MORPHINE 2 MG/ML ORAL SOLUTION [5176]
|
Facility
|
OP
|
$0.33
|
|
Service Code
|
NDC 68094-001-62
|
Hospital Charge Code |
1734062
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.18 |
Max. Negotiated Rate |
$0.25 |
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.20
|
Rate for Payer: Aetna of CA Government/Medicare |
$0.20
|
Rate for Payer: Cash Price |
$0.15
|
Rate for Payer: Health Smart Auto/Commercial |
$0.20
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.20
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.25
|
|
MORPHINE 2 MG/ML ORAL SOLUTION [5176]
|
Facility
|
IP
|
$0.33
|
|
Service Code
|
NDC 68094-001-59
|
Hospital Charge Code |
1734062
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.18 |
Max. Negotiated Rate |
$0.26 |
Rate for Payer: Cash Price |
$0.15
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.26
|
Rate for Payer: Health Smart Auto/Commercial |
$0.20
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.25
|
|
MORPHINE 2 MG/ML ORAL SOLUTION [5176]
|
Facility
|
IP
|
$0.06
|
|
Service Code
|
NDC 0054-0237-63
|
Hospital Charge Code |
1715007
|
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
|
|
MORPHINE 2 MG/ML ORAL SOLUTION [5176]
|
Facility
|
OP
|
$0.06
|
|
Service Code
|
NDC 0054-0237-63
|
Hospital Charge Code |
1715007
|
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
|
|
MORPHINE 2 MG/ML ORAL SOLUTION [5176]
|
Facility
|
OP
|
$0.33
|
|
Service Code
|
NDC 60687-760-40
|
Hospital Charge Code |
1734062
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.18 |
Max. Negotiated Rate |
$0.25 |
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.20
|
Rate for Payer: Aetna of CA Government/Medicare |
$0.20
|
Rate for Payer: Cash Price |
$0.15
|
Rate for Payer: Health Smart Auto/Commercial |
$0.20
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.20
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.25
|
|
MORPHINE 2 MG/ML ORAL SOLUTION [5176]
|
Facility
|
IP
|
$0.33
|
|
Service Code
|
NDC 68094-001-62
|
Hospital Charge Code |
1734062
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.18 |
Max. Negotiated Rate |
$0.26 |
Rate for Payer: Cash Price |
$0.15
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.26
|
Rate for Payer: Health Smart Auto/Commercial |
$0.20
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.25
|
|
MORPHINE 2 MG/ML ORAL SOLUTION [5176]
|
Facility
|
OP
|
$0.33
|
|
Service Code
|
NDC 68094-001-59
|
Hospital Charge Code |
1734062
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.18 |
Max. Negotiated Rate |
$0.25 |
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.20
|
Rate for Payer: Aetna of CA Government/Medicare |
$0.20
|
Rate for Payer: Cash Price |
$0.15
|
Rate for Payer: Health Smart Auto/Commercial |
$0.20
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.20
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.25
|
|
MORPHINE 2 MG/ML ORAL SOLUTION [5176]
|
Facility
|
IP
|
$0.11
|
|
Service Code
|
NDC 9999-9951-76
|
Hospital Charge Code |
1734062
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.06 |
Max. Negotiated Rate |
$0.09 |
Rate for Payer: Cash Price |
$0.05
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.09
|
Rate for Payer: Health Smart Auto/Commercial |
$0.07
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.08
|
|
MORPHINE 2 MG/ML ORAL SOLUTION [5176]
|
Facility
|
IP
|
$0.33
|
|
Service Code
|
NDC 60687-760-40
|
Hospital Charge Code |
1734062
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.18 |
Max. Negotiated Rate |
$0.26 |
Rate for Payer: Cash Price |
$0.15
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.26
|
Rate for Payer: Health Smart Auto/Commercial |
$0.20
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.25
|
|
MORPHINE 2 MG/ML ORAL SOLUTION [5176]
|
Facility
|
OP
|
$0.11
|
|
Service Code
|
NDC 9999-9951-76
|
Hospital Charge Code |
1734062
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.06 |
Max. Negotiated Rate |
$0.08 |
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.07
|
Rate for Payer: Aetna of CA Government/Medicare |
$0.07
|
Rate for Payer: Cash Price |
$0.05
|
Rate for Payer: Health Smart Auto/Commercial |
$0.07
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.07
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.08
|
|
MORPHINE 30 MG IMMEDIATE RELEASE TABLET [5179]
|
Facility
|
IP
|
$1.54
|
|
Service Code
|
NDC 0054-0236-24
|
Hospital Charge Code |
1731006
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.85 |
Max. Negotiated Rate |
$1.23 |
Rate for Payer: Cash Price |
$0.69
|
Rate for Payer: Cigna of CA HMO/PPO |
$1.23
|
Rate for Payer: Health Smart Auto/Commercial |
$0.92
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.85
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.16
|
|
MORPHINE 30 MG IMMEDIATE RELEASE TABLET [5179]
|
Facility
|
OP
|
$1.54
|
|
Service Code
|
NDC 0054-0236-24
|
Hospital Charge Code |
1731006
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.85 |
Max. Negotiated Rate |
$1.16 |
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.92
|
Rate for Payer: Aetna of CA Government/Medicare |
$0.92
|
Rate for Payer: Cash Price |
$0.69
|
Rate for Payer: Health Smart Auto/Commercial |
$0.92
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.92
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.85
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.16
|
|
MORPHINE 4 MG/ML INJECTION SOLUTION [154937]
|
Facility
|
OP
|
$3.44
|
|
Service Code
|
CPT J2272
|
Hospital Charge Code |
1737083
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$1.89 |
Max. Negotiated Rate |
$2.58 |
Rate for Payer: Cash Price |
$1.55
|
Rate for Payer: Health Smart Auto/Commercial |
$2.06
|
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$2.06
|
Rate for Payer: Aetna of CA Government/Medicare |
$2.06
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$2.06
|
Rate for Payer: LLUH Dept of Risk Management WC |
$1.89
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.58
|
|
MORPHINE 4 MG/ML INJECTION SOLUTION [154937]
|
Facility
|
IP
|
$3.44
|
|
Service Code
|
CPT J2272
|
Hospital Charge Code |
1737083
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$1.89 |
Max. Negotiated Rate |
$2.75 |
Rate for Payer: Cash Price |
$1.55
|
Rate for Payer: Cigna of CA HMO/PPO |
$2.75
|
Rate for Payer: Health Smart Auto/Commercial |
$2.06
|
Rate for Payer: LLUH Dept of Risk Management WC |
$1.89
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.58
|
|
MORPHINE 4 MG/ML INJECTION SYRINGE. [4085172]
|
Facility
|
OP
|
$2.34
|
|
Service Code
|
CPT J2270
|
Hospital Charge Code |
1737083
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$1.29 |
Max. Negotiated Rate |
$1.76 |
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.40
|
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$2.06
|
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.80
|
Rate for Payer: Aetna of CA Government/Medicare |
$1.80
|
Rate for Payer: Aetna of CA Government/Medicare |
$2.06
|
Rate for Payer: Aetna of CA Government/Medicare |
$1.40
|
Rate for Payer: Cash Price |
$1.05
|
Rate for Payer: Cash Price |
$1.35
|
Rate for Payer: Cash Price |
$1.55
|
Rate for Payer: Health Smart Auto/Commercial |
$2.06
|
Rate for Payer: Health Smart Auto/Commercial |
$1.40
|
Rate for Payer: Health Smart Auto/Commercial |
$1.80
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.40
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$2.06
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.80
|
Rate for Payer: LLUH Dept of Risk Management WC |
$1.89
|
Rate for Payer: LLUH Dept of Risk Management WC |
$1.29
|
Rate for Payer: LLUH Dept of Risk Management WC |
$1.65
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.25
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.58
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.76
|
|
MORPHINE 4 MG/ML INJECTION SYRINGE. [4085172]
|
Facility
|
IP
|
$3.00
|
|
Service Code
|
CPT J2270
|
Hospital Charge Code |
1737083
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$1.65 |
Max. Negotiated Rate |
$2.40 |
Rate for Payer: Cash Price |
$1.35
|
Rate for Payer: Cash Price |
$1.05
|
Rate for Payer: Cash Price |
$1.55
|
Rate for Payer: Cigna of CA HMO/PPO |
$2.40
|
Rate for Payer: Cigna of CA HMO/PPO |
$1.87
|
Rate for Payer: Cigna of CA HMO/PPO |
$2.75
|
Rate for Payer: Health Smart Auto/Commercial |
$1.80
|
Rate for Payer: Health Smart Auto/Commercial |
$1.40
|
Rate for Payer: Health Smart Auto/Commercial |
$2.06
|
Rate for Payer: LLUH Dept of Risk Management WC |
$1.65
|
Rate for Payer: LLUH Dept of Risk Management WC |
$1.89
|
Rate for Payer: LLUH Dept of Risk Management WC |
$1.29
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.58
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.76
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.25
|
|
MORPHINE 4 MG/ML INTRAVENOUS SOLUTION [211583]
|
Facility
|
OP
|
$3.00
|
|
Service Code
|
CPT J2270
|
Hospital Charge Code |
1737083
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$1.65 |
Max. Negotiated Rate |
$2.25 |
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.80
|
Rate for Payer: Aetna of CA Government/Medicare |
$1.80
|
Rate for Payer: Cash Price |
$1.35
|
Rate for Payer: Health Smart Auto/Commercial |
$1.80
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.80
|
Rate for Payer: LLUH Dept of Risk Management WC |
$1.65
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.25
|
|
MORPHINE 4 MG/ML INTRAVENOUS SOLUTION [211583]
|
Facility
|
IP
|
$3.00
|
|
Service Code
|
CPT J2270
|
Hospital Charge Code |
1737083
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$1.65 |
Max. Negotiated Rate |
$2.40 |
Rate for Payer: Cash Price |
$1.35
|
Rate for Payer: Cigna of CA HMO/PPO |
$2.40
|
Rate for Payer: Health Smart Auto/Commercial |
$1.80
|
Rate for Payer: LLUH Dept of Risk Management WC |
$1.65
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.25
|
|
MORPHINE 50 MG/50 ML (1 MG/ML) IN 0.9 % SODIUM CHLORIDE IV PCA SYRINGE [120175]
|
Facility
|
OP
|
$0.23
|
|
Service Code
|
CPT J2270
|
Hospital Charge Code |
1737072
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.13 |
Max. Negotiated Rate |
$0.17 |
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.14
|
Rate for Payer: Aetna of CA Government/Medicare |
$0.14
|
Rate for Payer: Cash Price |
$0.10
|
Rate for Payer: Health Smart Auto/Commercial |
$0.14
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.14
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.17
|
|
MORPHINE 50 MG/50 ML (1 MG/ML) IN 0.9 % SODIUM CHLORIDE IV PCA SYRINGE [120175]
|
Facility
|
IP
|
$0.23
|
|
Service Code
|
CPT J2270
|
Hospital Charge Code |
1737072
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.13 |
Max. Negotiated Rate |
$0.18 |
Rate for Payer: Cash Price |
$0.10
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.18
|
Rate for Payer: Health Smart Auto/Commercial |
$0.14
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.17
|
|
MORPHINE 50 MG/50 ML (1 MG/ML) IN 0.9 % SODIUM CHLORIDE IV PCA SYRINGE. [40820175]
|
Facility
|
OP
|
$0.21
|
|
Service Code
|
CPT J2270
|
Hospital Charge Code |
1737072
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.12 |
Max. Negotiated Rate |
$0.16 |
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.13
|
Rate for Payer: Aetna of CA Government/Medicare |
$0.13
|
Rate for Payer: Cash Price |
$0.09
|
Rate for Payer: Health Smart Auto/Commercial |
$0.13
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.13
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.16
|
|
MORPHINE 50 MG/50 ML (1 MG/ML) IN 0.9 % SODIUM CHLORIDE IV PCA SYRINGE. [40820175]
|
Facility
|
IP
|
$0.21
|
|
Service Code
|
CPT J2270
|
Hospital Charge Code |
1737072
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.12 |
Max. Negotiated Rate |
$0.17 |
Rate for Payer: Cash Price |
$0.09
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.17
|
Rate for Payer: Health Smart Auto/Commercial |
$0.13
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.16
|
|
MORPHINE 50 MG/50 ML (1 MG/ML) IN 0.9 % SODIUM CHLORIDE PREMIX IV PCA SYRINGE - ADULT DISCRETE [40820485]
|
Facility
|
OP
|
$0.21
|
|
Service Code
|
CPT J2270
|
Hospital Charge Code |
1737072
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.12 |
Max. Negotiated Rate |
$0.16 |
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.13
|
Rate for Payer: Aetna of CA Government/Medicare |
$0.13
|
Rate for Payer: Cash Price |
$0.09
|
Rate for Payer: Health Smart Auto/Commercial |
$0.13
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.13
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.16
|
|
MORPHINE 50 MG/50 ML (1 MG/ML) IN 0.9 % SODIUM CHLORIDE PREMIX IV PCA SYRINGE - ADULT DISCRETE [40820485]
|
Facility
|
IP
|
$0.21
|
|
Service Code
|
CPT J2270
|
Hospital Charge Code |
1737072
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.12 |
Max. Negotiated Rate |
$0.17 |
Rate for Payer: Cash Price |
$0.09
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.17
|
Rate for Payer: Health Smart Auto/Commercial |
$0.13
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.16
|
|
MORPHINE 50 MG/50 ML IN NS IV PCA SYRINGE [40820379]
|
Facility
|
IP
|
$0.21
|
|
Service Code
|
CPT J2270
|
Hospital Charge Code |
1737072
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.12 |
Max. Negotiated Rate |
$0.17 |
Rate for Payer: Cash Price |
$0.09
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.17
|
Rate for Payer: Health Smart Auto/Commercial |
$0.13
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.16
|
|