|
LANOLIN ALCOHOLS-MINERAL OIL-W.PETROLATUM-CERESIN TOPICAL CREAM [120012]
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
NDC 7214000022
|
| Hospital Charge Code |
NDG11371C
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.05
|
| Rate for Payer: Cash Price |
$0.03
|
| 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 |
$0.05
|
|
|
LANOLIN-MINERAL OIL LOTION [2787]
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 7214011019
|
| Hospital Charge Code |
NDG2787
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Senior |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Senior |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.01
|
| 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 |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Senior |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
LANOLIN-MINERAL OIL LOTION [2787]
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 7214011019
|
| Hospital Charge Code |
NDG2787
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Senior |
$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: Multiplan Commercial |
$0.02
|
|
|
LANREOTIDE 60 MG/0.2 ML SUBCUTANEOUS SYRINGE [88570]
|
Facility
|
OP
|
$36,528.00
|
|
|
Service Code
|
CPT J1930
|
| Hospital Charge Code |
ERX88570
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.44 |
| Max. Negotiated Rate |
$27,396.00 |
| Rate for Payer: Adventist Health Commercial |
$7,305.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$119.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25,094.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.96
|
| Rate for Payer: Blue Shield of California Commercial |
$91.89
|
| Rate for Payer: Blue Shield of California EPN |
$91.89
|
| Rate for Payer: Cash Price |
$16,437.60
|
| Rate for Payer: Cash Price |
$16,437.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16,802.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.29
|
| Rate for Payer: Dignity Health Senior |
$53.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,377.92
|
| Rate for Payer: EPIC Health Plan Medicare |
$48.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,912.46
|
| Rate for Payer: Heritage Provider Network Senior |
$16,912.46
|
| Rate for Payer: Humana Medicare |
$48.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$82.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$92.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,611.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$57.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,132.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$61.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$61.04
|
| Rate for Payer: Multiplan Commercial |
$27,396.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$14,611.20
|
| Rate for Payer: TriValley Medical Group Senior |
$14,611.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,318.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12,204.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.29
|
| Rate for Payer: Vantage Medical Group Senior |
$48.44
|
|
|
LANREOTIDE 60 MG/0.2 ML SUBCUTANEOUS SYRINGE [88570]
|
Facility
|
IP
|
$36,528.00
|
|
|
Service Code
|
CPT J1930
|
| Hospital Charge Code |
ERX88570
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,611.57 |
| Max. Negotiated Rate |
$27,396.00 |
| Rate for Payer: Adventist Health Commercial |
$7,305.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25,094.74
|
| Rate for Payer: Cash Price |
$16,437.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16,802.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,725.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$24,729.46
|
| Rate for Payer: Heritage Provider Network Senior |
$24,729.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,611.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,132.00
|
| Rate for Payer: Multiplan Commercial |
$27,396.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,318.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12,204.00
|
|
|
LANREOTIDE 90 MG/0.3 ML SUBCUTANEOUS SYRINGE [87860]
|
Facility
|
OP
|
$32,432.00
|
|
|
Service Code
|
CPT J1930
|
| Hospital Charge Code |
NDG87860
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.44 |
| Max. Negotiated Rate |
$24,324.00 |
| Rate for Payer: Adventist Health Commercial |
$6,486.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$119.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22,280.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.96
|
| Rate for Payer: Blue Shield of California Commercial |
$91.89
|
| Rate for Payer: Blue Shield of California EPN |
$91.89
|
| Rate for Payer: Cash Price |
$14,594.40
|
| Rate for Payer: Cash Price |
$14,594.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14,918.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.29
|
| Rate for Payer: Dignity Health Senior |
$53.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,756.48
|
| Rate for Payer: EPIC Health Plan Medicare |
$48.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,016.02
|
| Rate for Payer: Heritage Provider Network Senior |
$15,016.02
|
| Rate for Payer: Humana Medicare |
$48.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$82.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$92.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,870.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$57.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,108.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$61.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$61.04
|
| Rate for Payer: Multiplan Commercial |
$24,324.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$12,972.80
|
| Rate for Payer: TriValley Medical Group Senior |
$12,972.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11,824.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,835.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.29
|
| Rate for Payer: Vantage Medical Group Senior |
$48.44
|
|
|
LANREOTIDE 90 MG/0.3 ML SUBCUTANEOUS SYRINGE [87860]
|
Facility
|
IP
|
$32,432.00
|
|
|
Service Code
|
CPT J1930
|
| Hospital Charge Code |
NDG87860
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,870.19 |
| Max. Negotiated Rate |
$24,324.00 |
| Rate for Payer: Adventist Health Commercial |
$6,486.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22,280.78
|
| Rate for Payer: Cash Price |
$14,594.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14,918.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,513.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$21,956.46
|
| Rate for Payer: Heritage Provider Network Senior |
$21,956.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,870.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,108.00
|
| Rate for Payer: Multiplan Commercial |
$24,324.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11,824.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,835.53
|
|
|
LANSOPRAZOLE 15 MG CAPSULE,DELAYED RELEASE [27691]
|
Facility
|
OP
|
$3.65
|
|
|
Service Code
|
NDC 60687-111-21
|
| Hospital Charge Code |
1711714
|
|
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 |
$2.27
|
| Rate for Payer: Blue Shield of California EPN |
$2.14
|
| Rate for Payer: Cash Price |
$1.64
|
| 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 |
$1.76
|
| 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
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.46
|
| Rate for Payer: TriValley Medical Group Senior |
$1.46
|
| 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 |
1711714
|
|
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: Aetna of CA Non-Gatekeeper |
$2.51
|
| Rate for Payer: Cash Price |
$1.64
|
| 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 15 MG CAPSULE,DELAYED RELEASE [27691]
|
Facility
|
IP
|
$3.65
|
|
|
Service Code
|
NDC 60687-111-21
|
| Hospital Charge Code |
1711714
|
|
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: Aetna of CA Non-Gatekeeper |
$2.51
|
| Rate for Payer: Cash Price |
$1.64
|
| 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 15 MG CAPSULE,DELAYED RELEASE [27691]
|
Facility
|
OP
|
$3.65
|
|
|
Service Code
|
NDC 60687-111-11
|
| Hospital Charge Code |
1711714
|
|
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 |
$2.27
|
| Rate for Payer: Blue Shield of California EPN |
$2.14
|
| Rate for Payer: Cash Price |
$1.64
|
| 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 |
$1.76
|
| 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
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.46
|
| Rate for Payer: TriValley Medical Group Senior |
$1.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.10
|
| Rate for Payer: Vantage Medical Group Senior |
$3.10
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET [34595]
|
Facility
|
IP
|
$16.60
|
|
|
Service Code
|
NDC 64764-544-11
|
| Hospital Charge Code |
1711847
|
|
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: Aetna of CA Non-Gatekeeper |
$11.40
|
| Rate for Payer: Cash Price |
$7.47
|
| 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 |
1711847
|
|
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 |
$10.31
|
| Rate for Payer: Blue Shield of California EPN |
$9.74
|
| Rate for Payer: Cash Price |
$7.47
|
| 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 |
$8.00
|
| 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
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.64
|
| Rate for Payer: TriValley Medical Group Senior |
$6.64
|
| 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 |
1715980
|
|
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: Aetna of CA Non-Gatekeeper |
$0.39
|
| Rate for Payer: Cash Price |
$0.26
|
| 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 |
1715980
|
|
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 |
$0.33
|
| Rate for Payer: Cash Price |
$0.26
|
| 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: 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: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
|
|
LANTHANUM 1,000 MG CHEWABLE TABLET [43548]
|
Facility
|
OP
|
$6.67
|
|
|
Service Code
|
NDC 68180-821-47
|
| Hospital Charge Code |
1711937
|
|
Hospital Revenue Code
|
259
|
| 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 |
$4.14
|
| Rate for Payer: Blue Shield of California EPN |
$3.92
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.34
|
| 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 |
$4.13
|
| Rate for Payer: Heritage Provider Network Senior |
$4.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.21
|
| 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: TriValley Medical Group Commercial |
$2.67
|
| Rate for Payer: TriValley Medical Group Senior |
$2.67
|
| 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
|
$12.95
|
|
|
Service Code
|
NDC 66993-424-85
|
| Hospital Charge Code |
1711937
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$9.71 |
| Rate for Payer: Adventist Health Commercial |
$2.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.90
|
| Rate for Payer: Cash Price |
$5.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.77
|
| Rate for Payer: Heritage Provider Network Senior |
$8.77
|
| 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
|
|
|
LANTHANUM 1,000 MG CHEWABLE TABLET [43548]
|
Facility
|
IP
|
$6.67
|
|
|
Service Code
|
NDC 68180-821-47
|
| Hospital Charge Code |
1711937
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Adventist Health Commercial |
$1.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.58
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.52
|
| Rate for Payer: Heritage Provider Network Senior |
$4.52
|
| 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
|
|
|
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: 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 |
$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: TriValley Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Senior |
$5.18
|
| 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 66993-424-75
|
| Hospital Charge Code |
1711937
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$9.71 |
| Rate for Payer: Adventist Health Commercial |
$2.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.90
|
| Rate for Payer: Cash Price |
$5.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.77
|
| Rate for Payer: Heritage Provider Network Senior |
$8.77
|
| 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
|
|
|
LANTHANUM 1,000 MG CHEWABLE TABLET [43548]
|
Facility
|
OP
|
$6.67
|
|
|
Service Code
|
NDC 68180-821-10
|
| Hospital Charge Code |
1711937
|
|
Hospital Revenue Code
|
259
|
| 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 |
$4.14
|
| Rate for Payer: Blue Shield of California EPN |
$3.92
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.34
|
| 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 |
$4.13
|
| Rate for Payer: Heritage Provider Network Senior |
$4.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.21
|
| 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: TriValley Medical Group Commercial |
$2.67
|
| Rate for Payer: TriValley Medical Group Senior |
$2.67
|
| 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 66993-424-85
|
| 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: 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 |
$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: TriValley Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Senior |
$5.18
|
| 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
|
$6.67
|
|
|
Service Code
|
NDC 68180-821-10
|
| Hospital Charge Code |
1711937
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Adventist Health Commercial |
$1.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.58
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.52
|
| Rate for Payer: Heritage Provider Network Senior |
$4.52
|
| 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
|
|
|
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: 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 |
$8.95
|
| 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: TriValley Medical Group Commercial |
$5.76
|
| Rate for Payer: TriValley Medical Group Senior |
$5.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.25
|
| Rate for Payer: Vantage Medical Group Senior |
$12.25
|
|
