|
MILRINONE 20 MG/100 ML(200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS PIGGYBK [14961]
|
Facility
|
IP
|
$0.18
|
|
|
Service Code
|
CPT J2260
|
| Hospital Charge Code |
1771234
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.14
|
|
|
MILRINONE 20 MG/100 ML(200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS PIGGYBK [14961]
|
Facility
|
OP
|
$0.18
|
|
|
Service Code
|
CPT J2260
|
| Hospital Charge Code |
1771234
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.11
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.11
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.14
|
|
|
MILRINONE 40 MG/200 ML(200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS PIGGYBK [119863]
|
Facility
|
OP
|
$0.19
|
|
|
Service Code
|
CPT J2260
|
| Hospital Charge Code |
NDG119863
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.11
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.11
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.11
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.11
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.11
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.14
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.14
|
|
|
MILRINONE 40 MG/200 ML(200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS PIGGYBK [119863]
|
Facility
|
IP
|
$0.19
|
|
|
Service Code
|
CPT J2260
|
| Hospital Charge Code |
NDG119863
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.11
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.14
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.14
|
|
|
MILRINONE 5 MG/50 ML D5.2NS SYRINGE [4080686]
|
Facility
|
OP
|
$42.93
|
|
|
Service Code
|
CPT J2260
|
| Hospital Charge Code |
NDC4080686
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.61 |
| Max. Negotiated Rate |
$32.20 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$25.76
|
| Rate for Payer: Aetna of CA Government/Medicare |
$25.76
|
| Rate for Payer: Cash Price |
$19.32
|
| Rate for Payer: Health Smart Auto/Commercial |
$25.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$25.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.61
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$32.20
|
|
|
MILRINONE 5 MG/50 ML D5.2NS SYRINGE [4080686]
|
Facility
|
IP
|
$42.93
|
|
|
Service Code
|
CPT J2260
|
| Hospital Charge Code |
NDC4080686
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.61 |
| Max. Negotiated Rate |
$34.34 |
| Rate for Payer: Cash Price |
$19.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34.34
|
| Rate for Payer: Health Smart Auto/Commercial |
$25.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.61
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$32.20
|
|
|
MINERAL OIL ENEMA [5087]
|
Facility
|
IP
|
$0.02
|
|
|
Service Code
|
NDC 0132-0301-40
|
| Hospital Charge Code |
1748010
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.02
|
|
|
MINERAL OIL ENEMA [5087]
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
NDC 0132-0301-40
|
| Hospital Charge Code |
1748010
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.01
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.02
|
|
|
MINERAL OIL, LIGHT STERILE [226645]
|
Facility
|
IP
|
$9.10
|
|
|
Service Code
|
NDC 6332325402
|
| Hospital Charge Code |
NDG03424
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$7.28 |
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.28
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$6.82
|
|
|
MINERAL OIL, LIGHT STERILE [226645]
|
Facility
|
IP
|
$2.10
|
|
|
Service Code
|
NDC 6332325410
|
| Hospital Charge Code |
1780019
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$1.68 |
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.68
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.16
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.58
|
|
|
MINERAL OIL, LIGHT STERILE [226645]
|
Facility
|
OP
|
$9.10
|
|
|
Service Code
|
NDC 6332325402
|
| Hospital Charge Code |
NDG03424
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$6.82 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$5.46
|
| Rate for Payer: Aetna of CA Government/Medicare |
$5.46
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$5.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$6.82
|
|
|
MINERAL OIL, LIGHT STERILE [226645]
|
Facility
|
OP
|
$2.10
|
|
|
Service Code
|
NDC 6332325410
|
| Hospital Charge Code |
1780019
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$1.58 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.26
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.26
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.16
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.58
|
|
|
MINERAL OIL ORAL [5086]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 46122-395-16
|
| Hospital Charge Code |
1715626
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.01
|
|
|
MINERAL OIL ORAL [5086]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 46122-395-16
|
| Hospital Charge Code |
1715626
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.01
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.01
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.01
|
|
|
MINOCYCLINE 100 MG CAPSULE [5110]
|
Facility
|
IP
|
$0.67
|
|
|
Service Code
|
NDC 0591-5695-50
|
| Hospital Charge Code |
1710661
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.54
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.50
|
|
|
MINOCYCLINE 100 MG CAPSULE [5110]
|
Facility
|
OP
|
$1.32
|
|
|
Service Code
|
NDC 60687-336-11
|
| Hospital Charge Code |
1710661
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.79
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.79
|
| Rate for Payer: Cash Price |
$0.59
|
| 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: LLUH Dept of Risk Management WC |
$0.73
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.99
|
|
|
MINOCYCLINE 100 MG CAPSULE [5110]
|
Facility
|
IP
|
$1.32
|
|
|
Service Code
|
NDC 60687-336-11
|
| Hospital Charge Code |
1710661
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$1.06 |
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.06
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.73
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.99
|
|
|
MINOCYCLINE 100 MG CAPSULE [5110]
|
Facility
|
OP
|
$0.67
|
|
|
Service Code
|
NDC 0591-5695-50
|
| Hospital Charge Code |
1710661
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.40
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.40
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.50
|
|
|
MINOCYCLINE 100 MG CAPSULE [5110]
|
Facility
|
IP
|
$1.32
|
|
|
Service Code
|
NDC 60687-336-65
|
| Hospital Charge Code |
1710661
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$1.06 |
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.06
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.73
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.99
|
|
|
MINOCYCLINE 100 MG CAPSULE [5110]
|
Facility
|
OP
|
$0.67
|
|
|
Service Code
|
NDC 65862-211-50
|
| Hospital Charge Code |
1710661
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.40
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.40
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.50
|
|
|
MINOCYCLINE 100 MG CAPSULE [5110]
|
Facility
|
IP
|
$0.67
|
|
|
Service Code
|
NDC 65862-211-50
|
| Hospital Charge Code |
1710661
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.54
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.50
|
|
|
MINOCYCLINE 100 MG CAPSULE [5110]
|
Facility
|
IP
|
$0.67
|
|
|
Service Code
|
NDC 57664-853-85
|
| Hospital Charge Code |
1710661
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.54
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.50
|
|
|
MINOCYCLINE 100 MG CAPSULE [5110]
|
Facility
|
OP
|
$0.67
|
|
|
Service Code
|
NDC 57664-853-85
|
| Hospital Charge Code |
1710661
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.40
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.40
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.50
|
|
|
MINOCYCLINE 100 MG CAPSULE [5110]
|
Facility
|
OP
|
$1.32
|
|
|
Service Code
|
NDC 60687-336-65
|
| Hospital Charge Code |
1710661
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.79
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.79
|
| Rate for Payer: Cash Price |
$0.59
|
| 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: LLUH Dept of Risk Management WC |
$0.73
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.99
|
|
|
MINOCYCLINE 100 MG INTRAVENOUS SOLUTION [10612]
|
Facility
|
IP
|
$286.80
|
|
|
Service Code
|
NDC 70842-160-10
|
| Hospital Charge Code |
ERX10612
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$157.74 |
| Max. Negotiated Rate |
$229.44 |
| Rate for Payer: Cash Price |
$129.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$229.44
|
| Rate for Payer: Health Smart Auto/Commercial |
$172.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.74
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$215.10
|
|
