|
LACTULOSE 20 GRAM ORAL PACKET [24586]
|
Facility
|
IP
|
$7.84
|
|
|
Service Code
|
NDC 66220-729-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$7.06 |
| Rate for Payer: Adventist Health Commercial |
$1.57
|
| Rate for Payer: Blue Shield of California Commercial |
$6.06
|
| Rate for Payer: Blue Shield of California EPN |
$3.95
|
| Rate for Payer: Cash Price |
$4.31
|
| Rate for Payer: Central Health Plan Commercial |
$6.27
|
| Rate for Payer: Cigna of CA HMO |
$5.49
|
| Rate for Payer: Cigna of CA PPO |
$5.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.14
|
| Rate for Payer: EPIC Health Plan Senior |
$3.14
|
| Rate for Payer: Galaxy Health WC |
$6.66
|
| Rate for Payer: Global Benefits Group Commercial |
$4.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.57
|
| Rate for Payer: Multiplan Commercial |
$5.88
|
| Rate for Payer: Networks By Design Commercial |
$5.10
|
| Rate for Payer: Prime Health Services Commercial |
$6.66
|
|
|
LACTULOSE 20 GRAM ORAL PACKET [24586]
|
Facility
|
OP
|
$7.84
|
|
|
Service Code
|
NDC 66220-729-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$7.06 |
| Rate for Payer: Adventist Health Commercial |
$1.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4.79
|
| Rate for Payer: Blue Shield of California EPN |
$3.13
|
| Rate for Payer: Cash Price |
$4.31
|
| Rate for Payer: Central Health Plan Commercial |
$6.27
|
| Rate for Payer: Cigna of CA HMO |
$5.49
|
| Rate for Payer: Cigna of CA PPO |
$5.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.14
|
| Rate for Payer: EPIC Health Plan Senior |
$3.14
|
| Rate for Payer: Galaxy Health WC |
$6.66
|
| Rate for Payer: Global Benefits Group Commercial |
$4.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.06
|
| Rate for Payer: InnovAge PACE Commercial |
$3.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.49
|
| Rate for Payer: Multiplan Commercial |
$5.88
|
| Rate for Payer: Networks By Design Commercial |
$5.10
|
| Rate for Payer: Prime Health Services Commercial |
$6.66
|
| Rate for Payer: Riverside University Health System MISP |
$3.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.92
|
| Rate for Payer: United Healthcare All Other HMO |
$3.92
|
| Rate for Payer: United Healthcare HMO Rider |
$3.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.66
|
| Rate for Payer: Vantage Medical Group Senior |
$6.66
|
|
|
LACTULOSE 20 GRAM ORAL PACKET [24586]
|
Facility
|
OP
|
$10.72
|
|
|
Service Code
|
NDC 0121-1930-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$9.65 |
| Rate for Payer: Adventist Health Commercial |
$2.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.30
|
| Rate for Payer: Blue Shield of California Commercial |
$6.55
|
| Rate for Payer: Blue Shield of California EPN |
$4.28
|
| Rate for Payer: Cash Price |
$5.89
|
| Rate for Payer: Central Health Plan Commercial |
$8.58
|
| Rate for Payer: Cigna of CA HMO |
$7.50
|
| Rate for Payer: Cigna of CA PPO |
$7.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.29
|
| Rate for Payer: EPIC Health Plan Senior |
$4.29
|
| Rate for Payer: Galaxy Health WC |
$9.11
|
| Rate for Payer: Global Benefits Group Commercial |
$6.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.65
|
| Rate for Payer: InnovAge PACE Commercial |
$5.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$8.04
|
| Rate for Payer: Networks By Design Commercial |
$6.97
|
| Rate for Payer: Prime Health Services Commercial |
$9.11
|
| Rate for Payer: Riverside University Health System MISP |
$4.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.36
|
| Rate for Payer: United Healthcare All Other HMO |
$5.36
|
| Rate for Payer: United Healthcare HMO Rider |
$5.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.11
|
| Rate for Payer: Vantage Medical Group Senior |
$9.11
|
|
|
LACTULOSE 20 GRAM ORAL PACKET [24586]
|
Facility
|
OP
|
$12.18
|
|
|
Service Code
|
NDC 66220-729-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$10.96 |
| Rate for Payer: Adventist Health Commercial |
$2.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.15
|
| Rate for Payer: Blue Shield of California Commercial |
$7.44
|
| Rate for Payer: Blue Shield of California EPN |
$4.86
|
| Rate for Payer: Cash Price |
$6.70
|
| Rate for Payer: Central Health Plan Commercial |
$9.74
|
| Rate for Payer: Cigna of CA HMO |
$8.53
|
| Rate for Payer: Cigna of CA PPO |
$8.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.87
|
| Rate for Payer: EPIC Health Plan Senior |
$4.87
|
| Rate for Payer: Galaxy Health WC |
$10.35
|
| Rate for Payer: Global Benefits Group Commercial |
$7.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.96
|
| Rate for Payer: InnovAge PACE Commercial |
$6.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.53
|
| Rate for Payer: Multiplan Commercial |
$9.13
|
| Rate for Payer: Networks By Design Commercial |
$7.92
|
| Rate for Payer: Prime Health Services Commercial |
$10.35
|
| Rate for Payer: Riverside University Health System MISP |
$4.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.09
|
| Rate for Payer: United Healthcare All Other HMO |
$6.09
|
| Rate for Payer: United Healthcare HMO Rider |
$6.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.35
|
| Rate for Payer: Vantage Medical Group Senior |
$10.35
|
|
|
LACTULOSE 20 GRAM ORAL PACKET [24586]
|
Facility
|
IP
|
$10.72
|
|
|
Service Code
|
NDC 0121-1930-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$9.65 |
| Rate for Payer: Adventist Health Commercial |
$2.14
|
| Rate for Payer: Blue Shield of California Commercial |
$8.29
|
| Rate for Payer: Blue Shield of California EPN |
$5.40
|
| Rate for Payer: Cash Price |
$5.89
|
| Rate for Payer: Central Health Plan Commercial |
$8.58
|
| Rate for Payer: Cigna of CA HMO |
$7.50
|
| Rate for Payer: Cigna of CA PPO |
$7.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.29
|
| Rate for Payer: EPIC Health Plan Senior |
$4.29
|
| Rate for Payer: Galaxy Health WC |
$9.11
|
| Rate for Payer: Global Benefits Group Commercial |
$6.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.14
|
| Rate for Payer: Multiplan Commercial |
$8.04
|
| Rate for Payer: Networks By Design Commercial |
$6.97
|
| Rate for Payer: Prime Health Services Commercial |
$9.11
|
|
|
LACTULOSE 20 GRAM ORAL PACKET [24586]
|
Facility
|
IP
|
$12.18
|
|
|
Service Code
|
NDC 66220-729-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$10.96 |
| Rate for Payer: Adventist Health Commercial |
$2.44
|
| Rate for Payer: Blue Shield of California Commercial |
$9.42
|
| Rate for Payer: Blue Shield of California EPN |
$6.14
|
| Rate for Payer: Cash Price |
$6.70
|
| Rate for Payer: Central Health Plan Commercial |
$9.74
|
| Rate for Payer: Cigna of CA HMO |
$8.53
|
| Rate for Payer: Cigna of CA PPO |
$8.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.87
|
| Rate for Payer: EPIC Health Plan Senior |
$4.87
|
| Rate for Payer: Galaxy Health WC |
$10.35
|
| Rate for Payer: Global Benefits Group Commercial |
$7.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.44
|
| Rate for Payer: Multiplan Commercial |
$9.13
|
| Rate for Payer: Networks By Design Commercial |
$7.92
|
| Rate for Payer: Prime Health Services Commercial |
$10.35
|
|
|
LAMIVUDINE 100 MG TABLET [24419]
|
Facility
|
OP
|
$14.06
|
|
|
Service Code
|
NDC 60505-3250-6
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.81 |
| Max. Negotiated Rate |
$12.65 |
| Rate for Payer: Adventist Health Commercial |
$2.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.26
|
| Rate for Payer: Blue Shield of California Commercial |
$8.59
|
| Rate for Payer: Blue Shield of California EPN |
$5.61
|
| Rate for Payer: Cash Price |
$7.73
|
| Rate for Payer: Central Health Plan Commercial |
$11.25
|
| Rate for Payer: Cigna of CA HMO |
$9.84
|
| Rate for Payer: Cigna of CA PPO |
$9.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.62
|
| Rate for Payer: EPIC Health Plan Senior |
$5.62
|
| Rate for Payer: Galaxy Health WC |
$11.95
|
| Rate for Payer: Global Benefits Group Commercial |
$8.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.65
|
| Rate for Payer: InnovAge PACE Commercial |
$7.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.84
|
| Rate for Payer: Multiplan Commercial |
$10.54
|
| Rate for Payer: Networks By Design Commercial |
$9.14
|
| Rate for Payer: Prime Health Services Commercial |
$11.95
|
| Rate for Payer: Riverside University Health System MISP |
$5.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.03
|
| Rate for Payer: United Healthcare All Other HMO |
$7.03
|
| Rate for Payer: United Healthcare HMO Rider |
$7.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.95
|
| Rate for Payer: Vantage Medical Group Senior |
$11.95
|
|
|
LAMIVUDINE 100 MG TABLET [24419]
|
Facility
|
IP
|
$14.06
|
|
|
Service Code
|
NDC 60505-3250-6
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.81 |
| Max. Negotiated Rate |
$12.65 |
| Rate for Payer: Adventist Health Commercial |
$2.81
|
| Rate for Payer: Blue Shield of California Commercial |
$10.87
|
| Rate for Payer: Blue Shield of California EPN |
$7.09
|
| Rate for Payer: Cash Price |
$7.73
|
| Rate for Payer: Central Health Plan Commercial |
$11.25
|
| Rate for Payer: Cigna of CA HMO |
$9.84
|
| Rate for Payer: Cigna of CA PPO |
$9.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.62
|
| Rate for Payer: EPIC Health Plan Senior |
$5.62
|
| Rate for Payer: Galaxy Health WC |
$11.95
|
| Rate for Payer: Global Benefits Group Commercial |
$8.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.81
|
| Rate for Payer: Multiplan Commercial |
$10.54
|
| Rate for Payer: Networks By Design Commercial |
$9.14
|
| Rate for Payer: Prime Health Services Commercial |
$11.95
|
|
|
LAMIVUDINE 10 MG/ML ORAL SOLUTION [15881]
|
Facility
|
OP
|
$0.55
|
|
|
Service Code
|
NDC 49702-205-48
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.32
|
| Rate for Payer: Blue Shield of California Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Central Health Plan Commercial |
$0.44
|
| Rate for Payer: Cigna of CA HMO |
$0.39
|
| Rate for Payer: Cigna of CA PPO |
$0.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Senior |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.47
|
| Rate for Payer: Global Benefits Group Commercial |
$0.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.50
|
| Rate for Payer: InnovAge PACE Commercial |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Networks By Design Commercial |
$0.36
|
| Rate for Payer: Prime Health Services Commercial |
$0.47
|
| Rate for Payer: Riverside University Health System MISP |
$0.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.28
|
| Rate for Payer: United Healthcare All Other HMO |
$0.28
|
| Rate for Payer: United Healthcare HMO Rider |
$0.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.47
|
| Rate for Payer: Vantage Medical Group Senior |
$0.47
|
|
|
LAMIVUDINE 10 MG/ML ORAL SOLUTION [15881]
|
Facility
|
IP
|
$0.55
|
|
|
Service Code
|
NDC 49702-205-48
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.28
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Central Health Plan Commercial |
$0.44
|
| Rate for Payer: Cigna of CA HMO |
$0.39
|
| Rate for Payer: Cigna of CA PPO |
$0.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Senior |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.47
|
| Rate for Payer: Global Benefits Group Commercial |
$0.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Networks By Design Commercial |
$0.36
|
| Rate for Payer: Prime Health Services Commercial |
$0.47
|
|
|
LAMIVUDINE 150 MG TABLET [15880]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 33342-001-09
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.77
|
| Rate for Payer: Blue Shield of California EPN |
$0.50
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Central Health Plan Commercial |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Senior |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
|
|
LAMIVUDINE 150 MG TABLET [15880]
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
NDC 60687-720-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.29
|
| Rate for Payer: Blue Shield of California Commercial |
$5.50
|
| Rate for Payer: Blue Shield of California EPN |
$3.59
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Central Health Plan Commercial |
$7.20
|
| Rate for Payer: Cigna of CA HMO |
$6.30
|
| Rate for Payer: Cigna of CA PPO |
$6.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3.60
|
| Rate for Payer: Galaxy Health WC |
$7.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.10
|
| Rate for Payer: InnovAge PACE Commercial |
$4.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$6.75
|
| Rate for Payer: Networks By Design Commercial |
$5.85
|
| Rate for Payer: Prime Health Services Commercial |
$7.65
|
| Rate for Payer: Riverside University Health System MISP |
$3.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.65
|
| Rate for Payer: Vantage Medical Group Senior |
$7.65
|
|
|
LAMIVUDINE 150 MG TABLET [15880]
|
Facility
|
OP
|
$4.50
|
|
|
Service Code
|
NDC 60505-3251-6
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Adventist Health Commercial |
$0.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.64
|
| Rate for Payer: Blue Shield of California Commercial |
$2.75
|
| Rate for Payer: Blue Shield of California EPN |
$1.80
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Central Health Plan Commercial |
$3.60
|
| Rate for Payer: Cigna of CA HMO |
$3.15
|
| Rate for Payer: Cigna of CA PPO |
$3.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1.80
|
| Rate for Payer: Galaxy Health WC |
$3.83
|
| Rate for Payer: Global Benefits Group Commercial |
$2.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.05
|
| Rate for Payer: InnovAge PACE Commercial |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.15
|
| Rate for Payer: Multiplan Commercial |
$3.38
|
| Rate for Payer: Networks By Design Commercial |
$2.92
|
| Rate for Payer: Prime Health Services Commercial |
$3.83
|
| Rate for Payer: Riverside University Health System MISP |
$1.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.25
|
| Rate for Payer: United Healthcare All Other HMO |
$2.25
|
| Rate for Payer: United Healthcare HMO Rider |
$2.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Vantage Medical Group Senior |
$3.83
|
|
|
LAMIVUDINE 150 MG TABLET [15880]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 33342-001-09
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.59
|
| Rate for Payer: Blue Shield of California Commercial |
$0.61
|
| Rate for Payer: Blue Shield of California EPN |
$0.40
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Central Health Plan Commercial |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Senior |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.90
|
| Rate for Payer: InnovAge PACE Commercial |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
| Rate for Payer: Riverside University Health System MISP |
$0.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
LAMIVUDINE 150 MG TABLET [15880]
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
NDC 60687-720-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6.96
|
| Rate for Payer: Blue Shield of California EPN |
$4.54
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Central Health Plan Commercial |
$7.20
|
| Rate for Payer: Cigna of CA HMO |
$6.30
|
| Rate for Payer: Cigna of CA PPO |
$6.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3.60
|
| Rate for Payer: Galaxy Health WC |
$7.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: Multiplan Commercial |
$6.75
|
| Rate for Payer: Networks By Design Commercial |
$5.85
|
| Rate for Payer: Prime Health Services Commercial |
$7.65
|
|
|
LAMIVUDINE 150 MG TABLET [15880]
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
NDC 60687-720-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6.96
|
| Rate for Payer: Blue Shield of California EPN |
$4.54
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Central Health Plan Commercial |
$7.20
|
| Rate for Payer: Cigna of CA HMO |
$6.30
|
| Rate for Payer: Cigna of CA PPO |
$6.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3.60
|
| Rate for Payer: Galaxy Health WC |
$7.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: Multiplan Commercial |
$6.75
|
| Rate for Payer: Networks By Design Commercial |
$5.85
|
| Rate for Payer: Prime Health Services Commercial |
$7.65
|
|
|
LAMIVUDINE 150 MG TABLET [15880]
|
Facility
|
IP
|
$4.50
|
|
|
Service Code
|
NDC 60505-3251-6
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Adventist Health Commercial |
$0.90
|
| Rate for Payer: Blue Shield of California Commercial |
$3.48
|
| Rate for Payer: Blue Shield of California EPN |
$2.27
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Central Health Plan Commercial |
$3.60
|
| Rate for Payer: Cigna of CA HMO |
$3.15
|
| Rate for Payer: Cigna of CA PPO |
$3.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1.80
|
| Rate for Payer: Galaxy Health WC |
$3.83
|
| Rate for Payer: Global Benefits Group Commercial |
$2.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$3.38
|
| Rate for Payer: Networks By Design Commercial |
$2.92
|
| Rate for Payer: Prime Health Services Commercial |
$3.83
|
|
|
LAMIVUDINE 150 MG TABLET [15880]
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
NDC 60687-720-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.29
|
| Rate for Payer: Blue Shield of California Commercial |
$5.50
|
| Rate for Payer: Blue Shield of California EPN |
$3.59
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Central Health Plan Commercial |
$7.20
|
| Rate for Payer: Cigna of CA HMO |
$6.30
|
| Rate for Payer: Cigna of CA PPO |
$6.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3.60
|
| Rate for Payer: Galaxy Health WC |
$7.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.10
|
| Rate for Payer: InnovAge PACE Commercial |
$4.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$6.75
|
| Rate for Payer: Networks By Design Commercial |
$5.85
|
| Rate for Payer: Prime Health Services Commercial |
$7.65
|
| Rate for Payer: Riverside University Health System MISP |
$3.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.65
|
| Rate for Payer: Vantage Medical Group Senior |
$7.65
|
|
|
LAMIVUDINE 150 MG-ZIDOVUDINE 300 MG TABLET [21810]
|
Facility
|
IP
|
$2.67
|
|
|
Service Code
|
NDC 31722-506-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: Adventist Health Commercial |
$0.53
|
| Rate for Payer: Blue Shield of California Commercial |
$2.06
|
| Rate for Payer: Blue Shield of California EPN |
$1.35
|
| Rate for Payer: Cash Price |
$1.47
|
| Rate for Payer: Central Health Plan Commercial |
$2.14
|
| Rate for Payer: Cigna of CA HMO |
$1.87
|
| Rate for Payer: Cigna of CA PPO |
$1.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.07
|
| Rate for Payer: EPIC Health Plan Senior |
$1.07
|
| Rate for Payer: Galaxy Health WC |
$2.27
|
| Rate for Payer: Global Benefits Group Commercial |
$1.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: Multiplan Commercial |
$2.00
|
| Rate for Payer: Networks By Design Commercial |
$1.74
|
| Rate for Payer: Prime Health Services Commercial |
$2.27
|
|
|
LAMIVUDINE 150 MG-ZIDOVUDINE 300 MG TABLET [21810]
|
Facility
|
OP
|
$2.67
|
|
|
Service Code
|
NDC 31722-506-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: Adventist Health Commercial |
$0.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.57
|
| Rate for Payer: Blue Shield of California Commercial |
$1.63
|
| Rate for Payer: Blue Shield of California EPN |
$1.07
|
| Rate for Payer: Cash Price |
$1.47
|
| Rate for Payer: Central Health Plan Commercial |
$2.14
|
| Rate for Payer: Cigna of CA HMO |
$1.87
|
| Rate for Payer: Cigna of CA PPO |
$1.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.07
|
| Rate for Payer: EPIC Health Plan Senior |
$1.07
|
| Rate for Payer: Galaxy Health WC |
$2.27
|
| Rate for Payer: Global Benefits Group Commercial |
$1.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.40
|
| Rate for Payer: InnovAge PACE Commercial |
$1.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.87
|
| Rate for Payer: Multiplan Commercial |
$2.00
|
| Rate for Payer: Networks By Design Commercial |
$1.74
|
| Rate for Payer: Prime Health Services Commercial |
$2.27
|
| Rate for Payer: Riverside University Health System MISP |
$1.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.33
|
| Rate for Payer: United Healthcare All Other HMO |
$1.33
|
| Rate for Payer: United Healthcare HMO Rider |
$1.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.27
|
| Rate for Payer: Vantage Medical Group Senior |
$2.27
|
|
|
LAMIVUDINE-ZIDOVUDINE ORAL SOLUTION COMPOUND [4080404]
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
NDC 9994-0804-04
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California Commercial |
$0.93
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Central Health Plan Commercial |
$0.96
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Senior |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: Networks By Design Commercial |
$0.78
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
|
|
LAMIVUDINE-ZIDOVUDINE ORAL SOLUTION COMPOUND [4080404]
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
NDC 9994-0804-04
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.70
|
| Rate for Payer: Blue Shield of California Commercial |
$0.73
|
| Rate for Payer: Blue Shield of California EPN |
$0.48
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Central Health Plan Commercial |
$0.96
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Senior |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.08
|
| Rate for Payer: InnovAge PACE Commercial |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.84
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: Networks By Design Commercial |
$0.78
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
| Rate for Payer: Riverside University Health System MISP |
$0.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.60
|
| Rate for Payer: United Healthcare All Other HMO |
$0.60
|
| Rate for Payer: United Healthcare HMO Rider |
$0.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: Vantage Medical Group Senior |
$1.02
|
|
|
LAMOTRIGINE 100 MG DISINTEGRATING TABLET [96941]
|
Facility
|
OP
|
$9.73
|
|
|
Service Code
|
NDC 49884-486-11
|
| 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 |
$5.71
|
| Rate for Payer: Blue Shield of California Commercial |
$5.95
|
| Rate for Payer: Blue Shield of California EPN |
$3.88
|
| Rate for Payer: Cash Price |
$5.35
|
| 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: 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: InnovAge PACE Commercial |
$4.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.81
|
| Rate for Payer: Molina Healthcare of CA 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
|
IP
|
$6.83
|
|
|
Service Code
|
NDC 43598-552-30
|
| 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 |
$5.28
|
| Rate for Payer: Blue Shield of California EPN |
$3.44
|
| Rate for Payer: Cash Price |
$3.76
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$4.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.23
|
| 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
|
OP
|
$6.83
|
|
|
Service Code
|
NDC 43598-552-30
|
| 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 |
$4.01
|
| Rate for Payer: Blue Shield of California Commercial |
$4.17
|
| Rate for Payer: Blue Shield of California EPN |
$2.73
|
| Rate for Payer: Cash Price |
$3.76
|
| 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: 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: InnovAge PACE Commercial |
$3.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.78
|
| Rate for Payer: Molina Healthcare of CA 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
|
|
