|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION [188928]
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 99991889280
|
| 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 Gatekeeper |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$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: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.04
|
| Rate for Payer: Dignity Health Senior |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Senior |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION [188928]
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
NDC 99991889280
|
| 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: Cash Price |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Senior |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION [188928]
|
Facility
|
OP
|
$0.07
|
|
|
Service Code
|
NDC 0116-4005-30
|
| 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: Aetna of CA Gatekeeper |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.05
|
| 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 |
$0.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.06
|
| Rate for Payer: Dignity Health Senior |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Senior |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Senior |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Vantage Medical Group Senior |
$0.06
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION [188928]
|
Facility
|
OP
|
$0.07
|
|
|
Service Code
|
NDC 0121-1154-00
|
| 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: Aetna of CA Gatekeeper |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.05
|
| 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 |
$0.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.06
|
| Rate for Payer: Dignity Health Senior |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Senior |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Senior |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Vantage Medical Group Senior |
$0.06
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION [188928]
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
NDC 0116-4005-41
|
| 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: Cash Price |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Senior |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION [188928]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 0121-1154-40
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Senior |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION [188928]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 0121-1154-40
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: Dignity Health Senior |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Senior |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Senior |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION [188928]
|
Facility
|
OP
|
$0.07
|
|
|
Service Code
|
NDC 0116-4005-41
|
| 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: Aetna of CA Gatekeeper |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.05
|
| 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 |
$0.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.06
|
| Rate for Payer: Dignity Health Senior |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Senior |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Senior |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Vantage Medical Group Senior |
$0.06
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION [188928]
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
NDC 0121-1154-00
|
| 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: Cash Price |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Senior |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
|
|
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 |
$1.42 |
| Max. Negotiated Rate |
$5.88 |
| Rate for Payer: Adventist Health Commercial |
$1.57
|
| Rate for Payer: Cash Price |
$4.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.31
|
| Rate for Payer: Heritage Provider Network Senior |
$5.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.96
|
| Rate for Payer: Multiplan Commercial |
$5.88
|
|
|
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 |
$2.20 |
| Max. Negotiated Rate |
$9.13 |
| Rate for Payer: Adventist Health Commercial |
$2.44
|
| Rate for Payer: Cash Price |
$6.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.25
|
| Rate for Payer: Heritage Provider Network Senior |
$8.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.04
|
| Rate for Payer: Multiplan Commercial |
$9.13
|
|
|
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 |
$1.94 |
| Max. Negotiated Rate |
$8.04 |
| Rate for Payer: Adventist Health Commercial |
$2.14
|
| Rate for Payer: Cash Price |
$5.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.26
|
| Rate for Payer: Heritage Provider Network Senior |
$7.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.68
|
| Rate for Payer: Multiplan Commercial |
$8.04
|
|
|
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 |
$1.42 |
| Max. Negotiated Rate |
$6.66 |
| Rate for Payer: Adventist Health Commercial |
$1.57
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.39
|
| 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: Blue Shield of California Commercial |
$4.78
|
| Rate for Payer: Blue Shield of California EPN |
$3.83
|
| Rate for Payer: Cash Price |
$4.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.66
|
| Rate for Payer: Dignity Health Senior |
$6.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.85
|
| Rate for Payer: Heritage Provider Network Senior |
$4.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.96
|
| 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: TriValley Medical Group Commercial |
$3.14
|
| Rate for Payer: TriValley Medical Group Senior |
$3.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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
|
$12.18
|
|
|
Service Code
|
NDC 66220-729-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$10.35 |
| Rate for Payer: Adventist Health Commercial |
$2.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.37
|
| 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: Blue Shield of California Commercial |
$7.43
|
| Rate for Payer: Blue Shield of California EPN |
$5.94
|
| Rate for Payer: Cash Price |
$6.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.35
|
| Rate for Payer: Dignity Health Senior |
$10.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.54
|
| Rate for Payer: Heritage Provider Network Senior |
$7.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.04
|
| 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: TriValley Medical Group Commercial |
$4.87
|
| Rate for Payer: TriValley Medical Group Senior |
$4.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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
|
OP
|
$10.72
|
|
|
Service Code
|
NDC 0121-1930-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.94 |
| Max. Negotiated Rate |
$9.11 |
| Rate for Payer: Adventist Health Commercial |
$2.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.36
|
| 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: Blue Shield of California Commercial |
$6.54
|
| Rate for Payer: Blue Shield of California EPN |
$5.23
|
| Rate for Payer: Cash Price |
$5.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.11
|
| Rate for Payer: Dignity Health Senior |
$9.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.64
|
| Rate for Payer: Heritage Provider Network Senior |
$6.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.68
|
| 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: TriValley Medical Group Commercial |
$4.29
|
| Rate for Payer: TriValley Medical Group Senior |
$4.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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
|
|
|
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 |
$2.54 |
| Max. Negotiated Rate |
$11.95 |
| Rate for Payer: Adventist Health Commercial |
$2.81
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.66
|
| 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: Blue Shield of California Commercial |
$8.58
|
| Rate for Payer: Blue Shield of California EPN |
$6.86
|
| Rate for Payer: Cash Price |
$7.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.95
|
| Rate for Payer: Dignity Health Senior |
$11.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.70
|
| Rate for Payer: Heritage Provider Network Senior |
$8.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.52
|
| 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: TriValley Medical Group Commercial |
$5.62
|
| Rate for Payer: TriValley Medical Group Senior |
$5.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 |
$2.54 |
| Max. Negotiated Rate |
$10.54 |
| Rate for Payer: Adventist Health Commercial |
$2.81
|
| Rate for Payer: Cash Price |
$7.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.52
|
| Rate for Payer: Heritage Provider Network Senior |
$9.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.52
|
| Rate for Payer: Multiplan Commercial |
$10.54
|
|
|
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 |
$0.10 |
| Max. Negotiated Rate |
$0.47 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.38
|
| 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: Blue Shield of California Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.47
|
| Rate for Payer: Dignity Health Senior |
$0.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.34
|
| Rate for Payer: Heritage Provider Network Senior |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| 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: TriValley Medical Group Commercial |
$0.22
|
| Rate for Payer: TriValley Medical Group Senior |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 |
$0.10 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.37
|
| Rate for Payer: Heritage Provider Network Senior |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
|
|
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 |
$1.63 |
| Max. Negotiated Rate |
$6.75 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.09
|
| Rate for Payer: Heritage Provider Network Senior |
$6.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$6.75
|
|
|
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 |
$1.63 |
| Max. Negotiated Rate |
$6.75 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.09
|
| Rate for Payer: Heritage Provider Network Senior |
$6.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$6.75
|
|
|
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 |
$0.18 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.68
|
| Rate for Payer: Heritage Provider Network Senior |
$0.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
|
|
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 |
$1.63 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.18
|
| 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: Blue Shield of California Commercial |
$5.49
|
| Rate for Payer: Blue Shield of California EPN |
$4.39
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.65
|
| Rate for Payer: Dignity Health Senior |
$7.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.57
|
| Rate for Payer: Heritage Provider Network Senior |
$5.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| 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: TriValley Medical Group Commercial |
$3.60
|
| Rate for Payer: TriValley Medical Group Senior |
$3.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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
|
$9.00
|
|
|
Service Code
|
NDC 60687-720-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.18
|
| 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: Blue Shield of California Commercial |
$5.49
|
| Rate for Payer: Blue Shield of California EPN |
$4.39
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.65
|
| Rate for Payer: Dignity Health Senior |
$7.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.57
|
| Rate for Payer: Heritage Provider Network Senior |
$5.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| 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: TriValley Medical Group Commercial |
$3.60
|
| Rate for Payer: TriValley Medical Group Senior |
$3.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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
|
$1.00
|
|
|
Service Code
|
NDC 33342-001-09
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.69
|
| 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: Blue Shield of California Commercial |
$0.61
|
| Rate for Payer: Blue Shield of California EPN |
$0.49
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: Dignity Health Senior |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.62
|
| Rate for Payer: Heritage Provider Network Senior |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| 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: TriValley Medical Group Commercial |
$0.40
|
| Rate for Payer: TriValley Medical Group Senior |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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
|
|
