Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

LACTULOSE 20 GRAM/30 ML ORAL SOLUTION [188928]

Facility

IP

$0.05

Service Code	NDC 0121-1154-30
Hospital Charge Code	1716064
Hospital Revenue Code	259
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.04
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cigna of CA HMO/PPO	$0.04
Rate for Payer: Health Smart Auto/Commercial	$0.03
Rate for Payer: LLUH Dept of Risk Management WC	$0.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.04

LACTULOSE 20 GRAM/30 ML ORAL SOLUTION [188928]

Facility

OP

$0.03

Service Code	NDC 9991-8892-80
Hospital Charge Code	1716064
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.02
Rate for Payer: Aetna of CA Government/Medicare	$0.02
Rate for Payer: Cash Price	$0.01
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.02

LACTULOSE 20 GRAM/30 ML ORAL SOLUTION [188928]

Facility

IP

$0.05

Service Code	NDC 0121-1154-00
Hospital Charge Code	1716064
Hospital Revenue Code	259
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.04
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cigna of CA HMO/PPO	$0.04
Rate for Payer: Health Smart Auto/Commercial	$0.03
Rate for Payer: LLUH Dept of Risk Management WC	$0.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.04

LACTULOSE 20 GRAM/30 ML ORAL SOLUTION [188928]

Facility

IP

$0.03

Service Code	NDC 0121-1154-06
Hospital Charge Code	1716064
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cigna of CA HMO/PPO	$0.02
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.02

LACTULOSE 20 GRAM/30 ML ORAL SOLUTION [188928]

Facility

OP

$0.03

Service Code	NDC 0121-1154-06
Hospital Charge Code	1716064
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.02
Rate for Payer: Aetna of CA Government/Medicare	$0.02
Rate for Payer: Cash Price	$0.01
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.02

LACTULOSE 20 GRAM/30 ML ORAL SOLUTION [188928]

Facility

IP

$0.05

Service Code	NDC 0121-1154-40
Hospital Charge Code	1716064
Hospital Revenue Code	259
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.04
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cigna of CA HMO/PPO	$0.04
Rate for Payer: Health Smart Auto/Commercial	$0.03
Rate for Payer: LLUH Dept of Risk Management WC	$0.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.04

LACTULOSE 20 GRAM/30 ML ORAL SOLUTION [188928]

Facility

OP

$0.05

Service Code	NDC 0121-1154-40
Hospital Charge Code	1716064
Hospital Revenue Code	259
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.04
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.03
Rate for Payer: Aetna of CA Government/Medicare	$0.03
Rate for Payer: Cash Price	$0.02
Rate for Payer: Health Smart Auto/Commercial	$0.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.03
Rate for Payer: LLUH Dept of Risk Management WC	$0.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.04

LACTULOSE 20 GRAM/30 ML ORAL SOLUTION [188928]

Facility

IP

$0.03

Service Code	NDC 9991-8892-80
Hospital Charge Code	1716064
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cigna of CA HMO/PPO	$0.02
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.02

LACTULOSE 20 GRAM/30 ML ORAL SOLUTION [188928]

Facility

OP

$0.05

Service Code	NDC 0121-1154-00
Hospital Charge Code	1716064
Hospital Revenue Code	259
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.04
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.03
Rate for Payer: Aetna of CA Government/Medicare	$0.03
Rate for Payer: Cash Price	$0.02
Rate for Payer: Health Smart Auto/Commercial	$0.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.03
Rate for Payer: LLUH Dept of Risk Management WC	$0.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.04

LACTULOSE 20 GRAM ORAL PACKET [24586]

Facility

OP

$7.84

Service Code	NDC 66220-729-01
Hospital Charge Code	1713149
Hospital Revenue Code	259
Min. Negotiated Rate	$4.31
Max. Negotiated Rate	$5.88
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.70
Rate for Payer: Aetna of CA Government/Medicare	$4.70
Rate for Payer: Cash Price	$3.53
Rate for Payer: Health Smart Auto/Commercial	$4.70
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.70
Rate for Payer: LLUH Dept of Risk Management WC	$4.31
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.88

LACTULOSE 20 GRAM ORAL PACKET [24586]

Facility

IP

$10.42

Service Code	NDC 66220-729-30
Hospital Charge Code	1713149
Hospital Revenue Code	259
Min. Negotiated Rate	$5.73
Max. Negotiated Rate	$8.34
Rate for Payer: Cash Price	$4.69
Rate for Payer: Cigna of CA HMO/PPO	$8.34
Rate for Payer: Health Smart Auto/Commercial	$6.25
Rate for Payer: LLUH Dept of Risk Management WC	$5.73
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.82

LACTULOSE 20 GRAM ORAL PACKET [24586]

Facility

OP

$10.42

Service Code	NDC 66220-729-30
Hospital Charge Code	1713149
Hospital Revenue Code	259
Min. Negotiated Rate	$5.73
Max. Negotiated Rate	$7.82
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.25
Rate for Payer: Aetna of CA Government/Medicare	$6.25
Rate for Payer: Cash Price	$4.69
Rate for Payer: Health Smart Auto/Commercial	$6.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.25
Rate for Payer: LLUH Dept of Risk Management WC	$5.73
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.82

LACTULOSE 20 GRAM ORAL PACKET [24586]

Facility

IP

$7.84

Service Code	NDC 66220-729-01
Hospital Charge Code	1713149
Hospital Revenue Code	259
Min. Negotiated Rate	$4.31
Max. Negotiated Rate	$6.27
Rate for Payer: Cash Price	$3.53
Rate for Payer: Cigna of CA HMO/PPO	$6.27
Rate for Payer: Health Smart Auto/Commercial	$4.70
Rate for Payer: LLUH Dept of Risk Management WC	$4.31
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.88

LAMIVUDINE 100 MG TABLET [24419]

Facility

OP

$14.06

Service Code	NDC 60505-3250-6
Hospital Charge Code	1712224
Hospital Revenue Code	259
Min. Negotiated Rate	$7.73
Max. Negotiated Rate	$10.54
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$8.44
Rate for Payer: Aetna of CA Government/Medicare	$8.44
Rate for Payer: Cash Price	$6.33
Rate for Payer: Health Smart Auto/Commercial	$8.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$8.44
Rate for Payer: LLUH Dept of Risk Management WC	$7.73
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$10.54

LAMIVUDINE 100 MG TABLET [24419]

Facility

IP

$14.06

Service Code	NDC 60505-3250-6
Hospital Charge Code	1712224
Hospital Revenue Code	259
Min. Negotiated Rate	$7.73
Max. Negotiated Rate	$11.25
Rate for Payer: Cash Price	$6.33
Rate for Payer: Cigna of CA HMO/PPO	$11.25
Rate for Payer: Health Smart Auto/Commercial	$8.44
Rate for Payer: LLUH Dept of Risk Management WC	$7.73
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$10.54

LAMIVUDINE 10 MG/ML ORAL SOLUTION [15881]

Facility

IP

$0.42

Service Code	NDC 54838-566-70
Hospital Charge Code	1715963
Hospital Revenue Code	259
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.34
Rate for Payer: Cash Price	$0.19
Rate for Payer: Cigna of CA HMO/PPO	$0.34
Rate for Payer: Health Smart Auto/Commercial	$0.25
Rate for Payer: LLUH Dept of Risk Management WC	$0.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.32

LAMIVUDINE 10 MG/ML ORAL SOLUTION [15881]

Facility

IP

$0.55

Service Code	NDC 49702-205-48
Hospital Charge Code	1715963
Hospital Revenue Code	259
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.44
Rate for Payer: Cash Price	$0.25
Rate for Payer: Cigna of CA HMO/PPO	$0.44
Rate for Payer: Health Smart Auto/Commercial	$0.33
Rate for Payer: LLUH Dept of Risk Management WC	$0.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.41

LAMIVUDINE 10 MG/ML ORAL SOLUTION [15881]

Facility

OP

$0.42

Service Code	NDC 54838-566-70
Hospital Charge Code	1715963
Hospital Revenue Code	259
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.32
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.25
Rate for Payer: Aetna of CA Government/Medicare	$0.25
Rate for Payer: Cash Price	$0.19
Rate for Payer: Health Smart Auto/Commercial	$0.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.25
Rate for Payer: LLUH Dept of Risk Management WC	$0.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.32

LAMIVUDINE 10 MG/ML ORAL SOLUTION [15881]

Facility

OP

$0.55

Service Code	NDC 49702-205-48
Hospital Charge Code	1715963
Hospital Revenue Code	259
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.41
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.33
Rate for Payer: Aetna of CA Government/Medicare	$0.33
Rate for Payer: Cash Price	$0.25
Rate for Payer: Health Smart Auto/Commercial	$0.33
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.33
Rate for Payer: LLUH Dept of Risk Management WC	$0.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.41

LAMIVUDINE 150 MG TABLET [15880]

Facility

IP

$0.80

Service Code	NDC 64380-710-03
Hospital Charge Code	1712183
Hospital Revenue Code	259
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$0.64
Rate for Payer: Cash Price	$0.36
Rate for Payer: Cigna of CA HMO/PPO	$0.64
Rate for Payer: Health Smart Auto/Commercial	$0.48
Rate for Payer: LLUH Dept of Risk Management WC	$0.44
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.60

LAMIVUDINE 150 MG TABLET [15880]

Facility

OP

$0.80

Service Code	NDC 64380-710-03
Hospital Charge Code	1712183
Hospital Revenue Code	259
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$0.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.48
Rate for Payer: Aetna of CA Government/Medicare	$0.48
Rate for Payer: Cash Price	$0.36
Rate for Payer: Health Smart Auto/Commercial	$0.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.48
Rate for Payer: LLUH Dept of Risk Management WC	$0.44
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.60

LAMIVUDINE 150 MG TABLET [15880]

Facility

IP

$8.32

Service Code	NDC 49702-203-18
Hospital Charge Code	1712183
Hospital Revenue Code	259
Min. Negotiated Rate	$4.58
Max. Negotiated Rate	$6.66
Rate for Payer: Cash Price	$3.74
Rate for Payer: Cigna of CA HMO/PPO	$6.66
Rate for Payer: Health Smart Auto/Commercial	$4.99
Rate for Payer: LLUH Dept of Risk Management WC	$4.58
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.24

LAMIVUDINE 150 MG TABLET [15880]

Facility

OP

$8.32

Service Code	NDC 49702-203-18
Hospital Charge Code	1712183
Hospital Revenue Code	259
Min. Negotiated Rate	$4.58
Max. Negotiated Rate	$6.24
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.99
Rate for Payer: Aetna of CA Government/Medicare	$4.99
Rate for Payer: Cash Price	$3.74
Rate for Payer: Health Smart Auto/Commercial	$4.99
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.99
Rate for Payer: LLUH Dept of Risk Management WC	$4.58
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.24

LAMIVUDINE 150 MG TABLET [15880]

Facility

IP

$4.50

Service Code	NDC 60505-3251-6
Hospital Charge Code	1712183
Hospital Revenue Code	259
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$3.60
Rate for Payer: Cash Price	$2.03
Rate for Payer: Cigna of CA HMO/PPO	$3.60
Rate for Payer: Health Smart Auto/Commercial	$2.70
Rate for Payer: LLUH Dept of Risk Management WC	$2.48
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.38

LAMIVUDINE 150 MG TABLET [15880]

Facility

OP

$4.50

Service Code	NDC 60505-3251-6
Hospital Charge Code	1712183
Hospital Revenue Code	259
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$3.38
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.70
Rate for Payer: Aetna of CA Government/Medicare	$2.70
Rate for Payer: Cash Price	$2.03
Rate for Payer: Health Smart Auto/Commercial	$2.70
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.70
Rate for Payer: LLUH Dept of Risk Management WC	$2.48
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.38

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