|
LAMOTRIGINE 100 MG DISINTEGRATING TABLET [96941]
|
Facility
|
IP
|
$9.73
|
|
|
Service Code
|
NDC 4988448654
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$8.76 |
| Rate for Payer: Adventist Health Commercial |
$1.95
|
| Rate for Payer: Blue Shield of California Commercial |
$7.80
|
| Rate for Payer: Blue Shield of California EPN |
$4.90
|
| Rate for Payer: Cash Price |
$4.38
|
| Rate for Payer: Central Health Plan Commercial |
$7.78
|
| Rate for Payer: Cigna of CA HMO |
$6.81
|
| Rate for Payer: Cigna of CA PPO |
$6.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.89
|
| Rate for Payer: EPIC Health Plan Senior |
$3.89
|
| Rate for Payer: Galaxy Health WC |
$8.27
|
| Rate for Payer: Global Benefits Group Commercial |
$5.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.95
|
| Rate for Payer: Multiplan Commercial |
$7.30
|
| 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 4988448654
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$8.76 |
| Rate for Payer: Adventist Health Commercial |
$1.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.91
|
| 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 |
$7.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.66
|
| Rate for Payer: Blue Shield of California Commercial |
$6.17
|
| Rate for Payer: Blue Shield of California EPN |
$3.88
|
| Rate for Payer: Cash Price |
$4.38
|
| Rate for Payer: Central Health Plan Commercial |
$7.78
|
| 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 Medi-Cal |
$8.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.89
|
| Rate for Payer: EPIC Health Plan Senior |
$3.89
|
| Rate for Payer: Galaxy Health WC |
$8.27
|
| Rate for Payer: Global Benefits Group Commercial |
$5.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.81
|
| Rate for Payer: Multiplan Commercial |
$7.30
|
| Rate for Payer: Networks By Design Commercial |
$6.32
|
| Rate for Payer: Prime Health Services Commercial |
$8.27
|
| Rate for Payer: Riverside University Health System MISP |
$3.89
|
| 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 |
$4.87
|
| Rate for Payer: United Healthcare All Other HMO |
$4.87
|
| Rate for Payer: United Healthcare HMO Rider |
$4.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.87
|
| 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
|
|
|
LAMOTRIGINE 100 MG DISINTEGRATING TABLET [96941]
|
Facility
|
OP
|
$4.48
|
|
|
Service Code
|
NDC 0115994101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$4.03 |
| Rate for Payer: Adventist Health Commercial |
$0.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.61
|
| Rate for Payer: Blue Shield of California Commercial |
$2.84
|
| Rate for Payer: Blue Shield of California EPN |
$1.79
|
| Rate for Payer: Cash Price |
$2.02
|
| Rate for Payer: Central Health Plan Commercial |
$3.58
|
| Rate for Payer: Cigna of CA HMO |
$3.14
|
| Rate for Payer: Cigna of CA PPO |
$3.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.79
|
| Rate for Payer: EPIC Health Plan Senior |
$1.79
|
| Rate for Payer: Galaxy Health WC |
$3.81
|
| Rate for Payer: Global Benefits Group Commercial |
$2.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.14
|
| Rate for Payer: Multiplan Commercial |
$3.36
|
| Rate for Payer: Networks By Design Commercial |
$2.91
|
| Rate for Payer: Prime Health Services Commercial |
$3.81
|
| Rate for Payer: Riverside University Health System MISP |
$1.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.24
|
| Rate for Payer: United Healthcare All Other HMO |
$2.24
|
| Rate for Payer: United Healthcare HMO Rider |
$2.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.81
|
| Rate for Payer: Vantage Medical Group Senior |
$3.81
|
|
|
LAMOTRIGINE 100 MG DISINTEGRATING TABLET [96941]
|
Facility
|
IP
|
$6.38
|
|
|
Service Code
|
NDC 6991837030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$5.74 |
| Rate for Payer: Adventist Health Commercial |
$1.28
|
| Rate for Payer: Blue Shield of California Commercial |
$5.12
|
| Rate for Payer: Blue Shield of California EPN |
$3.22
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: Central Health Plan Commercial |
$5.10
|
| Rate for Payer: Cigna of CA HMO |
$4.47
|
| Rate for Payer: Cigna of CA PPO |
$4.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.55
|
| Rate for Payer: EPIC Health Plan Senior |
$2.55
|
| Rate for Payer: Galaxy Health WC |
$5.42
|
| Rate for Payer: Global Benefits Group Commercial |
$3.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: Multiplan Commercial |
$4.79
|
| 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
|
OP
|
$6.83
|
|
|
Service Code
|
NDC 4359855230
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$6.15 |
| Rate for Payer: Adventist Health Commercial |
$1.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.97
|
| Rate for Payer: Blue Shield of California Commercial |
$4.33
|
| Rate for Payer: Blue Shield of California EPN |
$2.73
|
| Rate for Payer: Cash Price |
$3.07
|
| Rate for Payer: Central Health Plan Commercial |
$5.46
|
| Rate for Payer: Cigna of CA HMO |
$4.78
|
| Rate for Payer: Cigna of CA PPO |
$4.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.73
|
| Rate for Payer: EPIC Health Plan Senior |
$2.73
|
| Rate for Payer: Galaxy Health WC |
$5.81
|
| Rate for Payer: Global Benefits Group Commercial |
$4.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.78
|
| Rate for Payer: Multiplan Commercial |
$5.12
|
| Rate for Payer: Networks By Design Commercial |
$4.44
|
| Rate for Payer: Prime Health Services Commercial |
$5.81
|
| Rate for Payer: Riverside University Health System MISP |
$2.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.42
|
| Rate for Payer: United Healthcare All Other HMO |
$3.42
|
| Rate for Payer: United Healthcare HMO Rider |
$3.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.81
|
| Rate for Payer: Vantage Medical Group Senior |
$5.81
|
|
|
LAMOTRIGINE 100 MG DISINTEGRATING TABLET [96941]
|
Facility
|
IP
|
$4.48
|
|
|
Service Code
|
NDC 0115994101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$4.03 |
| Rate for Payer: Adventist Health Commercial |
$0.90
|
| Rate for Payer: Blue Shield of California Commercial |
$3.59
|
| Rate for Payer: Blue Shield of California EPN |
$2.26
|
| Rate for Payer: Cash Price |
$2.02
|
| Rate for Payer: Central Health Plan Commercial |
$3.58
|
| Rate for Payer: Cigna of CA HMO |
$3.14
|
| Rate for Payer: Cigna of CA PPO |
$3.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.79
|
| Rate for Payer: EPIC Health Plan Senior |
$1.79
|
| Rate for Payer: Galaxy Health WC |
$3.81
|
| Rate for Payer: Global Benefits Group Commercial |
$2.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$3.36
|
| Rate for Payer: Networks By Design Commercial |
$2.91
|
| Rate for Payer: Prime Health Services Commercial |
$3.81
|
|
|
LAMOTRIGINE 100 MG DISINTEGRATING TABLET [96941]
|
Facility
|
IP
|
$6.83
|
|
|
Service Code
|
NDC 4359855230
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$6.15 |
| Rate for Payer: Adventist Health Commercial |
$1.37
|
| Rate for Payer: Blue Shield of California Commercial |
$5.48
|
| Rate for Payer: Blue Shield of California EPN |
$3.44
|
| Rate for Payer: Cash Price |
$3.07
|
| Rate for Payer: Central Health Plan Commercial |
$5.46
|
| Rate for Payer: Cigna of CA HMO |
$4.78
|
| Rate for Payer: Cigna of CA PPO |
$4.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.73
|
| Rate for Payer: EPIC Health Plan Senior |
$2.73
|
| Rate for Payer: Galaxy Health WC |
$5.81
|
| Rate for Payer: Global Benefits Group Commercial |
$4.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.37
|
| Rate for Payer: Multiplan Commercial |
$5.12
|
| Rate for Payer: Networks By Design Commercial |
$4.44
|
| Rate for Payer: Prime Health Services Commercial |
$5.81
|
|
|
LAMOTRIGINE 100 MG DISINTEGRATING TABLET [96941]
|
Facility
|
IP
|
$9.73
|
|
|
Service Code
|
NDC 4988448611
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$8.76 |
| Rate for Payer: Adventist Health Commercial |
$1.95
|
| Rate for Payer: Blue Shield of California Commercial |
$7.80
|
| Rate for Payer: Blue Shield of California EPN |
$4.90
|
| Rate for Payer: Cash Price |
$4.38
|
| Rate for Payer: Central Health Plan Commercial |
$7.78
|
| Rate for Payer: Cigna of CA HMO |
$6.81
|
| Rate for Payer: Cigna of CA PPO |
$6.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.89
|
| Rate for Payer: EPIC Health Plan Senior |
$3.89
|
| Rate for Payer: Galaxy Health WC |
$8.27
|
| Rate for Payer: Global Benefits Group Commercial |
$5.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.95
|
| Rate for Payer: Multiplan Commercial |
$7.30
|
| 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
|
$6.38
|
|
|
Service Code
|
NDC 6991837030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$5.74 |
| Rate for Payer: Adventist Health Commercial |
$1.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.87
|
| 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 |
$4.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.71
|
| Rate for Payer: Blue Shield of California Commercial |
$4.04
|
| Rate for Payer: Blue Shield of California EPN |
$2.55
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: Central Health Plan Commercial |
$5.10
|
| 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 Medi-Cal |
$5.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.55
|
| Rate for Payer: EPIC Health Plan Senior |
$2.55
|
| Rate for Payer: Galaxy Health WC |
$5.42
|
| Rate for Payer: Global Benefits Group Commercial |
$3.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.47
|
| Rate for Payer: Multiplan Commercial |
$4.79
|
| Rate for Payer: Networks By Design Commercial |
$4.15
|
| Rate for Payer: Prime Health Services Commercial |
$5.42
|
| Rate for Payer: Riverside University Health System MISP |
$2.55
|
| 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 TABLET [13982]
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
NDC 6808431911
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Central Health Plan Commercial |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.16
|
| Rate for Payer: Cigna of CA PPO |
$0.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.15
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
|
|
LAMOTRIGINE 100 MG TABLET [13982]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 6233203831
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
| Rate for Payer: Riverside University Health System MISP |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
LAMOTRIGINE 100 MG TABLET [13982]
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
NDC 6808431901
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Central Health Plan Commercial |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.16
|
| Rate for Payer: Cigna of CA PPO |
$0.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.15
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
|
|
LAMOTRIGINE 100 MG TABLET [13982]
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
NDC 6808431911
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Central Health Plan Commercial |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.16
|
| Rate for Payer: Cigna of CA PPO |
$0.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.15
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
| Rate for Payer: Riverside University Health System MISP |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO |
$0.12
|
| Rate for Payer: United Healthcare HMO Rider |
$0.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
LAMOTRIGINE 100 MG TABLET [13982]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 5167241311
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
| Rate for Payer: Riverside University Health System MISP |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
LAMOTRIGINE 100 MG TABLET [13982]
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
NDC 2930011201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
|
|
LAMOTRIGINE 100 MG TABLET [13982]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 6233203831
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
|
|
LAMOTRIGINE 100 MG TABLET [13982]
|
Facility
|
OP
|
$0.28
|
|
|
Service Code
|
NDC 6838200801
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Central Health Plan Commercial |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Senior |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.24
|
| Rate for Payer: Riverside University Health System MISP |
$0.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO |
$0.14
|
| Rate for Payer: United Healthcare HMO Rider |
$0.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: Vantage Medical Group Senior |
$0.24
|
|
|
LAMOTRIGINE 100 MG TABLET [13982]
|
Facility
|
IP
|
$0.28
|
|
|
Service Code
|
NDC 6838200801
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Central Health Plan Commercial |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Senior |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.24
|
|
|
LAMOTRIGINE 100 MG TABLET [13982]
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
NDC 6808431901
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Central Health Plan Commercial |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.16
|
| Rate for Payer: Cigna of CA PPO |
$0.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.15
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
| Rate for Payer: Riverside University Health System MISP |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO |
$0.12
|
| Rate for Payer: United Healthcare HMO Rider |
$0.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
LAMOTRIGINE 100 MG TABLET [13982]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 5167241311
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
|
|
LAMOTRIGINE 100 MG TABLET [13982]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 2930011201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
| Rate for Payer: Riverside University Health System MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
|
LAMOTRIGINE 150 MG TABLET [14266]
|
Facility
|
OP
|
$0.30
|
|
|
Service Code
|
NDC 6838200914
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Central Health Plan Commercial |
$0.24
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: Riverside University Health System MISP |
$0.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.15
|
| Rate for Payer: United Healthcare All Other HMO |
$0.15
|
| Rate for Payer: United Healthcare HMO Rider |
$0.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
|
LAMOTRIGINE 150 MG TABLET [14266]
|
Facility
|
IP
|
$0.13
|
|
|
Service Code
|
NDC 2930011316
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.09
|
| Rate for Payer: Cigna of CA PPO |
$0.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.11
|
|
|
LAMOTRIGINE 150 MG TABLET [14266]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 6233203960
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
LAMOTRIGINE 150 MG TABLET [14266]
|
Facility
|
OP
|
$0.13
|
|
|
Service Code
|
NDC 2930011316
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.09
|
| Rate for Payer: Cigna of CA PPO |
$0.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.11
|
| Rate for Payer: Riverside University Health System MISP |
$0.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: Vantage Medical Group Senior |
$0.11
|
|
