|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET [14825]
|
Facility
|
IP
|
$96.38
|
|
|
Service Code
|
NDC 70700-268-99
|
| Hospital Charge Code |
ERX14825
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$53.01 |
| Max. Negotiated Rate |
$77.10 |
| Rate for Payer: Cash Price |
$43.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$77.10
|
| Rate for Payer: Health Smart Auto/Commercial |
$57.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.01
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$72.28
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET [14825]
|
Facility
|
IP
|
$83.76
|
|
|
Service Code
|
NDC 67877-749-57
|
| Hospital Charge Code |
ERX14825
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$46.07 |
| Max. Negotiated Rate |
$67.01 |
| Rate for Payer: Cash Price |
$37.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$67.01
|
| Rate for Payer: Health Smart Auto/Commercial |
$50.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.07
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$62.82
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET [14825]
|
Facility
|
IP
|
$109.52
|
|
|
Service Code
|
NDC 0456-4300-01
|
| Hospital Charge Code |
ERX14825
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$60.24 |
| Max. Negotiated Rate |
$87.62 |
| Rate for Payer: Cash Price |
$49.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.62
|
| Rate for Payer: Health Smart Auto/Commercial |
$65.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.24
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$82.14
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET [14825]
|
Facility
|
OP
|
$109.52
|
|
|
Service Code
|
NDC 0456-4300-01
|
| Hospital Charge Code |
ERX14825
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$60.24 |
| Max. Negotiated Rate |
$82.14 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$65.71
|
| Rate for Payer: Aetna of CA Government/Medicare |
$65.71
|
| Rate for Payer: Cash Price |
$49.28
|
| Rate for Payer: Health Smart Auto/Commercial |
$65.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$65.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.24
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$82.14
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET [14825]
|
Facility
|
OP
|
$109.52
|
|
|
Service Code
|
NDC 0456-4300-08
|
| Hospital Charge Code |
ERX14825
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$60.24 |
| Max. Negotiated Rate |
$82.14 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$65.71
|
| Rate for Payer: Aetna of CA Government/Medicare |
$65.71
|
| Rate for Payer: Cash Price |
$49.28
|
| Rate for Payer: Health Smart Auto/Commercial |
$65.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$65.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.24
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$82.14
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET [14825]
|
Facility
|
IP
|
$109.52
|
|
|
Service Code
|
NDC 0456-4300-08
|
| Hospital Charge Code |
ERX14825
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$60.24 |
| Max. Negotiated Rate |
$87.62 |
| Rate for Payer: Cash Price |
$49.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.62
|
| Rate for Payer: Health Smart Auto/Commercial |
$65.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.24
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$82.14
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET [14825]
|
Facility
|
OP
|
$83.76
|
|
|
Service Code
|
NDC 67877-749-57
|
| Hospital Charge Code |
ERX14825
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$46.07 |
| Max. Negotiated Rate |
$62.82 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$50.26
|
| Rate for Payer: Aetna of CA Government/Medicare |
$50.26
|
| Rate for Payer: Cash Price |
$37.69
|
| Rate for Payer: Health Smart Auto/Commercial |
$50.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$50.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.07
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$62.82
|
|
|
FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION [88011]
|
Facility
|
OP
|
$23.10
|
|
|
Service Code
|
CPT Q2009
|
| Hospital Charge Code |
1720991
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.70 |
| Max. Negotiated Rate |
$17.32 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$13.86
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.73
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$5.40
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.73
|
| Rate for Payer: Aetna of CA Government/Medicare |
$13.86
|
| Rate for Payer: Aetna of CA Government/Medicare |
$5.40
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.73
|
| Rate for Payer: Health Smart Auto/Commercial |
$13.86
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$5.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.58
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.16
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$17.32
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$6.75
|
|
|
FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION [88011]
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
CPT Q2009
|
| Hospital Charge Code |
1720991
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$7.20 |
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.20
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.73
|
| Rate for Payer: Health Smart Auto/Commercial |
$13.86
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.58
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$17.32
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.16
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$6.75
|
|
|
FOSPHENYTOIN 500 MG PE/10 ML INJECTION SOLUTION [88010]
|
Facility
|
OP
|
$13.86
|
|
|
Service Code
|
CPT Q2009
|
| Hospital Charge Code |
1720986
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.62 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$8.32
|
| Rate for Payer: Aetna of CA Government/Medicare |
$8.32
|
| Rate for Payer: Cash Price |
$6.24
|
| Rate for Payer: Health Smart Auto/Commercial |
$8.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$8.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.62
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$10.40
|
|
|
FOSPHENYTOIN 500 MG PE/10 ML INJECTION SOLUTION [88010]
|
Facility
|
IP
|
$13.86
|
|
|
Service Code
|
CPT Q2009
|
| Hospital Charge Code |
1720986
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.62 |
| Max. Negotiated Rate |
$11.09 |
| Rate for Payer: Cash Price |
$6.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.09
|
| Rate for Payer: Health Smart Auto/Commercial |
$8.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.62
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$10.40
|
|
|
FOSPHENYTOIN 50 MG PE/ML IV INJECTION SOLUTION WRAP [408056880]
|
Facility
|
OP
|
$13.86
|
|
|
Service Code
|
CPT Q2009
|
| Hospital Charge Code |
1720986
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.62 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$8.32
|
| Rate for Payer: Aetna of CA Government/Medicare |
$8.32
|
| Rate for Payer: Cash Price |
$6.24
|
| Rate for Payer: Health Smart Auto/Commercial |
$8.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$8.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.62
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$10.40
|
|
|
FOSPHENYTOIN 50 MG PE/ML IV INJECTION SOLUTION WRAP [408056880]
|
Facility
|
OP
|
$2.88
|
|
|
Service Code
|
CPT Q2009
|
| Hospital Charge Code |
1720991
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$2.16 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.73
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$5.40
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$13.86
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.73
|
| Rate for Payer: Aetna of CA Government/Medicare |
$5.40
|
| Rate for Payer: Aetna of CA Government/Medicare |
$13.86
|
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.40
|
| Rate for Payer: Health Smart Auto/Commercial |
$13.86
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$13.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$5.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.95
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.16
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$6.75
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$17.32
|
|
|
FOSPHENYTOIN 50 MG PE/ML IV INJECTION SOLUTION WRAP [408056880]
|
Facility
|
IP
|
$13.86
|
|
|
Service Code
|
CPT Q2009
|
| Hospital Charge Code |
1720986
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.62 |
| Max. Negotiated Rate |
$11.09 |
| Rate for Payer: Cash Price |
$6.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.09
|
| Rate for Payer: Health Smart Auto/Commercial |
$8.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.62
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$10.40
|
|
|
FOSPHENYTOIN 50 MG PE/ML IV INJECTION SOLUTION WRAP [408056880]
|
Facility
|
IP
|
$23.10
|
|
|
Service Code
|
CPT Q2009
|
| Hospital Charge Code |
1720991
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.70 |
| Max. Negotiated Rate |
$18.48 |
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.30
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.40
|
| Rate for Payer: Health Smart Auto/Commercial |
$13.86
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.70
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$6.75
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$17.32
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.16
|
|
|
FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE [32767]
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT J9394
|
| Hospital Charge Code |
1755723
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$50.40
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$72.00
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$61.20
|
| Rate for Payer: Aetna of CA Government/Medicare |
$72.00
|
| Rate for Payer: Aetna of CA Government/Medicare |
$61.20
|
| Rate for Payer: Aetna of CA Government/Medicare |
$50.40
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Health Smart Auto/Commercial |
$72.00
|
| Rate for Payer: Health Smart Auto/Commercial |
$50.40
|
| Rate for Payer: Health Smart Auto/Commercial |
$61.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$72.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$50.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$61.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.20
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$63.00
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$90.00
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$76.50
|
|
|
FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE [32767]
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT J9394
|
| Hospital Charge Code |
1755723
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$96.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$67.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$81.60
|
| Rate for Payer: Health Smart Auto/Commercial |
$61.20
|
| Rate for Payer: Health Smart Auto/Commercial |
$72.00
|
| Rate for Payer: Health Smart Auto/Commercial |
$50.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.00
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$90.00
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$63.00
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$76.50
|
|
|
FUROSEMIDE 10 MG/ML CONTINUOUS INFUSION (UNDILUTED) [4083291]
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
CPT J1940
|
| Hospital Charge Code |
1720047
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.22
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.20
|
|
|
FUROSEMIDE 10 MG/ML CONTINUOUS INFUSION (UNDILUTED) [4083291]
|
Facility
|
OP
|
$0.27
|
|
|
Service Code
|
CPT J1940
|
| Hospital Charge Code |
1720047
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.16
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.16
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.20
|
|
|
FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]
|
Facility
|
OP
|
$1.26
|
|
|
Service Code
|
CPT J1940
|
| Hospital Charge Code |
1720029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.76
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.79
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.76
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.79
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.76
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.73
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.99
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.95
|
|
|
FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]
|
Facility
|
OP
|
$0.87
|
|
|
Service Code
|
CPT J1940
|
| Hospital Charge Code |
1720037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.52
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.53
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.25
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.18
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.50
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.53
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.50
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.52
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.25
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.18
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cash Price |
$0.38
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.52
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.25
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.50
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.18
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.31
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.66
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.65
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.23
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.63
|
|
|
FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]
|
Facility
|
IP
|
$0.38
|
|
|
Service Code
|
CPT J1940
|
| Hospital Charge Code |
1720047
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.30
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.23
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.22
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.14
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.18
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.29
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.28
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.29
|
|
|
FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]
|
Facility
|
OP
|
$0.39
|
|
|
Service Code
|
CPT J1940
|
| Hospital Charge Code |
1720047
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.23
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.23
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.14
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.22
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.14
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.23
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.23
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.22
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.22
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.14
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.23
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.29
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.18
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.28
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.29
|
|
|
FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]
|
Facility
|
IP
|
$0.88
|
|
|
Service Code
|
CPT J1940
|
| Hospital Charge Code |
1720037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$0.70 |
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.33
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.25
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.53
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.18
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.52
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.63
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.31
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.66
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.23
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.65
|
|
|
FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]
|
Facility
|
IP
|
$1.32
|
|
|
Service Code
|
CPT J1940
|
| Hospital Charge Code |
1720029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$1.06 |
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.06
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.79
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.73
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.95
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.99
|
|
