|
LANTHANUM 1,000 MG CHEWABLE TABLET [43548]
|
Facility
OP
|
$12.95
|
|
|
Service Code
|
NDC 66993-424-75
|
| Hospital Charge Code |
1711937
|
|
Hospital Revenue Code
|
259
|
| 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: AlphaCare Medical Group Commercial/Exchange |
$11.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.71
|
| Rate for Payer: Blue Shield of California Commercial |
$8.04
|
| Rate for Payer: Blue Shield of California EPN |
$7.60
|
| Rate for Payer: Cash Price |
$5.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.42
|
| 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 |
$8.02
|
| Rate for Payer: Heritage Provider Network Senior |
$8.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.24
|
| 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: Vantage Medical Group Medi-Cal |
$11.01
|
| Rate for Payer: Vantage Medical Group Senior |
$11.01
|
|
|
LANTHANUM 500 MG CHEWABLE TABLET [39975]
|
Facility
IP
|
$14.41
|
|
|
Service Code
|
NDC 54092-252-45
|
| Hospital Charge Code |
1711939
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$10.81 |
| Rate for Payer: Adventist Health Commercial |
$2.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.90
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.76
|
| Rate for Payer: Heritage Provider Network Senior |
$9.76
|
| 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
|
|
|
LANTHANUM 500 MG CHEWABLE TABLET [39975]
|
Facility
OP
|
$14.41
|
|
|
Service Code
|
NDC 54092-252-45
|
| Hospital Charge Code |
1711939
|
|
Hospital Revenue Code
|
259
|
| 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: AlphaCare Medical Group Commercial/Exchange |
$12.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.93
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.81
|
| Rate for Payer: Blue Shield of California Commercial |
$8.95
|
| Rate for Payer: Blue Shield of California EPN |
$8.46
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.37
|
| 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 |
$8.92
|
| Rate for Payer: Heritage Provider Network Senior |
$8.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.95
|
| 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: Vantage Medical Group Medi-Cal |
$12.25
|
| Rate for Payer: Vantage Medical Group Senior |
$12.25
|
|
|
Laparoscopic Assisted Surgery
|
Facility
IP
|
$10,600.00
|
|
|
Service Code
|
ICD 0DTJ4ZZ
|
| Min. Negotiated Rate |
$8,285.00 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$8,285.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,600.00
|
|
|
Laparoscopic Assisted Surgery
|
Facility
IP
|
$10,600.00
|
|
|
Service Code
|
ICD 0F544ZZ
|
| Min. Negotiated Rate |
$8,285.00 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$8,285.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,790.00
|
| Rate for Payer: Blue Shield of California EPN |
$8,392.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,600.00
|
|
|
Laparoscopic Assisted Surgery
|
Facility
IP
|
$10,600.00
|
|
|
Service Code
|
ICD 0UT14ZZ
|
| Min. Negotiated Rate |
$8,285.00 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$8,285.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,600.00
|
|
|
Laparoscopic Assisted Surgery
|
Facility
IP
|
$10,600.00
|
|
|
Service Code
|
ICD 0FT44ZZ
|
| Min. Negotiated Rate |
$8,285.00 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$8,285.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,790.00
|
| Rate for Payer: Blue Shield of California EPN |
$8,392.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,600.00
|
|
|
Laparoscopic Assisted Surgery
|
Facility
IP
|
$10,600.00
|
|
|
Service Code
|
ICD 0FB44ZZ
|
| Min. Negotiated Rate |
$8,285.00 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$8,285.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,790.00
|
| Rate for Payer: Blue Shield of California EPN |
$8,392.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,600.00
|
|
|
Laparoscopic Assisted Surgery
|
Facility
IP
|
$10,600.00
|
|
|
Service Code
|
ICD 0UT24ZZ
|
| Min. Negotiated Rate |
$8,285.00 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$8,285.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,600.00
|
|
|
Laparoscopic Assisted Surgery
|
Facility
IP
|
$10,600.00
|
|
|
Service Code
|
ICD 0UT94ZZ
|
| Min. Negotiated Rate |
$8,285.00 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$8,285.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,600.00
|
|
|
Laparoscopic Assisted Surgery
|
Facility
IP
|
$10,600.00
|
|
|
Service Code
|
ICD 0UT9FZZ
|
| Min. Negotiated Rate |
$8,285.00 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$8,285.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,600.00
|
|
|
Laparoscopic Assisted Surgery
|
Facility
IP
|
$10,600.00
|
|
|
Service Code
|
ICD 0UT04ZZ
|
| Min. Negotiated Rate |
$8,285.00 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$8,285.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,600.00
|
|
|
Laparoscopic Surgery
|
Facility
IP
|
$10,600.00
|
|
|
Service Code
|
ICD 0UQ14ZZ
|
| Min. Negotiated Rate |
$10,600.00 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$10,600.00
|
|
|
Laparoscopic Surgery
|
Facility
IP
|
$10,600.00
|
|
|
Service Code
|
ICD 0DTL4ZZ
|
| Min. Negotiated Rate |
$10,600.00 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$10,600.00
|
|
|
Laparoscopic Surgery
|
Facility
IP
|
$10,600.00
|
|
|
Service Code
|
ICD 0DTM4ZZ
|
| Min. Negotiated Rate |
$10,600.00 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$10,600.00
|
|
|
Laparoscopic Surgery
|
Facility
IP
|
$10,600.00
|
|
|
Service Code
|
ICD CUC04ZZ
|
| Min. Negotiated Rate |
$10,600.00 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$10,600.00
|
|
|
Laparoscopic Surgery
|
Facility
IP
|
$10,600.00
|
|
|
Service Code
|
ICD 0UC14ZZ
|
| Min. Negotiated Rate |
$10,600.00 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$10,600.00
|
|
|
Laparoscopic Surgery
|
Facility
IP
|
$10,600.00
|
|
|
Service Code
|
ICD 0UB98ZX
|
| Min. Negotiated Rate |
$10,600.00 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$10,600.00
|
|
|
Laparoscopic Surgery
|
Facility
IP
|
$10,600.00
|
|
|
Service Code
|
ICD 0UB14ZZ
|
| Min. Negotiated Rate |
$10,600.00 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$10,600.00
|
|
|
Laparoscopic Surgery
|
Facility
IP
|
$10,600.00
|
|
|
Service Code
|
ICD 0FF68ZZ
|
| Min. Negotiated Rate |
$10,600.00 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$10,600.00
|
|
|
Laparoscopic Surgery
|
Facility
IP
|
$10,600.00
|
|
|
Service Code
|
ICD 0FN14ZZ
|
| Min. Negotiated Rate |
$10,600.00 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$10,600.00
|
|
|
Laparoscopic Surgery
|
Facility
IP
|
$10,600.00
|
|
|
Service Code
|
ICD 0DNM4ZZ
|
| Min. Negotiated Rate |
$10,600.00 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$10,600.00
|
|
|
Laparoscopic Surgery
|
Facility
IP
|
$10,600.00
|
|
|
Service Code
|
ICD 0CUA47Z
|
| Min. Negotiated Rate |
$10,600.00 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$10,600.00
|
|
|
Laparoscopic Surgery
|
Facility
IP
|
$10,600.00
|
|
|
Service Code
|
ICD 0TN14ZZ
|
| Min. Negotiated Rate |
$10,600.00 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$10,600.00
|
|
|
Laparoscopic Surgery
|
Facility
IP
|
$10,600.00
|
|
|
Service Code
|
ICD 0FNC4ZZ
|
| Min. Negotiated Rate |
$10,600.00 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$10,600.00
|
|
