|
LANSOPRAZOLE 15 MG CAPSULE,DELAYED RELEASE [27691]
|
Facility
|
OP
|
$3.65
|
|
|
Service Code
|
NDC 60687-111-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$3.10 |
| Rate for Payer: Adventist Health Commercial |
$0.73
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.74
|
| Rate for Payer: Blue Shield of California Commercial |
$2.23
|
| Rate for Payer: Blue Shield of California EPN |
$1.78
|
| Rate for Payer: Cash Price |
$2.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.10
|
| Rate for Payer: Dignity Health Senior |
$3.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.26
|
| Rate for Payer: Heritage Provider Network Senior |
$2.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.56
|
| Rate for Payer: Multiplan Commercial |
$2.74
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.46
|
| Rate for Payer: TriValley Medical Group Senior |
$1.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.10
|
| Rate for Payer: Vantage Medical Group Senior |
$3.10
|
|
|
LANSOPRAZOLE 15 MG CAPSULE,DELAYED RELEASE [27691]
|
Facility
|
OP
|
$3.65
|
|
|
Service Code
|
NDC 60687-111-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$3.10 |
| Rate for Payer: Adventist Health Commercial |
$0.73
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.74
|
| Rate for Payer: Blue Shield of California Commercial |
$2.23
|
| Rate for Payer: Blue Shield of California EPN |
$1.78
|
| Rate for Payer: Cash Price |
$2.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.10
|
| Rate for Payer: Dignity Health Senior |
$3.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.26
|
| Rate for Payer: Heritage Provider Network Senior |
$2.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.56
|
| Rate for Payer: Multiplan Commercial |
$2.74
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.46
|
| Rate for Payer: TriValley Medical Group Senior |
$1.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.10
|
| Rate for Payer: Vantage Medical Group Senior |
$3.10
|
|
|
LANSOPRAZOLE 15 MG CAPSULE,DELAYED RELEASE [27691]
|
Facility
|
IP
|
$3.65
|
|
|
Service Code
|
NDC 60687-111-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.74 |
| Rate for Payer: Adventist Health Commercial |
$0.73
|
| Rate for Payer: Cash Price |
$2.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.47
|
| Rate for Payer: Heritage Provider Network Senior |
$2.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.91
|
| Rate for Payer: Multiplan Commercial |
$2.74
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET [34595]
|
Facility
|
IP
|
$16.60
|
|
|
Service Code
|
NDC 64764-544-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$12.45 |
| Rate for Payer: Adventist Health Commercial |
$3.32
|
| Rate for Payer: Cash Price |
$9.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.24
|
| Rate for Payer: Heritage Provider Network Senior |
$11.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.15
|
| Rate for Payer: Multiplan Commercial |
$12.45
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET [34595]
|
Facility
|
OP
|
$16.60
|
|
|
Service Code
|
NDC 64764-544-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$14.11 |
| Rate for Payer: Adventist Health Commercial |
$3.32
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.45
|
| Rate for Payer: Blue Shield of California Commercial |
$10.13
|
| Rate for Payer: Blue Shield of California EPN |
$8.10
|
| Rate for Payer: Cash Price |
$9.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.11
|
| Rate for Payer: Dignity Health Senior |
$14.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.28
|
| Rate for Payer: Heritage Provider Network Senior |
$10.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.62
|
| Rate for Payer: Multiplan Commercial |
$12.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.64
|
| Rate for Payer: TriValley Medical Group Senior |
$6.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.11
|
| Rate for Payer: Vantage Medical Group Senior |
$14.11
|
|
|
LANSOPRAZOLE ORAL SUSPENSION COMPOUND 3 MG/ML [4080290]
|
Facility
|
IP
|
$0.57
|
|
|
Service Code
|
NDC 9994-0802-90
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.39
|
| Rate for Payer: Heritage Provider Network Senior |
$0.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.43
|
|
|
LANSOPRAZOLE ORAL SUSPENSION COMPOUND 3 MG/ML [4080290]
|
Facility
|
OP
|
$0.57
|
|
|
Service Code
|
NDC 9994-0802-90
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.28
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
| Rate for Payer: Dignity Health Senior |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.35
|
| Rate for Payer: Heritage Provider Network Senior |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$0.43
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.23
|
| Rate for Payer: TriValley Medical Group Senior |
$0.23
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
|
|
LANTHANUM 1,000 MG CHEWABLE TABLET [43548]
|
Facility
|
IP
|
$12.95
|
|
|
Service Code
|
NDC 66993-424-75
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$9.71 |
| Rate for Payer: Adventist Health Commercial |
$2.59
|
| Rate for Payer: Cash Price |
$7.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.00
|
| Rate for Payer: Heritage Provider Network Senior |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.24
|
| Rate for Payer: Multiplan Commercial |
$9.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.29
|
|
|
LANTHANUM 1,000 MG CHEWABLE TABLET [43548]
|
Facility
|
OP
|
$12.95
|
|
|
Service Code
|
NDC 66993-424-85
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$11.01 |
| Rate for Payer: Adventist Health Commercial |
$2.59
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.71
|
| Rate for Payer: Blue Shield of California Commercial |
$7.90
|
| Rate for Payer: Blue Shield of California EPN |
$6.32
|
| Rate for Payer: Cash Price |
$7.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.01
|
| Rate for Payer: Dignity Health Senior |
$11.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.00
|
| Rate for Payer: Heritage Provider Network Senior |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.06
|
| Rate for Payer: Multiplan Commercial |
$9.71
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Senior |
$5.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.01
|
| Rate for Payer: Vantage Medical Group Senior |
$11.01
|
|
|
LANTHANUM 1,000 MG CHEWABLE TABLET [43548]
|
Facility
|
IP
|
$12.95
|
|
|
Service Code
|
NDC 66993-424-85
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$9.71 |
| Rate for Payer: Adventist Health Commercial |
$2.59
|
| Rate for Payer: Cash Price |
$7.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.00
|
| Rate for Payer: Heritage Provider Network Senior |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.24
|
| Rate for Payer: Multiplan Commercial |
$9.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.29
|
|
|
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 |
$1.21 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Adventist Health Commercial |
$1.33
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.09
|
| Rate for Payer: Heritage Provider Network Senior |
$3.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.67
|
| Rate for Payer: Multiplan Commercial |
$5.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.21
|
|
|
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 |
$1.21 |
| Max. Negotiated Rate |
$5.67 |
| Rate for Payer: Adventist Health Commercial |
$1.33
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.58
|
| 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: Blue Shield of California Commercial |
$4.07
|
| Rate for Payer: Blue Shield of California EPN |
$3.25
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.67
|
| Rate for Payer: Dignity Health Senior |
$5.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.09
|
| Rate for Payer: Heritage Provider Network Senior |
$3.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.67
|
| 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: TriValley Medical Group Commercial |
$2.67
|
| Rate for Payer: TriValley Medical Group Senior |
$2.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.67
|
| Rate for Payer: Vantage Medical Group Senior |
$5.67
|
|
|
LANTHANUM 1,000 MG CHEWABLE TABLET [43548]
|
Facility
|
OP
|
$12.95
|
|
|
Service Code
|
NDC 66993-424-75
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$11.01 |
| Rate for Payer: Adventist Health Commercial |
$2.59
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.71
|
| Rate for Payer: Blue Shield of California Commercial |
$7.90
|
| Rate for Payer: Blue Shield of California EPN |
$6.32
|
| Rate for Payer: Cash Price |
$7.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.01
|
| Rate for Payer: Dignity Health Senior |
$11.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.00
|
| Rate for Payer: Heritage Provider Network Senior |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.06
|
| Rate for Payer: Multiplan Commercial |
$9.71
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Senior |
$5.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.01
|
| Rate for Payer: Vantage Medical Group Senior |
$11.01
|
|
|
LANTHANUM 1,000 MG CHEWABLE TABLET [43548]
|
Facility
|
OP
|
$6.67
|
|
|
Service Code
|
NDC 68180-821-47
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$5.67 |
| Rate for Payer: Adventist Health Commercial |
$1.33
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.58
|
| 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: Blue Shield of California Commercial |
$4.07
|
| Rate for Payer: Blue Shield of California EPN |
$3.25
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.67
|
| Rate for Payer: Dignity Health Senior |
$5.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.09
|
| Rate for Payer: Heritage Provider Network Senior |
$3.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.67
|
| 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: TriValley Medical Group Commercial |
$2.67
|
| Rate for Payer: TriValley Medical Group Senior |
$2.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.21
|
| 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 |
$1.21 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Adventist Health Commercial |
$1.33
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.09
|
| Rate for Payer: Heritage Provider Network Senior |
$3.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.67
|
| Rate for Payer: Multiplan Commercial |
$5.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.21
|
|
|
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 |
$2.61 |
| Max. Negotiated Rate |
$12.25 |
| Rate for Payer: Adventist Health Commercial |
$2.88
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.90
|
| 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: Blue Shield of California Commercial |
$8.79
|
| Rate for Payer: Blue Shield of California EPN |
$7.03
|
| Rate for Payer: Cash Price |
$7.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.25
|
| Rate for Payer: Dignity Health Senior |
$12.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.67
|
| Rate for Payer: Heritage Provider Network Senior |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| 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: TriValley Medical Group Commercial |
$5.76
|
| Rate for Payer: TriValley Medical Group Senior |
$5.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.77
|
| 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
|
|
|
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 |
$2.61 |
| Max. Negotiated Rate |
$10.81 |
| Rate for Payer: Adventist Health Commercial |
$2.88
|
| Rate for Payer: Cash Price |
$7.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.67
|
| Rate for Payer: Heritage Provider Network Senior |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$10.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.77
|
|
|
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 |
$37.66 |
| Max. Negotiated Rate |
$200.41 |
| Rate for Payer: Adventist Health Commercial |
$53.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$142.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$183.57
|
| 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 HMO/PPO |
$99.43
|
| Rate for Payer: Blue Shield of California Commercial |
$37.66
|
| Rate for Payer: Blue Shield of California EPN |
$37.66
|
| Rate for Payer: Cash Price |
$146.97
|
| Rate for Payer: Cash Price |
$146.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$122.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$49.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.87
|
| Rate for Payer: Dignity Health Senior |
$43.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$171.01
|
| Rate for Payer: EPIC Health Plan Medicare |
$39.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.72
|
| Rate for Payer: Heritage Provider Network Senior |
$123.72
|
| 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: Kaiser Permanente of CA Commercial |
$127.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$45.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$50.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.25
|
| Rate for Payer: Multiplan Commercial |
$200.41
|
| Rate for Payer: TriValley Medical Group Commercial |
$106.88
|
| Rate for Payer: TriValley Medical Group Senior |
$106.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$96.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$88.47
|
| 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
|
|
|
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 |
$48.37 |
| Max. Negotiated Rate |
$200.41 |
| Rate for Payer: Adventist Health Commercial |
$53.44
|
| Rate for Payer: Cash Price |
$146.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$122.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.72
|
| Rate for Payer: Heritage Provider Network Senior |
$123.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.80
|
| Rate for Payer: Multiplan Commercial |
$200.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$96.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$88.47
|
|
|
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 |
$1.56 |
| Max. Negotiated Rate |
$7.34 |
| Rate for Payer: Adventist Health Commercial |
$1.73
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.94
|
| 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: Blue Shield of California Commercial |
$5.27
|
| Rate for Payer: Blue Shield of California EPN |
$4.22
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.34
|
| Rate for Payer: Dignity Health Senior |
$7.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.35
|
| Rate for Payer: Heritage Provider Network Senior |
$5.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| 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: TriValley Medical Group Commercial |
$3.46
|
| Rate for Payer: TriValley Medical Group Senior |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 |
$0.43 |
| Max. Negotiated Rate |
$2.02 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.64
|
| 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: Blue Shield of California Commercial |
$1.45
|
| Rate for Payer: Blue Shield of California EPN |
$1.16
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.02
|
| Rate for Payer: Dignity Health Senior |
$2.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.47
|
| Rate for Payer: Heritage Provider Network Senior |
$1.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.60
|
| 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: TriValley Medical Group Commercial |
$0.95
|
| Rate for Payer: TriValley Medical Group Senior |
$0.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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
|
$5.14
|
|
|
Service Code
|
NDC 61314-547-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$4.37 |
| Rate for Payer: Adventist Health Commercial |
$1.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.53
|
| 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: Blue Shield of California Commercial |
$3.14
|
| Rate for Payer: Blue Shield of California EPN |
$2.51
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.37
|
| Rate for Payer: Dignity Health Senior |
$4.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.18
|
| Rate for Payer: Heritage Provider Network Senior |
$3.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| 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: TriValley Medical Group Commercial |
$2.06
|
| Rate for Payer: TriValley Medical Group Senior |
$2.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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
|
$8.64
|
|
|
Service Code
|
NDC 24208-463-25
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$6.48 |
| Rate for Payer: Adventist Health Commercial |
$1.73
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.85
|
| Rate for Payer: Heritage Provider Network Senior |
$5.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Multiplan Commercial |
$6.48
|
|
|
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 |
$0.43 |
| Max. Negotiated Rate |
$1.78 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.61
|
| Rate for Payer: Heritage Provider Network Senior |
$1.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.60
|
| Rate for Payer: Multiplan Commercial |
$1.78
|
|
|
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 |
$0.93 |
| Max. Negotiated Rate |
$3.85 |
| Rate for Payer: Adventist Health Commercial |
$1.03
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.48
|
| Rate for Payer: Heritage Provider Network Senior |
$3.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: Multiplan Commercial |
$3.85
|
|
