|
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 |
$1.88 |
| Max. Negotiated Rate |
$6.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.67
|
| Rate for Payer: Blue Distinction Transplant |
$4.70
|
| Rate for Payer: Blue Shield of California Commercial |
$5.78
|
| Rate for Payer: Blue Shield of California EPN |
$4.58
|
| Rate for Payer: Cash Price |
$3.53
|
| Rate for Payer: Cigna of CA HMO |
$5.49
|
| Rate for Payer: Cigna of CA PPO |
$5.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.66
|
| Rate for Payer: Dignity Health Media |
$6.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.14
|
| Rate for Payer: Galaxy Health WC |
$6.66
|
| Rate for Payer: Global Benefits Group Commercial |
$4.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.88
|
| Rate for Payer: Multiplan Commercial |
$6.27
|
| Rate for Payer: Networks By Design Commercial |
$5.10
|
| Rate for Payer: Prime Health Services Commercial |
$6.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.92
|
| Rate for Payer: United Healthcare All Other HMO |
$3.92
|
| Rate for Payer: United Healthcare HMO Rider |
$3.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.66
|
| Rate for Payer: Vantage Medical Group Senior |
$6.66
|
|
|
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 |
$1.88 |
| Max. Negotiated Rate |
$6.66 |
| Rate for Payer: Blue Shield of California Commercial |
$5.58
|
| Rate for Payer: Blue Shield of California EPN |
$4.01
|
| Rate for Payer: Cash Price |
$3.53
|
| Rate for Payer: Cigna of CA HMO |
$5.49
|
| Rate for Payer: Cigna of CA PPO |
$5.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.14
|
| Rate for Payer: Galaxy Health WC |
$6.66
|
| Rate for Payer: Global Benefits Group Commercial |
$4.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.88
|
| Rate for Payer: Multiplan Commercial |
$6.27
|
| Rate for Payer: Networks By Design Commercial |
$5.10
|
| Rate for Payer: Prime Health Services Commercial |
$6.66
|
|
|
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 |
$3.37 |
| Max. Negotiated Rate |
$11.95 |
| Rate for Payer: Blue Shield of California Commercial |
$10.01
|
| Rate for Payer: Blue Shield of California EPN |
$7.20
|
| Rate for Payer: Cash Price |
$6.33
|
| Rate for Payer: Cigna of CA HMO |
$9.84
|
| Rate for Payer: Cigna of CA PPO |
$9.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.62
|
| Rate for Payer: Galaxy Health WC |
$11.95
|
| Rate for Payer: Global Benefits Group Commercial |
$8.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.37
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.14
|
| Rate for Payer: Prime Health Services Commercial |
$11.95
|
|
|
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 |
$3.37 |
| Max. Negotiated Rate |
$11.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.38
|
| Rate for Payer: Blue Distinction Transplant |
$8.44
|
| Rate for Payer: Blue Shield of California Commercial |
$10.36
|
| Rate for Payer: Blue Shield of California EPN |
$8.21
|
| Rate for Payer: Cash Price |
$6.33
|
| Rate for Payer: Cigna of CA HMO |
$9.84
|
| Rate for Payer: Cigna of CA PPO |
$9.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.95
|
| Rate for Payer: Dignity Health Media |
$11.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.62
|
| Rate for Payer: Galaxy Health WC |
$11.95
|
| Rate for Payer: Global Benefits Group Commercial |
$8.44
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.37
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.14
|
| Rate for Payer: Prime Health Services Commercial |
$11.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.03
|
| Rate for Payer: United Healthcare All Other HMO |
$7.03
|
| Rate for Payer: United Healthcare HMO Rider |
$7.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.95
|
| Rate for Payer: Vantage Medical Group Senior |
$11.95
|
|
|
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 |
$0.13 |
| Max. Negotiated Rate |
$0.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.33
|
| Rate for Payer: Blue Distinction Transplant |
$0.33
|
| Rate for Payer: Blue Shield of California Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California EPN |
$0.32
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Cigna of CA HMO |
$0.39
|
| Rate for Payer: Cigna of CA PPO |
$0.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.47
|
| Rate for Payer: Dignity Health Media |
$0.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.47
|
| Rate for Payer: Global Benefits Group Commercial |
$0.33
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: Networks By Design Commercial |
$0.36
|
| Rate for Payer: Prime Health Services Commercial |
$0.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.28
|
| Rate for Payer: United Healthcare All Other HMO |
$0.28
|
| Rate for Payer: United Healthcare HMO Rider |
$0.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.47
|
| Rate for Payer: Vantage Medical Group Senior |
$0.47
|
|
|
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 |
$0.13 |
| Max. Negotiated Rate |
$0.47 |
| Rate for Payer: Blue Shield of California Commercial |
$0.39
|
| Rate for Payer: Blue Shield of California EPN |
$0.28
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Cigna of CA HMO |
$0.39
|
| Rate for Payer: Cigna of CA PPO |
$0.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.47
|
| Rate for Payer: Global Benefits Group Commercial |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: Networks By Design Commercial |
$0.36
|
| Rate for Payer: Prime Health Services Commercial |
$0.47
|
|
|
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 |
$0.10 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.25
|
| Rate for Payer: Blue Distinction Transplant |
$0.25
|
| Rate for Payer: Blue Shield of California Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California EPN |
$0.25
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cigna of CA HMO |
$0.29
|
| Rate for Payer: Cigna of CA PPO |
$0.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.36
|
| Rate for Payer: Dignity Health Media |
$0.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.17
|
| Rate for Payer: Galaxy Health WC |
$0.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.34
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Prime Health Services Commercial |
$0.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.21
|
| Rate for Payer: United Healthcare All Other HMO |
$0.21
|
| Rate for Payer: United Healthcare HMO Rider |
$0.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: Vantage Medical Group Senior |
$0.36
|
|
|
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 |
$0.10 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cigna of CA HMO |
$0.29
|
| Rate for Payer: Cigna of CA PPO |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: Galaxy Health WC |
$0.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.34
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Prime Health Services Commercial |
$0.36
|
|
|
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 |
$1.08 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.68
|
| Rate for Payer: Blue Distinction Transplant |
$2.70
|
| Rate for Payer: Blue Shield of California Commercial |
$3.32
|
| Rate for Payer: Blue Shield of California EPN |
$2.63
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Cigna of CA HMO |
$3.15
|
| Rate for Payer: Cigna of CA PPO |
$3.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.82
|
| Rate for Payer: Dignity Health Media |
$3.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.80
|
| Rate for Payer: Galaxy Health WC |
$3.82
|
| Rate for Payer: Global Benefits Group Commercial |
$2.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: Multiplan Commercial |
$3.60
|
| Rate for Payer: Networks By Design Commercial |
$2.92
|
| Rate for Payer: Prime Health Services Commercial |
$3.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.25
|
| Rate for Payer: United Healthcare All Other HMO |
$2.25
|
| Rate for Payer: United Healthcare HMO Rider |
$2.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.82
|
| Rate for Payer: Vantage Medical Group Senior |
$3.82
|
|
|
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 |
$0.19 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.48
|
| Rate for Payer: Blue Distinction Transplant |
$0.48
|
| Rate for Payer: Blue Shield of California Commercial |
$0.59
|
| Rate for Payer: Blue Shield of California EPN |
$0.47
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cigna of CA HMO |
$0.56
|
| Rate for Payer: Cigna of CA PPO |
$0.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.68
|
| Rate for Payer: Dignity Health Media |
$0.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.68
|
| Rate for Payer: Global Benefits Group Commercial |
$0.48
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.64
|
| Rate for Payer: Networks By Design Commercial |
$0.52
|
| Rate for Payer: Prime Health Services Commercial |
$0.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO |
$0.40
|
| Rate for Payer: United Healthcare HMO Rider |
$0.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.68
|
| Rate for Payer: Vantage Medical Group Senior |
$0.68
|
|
|
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 |
$2.00 |
| Max. Negotiated Rate |
$7.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.96
|
| Rate for Payer: Blue Distinction Transplant |
$4.99
|
| Rate for Payer: Blue Shield of California Commercial |
$6.13
|
| Rate for Payer: Blue Shield of California EPN |
$4.86
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Cigna of CA HMO |
$5.82
|
| Rate for Payer: Cigna of CA PPO |
$5.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.07
|
| Rate for Payer: Dignity Health Media |
$7.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.33
|
| Rate for Payer: Galaxy Health WC |
$7.07
|
| Rate for Payer: Global Benefits Group Commercial |
$4.99
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: Networks By Design Commercial |
$5.41
|
| Rate for Payer: Prime Health Services Commercial |
$7.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.16
|
| Rate for Payer: United Healthcare All Other HMO |
$4.16
|
| Rate for Payer: United Healthcare HMO Rider |
$4.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.07
|
| Rate for Payer: Vantage Medical Group Senior |
$7.07
|
|
|
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 |
$0.19 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California EPN |
$0.41
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cigna of CA HMO |
$0.56
|
| Rate for Payer: Cigna of CA PPO |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.68
|
| Rate for Payer: Global Benefits Group Commercial |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.64
|
| Rate for Payer: Networks By Design Commercial |
$0.52
|
| Rate for Payer: Prime Health Services Commercial |
$0.68
|
|
|
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 |
$1.08 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: Blue Shield of California Commercial |
$3.20
|
| Rate for Payer: Blue Shield of California EPN |
$2.30
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Cigna of CA HMO |
$3.15
|
| Rate for Payer: Cigna of CA PPO |
$3.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.80
|
| Rate for Payer: Galaxy Health WC |
$3.82
|
| Rate for Payer: Global Benefits Group Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: Multiplan Commercial |
$3.60
|
| Rate for Payer: Networks By Design Commercial |
$2.92
|
| Rate for Payer: Prime Health Services Commercial |
$3.82
|
|
|
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 |
$2.00 |
| Max. Negotiated Rate |
$7.07 |
| Rate for Payer: Blue Shield of California Commercial |
$5.92
|
| Rate for Payer: Blue Shield of California EPN |
$4.26
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Cigna of CA HMO |
$5.82
|
| Rate for Payer: Cigna of CA PPO |
$5.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.33
|
| Rate for Payer: Galaxy Health WC |
$7.07
|
| Rate for Payer: Global Benefits Group Commercial |
$4.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: Networks By Design Commercial |
$5.41
|
| Rate for Payer: Prime Health Services Commercial |
$7.07
|
|
|
LAMIVUDINE 150 MG-ZIDOVUDINE 300 MG TABLET [21810]
|
Facility
|
OP
|
$2.67
|
|
|
Service Code
|
NDC 31722-506-60
|
| Hospital Charge Code |
1710907
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.27 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.59
|
| Rate for Payer: Blue Distinction Transplant |
$1.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1.97
|
| Rate for Payer: Blue Shield of California EPN |
$1.56
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna of CA HMO |
$1.87
|
| Rate for Payer: Cigna of CA PPO |
$1.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.27
|
| Rate for Payer: Dignity Health Media |
$2.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.07
|
| Rate for Payer: Galaxy Health WC |
$2.27
|
| Rate for Payer: Global Benefits Group Commercial |
$1.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: Multiplan Commercial |
$2.14
|
| Rate for Payer: Networks By Design Commercial |
$1.74
|
| Rate for Payer: Prime Health Services Commercial |
$2.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.34
|
| Rate for Payer: United Healthcare All Other HMO |
$1.34
|
| Rate for Payer: United Healthcare HMO Rider |
$1.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.27
|
| Rate for Payer: Vantage Medical Group Senior |
$2.27
|
|
|
LAMIVUDINE 150 MG-ZIDOVUDINE 300 MG TABLET [21810]
|
Facility
|
IP
|
$2.67
|
|
|
Service Code
|
NDC 31722-506-60
|
| Hospital Charge Code |
1710907
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.27 |
| Rate for Payer: Blue Shield of California Commercial |
$1.90
|
| Rate for Payer: Blue Shield of California EPN |
$1.37
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna of CA HMO |
$1.87
|
| Rate for Payer: Cigna of CA PPO |
$1.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.07
|
| Rate for Payer: Galaxy Health WC |
$2.27
|
| Rate for Payer: Global Benefits Group Commercial |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: Multiplan Commercial |
$2.14
|
| Rate for Payer: Networks By Design Commercial |
$1.74
|
| Rate for Payer: Prime Health Services Commercial |
$2.27
|
|
|
LAMIVUDINE-ZIDOVUDINE ORAL SOLUTION COMPOUND [4080404]
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
NDC 9994-0804-04
|
| Hospital Charge Code |
1715309
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Blue Shield of California Commercial |
$0.85
|
| Rate for Payer: Blue Shield of California EPN |
$0.61
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.96
|
| Rate for Payer: Networks By Design Commercial |
$0.78
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
|
|
LAMIVUDINE-ZIDOVUDINE ORAL SOLUTION COMPOUND [4080404]
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
NDC 9994-0804-04
|
| Hospital Charge Code |
1715309
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.71
|
| Rate for Payer: Blue Distinction Transplant |
$0.72
|
| Rate for Payer: Blue Shield of California Commercial |
$0.88
|
| Rate for Payer: Blue Shield of California EPN |
$0.70
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.02
|
| Rate for Payer: Dignity Health Media |
$1.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.96
|
| Rate for Payer: Networks By Design Commercial |
$0.78
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.60
|
| Rate for Payer: United Healthcare All Other HMO |
$0.60
|
| Rate for Payer: United Healthcare HMO Rider |
$0.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: Vantage Medical Group Senior |
$1.02
|
|
|
LAMOTRIGINE 100 MG DISINTEGRATING TABLET [96941]
|
Facility
|
OP
|
$6.38
|
|
|
Service Code
|
NDC 69918-370-30
|
| Hospital Charge Code |
1712436
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$5.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.80
|
| Rate for Payer: Blue Distinction Transplant |
$3.83
|
| Rate for Payer: Blue Shield of California Commercial |
$4.70
|
| Rate for Payer: Blue Shield of California EPN |
$3.73
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: Cigna of CA HMO |
$4.47
|
| Rate for Payer: Cigna of CA PPO |
$4.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.42
|
| Rate for Payer: Dignity Health Media |
$5.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.55
|
| Rate for Payer: Galaxy Health WC |
$5.42
|
| Rate for Payer: Global Benefits Group Commercial |
$3.83
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.53
|
| Rate for Payer: Multiplan Commercial |
$5.10
|
| Rate for Payer: Networks By Design Commercial |
$4.15
|
| Rate for Payer: Prime Health Services Commercial |
$5.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.19
|
| Rate for Payer: United Healthcare All Other HMO |
$3.19
|
| Rate for Payer: United Healthcare HMO Rider |
$3.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.42
|
| Rate for Payer: Vantage Medical Group Senior |
$5.42
|
|
|
LAMOTRIGINE 100 MG DISINTEGRATING TABLET [96941]
|
Facility
|
IP
|
$9.73
|
|
|
Service Code
|
NDC 49884-486-54
|
| Hospital Charge Code |
1712436
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$8.27 |
| Rate for Payer: Blue Shield of California Commercial |
$6.93
|
| Rate for Payer: Blue Shield of California EPN |
$4.98
|
| Rate for Payer: Cash Price |
$4.38
|
| Rate for Payer: Cigna of CA HMO |
$6.81
|
| Rate for Payer: Cigna of CA PPO |
$6.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.89
|
| Rate for Payer: Galaxy Health WC |
$8.27
|
| Rate for Payer: Global Benefits Group Commercial |
$5.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.34
|
| Rate for Payer: Multiplan Commercial |
$7.78
|
| Rate for Payer: Networks By Design Commercial |
$6.32
|
| Rate for Payer: Prime Health Services Commercial |
$8.27
|
|
|
LAMOTRIGINE 100 MG DISINTEGRATING TABLET [96941]
|
Facility
|
OP
|
$9.08
|
|
|
Service Code
|
NDC 43598-552-30
|
| Hospital Charge Code |
1712436
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$7.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.41
|
| Rate for Payer: Blue Distinction Transplant |
$5.45
|
| Rate for Payer: Blue Shield of California Commercial |
$6.69
|
| Rate for Payer: Blue Shield of California EPN |
$5.30
|
| Rate for Payer: Cash Price |
$4.09
|
| Rate for Payer: Cigna of CA HMO |
$6.36
|
| Rate for Payer: Cigna of CA PPO |
$6.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.72
|
| Rate for Payer: Dignity Health Media |
$7.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.63
|
| Rate for Payer: Galaxy Health WC |
$7.72
|
| Rate for Payer: Global Benefits Group Commercial |
$5.45
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.18
|
| Rate for Payer: Multiplan Commercial |
$7.26
|
| Rate for Payer: Networks By Design Commercial |
$5.90
|
| Rate for Payer: Prime Health Services Commercial |
$7.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.54
|
| Rate for Payer: United Healthcare All Other HMO |
$4.54
|
| Rate for Payer: United Healthcare HMO Rider |
$4.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.72
|
| Rate for Payer: Vantage Medical Group Senior |
$7.72
|
|
|
LAMOTRIGINE 100 MG DISINTEGRATING TABLET [96941]
|
Facility
|
IP
|
$6.38
|
|
|
Service Code
|
NDC 69918-370-30
|
| Hospital Charge Code |
1712436
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$5.42 |
| Rate for Payer: Blue Shield of California Commercial |
$4.54
|
| Rate for Payer: Blue Shield of California EPN |
$3.27
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: Cigna of CA HMO |
$4.47
|
| Rate for Payer: Cigna of CA PPO |
$4.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.55
|
| Rate for Payer: Galaxy Health WC |
$5.42
|
| Rate for Payer: Global Benefits Group Commercial |
$3.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.53
|
| Rate for Payer: Multiplan Commercial |
$5.10
|
| Rate for Payer: Networks By Design Commercial |
$4.15
|
| Rate for Payer: Prime Health Services Commercial |
$5.42
|
|
|
LAMOTRIGINE 100 MG DISINTEGRATING TABLET [96941]
|
Facility
|
IP
|
$9.08
|
|
|
Service Code
|
NDC 43598-552-30
|
| Hospital Charge Code |
1712436
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$7.72 |
| Rate for Payer: Blue Shield of California Commercial |
$6.46
|
| Rate for Payer: Blue Shield of California EPN |
$4.65
|
| Rate for Payer: Cash Price |
$4.09
|
| Rate for Payer: Cigna of CA HMO |
$6.36
|
| Rate for Payer: Cigna of CA PPO |
$6.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.63
|
| Rate for Payer: Galaxy Health WC |
$7.72
|
| Rate for Payer: Global Benefits Group Commercial |
$5.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.18
|
| Rate for Payer: Multiplan Commercial |
$7.26
|
| Rate for Payer: Networks By Design Commercial |
$5.90
|
| Rate for Payer: Prime Health Services Commercial |
$7.72
|
|
|
LAMOTRIGINE 100 MG DISINTEGRATING TABLET [96941]
|
Facility
|
IP
|
$9.73
|
|
|
Service Code
|
NDC 49884-486-11
|
| Hospital Charge Code |
1712436
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$8.27 |
| Rate for Payer: Blue Shield of California Commercial |
$6.93
|
| Rate for Payer: Blue Shield of California EPN |
$4.98
|
| Rate for Payer: Cash Price |
$4.38
|
| Rate for Payer: Cigna of CA HMO |
$6.81
|
| Rate for Payer: Cigna of CA PPO |
$6.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.89
|
| Rate for Payer: Galaxy Health WC |
$8.27
|
| Rate for Payer: Global Benefits Group Commercial |
$5.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.34
|
| Rate for Payer: Multiplan Commercial |
$7.78
|
| Rate for Payer: Networks By Design Commercial |
$6.32
|
| Rate for Payer: Prime Health Services Commercial |
$8.27
|
|
|
LAMOTRIGINE 100 MG DISINTEGRATING TABLET [96941]
|
Facility
|
OP
|
$9.73
|
|
|
Service Code
|
NDC 49884-486-11
|
| Hospital Charge Code |
1712436
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$8.27 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.80
|
| Rate for Payer: Blue Distinction Transplant |
$5.84
|
| Rate for Payer: Blue Shield of California Commercial |
$7.17
|
| Rate for Payer: Blue Shield of California EPN |
$5.68
|
| Rate for Payer: Cash Price |
$4.38
|
| Rate for Payer: Cigna of CA HMO |
$6.81
|
| Rate for Payer: Cigna of CA PPO |
$6.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.27
|
| Rate for Payer: Dignity Health Media |
$8.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.89
|
| Rate for Payer: Galaxy Health WC |
$8.27
|
| Rate for Payer: Global Benefits Group Commercial |
$5.84
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.34
|
| Rate for Payer: Multiplan Commercial |
$7.78
|
| Rate for Payer: Networks By Design Commercial |
$6.32
|
| Rate for Payer: Prime Health Services Commercial |
$8.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.86
|
| Rate for Payer: United Healthcare All Other HMO |
$4.86
|
| Rate for Payer: United Healthcare HMO Rider |
$4.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.27
|
| Rate for Payer: Vantage Medical Group Senior |
$8.27
|
|
