|
LAMOTRIGINE 25 MG TABLET [13981]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 6808431801
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| 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 |
$0.14
|
| 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 |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
| Rate for Payer: Riverside University Health System MISP |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
|
|
LAMOTRIGINE 25 MG TABLET [13981]
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
NDC 6233203731
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
|
|
LAMOTRIGINE 25 MG TABLET [13981]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 6808431811
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| 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 |
$0.14
|
| 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 |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
| Rate for Payer: Riverside University Health System MISP |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
|
|
LAMOTRIGINE 25 MG TABLET [13981]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 6808431801
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| 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 |
$0.10
|
| Rate for Payer: Central Health Plan Commercial |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
|
|
LAMOTRIGINE 25 MG TABLET [13981]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 6808431811
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| 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 |
$0.10
|
| Rate for Payer: Central Health Plan Commercial |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
|
|
LAMOTRIGINE 25 MG TABLET [13981]
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
NDC 2930011101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| 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 |
$0.03
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$0.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.06
|
|
|
LAMOTRIGINE 25 MG TABLET [13981]
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 6233203731
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
| Rate for Payer: Riverside University Health System MISP |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.04
|
|
|
LAMOTRIGINE 50 MG DISINTEGRATING TABLET [96940]
|
Facility
|
IP
|
$4.24
|
|
|
Service Code
|
NDC 2724118430
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: Adventist Health Commercial |
$0.85
|
| Rate for Payer: Blue Shield of California Commercial |
$3.40
|
| Rate for Payer: Blue Shield of California EPN |
$2.14
|
| Rate for Payer: Cash Price |
$1.91
|
| Rate for Payer: Central Health Plan Commercial |
$3.39
|
| Rate for Payer: Cigna of CA HMO |
$2.97
|
| Rate for Payer: Cigna of CA PPO |
$2.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.70
|
| Rate for Payer: EPIC Health Plan Senior |
$1.70
|
| Rate for Payer: Galaxy Health WC |
$3.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.85
|
| Rate for Payer: Multiplan Commercial |
$3.18
|
| Rate for Payer: Networks By Design Commercial |
$2.76
|
| Rate for Payer: Prime Health Services Commercial |
$3.60
|
|
|
LAMOTRIGINE 50 MG DISINTEGRATING TABLET [96940]
|
Facility
|
IP
|
$6.41
|
|
|
Service Code
|
NDC 4359855130
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$5.77 |
| Rate for Payer: Adventist Health Commercial |
$1.28
|
| Rate for Payer: Blue Shield of California Commercial |
$5.14
|
| Rate for Payer: Blue Shield of California EPN |
$3.23
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: Central Health Plan Commercial |
$5.13
|
| Rate for Payer: Cigna of CA HMO |
$4.49
|
| Rate for Payer: Cigna of CA PPO |
$4.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.56
|
| Rate for Payer: EPIC Health Plan Senior |
$2.56
|
| Rate for Payer: Galaxy Health WC |
$5.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: Multiplan Commercial |
$4.81
|
| Rate for Payer: Networks By Design Commercial |
$4.17
|
| Rate for Payer: Prime Health Services Commercial |
$5.45
|
|
|
LAMOTRIGINE 50 MG DISINTEGRATING TABLET [96940]
|
Facility
|
OP
|
$4.24
|
|
|
Service Code
|
NDC 2724118430
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: Adventist Health Commercial |
$0.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.47
|
| Rate for Payer: Blue Shield of California Commercial |
$2.69
|
| Rate for Payer: Blue Shield of California EPN |
$1.69
|
| Rate for Payer: Cash Price |
$1.91
|
| Rate for Payer: Central Health Plan Commercial |
$3.39
|
| Rate for Payer: Cigna of CA HMO |
$2.97
|
| Rate for Payer: Cigna of CA PPO |
$2.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.70
|
| Rate for Payer: EPIC Health Plan Senior |
$1.70
|
| Rate for Payer: Galaxy Health WC |
$3.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.97
|
| Rate for Payer: Multiplan Commercial |
$3.18
|
| Rate for Payer: Networks By Design Commercial |
$2.76
|
| Rate for Payer: Prime Health Services Commercial |
$3.60
|
| Rate for Payer: Riverside University Health System MISP |
$1.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.12
|
| Rate for Payer: United Healthcare All Other HMO |
$2.12
|
| Rate for Payer: United Healthcare HMO Rider |
$2.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.60
|
| Rate for Payer: Vantage Medical Group Senior |
$3.60
|
|
|
LAMOTRIGINE 50 MG DISINTEGRATING TABLET [96940]
|
Facility
|
OP
|
$6.41
|
|
|
Service Code
|
NDC 4359855130
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$5.77 |
| Rate for Payer: Adventist Health Commercial |
$1.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.73
|
| Rate for Payer: Blue Shield of California Commercial |
$4.06
|
| Rate for Payer: Blue Shield of California EPN |
$2.56
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: Central Health Plan Commercial |
$5.13
|
| Rate for Payer: Cigna of CA HMO |
$4.49
|
| Rate for Payer: Cigna of CA PPO |
$4.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.56
|
| Rate for Payer: EPIC Health Plan Senior |
$2.56
|
| Rate for Payer: Galaxy Health WC |
$5.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.49
|
| Rate for Payer: Multiplan Commercial |
$4.81
|
| Rate for Payer: Networks By Design Commercial |
$4.17
|
| Rate for Payer: Prime Health Services Commercial |
$5.45
|
| Rate for Payer: Riverside University Health System MISP |
$2.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.21
|
| Rate for Payer: United Healthcare All Other HMO |
$3.21
|
| Rate for Payer: United Healthcare HMO Rider |
$3.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.45
|
| Rate for Payer: Vantage Medical Group Senior |
$5.45
|
|
|
LAMOTRIGINE 5 MG CHEWABLE DISPERSIBLE TABLET [104568]
|
Facility
|
IP
|
$11.42
|
|
|
Service Code
|
NDC 0173052600
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$10.28 |
| Rate for Payer: Adventist Health Commercial |
$2.28
|
| Rate for Payer: Blue Shield of California Commercial |
$9.16
|
| Rate for Payer: Blue Shield of California EPN |
$5.76
|
| Rate for Payer: Cash Price |
$5.14
|
| Rate for Payer: Central Health Plan Commercial |
$9.14
|
| Rate for Payer: Cigna of CA HMO |
$7.99
|
| Rate for Payer: Cigna of CA PPO |
$7.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.57
|
| Rate for Payer: EPIC Health Plan Senior |
$4.57
|
| Rate for Payer: Galaxy Health WC |
$9.71
|
| Rate for Payer: Global Benefits Group Commercial |
$6.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.28
|
| Rate for Payer: Multiplan Commercial |
$8.56
|
| Rate for Payer: Networks By Design Commercial |
$7.42
|
| Rate for Payer: Prime Health Services Commercial |
$9.71
|
|
|
LAMOTRIGINE 5 MG CHEWABLE DISPERSIBLE TABLET [104568]
|
Facility
|
OP
|
$11.42
|
|
|
Service Code
|
NDC 0173052600
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$10.28 |
| Rate for Payer: Adventist Health Commercial |
$2.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.64
|
| Rate for Payer: Blue Shield of California Commercial |
$7.24
|
| Rate for Payer: Blue Shield of California EPN |
$4.56
|
| Rate for Payer: Cash Price |
$5.14
|
| Rate for Payer: Central Health Plan Commercial |
$9.14
|
| Rate for Payer: Cigna of CA HMO |
$7.99
|
| Rate for Payer: Cigna of CA PPO |
$7.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.57
|
| Rate for Payer: EPIC Health Plan Senior |
$4.57
|
| Rate for Payer: Galaxy Health WC |
$9.71
|
| Rate for Payer: Global Benefits Group Commercial |
$6.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.99
|
| Rate for Payer: Multiplan Commercial |
$8.56
|
| Rate for Payer: Networks By Design Commercial |
$7.42
|
| Rate for Payer: Prime Health Services Commercial |
$9.71
|
| Rate for Payer: Riverside University Health System MISP |
$4.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.71
|
| Rate for Payer: United Healthcare All Other HMO |
$5.71
|
| Rate for Payer: United Healthcare HMO Rider |
$5.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.71
|
| Rate for Payer: Vantage Medical Group Senior |
$9.71
|
|
|
LANOLIN ALCOHOLS-MINERAL OIL-W.PETROLATUM-CERESIN TOPICAL CREAM [120012]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 7214003868
|
| 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
|
|
|
LANOLIN ALCOHOLS-MINERAL OIL-W.PETROLATUM-CERESIN TOPICAL CREAM [120012]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
NDC 7214003868
|
| 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: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| 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 |
$0.05
|
| 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: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.09
|
| 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 Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.07
|
| 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
|
| Rate for Payer: Riverside University Health System MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.06
|
| 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 |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
LANOLIN-MINERAL OIL LOTION [2787]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 7214011019
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
LANOLIN-MINERAL OIL LOTION [2787]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 7214011019
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Riverside University Health System MISP |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
LANREOTIDE 60 MG/0.2 ML SUBCUTANEOUS SYRINGE [88570]
|
Facility
|
OP
|
$40,158.00
|
|
|
Service Code
|
HCPCS J1930
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.43 |
| Max. Negotiated Rate |
$36,142.20 |
| Rate for Payer: Adventist Health Commercial |
$8,031.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$37.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$245.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$51.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.67
|
| Rate for Payer: Blue Shield of California Commercial |
$54.13
|
| Rate for Payer: Blue Shield of California EPN |
$49.21
|
| Rate for Payer: Cash Price |
$18,071.10
|
| Rate for Payer: Cash Price |
$18,071.10
|
| Rate for Payer: Central Health Plan Commercial |
$32,126.40
|
| Rate for Payer: Cigna of CA HMO |
$28,110.60
|
| Rate for Payer: Cigna of CA PPO |
$28,110.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28,110.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.76
|
| Rate for Payer: EPIC Health Plan Senior |
$41.17
|
| Rate for Payer: Galaxy Health WC |
$34,134.30
|
| Rate for Payer: Global Benefits Group Commercial |
$24,094.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$36,142.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$37.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25,500.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$75.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,031.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$50.16
|
| Rate for Payer: Multiplan Commercial |
$30,118.50
|
| Rate for Payer: Networks By Design Commercial |
$20,079.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$37.43
|
| Rate for Payer: Prime Health Services Commercial |
$34,134.30
|
| Rate for Payer: Prime Health Services Medicare |
$39.68
|
| Rate for Payer: Riverside University Health System MISP |
$41.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24,094.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24,094.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,071.30
|
| Rate for Payer: United Healthcare All Other HMO |
$14,669.72
|
| Rate for Payer: United Healthcare HMO Rider |
$14,352.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13,151.75
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.17
|
| Rate for Payer: Vantage Medical Group Senior |
$41.17
|
|
|
LANREOTIDE 60 MG/0.2 ML SUBCUTANEOUS SYRINGE [88570]
|
Facility
|
IP
|
$40,158.00
|
|
|
Service Code
|
HCPCS J1930
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8,031.60 |
| Max. Negotiated Rate |
$36,142.20 |
| Rate for Payer: Adventist Health Commercial |
$8,031.60
|
| Rate for Payer: Blue Shield of California Commercial |
$32,206.72
|
| Rate for Payer: Blue Shield of California EPN |
$20,239.63
|
| Rate for Payer: Cash Price |
$18,071.10
|
| Rate for Payer: Central Health Plan Commercial |
$32,126.40
|
| Rate for Payer: Cigna of CA HMO |
$28,110.60
|
| Rate for Payer: Cigna of CA PPO |
$28,110.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28,110.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,063.20
|
| Rate for Payer: EPIC Health Plan Senior |
$16,063.20
|
| Rate for Payer: Galaxy Health WC |
$34,134.30
|
| Rate for Payer: Global Benefits Group Commercial |
$24,094.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$36,142.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25,500.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23,693.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,031.60
|
| Rate for Payer: Multiplan Commercial |
$30,118.50
|
| Rate for Payer: Networks By Design Commercial |
$20,079.00
|
| Rate for Payer: Prime Health Services Commercial |
$34,134.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,071.30
|
| Rate for Payer: United Healthcare All Other HMO |
$14,669.72
|
| Rate for Payer: United Healthcare HMO Rider |
$14,352.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13,151.75
|
|
|
LANREOTIDE 90 MG/0.3 ML SUBCUTANEOUS SYRINGE [87860]
|
Facility
|
IP
|
$35,652.00
|
|
|
Service Code
|
HCPCS J1930
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,130.40 |
| Max. Negotiated Rate |
$32,086.80 |
| Rate for Payer: Adventist Health Commercial |
$7,130.40
|
| Rate for Payer: Blue Shield of California Commercial |
$28,592.90
|
| Rate for Payer: Blue Shield of California EPN |
$17,968.61
|
| Rate for Payer: Cash Price |
$16,043.40
|
| Rate for Payer: Central Health Plan Commercial |
$28,521.60
|
| Rate for Payer: Cigna of CA HMO |
$24,956.40
|
| Rate for Payer: Cigna of CA PPO |
$24,956.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24,956.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,260.80
|
| Rate for Payer: EPIC Health Plan Senior |
$14,260.80
|
| Rate for Payer: Galaxy Health WC |
$30,304.20
|
| Rate for Payer: Global Benefits Group Commercial |
$21,391.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$32,086.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22,639.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21,034.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,130.40
|
| Rate for Payer: Multiplan Commercial |
$26,739.00
|
| Rate for Payer: Networks By Design Commercial |
$17,826.00
|
| Rate for Payer: Prime Health Services Commercial |
$30,304.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,380.20
|
| Rate for Payer: United Healthcare All Other HMO |
$13,023.68
|
| Rate for Payer: United Healthcare HMO Rider |
$12,742.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,676.03
|
|
|
LANREOTIDE 90 MG/0.3 ML SUBCUTANEOUS SYRINGE [87860]
|
Facility
|
OP
|
$35,652.00
|
|
|
Service Code
|
HCPCS J1930
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.43 |
| Max. Negotiated Rate |
$32,086.80 |
| Rate for Payer: Adventist Health Commercial |
$7,130.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$37.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$245.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$51.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.67
|
| Rate for Payer: Blue Shield of California Commercial |
$54.13
|
| Rate for Payer: Blue Shield of California EPN |
$49.21
|
| Rate for Payer: Cash Price |
$16,043.40
|
| Rate for Payer: Cash Price |
$16,043.40
|
| Rate for Payer: Central Health Plan Commercial |
$28,521.60
|
| Rate for Payer: Cigna of CA HMO |
$24,956.40
|
| Rate for Payer: Cigna of CA PPO |
$24,956.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24,956.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.76
|
| Rate for Payer: EPIC Health Plan Senior |
$41.17
|
| Rate for Payer: Galaxy Health WC |
$30,304.20
|
| Rate for Payer: Global Benefits Group Commercial |
$21,391.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$32,086.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$37.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22,639.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$75.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,130.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$50.16
|
| Rate for Payer: Multiplan Commercial |
$26,739.00
|
| Rate for Payer: Networks By Design Commercial |
$17,826.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$37.43
|
| Rate for Payer: Prime Health Services Commercial |
$30,304.20
|
| Rate for Payer: Prime Health Services Medicare |
$39.68
|
| Rate for Payer: Riverside University Health System MISP |
$41.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21,391.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21,391.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,380.20
|
| Rate for Payer: United Healthcare All Other HMO |
$13,023.68
|
| Rate for Payer: United Healthcare HMO Rider |
$12,742.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,676.03
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.17
|
| Rate for Payer: Vantage Medical Group Senior |
$41.17
|
|
|
LANSOPRAZOLE 15 MG CAPSULE,DELAYED RELEASE [27691]
|
Facility
|
IP
|
$3.65
|
|
|
Service Code
|
NDC 6068711111
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$3.29 |
| Rate for Payer: Adventist Health Commercial |
$0.73
|
| Rate for Payer: Blue Shield of California Commercial |
$2.93
|
| Rate for Payer: Blue Shield of California EPN |
$1.84
|
| Rate for Payer: Cash Price |
$1.64
|
| Rate for Payer: Central Health Plan Commercial |
$2.92
|
| Rate for Payer: Cigna of CA HMO |
$2.56
|
| Rate for Payer: Cigna of CA PPO |
$2.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.46
|
| Rate for Payer: EPIC Health Plan Senior |
$1.46
|
| Rate for Payer: Galaxy Health WC |
$3.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.73
|
| Rate for Payer: Multiplan Commercial |
$2.74
|
| Rate for Payer: Networks By Design Commercial |
$2.37
|
| Rate for Payer: Prime Health Services Commercial |
$3.10
|
|
|
LANSOPRAZOLE 15 MG CAPSULE,DELAYED RELEASE [27691]
|
Facility
|
OP
|
$3.65
|
|
|
Service Code
|
NDC 6068711111
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$3.29 |
| Rate for Payer: Adventist Health Commercial |
$0.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.12
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California EPN |
$1.46
|
| Rate for Payer: Cash Price |
$1.64
|
| Rate for Payer: Central Health Plan Commercial |
$2.92
|
| Rate for Payer: Cigna of CA HMO |
$2.56
|
| Rate for Payer: Cigna of CA PPO |
$2.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.46
|
| Rate for Payer: EPIC Health Plan Senior |
$1.46
|
| Rate for Payer: Galaxy Health WC |
$3.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.56
|
| Rate for Payer: Multiplan Commercial |
$2.74
|
| Rate for Payer: Networks By Design Commercial |
$2.37
|
| Rate for Payer: Prime Health Services Commercial |
$3.10
|
| Rate for Payer: Riverside University Health System MISP |
$1.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.82
|
| Rate for Payer: United Healthcare All Other HMO |
$1.82
|
| Rate for Payer: United Healthcare HMO Rider |
$1.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.10
|
| Rate for Payer: Vantage Medical Group Senior |
$3.10
|
|
|
LANSOPRAZOLE 15 MG CAPSULE,DELAYED RELEASE [27691]
|
Facility
|
OP
|
$3.65
|
|
|
Service Code
|
NDC 6068711121
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$3.29 |
| Rate for Payer: Adventist Health Commercial |
$0.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.12
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California EPN |
$1.46
|
| Rate for Payer: Cash Price |
$1.64
|
| Rate for Payer: Central Health Plan Commercial |
$2.92
|
| Rate for Payer: Cigna of CA HMO |
$2.56
|
| Rate for Payer: Cigna of CA PPO |
$2.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.46
|
| Rate for Payer: EPIC Health Plan Senior |
$1.46
|
| Rate for Payer: Galaxy Health WC |
$3.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.56
|
| Rate for Payer: Multiplan Commercial |
$2.74
|
| Rate for Payer: Networks By Design Commercial |
$2.37
|
| Rate for Payer: Prime Health Services Commercial |
$3.10
|
| Rate for Payer: Riverside University Health System MISP |
$1.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.82
|
| Rate for Payer: United Healthcare All Other HMO |
$1.82
|
| Rate for Payer: United Healthcare HMO Rider |
$1.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.10
|
| Rate for Payer: Vantage Medical Group Senior |
$3.10
|
|
|
LANSOPRAZOLE 15 MG CAPSULE,DELAYED RELEASE [27691]
|
Facility
|
IP
|
$3.65
|
|
|
Service Code
|
NDC 6068711121
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$3.29 |
| Rate for Payer: Adventist Health Commercial |
$0.73
|
| Rate for Payer: Blue Shield of California Commercial |
$2.93
|
| Rate for Payer: Blue Shield of California EPN |
$1.84
|
| Rate for Payer: Cash Price |
$1.64
|
| Rate for Payer: Central Health Plan Commercial |
$2.92
|
| Rate for Payer: Cigna of CA HMO |
$2.56
|
| Rate for Payer: Cigna of CA PPO |
$2.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.46
|
| Rate for Payer: EPIC Health Plan Senior |
$1.46
|
| Rate for Payer: Galaxy Health WC |
$3.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.73
|
| Rate for Payer: Multiplan Commercial |
$2.74
|
| Rate for Payer: Networks By Design Commercial |
$2.37
|
| Rate for Payer: Prime Health Services Commercial |
$3.10
|
|
