|
LINEZOLID 600 MG TABLET [28224]
|
Facility
|
OP
|
$4.20
|
|
|
Service Code
|
NDC 6787741984
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.60
|
| 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 HMO/PPO |
$2.10
|
| Rate for Payer: Blue Shield of California Commercial |
$2.56
|
| Rate for Payer: Blue Shield of California EPN |
$2.05
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.73
|
| 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 |
$2.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.60
|
| Rate for Payer: Heritage Provider Network Senior |
$2.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.94
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.68
|
| Rate for Payer: TriValley Medical Group Senior |
$1.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 6787741984
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.15 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.70
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.84
|
| Rate for Payer: Heritage Provider Network Senior |
$2.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.05
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
|
|
LINEZOLID 600 MG TABLET [28224]
|
Facility
|
IP
|
$7.40
|
|
|
Service Code
|
NDC 6068730921
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$5.55 |
| Rate for Payer: Adventist Health Commercial |
$1.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.77
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.01
|
| Rate for Payer: Heritage Provider Network Senior |
$5.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.85
|
| Rate for Payer: Multiplan Commercial |
$5.55
|
|
|
LINEZOLID 600 MG TABLET [28224]
|
Facility
|
OP
|
$7.40
|
|
|
Service Code
|
NDC 6068730911
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$6.29 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.57
|
| Rate for Payer: Adventist Health Commercial |
$1.48
|
| 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 HMO/PPO |
$3.70
|
| Rate for Payer: Blue Shield of California Commercial |
$4.51
|
| Rate for Payer: Blue Shield of California EPN |
$3.61
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.81
|
| 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 |
$4.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.58
|
| Rate for Payer: Heritage Provider Network Senior |
$4.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.18
|
| Rate for Payer: Multiplan Commercial |
$5.55
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.96
|
| Rate for Payer: TriValley Medical Group Senior |
$2.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 600 MG TABLET [28224]
|
Facility
|
IP
|
$7.40
|
|
|
Service Code
|
NDC 6068730911
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$5.55 |
| Rate for Payer: Adventist Health Commercial |
$1.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.77
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.01
|
| Rate for Payer: Heritage Provider Network Senior |
$5.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.85
|
| Rate for Payer: Multiplan Commercial |
$5.55
|
|
|
LINEZOLID 600 MG TABLET [28224]
|
Facility
|
OP
|
$7.43
|
|
|
Service Code
|
NDC 0904655304
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$6.32 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.59
|
| 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 HMO/PPO |
$3.72
|
| Rate for Payer: Blue Shield of California Commercial |
$4.53
|
| Rate for Payer: Blue Shield of California EPN |
$3.63
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.83
|
| 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 |
$4.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.60
|
| Rate for Payer: Heritage Provider Network Senior |
$4.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.20
|
| Rate for Payer: Multiplan Commercial |
$5.57
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.97
|
| Rate for Payer: TriValley Medical Group Senior |
$2.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK [114051]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
HCPCS J2020
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$85.63 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| 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 Medi-Cal |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.63
|
| Rate for Payer: Blue Shield of California Commercial |
$6.46
|
| Rate for Payer: Blue Shield of California Commercial |
$6.46
|
| Rate for Payer: Blue Shield of California Commercial |
$6.46
|
| Rate for Payer: Blue Shield of California Commercial |
$6.46
|
| Rate for Payer: Blue Shield of California Commercial |
$6.46
|
| Rate for Payer: Blue Shield of California Commercial |
$6.46
|
| Rate for Payer: Blue Shield of California EPN |
$6.46
|
| Rate for Payer: Blue Shield of California EPN |
$6.46
|
| Rate for Payer: Blue Shield of California EPN |
$6.46
|
| Rate for Payer: Blue Shield of California EPN |
$6.46
|
| Rate for Payer: Blue Shield of California EPN |
$6.46
|
| Rate for Payer: Blue Shield of California EPN |
$6.46
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Senior |
$0.12
|
| Rate for Payer: Heritage Provider Network Senior |
$0.08
|
| Rate for Payer: Heritage Provider Network Senior |
$0.02
|
| Rate for Payer: Heritage Provider Network Senior |
$0.03
|
| Rate for Payer: Heritage Provider Network Senior |
$0.04
|
| Rate for Payer: Heritage Provider Network Senior |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| 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: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Senior |
$0.02
|
| Rate for Payer: TriValley Medical Group Senior |
$0.03
|
| Rate for Payer: TriValley Medical Group Senior |
$0.07
|
| Rate for Payer: TriValley Medical Group Senior |
$0.02
|
| Rate for Payer: TriValley Medical Group Senior |
$0.04
|
| Rate for Payer: TriValley Medical Group Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
| 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 |
$0.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.21
|
| Rate for Payer: Vantage Medical Group Senior |
$0.15
|
|
|
LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK [114051]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
HCPCS J2020
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| 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: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.16
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Senior |
$0.02
|
| Rate for Payer: Heritage Provider Network Senior |
$0.04
|
| Rate for Payer: Heritage Provider Network Senior |
$0.05
|
| Rate for Payer: Heritage Provider Network Senior |
$0.03
|
| Rate for Payer: Heritage Provider Network Senior |
$0.08
|
| Rate for Payer: Heritage Provider Network Senior |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| 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 |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.02
|
|
|
LINVOSELTAMAB-GCPT 20 MG/ML INTRAVENOUS SOLUTION [246702]
|
Facility
|
IP
|
$2,256.00
|
|
|
Service Code
|
HCPCS J9601
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$408.34 |
| Max. Negotiated Rate |
$1,692.00 |
| Rate for Payer: Adventist Health Commercial |
$451.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,452.86
|
| Rate for Payer: Cash Price |
$1,015.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,037.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,218.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,044.53
|
| Rate for Payer: Heritage Provider Network Senior |
$1,044.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$408.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$564.00
|
| Rate for Payer: Multiplan Commercial |
$1,692.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$815.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$746.96
|
|
|
LINVOSELTAMAB-GCPT 20 MG/ML INTRAVENOUS SOLUTION [246702]
|
Facility
|
OP
|
$2,256.00
|
|
|
Service Code
|
HCPCS J9601
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$99.31 |
| Max. Negotiated Rate |
$1,692.00 |
| Rate for Payer: Adventist Health Commercial |
$451.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,394.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$148.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$109.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$99.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,128.45
|
| Rate for Payer: Blue Shield of California Commercial |
$1,376.16
|
| Rate for Payer: Blue Shield of California EPN |
$1,100.93
|
| Rate for Payer: Cash Price |
$1,015.20
|
| Rate for Payer: Cash Price |
$1,015.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,037.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$148.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$109.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$99.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,443.84
|
| Rate for Payer: EPIC Health Plan Medicare |
$99.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,044.53
|
| Rate for Payer: Heritage Provider Network Senior |
$1,044.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$99.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,076.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$408.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$114.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$564.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$133.08
|
| Rate for Payer: Multiplan Commercial |
$1,692.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$902.40
|
| Rate for Payer: TriValley Medical Group Senior |
$902.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$815.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$746.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$148.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$109.24
|
| Rate for Payer: Vantage Medical Group Senior |
$99.31
|
|
|
LINVOSELTAMAB-GCPT 2 MG/ML INTRAVENOUS SOLUTION [246704]
|
Facility
|
IP
|
$225.60
|
|
|
Service Code
|
HCPCS J9601
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.83 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Adventist Health Commercial |
$45.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$145.29
|
| Rate for Payer: Cash Price |
$101.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$103.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$104.45
|
| Rate for Payer: Heritage Provider Network Senior |
$104.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.40
|
| Rate for Payer: Multiplan Commercial |
$169.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$81.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$74.70
|
|
|
LINVOSELTAMAB-GCPT 2 MG/ML INTRAVENOUS SOLUTION [246704]
|
Facility
|
OP
|
$225.60
|
|
|
Service Code
|
HCPCS J9601
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.83 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Adventist Health Commercial |
$45.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$139.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$148.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$109.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$99.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.85
|
| Rate for Payer: Blue Shield of California Commercial |
$137.62
|
| Rate for Payer: Blue Shield of California EPN |
$110.09
|
| Rate for Payer: Cash Price |
$101.52
|
| Rate for Payer: Cash Price |
$101.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$103.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$148.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$109.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$99.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.38
|
| Rate for Payer: EPIC Health Plan Medicare |
$99.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$104.45
|
| Rate for Payer: Heritage Provider Network Senior |
$104.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$99.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$107.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$114.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$133.08
|
| Rate for Payer: Multiplan Commercial |
$169.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$90.24
|
| Rate for Payer: TriValley Medical Group Senior |
$90.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$81.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$74.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$148.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$109.24
|
| Rate for Payer: Vantage Medical Group Senior |
$99.31
|
|
|
LIOTHYRONINE 25 MCG TABLET [4504]
|
Facility
|
IP
|
$1.06
|
|
|
Service Code
|
NDC 4279401912
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.68
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.72
|
| Rate for Payer: Heritage Provider Network Senior |
$0.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
|
|
LIOTHYRONINE 25 MCG TABLET [4504]
|
Facility
|
OP
|
$1.06
|
|
|
Service Code
|
NDC 4279401912
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.66
|
| 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 HMO/PPO |
$0.53
|
| Rate for Payer: Blue Shield of California Commercial |
$0.65
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.69
|
| 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 |
$0.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.66
|
| Rate for Payer: Heritage Provider Network Senior |
$0.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.42
|
| Rate for Payer: TriValley Medical Group Senior |
$0.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 6275659088
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.74 |
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.54
|
| 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 HMO/PPO |
$0.44
|
| Rate for Payer: Blue Shield of California Commercial |
$0.53
|
| Rate for Payer: Blue Shield of California EPN |
$0.42
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.57
|
| 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 |
$0.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.54
|
| Rate for Payer: Heritage Provider Network Senior |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.61
|
| Rate for Payer: Multiplan Commercial |
$0.65
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.35
|
| Rate for Payer: TriValley Medical Group Senior |
$0.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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
|
$0.87
|
|
|
Service Code
|
NDC 6275659088
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.56
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.59
|
| Rate for Payer: Heritage Provider Network Senior |
$0.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.65
|
|
|
LIOTHYRONINE 5 MCG TABLET [10443]
|
Facility
|
IP
|
$0.82
|
|
|
Service Code
|
NDC 4279401812
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.53
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.56
|
| Rate for Payer: Heritage Provider Network Senior |
$0.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
|
|
LIOTHYRONINE 5 MCG TABLET [10443]
|
Facility
|
OP
|
$0.82
|
|
|
Service Code
|
NDC 4279401812
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.70 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.51
|
| 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 HMO/PPO |
$0.41
|
| Rate for Payer: Blue Shield of California Commercial |
$0.50
|
| Rate for Payer: Blue Shield of California EPN |
$0.40
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.53
|
| 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 |
$0.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.51
|
| Rate for Payer: Heritage Provider Network Senior |
$0.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.33
|
| Rate for Payer: TriValley Medical Group Senior |
$0.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 (PORCINE) 20,880-78,300-78,300 UNIT TABLET [196333]
|
Facility
|
OP
|
$10.30
|
|
|
Service Code
|
NDC 7356220810
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$8.76 |
| Rate for Payer: Adventist Health Commercial |
$2.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.15
|
| Rate for Payer: Blue Shield of California Commercial |
$6.28
|
| Rate for Payer: Blue Shield of California EPN |
$5.03
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.38
|
| Rate for Payer: Heritage Provider Network Senior |
$6.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.21
|
| Rate for Payer: Multiplan Commercial |
$7.72
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.12
|
| Rate for Payer: TriValley Medical Group Senior |
$4.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.76
|
| Rate for Payer: Vantage Medical Group Senior |
$8.76
|
|
|
LIPASE-PROTEASE-AMYLASE (PORCINE) 20,880-78,300-78,300 UNIT TABLET [196333]
|
Facility
|
IP
|
$10.30
|
|
|
Service Code
|
NDC 7356220810
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$7.72 |
| Rate for Payer: Adventist Health Commercial |
$2.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.63
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.97
|
| Rate for Payer: Heritage Provider Network Senior |
$6.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.58
|
| Rate for Payer: Multiplan Commercial |
$7.72
|
|
|
LIPASE-PROTEASE-AMYLASE(PORK)12,000-38,000-60,000 UNIT CAPSULE,DEL REL [98035]
|
Facility
|
OP
|
$5.28
|
|
|
Service Code
|
NDC 0032004770
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$4.49 |
| Rate for Payer: Adventist Health Commercial |
$1.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.64
|
| Rate for Payer: Blue Shield of California Commercial |
$3.22
|
| Rate for Payer: Blue Shield of California EPN |
$2.58
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.27
|
| Rate for Payer: Heritage Provider Network Senior |
$3.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.70
|
| Rate for Payer: Multiplan Commercial |
$3.96
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.11
|
| Rate for Payer: TriValley Medical Group Senior |
$2.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4.49
|
|
|
LIPASE-PROTEASE-AMYLASE(PORK)12,000-38,000-60,000 UNIT CAPSULE,DEL REL [98035]
|
Facility
|
IP
|
$5.28
|
|
|
Service Code
|
NDC 0032004770
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: Adventist Health Commercial |
$1.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.40
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.57
|
| Rate for Payer: Heritage Provider Network Senior |
$3.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.32
|
| Rate for Payer: Multiplan Commercial |
$3.96
|
|
|
LIPASE-PROTEASE-AMYLASE (PORK) 3,000-9,500-15,000 UNIT CAPSULE,DEL REL [187996]
|
Facility
|
IP
|
$2.23
|
|
|
Service Code
|
NDC 0032120370
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Adventist Health Commercial |
$0.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.44
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.51
|
| Rate for Payer: Heritage Provider Network Senior |
$1.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$1.67
|
|
|
LIPASE-PROTEASE-AMYLASE (PORK) 3,000-9,500-15,000 UNIT CAPSULE,DEL REL [187996]
|
Facility
|
IP
|
$2.23
|
|
|
Service Code
|
NDC 0032004570
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Adventist Health Commercial |
$0.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.44
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.51
|
| Rate for Payer: Heritage Provider Network Senior |
$1.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$1.67
|
|
|
LIPASE-PROTEASE-AMYLASE (PORK) 3,000-9,500-15,000 UNIT CAPSULE,DEL REL [187996]
|
Facility
|
OP
|
$2.23
|
|
|
Service Code
|
NDC 0032120370
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Adventist Health Commercial |
$0.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.12
|
| Rate for Payer: Blue Shield of California Commercial |
$1.36
|
| Rate for Payer: Blue Shield of California EPN |
$1.09
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.38
|
| Rate for Payer: Heritage Provider Network Senior |
$1.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$1.67
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.89
|
| Rate for Payer: TriValley Medical Group Senior |
$0.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1.90
|
|
