA PPO |
$0.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: EPIC Health Plan Senior |
$0.42
|
| Rate for Payer: Galaxy Health WC |
$0.90
|
| Rate for Payer: Global Benefits Group Commercial |
$0.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.95
|
| Rate for Payer: InnovAge PACE Commercial |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.69
|
| Rate for Payer: Prime Health Services Commercial |
$0.90
|
| Rate for Payer: Riverside University Health System MISP |
$0.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.53
|
| Rate for Payer: United Healthcare All Other HMO |
$0.53
|
| Rate for Payer: United Healthcare HMO Rider |
$0.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.90
|
| Rate for Payer: Vantage Medical Group Senior |
$0.90
|
|
|
LIOTHYRONINE 25 MCG TABLET [4504]
|
Facility
|
OP
|
$0.87
|
|
|
Service Code
|
NDC 62756-590-88
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.78 |
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.51
|
| Rate for Payer: Blue Shield of California Commercial |
$0.53
|
| 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 |
$0.61
|
| Rate for Payer: Cigna of CA PPO |
$0.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: EPIC Health Plan Senior |
$0.35
|
| Rate for Payer: Galaxy Health WC |
$0.74
|
| Rate for Payer: Global Benefits Group Commercial |
$0.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.78
|
| Rate for Payer: InnovAge PACE Commercial |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.61
|
| Rate for Payer: Multiplan Commercial |
$0.65
|
| Rate for Payer: Networks By Design Commercial |
$0.57
|
| Rate for Payer: Prime Health Services Commercial |
$0.74
|
| Rate for Payer: Riverside University Health System MISP |
$0.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.52
|
| 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 |
$0.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.74
|
| Rate for Payer: Vantage Medical Group Senior |
$0.74
|
|
|
LIOTHYRONINE 25 MCG TABLET [4504]
|
Facility
|
IP
|
$1.06
|
|
|
Service Code
|
NDC 42794-019-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California Commercial |
$0.82
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Cash Price |
$0.58
|
| Rate for Payer: Central Health Plan Commercial |
$0.85
|
| Rate for Payer: Cigna of CA HMO |
$0.74
|
| Rate for Payer: Cigna of CA PPO |
$0.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: EPIC Health Plan Senior |
$0.42
|
| Rate for Payer: Galaxy Health WC |
$0.90
|
| Rate for Payer: Global Benefits Group Commercial |
$0.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.69
|
| Rate for Payer: Prime Health Services Commercial |
$0.90
|
|
|
LIOTHYRONINE 5 MCG TABLET [10443]
|
Facility
|
IP
|
$0.82
|
|
|
Service Code
|
NDC 42794-018-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.74 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.63
|
| Rate for Payer: Blue Shield of California EPN |
$0.41
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Central Health Plan Commercial |
$0.66
|
| Rate for Payer: Cigna of CA HMO |
$0.57
|
| Rate for Payer: Cigna of CA PPO |
$0.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.33
|
| Rate for Payer: EPIC Health Plan Senior |
$0.33
|
| Rate for Payer: Galaxy Health WC |
$0.70
|
| Rate for Payer: Global Benefits Group Commercial |
$0.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
| Rate for Payer: Networks By Design Commercial |
$0.53
|
| Rate for Payer: Prime Health Services Commercial |
$0.70
|
|
|
LIOTHYRONINE 5 MCG TABLET [10443]
|
Facility
|
OP
|
$0.82
|
|
|
Service Code
|
NDC 42794-018-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.74 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.48
|
| Rate for Payer: Blue Shield of California Commercial |
$0.50
|
| Rate for Payer: Blue Shield of California EPN |
$0.33
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Central Health Plan Commercial |
$0.66
|
| Rate for Payer: Cigna of CA HMO |
$0.57
|
| Rate for Payer: Cigna of CA PPO |
$0.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.33
|
| Rate for Payer: EPIC Health Plan Senior |
$0.33
|
| Rate for Payer: Galaxy Health WC |
$0.70
|
| Rate for Payer: Global Benefits Group Commercial |
$0.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.74
|
| Rate for Payer: InnovAge PACE Commercial |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
| Rate for Payer: Networks By Design Commercial |
$0.53
|
| Rate for Payer: Prime Health Services Commercial |
$0.70
|
| Rate for Payer: Riverside University Health System MISP |
$0.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.41
|
| Rate for Payer: United Healthcare All Other HMO |
$0.41
|
| Rate for Payer: United Healthcare HMO Rider |
$0.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.70
|
| Rate for Payer: Vantage Medical Group Senior |
$0.70
|
|
|
LIPASE-PROTEASE-AMYLASE 12,000-38,000-60,000 UNIT CAPSULE,DELAYED REL [98035]
|
Facility
|
OP
|
$5.15
|
|
|
Service Code
|
NDC 0032-0047-70
|
| 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 |
$3.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.86
|
| 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 |
$3.15
|
| Rate for Payer: Blue Shield of California EPN |
$2.05
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: Central Health Plan Commercial |
$4.12
|
| 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 |
$4.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.06
|
| Rate for Payer: EPIC Health Plan Senior |
$2.06
|
| Rate for Payer: Galaxy Health WC |
$4.38
|
| Rate for Payer: Global Benefits Group Commercial |
$3.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.63
|
| Rate for Payer: InnovAge PACE Commercial |
$2.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.19
|
| 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 |
$3.86
|
| Rate for Payer: Networks By Design Commercial |
$3.35
|
| Rate for Payer: Prime Health Services Commercial |
$4.38
|
| Rate for Payer: Riverside University Health System MISP |
$2.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.58
|
| Rate for Payer: United Healthcare All Other HMO |
$2.58
|
| Rate for Payer: United Healthcare HMO Rider |
$2.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.38
|
| Rate for Payer: Vantage Medical Group Senior |
$4.38
|
|
|
LIPASE-PROTEASE-AMYLASE 12,000-38,000-60,000 UNIT CAPSULE,DELAYED REL [98035]
|
Facility
|
IP
|
$5.15
|
|
|
Service Code
|
NDC 0032-0047-70
|
| 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 |
$3.98
|
| Rate for Payer: Blue Shield of California EPN |
$2.60
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: Central Health Plan Commercial |
$4.12
|
| 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 |
$4.38
|
| Rate for Payer: Global Benefits Group Commercial |
$3.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.03
|
| Rate for Payer: Multiplan Commercial |
$3.86
|
| Rate for Payer: Networks By Design Commercial |
$3.35
|
| Rate for Payer: Prime Health Services Commercial |
$4.38
|
|
|
LIPASE-PROTEASE-AMYLASE 20,880-78,300-78,300 UNIT TABLET [196333]
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
NDC 73562-208-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.87
|
| Rate for Payer: Blue Shield of California Commercial |
$6.11
|
| Rate for Payer: Blue Shield of California EPN |
$3.99
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Central Health Plan Commercial |
$8.00
|
| Rate for Payer: Cigna of CA HMO |
$7.00
|
| Rate for Payer: Cigna of CA PPO |
$7.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4.00
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.00
|
| Rate for Payer: InnovAge PACE Commercial |
$5.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.00
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Riverside University Health System MISP |
$4.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.50
|
| Rate for Payer: Vantage Medical Group Senior |
$8.50
|
|
|
LIPASE-PROTEASE-AMYLASE 20,880-78,300-78,300 UNIT TABLET [196333]
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
NDC 73562-208-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7.73
|
| Rate for Payer: Blue Shield of California EPN |
$5.04
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Central Health Plan Commercial |
$8.00
|
| Rate for Payer: Cigna of CA HMO |
$7.00
|
| Rate for Payer: Cigna of CA PPO |
$7.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4.00
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
|
|
LIPASE-PROTEASE-AMYLASE 24,000-76,000-120,000 UNIT CAPSULE,DELAYED REL [98036]
|
Facility
|
IP
|
$10.20
|
|
|
Service Code
|
NDC 0032-1224-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: Adventist Health Commercial |
$2.04
|
| Rate for Payer: Blue Shield of California Commercial |
$7.88
|
| Rate for Payer: Blue Shield of California EPN |
$5.14
|
| Rate for Payer: Cash Price |
$5.61
|
| Rate for Payer: Central Health Plan Commercial |
$8.16
|
| Rate for Payer: Cigna of CA HMO |
$7.14
|
| Rate for Payer: Cigna of CA PPO |
$7.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.08
|
| Rate for Payer: EPIC Health Plan Senior |
$4.08
|
| Rate for Payer: Galaxy Health WC |
$8.67
|
| Rate for Payer: Global Benefits Group Commercial |
$6.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.04
|
| Rate for Payer: Multiplan Commercial |
$7.65
|
| Rate for Payer: Networks By Design Commercial |
$6.63
|
| Rate for Payer: Prime Health Services Commercial |
$8.67
|
|
|
LIPASE-PROTEASE-AMYLASE 24,000-76,000-120,000 UNIT CAPSULE,DELAYED REL [98036]
|
Facility
|
OP
|
$10.20
|
|
|
Service Code
|
NDC 0032-1224-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: Adventist Health Commercial |
$2.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.99
|
| Rate for Payer: Blue Shield of California Commercial |
$6.23
|
| Rate for Payer: Blue Shield of California EPN |
$4.07
|
| Rate for Payer: Cash Price |
$5.61
|
| Rate for Payer: Central Health Plan Commercial |
$8.16
|
| Rate for Payer: Cigna of CA HMO |
$7.14
|
| Rate for Payer: Cigna of CA PPO |
$7.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.08
|
| Rate for Payer: EPIC Health Plan Senior |
$4.08
|
| Rate for Payer: Galaxy Health WC |
$8.67
|
| Rate for Payer: Global Benefits Group Commercial |
$6.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.18
|
| Rate for Payer: InnovAge PACE Commercial |
$5.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.14
|
| Rate for Payer: Multiplan Commercial |
$7.65
|
| Rate for Payer: Networks By Design Commercial |
$6.63
|
| Rate for Payer: Prime Health Services Commercial |
$8.67
|
| Rate for Payer: Riverside University Health System MISP |
$4.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.10
|
| Rate for Payer: United Healthcare All Other HMO |
$5.10
|
| Rate for Payer: United Healthcare HMO Rider |
$5.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.67
|
| Rate for Payer: Vantage Medical Group Senior |
$8.67
|
|
|
LIPASE-PROTEASE-AMYLASE 24,000-76,000-120,000 UNIT CAPSULE,DELAYED REL [98036]
|
Facility
|
OP
|
$10.20
|
|
|
Service Code
|
NDC 0032-2636-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: Adventist Health Commercial |
$2.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.99
|
| Rate for Payer: Blue Shield of California Commercial |
$6.23
|
| Rate for Payer: Blue Shield of California EPN |
$4.07
|
| Rate for Payer: Cash Price |
$5.61
|
| Rate for Payer: Central Health Plan Commercial |
$8.16
|
| Rate for Payer: Cigna of CA HMO |
$7.14
|
| Rate for Payer: Cigna of CA PPO |
$7.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.08
|
| Rate for Payer: EPIC Health Plan Senior |
$4.08
|
| Rate for Payer: Galaxy Health WC |
$8.67
|
| Rate for Payer: Global Benefits Group Commercial |
$6.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.18
|
| Rate for Payer: InnovAge PACE Commercial |
$5.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.14
|
| Rate for Payer: Multiplan Commercial |
$7.65
|
| Rate for Payer: Networks By Design Commercial |
$6.63
|
| Rate for Payer: Prime Health Services Commercial |
$8.67
|
| Rate for Payer: Riverside University Health System MISP |
$4.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.10
|
| Rate for Payer: United Healthcare All Other HMO |
$5.10
|
| Rate for Payer: United Healthcare HMO Rider |
$5.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.67
|
| Rate for Payer: Vantage Medical Group Senior |
$8.67
|
|
|
LIPASE-PROTEASE-AMYLASE 24,000-76,000-120,000 UNIT CAPSULE,DELAYED REL [98036]
|
Facility
|
IP
|
$10.20
|
|
|
Service Code
|
NDC 0032-2636-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: Adventist Health Commercial |
$2.04
|
| Rate for Payer: Blue Shield of California Commercial |
$7.88
|
| Rate for Payer: Blue Shield of California EPN |
$5.14
|
| Rate for Payer: Cash Price |
$5.61
|
| Rate for Payer: Central Health Plan Commercial |
$8.16
|
| Rate for Payer: Cigna of CA HMO |
$7.14
|
| Rate for Payer: Cigna of CA PPO |
$7.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.08
|
| Rate for Payer: EPIC Health Plan Senior |
$4.08
|
| Rate for Payer: Galaxy Health WC |
$8.67
|
| Rate for Payer: Global Benefits Group Commercial |
$6.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.04
|
| Rate for Payer: Multiplan Commercial |
$7.65
|
| Rate for Payer: Networks By Design Commercial |
$6.63
|
| Rate for Payer: Prime Health Services Commercial |
$8.67
|
|
|
LIPASE-PROTEASE-AMYLASE 3,000-9,500-15,000 UNIT CAPSULE, DELAYED REL [187996]
|
Facility
|
IP
|
$2.17
|
|
|
Service Code
|
NDC 0032-1203-70
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1.68
|
| Rate for Payer: Blue Shield of California EPN |
$1.09
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Central Health Plan Commercial |
$1.74
|
| Rate for Payer: Cigna of CA HMO |
$1.52
|
| Rate for Payer: Cigna of CA PPO |
$1.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.87
|
| Rate for Payer: EPIC Health Plan Senior |
$0.87
|
| Rate for Payer: Galaxy Health WC |
$1.84
|
| Rate for Payer: Global Benefits Group Commercial |
$1.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$1.63
|
| Rate for Payer: Networks By Design Commercial |
$1.41
|
| Rate for Payer: Prime Health Services Commercial |
$1.84
|
|
