Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

CARBAMAZEPINE 200 MG/10 ML ORAL SUSPENSION [1356]

Facility

IP

$0.45

Service Code	NDC 0121-1894-94
Hospital Charge Code	NDG1356
Hospital Revenue Code	259
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.36
Rate for Payer: Cash Price	$0.20
Rate for Payer: Cigna of CA HMO/PPO	$0.36
Rate for Payer: Health Smart Auto/Commercial	$0.27
Rate for Payer: LLUH Dept of Risk Management WC	$0.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.34

CARBAMAZEPINE 200 MG/10 ML ORAL SUSPENSION [1356]

Facility

OP

$0.45

Service Code	NDC 0121-1894-94
Hospital Charge Code	NDG1356
Hospital Revenue Code	259
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.34
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.27
Rate for Payer: Aetna of CA Government/Medicare	$0.27
Rate for Payer: Cash Price	$0.20
Rate for Payer: Health Smart Auto/Commercial	$0.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.27
Rate for Payer: LLUH Dept of Risk Management WC	$0.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.34

CARBAMAZEPINE 200 MG/10 ML ORAL SUSPENSION [1356]

Facility

OP

$0.45

Service Code	NDC 0121-1894-10
Hospital Charge Code	NDG1356
Hospital Revenue Code	259
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.34
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.27
Rate for Payer: Aetna of CA Government/Medicare	$0.27
Rate for Payer: Cash Price	$0.20
Rate for Payer: Health Smart Auto/Commercial	$0.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.27
Rate for Payer: LLUH Dept of Risk Management WC	$0.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.34

CARBAMAZEPINE 200 MG TABLET [1357]

Facility

OP

$1.08

Service Code	NDC 0904-6172-61
Hospital Charge Code	1710633
Hospital Revenue Code	259
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$0.81
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.65
Rate for Payer: Aetna of CA Government/Medicare	$0.65
Rate for Payer: Cash Price	$0.49
Rate for Payer: Health Smart Auto/Commercial	$0.65
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.65
Rate for Payer: LLUH Dept of Risk Management WC	$0.59
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.81

CARBAMAZEPINE 200 MG TABLET [1357]

Facility

IP

$1.08

Service Code	NDC 0904-6172-61
Hospital Charge Code	1710633
Hospital Revenue Code	259
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$0.86
Rate for Payer: Cash Price	$0.49
Rate for Payer: Cigna of CA HMO/PPO	$0.86
Rate for Payer: Health Smart Auto/Commercial	$0.65
Rate for Payer: LLUH Dept of Risk Management WC	$0.59
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.81

CARBAMAZEPINE 200 MG TABLET [1357]

Facility

IP

$0.18

Service Code	NDC 75834-221-01
Hospital Charge Code	1710633
Hospital Revenue Code	259
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.14
Rate for Payer: Cash Price	$0.08
Rate for Payer: Cigna of CA HMO/PPO	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.11
Rate for Payer: LLUH Dept of Risk Management WC	$0.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.14

CARBAMAZEPINE 200 MG TABLET [1357]

Facility

IP

$0.49

Service Code	NDC 51672-4005-1
Hospital Charge Code	1710633
Hospital Revenue Code	259
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.39
Rate for Payer: Cash Price	$0.22
Rate for Payer: Cigna of CA HMO/PPO	$0.39
Rate for Payer: Health Smart Auto/Commercial	$0.29
Rate for Payer: LLUH Dept of Risk Management WC	$0.27
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.37

CARBAMAZEPINE 200 MG TABLET [1357]

Facility

IP

$0.49

Service Code	NDC 60505-0183-0
Hospital Charge Code	1710633
Hospital Revenue Code	259
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.39
Rate for Payer: Cash Price	$0.22
Rate for Payer: Cigna of CA HMO/PPO	$0.39
Rate for Payer: Health Smart Auto/Commercial	$0.29
Rate for Payer: LLUH Dept of Risk Management WC	$0.27
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.37

CARBAMAZEPINE 200 MG TABLET [1357]

Facility

OP

$0.18

Service Code	NDC 75834-221-01
Hospital Charge Code	1710633
Hospital Revenue Code	259
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.11
Rate for Payer: Aetna of CA Government/Medicare	$0.11
Rate for Payer: Cash Price	$0.08
Rate for Payer: Health Smart Auto/Commercial	$0.11
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.11
Rate for Payer: LLUH Dept of Risk Management WC	$0.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.14

CARBAMAZEPINE 200 MG TABLET [1357]

Facility

OP

$0.49

Service Code	NDC 60505-0183-0
Hospital Charge Code	1710633
Hospital Revenue Code	259
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.37
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.29
Rate for Payer: Aetna of CA Government/Medicare	$0.29
Rate for Payer: Cash Price	$0.22
Rate for Payer: Health Smart Auto/Commercial	$0.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.29
Rate for Payer: LLUH Dept of Risk Management WC	$0.27
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.37

CARBAMAZEPINE 200 MG TABLET [1357]

Facility

OP

$0.49

Service Code	NDC 51672-4005-1
Hospital Charge Code	1710633
Hospital Revenue Code	259
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.37
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.29
Rate for Payer: Aetna of CA Government/Medicare	$0.29
Rate for Payer: Cash Price	$0.22
Rate for Payer: Health Smart Auto/Commercial	$0.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.29
Rate for Payer: LLUH Dept of Risk Management WC	$0.27
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.37

CARBAMAZEPINE ER 100 MG CAPSULE,EXTENDED RELEASE MPHASE12HR [37567]

Facility

IP

$1.96

Service Code	NDC 66993-407-32
Hospital Charge Code	1710949
Hospital Revenue Code	259
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$1.57
Rate for Payer: Cash Price	$0.88
Rate for Payer: Cigna of CA HMO/PPO	$1.57
Rate for Payer: Health Smart Auto/Commercial	$1.18
Rate for Payer: LLUH Dept of Risk Management WC	$1.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.47

CARBAMAZEPINE ER 100 MG CAPSULE,EXTENDED RELEASE MPHASE12HR [37567]

Facility

OP

$1.96

Service Code	NDC 66993-407-32
Hospital Charge Code	1710949
Hospital Revenue Code	259
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$1.47
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.18
Rate for Payer: Aetna of CA Government/Medicare	$1.18
Rate for Payer: Cash Price	$0.88
Rate for Payer: Health Smart Auto/Commercial	$1.18
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.18
Rate for Payer: LLUH Dept of Risk Management WC	$1.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.47

CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR [27634]

Facility

OP

$1.10

Service Code	NDC 0832-6022-11
Hospital Charge Code	1710877
Hospital Revenue Code	259
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$0.83
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.66
Rate for Payer: Aetna of CA Government/Medicare	$0.66
Rate for Payer: Cash Price	$0.50
Rate for Payer: Health Smart Auto/Commercial	$0.66
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.66
Rate for Payer: LLUH Dept of Risk Management WC	$0.61
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.83

CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR [27634]

Facility

IP

$1.10

Service Code	NDC 0832-6022-11
Hospital Charge Code	1710877
Hospital Revenue Code	259
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$0.88
Rate for Payer: Cash Price	$0.50
Rate for Payer: Cigna of CA HMO/PPO	$0.88
Rate for Payer: Health Smart Auto/Commercial	$0.66
Rate for Payer: LLUH Dept of Risk Management WC	$0.61
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.83

CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR [27634]

Facility

OP

$1.10

Service Code	NDC 0781-8016-01
Hospital Charge Code	1710877
Hospital Revenue Code	259
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$0.83
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.66
Rate for Payer: Aetna of CA Government/Medicare	$0.66
Rate for Payer: Cash Price	$0.50
Rate for Payer: Health Smart Auto/Commercial	$0.66
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.66
Rate for Payer: LLUH Dept of Risk Management WC	$0.61
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.83

CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR [27634]

Facility

IP

$1.10

Service Code	NDC 0781-8016-01
Hospital Charge Code	1710877
Hospital Revenue Code	259
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$0.88
Rate for Payer: Cash Price	$0.50
Rate for Payer: Cigna of CA HMO/PPO	$0.88
Rate for Payer: Health Smart Auto/Commercial	$0.66
Rate for Payer: LLUH Dept of Risk Management WC	$0.61
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.83

CARBAMAZEPINE ER 200 MG CAPSULE,EXTENDED RELEASE MPHASE12HR [27632]

Facility

OP

$1.96

Service Code	NDC 66993-408-32
Hospital Charge Code	1710925
Hospital Revenue Code	259
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$1.47
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.18
Rate for Payer: Aetna of CA Government/Medicare	$1.18
Rate for Payer: Cash Price	$0.88
Rate for Payer: Health Smart Auto/Commercial	$1.18
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.18
Rate for Payer: LLUH Dept of Risk Management WC	$1.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.47

CARBAMAZEPINE ER 200 MG CAPSULE,EXTENDED RELEASE MPHASE12HR [27632]

Facility

IP

$1.96

Service Code	NDC 66993-408-32
Hospital Charge Code	1710925
Hospital Revenue Code	259
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$1.57
Rate for Payer: Cash Price	$0.88
Rate for Payer: Cigna of CA HMO/PPO	$1.57
Rate for Payer: Health Smart Auto/Commercial	$1.18
Rate for Payer: LLUH Dept of Risk Management WC	$1.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.47

CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR [27635]

Facility

OP

$4.04

Service Code	NDC 60687-583-21
Hospital Charge Code	1711778
Hospital Revenue Code	259
Min. Negotiated Rate	$2.22
Max. Negotiated Rate	$3.03
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.42
Rate for Payer: Aetna of CA Government/Medicare	$2.42
Rate for Payer: Cash Price	$1.82
Rate for Payer: Health Smart Auto/Commercial	$2.42
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.42
Rate for Payer: LLUH Dept of Risk Management WC	$2.22
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.03

CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR [27635]

Facility

IP

$2.00

Service Code	NDC 0781-5987-01
Hospital Charge Code	1711778
Hospital Revenue Code	259
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$1.60
Rate for Payer: Cash Price	$0.90
Rate for Payer: Cigna of CA HMO/PPO	$1.60
Rate for Payer: Health Smart Auto/Commercial	$1.20
Rate for Payer: LLUH Dept of Risk Management WC	$1.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.50

CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR [27635]

Facility

IP

$0.96

Service Code	NDC 59746-790-01
Hospital Charge Code	1711778
Hospital Revenue Code	259
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$0.77
Rate for Payer: Cash Price	$0.43
Rate for Payer: Cigna of CA HMO/PPO	$0.77
Rate for Payer: Health Smart Auto/Commercial	$0.58
Rate for Payer: LLUH Dept of Risk Management WC	$0.53
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.72

CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR [27635]

Facility

IP

$4.04

Service Code	NDC 60687-583-21
Hospital Charge Code	1711778
Hospital Revenue Code	259
Min. Negotiated Rate	$2.22
Max. Negotiated Rate	$3.23
Rate for Payer: Cash Price	$1.82
Rate for Payer: Cigna of CA HMO/PPO	$3.23
Rate for Payer: Health Smart Auto/Commercial	$2.42
Rate for Payer: LLUH Dept of Risk Management WC	$2.22
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.03

CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR [27635]

Facility

OP

$4.04

Service Code	NDC 60687-583-11
Hospital Charge Code	1711778
Hospital Revenue Code	259
Min. Negotiated Rate	$2.22
Max. Negotiated Rate	$3.03
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.42
Rate for Payer: Aetna of CA Government/Medicare	$2.42
Rate for Payer: Cash Price	$1.82
Rate for Payer: Health Smart Auto/Commercial	$2.42
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.42
Rate for Payer: LLUH Dept of Risk Management WC	$2.22
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.03

CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR [27635]

Facility

OP

$2.00

Service Code	NDC 0781-5987-01
Hospital Charge Code	1711778
Hospital Revenue Code	259
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.20
Rate for Payer: Aetna of CA Government/Medicare	$1.20
Rate for Payer: Cash Price	$0.90
Rate for Payer: Health Smart Auto/Commercial	$1.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.20
Rate for Payer: LLUH Dept of Risk Management WC	$1.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.50

<<
<
84
85
86
87
88
89
90
91
92
93
>
>>