|
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 |
$0.93 |
| Max. Negotiated Rate |
$4.38 |
| 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 |
$3.54
|
| 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: Blue Shield of California Commercial |
$3.14
|
| Rate for Payer: Blue Shield of California EPN |
$2.51
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.38
|
| Rate for Payer: Dignity Health Senior |
$4.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.19
|
| Rate for Payer: Heritage Provider Network Senior |
$3.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.29
|
| 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: 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 |
$2.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 |
$0.93 |
| Max. Negotiated Rate |
$3.86 |
| Rate for Payer: Adventist Health Commercial |
$1.03
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.49
|
| Rate for Payer: Heritage Provider Network Senior |
$3.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.29
|
| Rate for Payer: Multiplan Commercial |
$3.86
|
|
|
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 |
$1.81 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.87
|
| 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: Blue Shield of California Commercial |
$6.10
|
| Rate for Payer: Blue Shield of California EPN |
$4.88
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.50
|
| Rate for Payer: Dignity Health Senior |
$8.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.19
|
| Rate for Payer: Heritage Provider Network Senior |
$6.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| 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: TriValley Medical Group Commercial |
$4.00
|
| Rate for Payer: TriValley Medical Group Senior |
$4.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 |
$1.81 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.77
|
| Rate for Payer: Heritage Provider Network Senior |
$6.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
|
|
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 |
$1.85 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Adventist Health Commercial |
$2.04
|
| Rate for Payer: Cash Price |
$5.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.91
|
| Rate for Payer: Heritage Provider Network Senior |
$6.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.55
|
| Rate for Payer: Multiplan Commercial |
$7.65
|
|
|
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 |
$1.85 |
| Max. Negotiated Rate |
$8.67 |
| Rate for Payer: Adventist Health Commercial |
$2.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.01
|
| 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: Blue Shield of California Commercial |
$6.22
|
| Rate for Payer: Blue Shield of California EPN |
$4.98
|
| Rate for Payer: Cash Price |
$5.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.67
|
| Rate for Payer: Dignity Health Senior |
$8.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.31
|
| Rate for Payer: Heritage Provider Network Senior |
$6.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.55
|
| 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: TriValley Medical Group Commercial |
$4.08
|
| Rate for Payer: TriValley Medical Group Senior |
$4.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 0032-1224-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$8.67 |
| Rate for Payer: Adventist Health Commercial |
$2.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.01
|
| 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: Blue Shield of California Commercial |
$6.22
|
| Rate for Payer: Blue Shield of California EPN |
$4.98
|
| Rate for Payer: Cash Price |
$5.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.67
|
| Rate for Payer: Dignity Health Senior |
$8.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.31
|
| Rate for Payer: Heritage Provider Network Senior |
$6.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.55
|
| 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: TriValley Medical Group Commercial |
$4.08
|
| Rate for Payer: TriValley Medical Group Senior |
$4.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 0032-1224-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Adventist Health Commercial |
$2.04
|
| Rate for Payer: Cash Price |
$5.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.91
|
| Rate for Payer: Heritage Provider Network Senior |
$6.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.55
|
| Rate for Payer: Multiplan Commercial |
$7.65
|
|
|
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 |
$0.39 |
| Max. Negotiated Rate |
$1.63 |
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.17
|
| 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 Medi-Cal |
$0.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$1.63
|
|
|
LIPASE-PROTEASE-AMYLASE 3,000-9,500-15,000 UNIT CAPSULE, DELAYED REL [187996]
|
Facility
|
OP
|
$2.17
|
|
|
Service Code
|
NDC 0032-0045-70
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.63
|
| Rate for Payer: Blue Shield of California Commercial |
$1.32
|
| Rate for Payer: Blue Shield of California EPN |
$1.06
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.84
|
| Rate for Payer: Dignity Health Senior |
$1.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.34
|
| Rate for Payer: Heritage Provider Network Senior |
$1.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.52
|
| Rate for Payer: Multiplan Commercial |
$1.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.87
|
| Rate for Payer: TriValley Medical Group Senior |
$0.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.84
|
| Rate for Payer: Vantage Medical Group Senior |
$1.84
|
|
|
LIPASE-PROTEASE-AMYLASE 3,000-9,500-15,000 UNIT CAPSULE, DELAYED REL [187996]
|
Facility
|
OP
|
$2.17
|
|
|
Service Code
|
NDC 0032-1203-70
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.63
|
| Rate for Payer: Blue Shield of California Commercial |
$1.32
|
| Rate for Payer: Blue Shield of California EPN |
$1.06
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.84
|
| Rate for Payer: Dignity Health Senior |
$1.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.34
|
| Rate for Payer: Heritage Provider Network Senior |
$1.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.52
|
| Rate for Payer: Multiplan Commercial |
$1.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.87
|
| Rate for Payer: TriValley Medical Group Senior |
$0.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.84
|
| Rate for Payer: Vantage Medical Group Senior |
$1.84
|
|
|
LIPASE-PROTEASE-AMYLASE 3,000-9,500-15,000 UNIT CAPSULE, DELAYED REL [187996]
|
Facility
|
IP
|
$2.17
|
|
|
Service Code
|
NDC 0032-0045-70
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.63 |
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.17
|
| 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 Medi-Cal |
$0.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$1.63
|
|
|
LIPASE-PROTEASE-AMYLASE 6,000-19,000-30,000 UNIT CAPSULE,DELAYED REL [98034]
|
Facility
|
OP
|
$2.58
|
|
|
Service Code
|
NDC 0032-0046-70
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$2.19 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.94
|
| Rate for Payer: Blue Shield of California Commercial |
$1.57
|
| Rate for Payer: Blue Shield of California EPN |
$1.26
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.19
|
| Rate for Payer: Dignity Health Senior |
$2.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.60
|
| Rate for Payer: Heritage Provider Network Senior |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.81
|
| Rate for Payer: Multiplan Commercial |
$1.94
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.03
|
| Rate for Payer: TriValley Medical Group Senior |
$1.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.19
|
| Rate for Payer: Vantage Medical Group Senior |
$2.19
|
|
|
LIPASE-PROTEASE-AMYLASE 6,000-19,000-30,000 UNIT CAPSULE,DELAYED REL [98034]
|
Facility
|
IP
|
$2.58
|
|
|
Service Code
|
NDC 0032-0046-70
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.75
|
| Rate for Payer: Heritage Provider Network Senior |
$1.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.65
|
| Rate for Payer: Multiplan Commercial |
$1.94
|
|
|
LIRAGLUTIDE 0.6 MG/0.1 ML (18 MG/3 ML) SUBCUTANEOUS PEN INJECTOR [100803]
|
Facility
|
OP
|
$108.70
|
|
|
Service Code
|
NDC 0169-4060-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.67 |
| Max. Negotiated Rate |
$92.39 |
| Rate for Payer: Adventist Health Commercial |
$21.74
|
| Rate for Payer: Aetna of CA Gatekeeper |
$58.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$74.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$92.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$59.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$81.53
|
| Rate for Payer: Blue Shield of California Commercial |
$66.31
|
| Rate for Payer: Blue Shield of California EPN |
$53.05
|
| Rate for Payer: Cash Price |
$59.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$70.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$92.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$92.39
|
| Rate for Payer: Dignity Health Senior |
$92.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.29
|
| Rate for Payer: Heritage Provider Network Senior |
$67.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$51.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$76.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$76.09
|
| Rate for Payer: Multiplan Commercial |
$81.53
|
| Rate for Payer: TriValley Medical Group Commercial |
$43.48
|
| Rate for Payer: TriValley Medical Group Senior |
$43.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$54.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$54.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$92.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$92.39
|
| Rate for Payer: Vantage Medical Group Senior |
$92.39
|
|
|
LIRAGLUTIDE 0.6 MG/0.1 ML (18 MG/3 ML) SUBCUTANEOUS PEN INJECTOR [100803]
|
Facility
|
IP
|
$108.70
|
|
|
Service Code
|
NDC 0169-4060-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.67 |
| Max. Negotiated Rate |
$81.53 |
| Rate for Payer: Adventist Health Commercial |
$21.74
|
| Rate for Payer: Cash Price |
$59.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.59
|
| Rate for Payer: Heritage Provider Network Senior |
$73.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.18
|
| Rate for Payer: Multiplan Commercial |
$81.53
|
|
|
LISINOPRIL 10 MG TABLET [10449]
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 68001-334-00
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.04
|
| Rate for Payer: Dignity Health Senior |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Senior |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.04
|
|
|
LISINOPRIL 10 MG TABLET [10449]
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
NDC 68001-334-00
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Senior |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
|
|
LISSAMINE GREEN 1.5 MG EYE STRIPS [77167]
|
Facility
|
OP
|
$0.36
|
|
|
Service Code
|
NDC 17238-920-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.27
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
| Rate for Payer: Dignity Health Senior |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Senior |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
|
LISSAMINE GREEN 1.5 MG EYE STRIPS [77167]
|
Facility
|
IP
|
$0.36
|
|
|
Service Code
|
NDC 17238-920-98
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.24
|
| Rate for Payer: Heritage Provider Network Senior |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
|
|
LISSAMINE GREEN 1.5 MG EYE STRIPS [77167]
|
Facility
|
OP
|
$0.36
|
|
|
Service Code
|
NDC 17238-920-98
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.27
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
| Rate for Payer: Dignity Health Senior |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Senior |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
|
LISSAMINE GREEN 1.5 MG EYE STRIPS [77167]
|
Facility
|
IP
|
$0.36
|
|
|
Service Code
|
NDC 17238-920-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.24
|
| Rate for Payer: Heritage Provider Network Senior |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
|
|
LITHIUM CARBONATE 150 MG CAPSULE [4528]
|
Facility
|
OP
|
$0.18
|
|
|
Service Code
|
NDC 0054-8526-25
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.15
|
| Rate for Payer: Dignity Health Senior |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Senior |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Vantage Medical Group Senior |
$0.15
|
|
|
LITHIUM CARBONATE 150 MG CAPSULE [4528]
|
Facility
|
IP
|
$0.18
|
|
|
Service Code
|
NDC 0054-8526-25
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Senior |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
|
|
LITHIUM CARBONATE 300 MG CAPSULE [4529]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 31722-545-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Senior |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
|
