|
ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION WRAP [40820934]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
CPT P9041
|
| Hospital Charge Code |
1770005
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.13
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.21
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.17
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.21
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.13
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.17
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.13
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.17
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.26
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.17
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.21
|
|
|
ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION WRAP [40820934]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
CPT P9041
|
| Hospital Charge Code |
1770006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.28
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.21
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.26
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.17
|
|
|
ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION WRAP [40820934]
|
Facility
|
IP
|
$0.79
|
|
|
Service Code
|
CPT P9041
|
| Hospital Charge Code |
1770002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$0.63 |
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.63
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.59
|
|
|
ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION WRAP [40820934]
|
Facility
|
IP
|
$0.28
|
|
|
Service Code
|
CPT P9041
|
| Hospital Charge Code |
1770005
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.28
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.13
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.17
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.21
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.17
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.26
|
|
|
ALBUMIN, HUMAN-KJDA 5 % INTRAVENOUS SOLUTION [223612]
|
Facility
|
IP
|
$0.35
|
|
|
Service Code
|
CPT P9045
|
| Hospital Charge Code |
1770006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.28
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.26
|
|
|
ALBUMIN, HUMAN-KJDA 5 % INTRAVENOUS SOLUTION [223612]
|
Facility
|
OP
|
$0.35
|
|
|
Service Code
|
CPT P9045
|
| Hospital Charge Code |
1770006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.21
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.21
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.26
|
|
|
ALBUMIN, HUMAN-KJDA 5 % INTRAVENOUS SOLUTION [223612]
|
Facility
|
OP
|
$0.35
|
|
|
Service Code
|
CPT P9045
|
| Hospital Charge Code |
1770005
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.21
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.21
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.26
|
|
|
ALBUMIN, HUMAN-KJDA 5 % INTRAVENOUS SOLUTION [223612]
|
Facility
|
IP
|
$0.35
|
|
|
Service Code
|
CPT P9045
|
| Hospital Charge Code |
1770005
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.28
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.26
|
|
|
ALBUTEROL (HFA) INHALER 90 MCG/ACTUATION FOR STATUS ASTHMATICUS [4081887]
|
Facility
|
IP
|
$5.08
|
|
|
Service Code
|
NDC 68180-963-01
|
| Hospital Charge Code |
1744112
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$4.06 |
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.06
|
| Rate for Payer: Health Smart Auto/Commercial |
$3.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.79
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$3.81
|
|
|
ALBUTEROL (HFA) INHALER 90 MCG/ACTUATION FOR STATUS ASTHMATICUS [4081887]
|
Facility
|
IP
|
$3.41
|
|
|
Service Code
|
NDC 0173-0682-24
|
| Hospital Charge Code |
1744126
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$2.73 |
| Rate for Payer: Cash Price |
$1.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.73
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.88
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.56
|
|
|
ALBUTEROL (HFA) INHALER 90 MCG/ACTUATION FOR STATUS ASTHMATICUS [4081887]
|
Facility
|
OP
|
$5.08
|
|
|
Service Code
|
NDC 68180-963-01
|
| Hospital Charge Code |
1744112
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$3.81 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$3.05
|
| Rate for Payer: Aetna of CA Government/Medicare |
$3.05
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Health Smart Auto/Commercial |
$3.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$3.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.79
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$3.81
|
|
|
ALBUTEROL (HFA) INHALER 90 MCG/ACTUATION FOR STATUS ASTHMATICUS [4081887]
|
Facility
|
OP
|
$3.41
|
|
|
Service Code
|
NDC 0173-0682-24
|
| Hospital Charge Code |
1744126
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$2.56 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$2.05
|
| Rate for Payer: Aetna of CA Government/Medicare |
$2.05
|
| Rate for Payer: Cash Price |
$1.53
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$2.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.88
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.56
|
|
|
ALBUTEROL SULFATE 0.63 MG/3 ML SOLUTION FOR NEBULIZATION [31577]
|
Facility
|
OP
|
$0.53
|
|
|
Service Code
|
NDC 0487-0301-01
|
| Hospital Charge Code |
NDG31577
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.32
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.32
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.40
|
|
|
ALBUTEROL SULFATE 0.63 MG/3 ML SOLUTION FOR NEBULIZATION [31577]
|
Facility
|
IP
|
$0.53
|
|
|
Service Code
|
NDC 0487-0301-01
|
| Hospital Charge Code |
NDG31577
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Health Smart Auto/Commercial |
$0.32
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.40
|
|
|
ALBUTEROL SULFATE 1.25 MG/3 ML SOLUTION FOR NEBULIZATION [31578]
|
Facility
|
OP
|
$0.53
|
|
|
Service Code
|
NDC 0487-9904-01
|
| Hospital Charge Code |
NDG31578
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.32
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.32
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.40
|
|
|
ALBUTEROL SULFATE 1.25 MG/3 ML SOLUTION FOR NEBULIZATION [31578]
|
Facility
|
IP
|
$0.53
|
|
|
Service Code
|
NDC 0487-9904-25
|
| Hospital Charge Code |
NDG31578
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.42
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.40
|
|
|
ALBUTEROL SULFATE 1.25 MG/3 ML SOLUTION FOR NEBULIZATION [31578]
|
Facility
|
IP
|
$0.53
|
|
|
Service Code
|
NDC 0487-9904-01
|
| Hospital Charge Code |
NDG31578
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.42
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.40
|
|
|
ALBUTEROL SULFATE 1.25 MG/3 ML SOLUTION FOR NEBULIZATION [31578]
|
Facility
|
OP
|
$0.53
|
|
|
Service Code
|
NDC 0487-9904-25
|
| Hospital Charge Code |
NDG31578
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.32
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.32
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.40
|
|
|
ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION [250]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 0378-8270-93
|
| Hospital Charge Code |
1781155
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.06
|
|
|
ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION [250]
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 0487-9501-25
|
| Hospital Charge Code |
1781155
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.04
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.05
|
|
|
ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION [250]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 0487-9501-03
|
| Hospital Charge Code |
1781155
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.05
|
|
|
ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION [250]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 0378-8270-64
|
| Hospital Charge Code |
1781155
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.05
|
|
|
ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION [250]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 0378-8270-52
|
| Hospital Charge Code |
1781155
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.05
|
|
|
ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION [250]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 0378-8270-62
|
| Hospital Charge Code |
1781155
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Health Smart Auto/Commercial |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.05
|
|
|
ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION [250]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
NDC 76204-200-30
|
| Hospital Charge Code |
1781155
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.06
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.08
|
|
