MORPHINE 50 MG/50 ML IN NS IV PCA SYRINGE [40820379]
|
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/ML INTRAVENOUS SOLUTION [111254]
|
Facility
|
OP
|
$0.93
|
|
Service Code
|
CPT J2270
|
Hospital Charge Code |
NDG111254
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.51 |
Max. Negotiated Rate |
$0.70 |
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.56
|
Rate for Payer: Aetna of CA Government/Medicare |
$0.56
|
Rate for Payer: Cash Price |
$0.42
|
Rate for Payer: Health Smart Auto/Commercial |
$0.56
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.56
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.51
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.70
|
|
MORPHINE 50 MG/ML INTRAVENOUS SOLUTION [111254]
|
Facility
|
IP
|
$0.93
|
|
Service Code
|
CPT J2270
|
Hospital Charge Code |
NDG111254
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.51 |
Max. Negotiated Rate |
$0.74 |
Rate for Payer: Cash Price |
$0.42
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.74
|
Rate for Payer: Health Smart Auto/Commercial |
$0.56
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.51
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.70
|
|
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLUTION [10655]
|
Facility
|
IP
|
$0.72
|
|
Service Code
|
NDC 0406-8003-15
|
Hospital Charge Code |
NDG10655B
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.40 |
Max. Negotiated Rate |
$0.58 |
Rate for Payer: Cash Price |
$0.32
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.58
|
Rate for Payer: Health Smart Auto/Commercial |
$0.43
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.54
|
|
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLUTION [10655]
|
Facility
|
IP
|
$0.66
|
|
Service Code
|
NDC 0406-8003-30
|
Hospital Charge Code |
1734037
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.36 |
Max. Negotiated Rate |
$0.53 |
Rate for Payer: Cash Price |
$0.30
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.53
|
Rate for Payer: Health Smart Auto/Commercial |
$0.40
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.50
|
|
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLUTION [10655]
|
Facility
|
OP
|
$0.66
|
|
Service Code
|
NDC 0406-8003-30
|
Hospital Charge Code |
1734037
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.36 |
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 |
$0.36
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.50
|
|
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLUTION [10655]
|
Facility
|
OP
|
$0.72
|
|
Service Code
|
NDC 0406-8003-15
|
Hospital Charge Code |
NDG10655B
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.40 |
Max. Negotiated Rate |
$0.54 |
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.43
|
Rate for Payer: Aetna of CA Government/Medicare |
$0.43
|
Rate for Payer: Cash Price |
$0.32
|
Rate for Payer: Health Smart Auto/Commercial |
$0.43
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.43
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.54
|
|
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLUTION [10655]
|
Facility
|
IP
|
$0.69
|
|
Service Code
|
NDC 9999-9106-55
|
Hospital Charge Code |
NDG10655
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.38 |
Max. Negotiated Rate |
$0.55 |
Rate for Payer: Cash Price |
$0.31
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.55
|
Rate for Payer: Health Smart Auto/Commercial |
$0.41
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.52
|
|
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLUTION [10655]
|
Facility
|
OP
|
$0.69
|
|
Service Code
|
NDC 9999-9106-55
|
Hospital Charge Code |
NDG10655
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.38 |
Max. Negotiated Rate |
$0.52 |
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.41
|
Rate for Payer: Aetna of CA Government/Medicare |
$0.41
|
Rate for Payer: Cash Price |
$0.31
|
Rate for Payer: Health Smart Auto/Commercial |
$0.41
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.41
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.52
|
|
MORPHINE ER 100 MG TABLET,EXTENDED RELEASE [20919]
|
Facility
|
OP
|
$5.52
|
|
Service Code
|
NDC 0406-8390-23
|
Hospital Charge Code |
1730071
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$3.04 |
Max. Negotiated Rate |
$4.14 |
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$3.31
|
Rate for Payer: Aetna of CA Government/Medicare |
$3.31
|
Rate for Payer: Cash Price |
$2.48
|
Rate for Payer: Health Smart Auto/Commercial |
$3.31
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$3.31
|
Rate for Payer: LLUH Dept of Risk Management WC |
$3.04
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$4.14
|
|
MORPHINE ER 100 MG TABLET,EXTENDED RELEASE [20919]
|
Facility
|
IP
|
$5.52
|
|
Service Code
|
NDC 0406-8390-23
|
Hospital Charge Code |
1730071
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$3.04 |
Max. Negotiated Rate |
$4.42 |
Rate for Payer: Cash Price |
$2.48
|
Rate for Payer: Cigna of CA HMO/PPO |
$4.42
|
Rate for Payer: Health Smart Auto/Commercial |
$3.31
|
Rate for Payer: LLUH Dept of Risk Management WC |
$3.04
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$4.14
|
|
MORPHINE ER 100 MG TABLET,EXTENDED RELEASE [20919]
|
Facility
|
IP
|
$5.52
|
|
Service Code
|
NDC 0406-8390-62
|
Hospital Charge Code |
1730071
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$3.04 |
Max. Negotiated Rate |
$4.42 |
Rate for Payer: Cash Price |
$2.48
|
Rate for Payer: Cigna of CA HMO/PPO |
$4.42
|
Rate for Payer: Health Smart Auto/Commercial |
$3.31
|
Rate for Payer: LLUH Dept of Risk Management WC |
$3.04
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$4.14
|
|
MORPHINE ER 100 MG TABLET,EXTENDED RELEASE [20919]
|
Facility
|
OP
|
$5.52
|
|
Service Code
|
NDC 0406-8390-62
|
Hospital Charge Code |
1730071
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$3.04 |
Max. Negotiated Rate |
$4.14 |
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$3.31
|
Rate for Payer: Aetna of CA Government/Medicare |
$3.31
|
Rate for Payer: Cash Price |
$2.48
|
Rate for Payer: Health Smart Auto/Commercial |
$3.31
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$3.31
|
Rate for Payer: LLUH Dept of Risk Management WC |
$3.04
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$4.14
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE [20920]
|
Facility
|
OP
|
$1.01
|
|
Service Code
|
NDC 0406-8315-62
|
Hospital Charge Code |
1730085
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.56 |
Max. Negotiated Rate |
$0.76 |
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.61
|
Rate for Payer: Aetna of CA Government/Medicare |
$0.61
|
Rate for Payer: Cash Price |
$0.45
|
Rate for Payer: Health Smart Auto/Commercial |
$0.61
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.61
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.76
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE [20920]
|
Facility
|
IP
|
$1.01
|
|
Service Code
|
NDC 0406-8315-62
|
Hospital Charge Code |
1730085
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.56 |
Max. Negotiated Rate |
$0.81 |
Rate for Payer: Cash Price |
$0.45
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.81
|
Rate for Payer: Health Smart Auto/Commercial |
$0.61
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.76
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE [20920]
|
Facility
|
OP
|
$1.01
|
|
Service Code
|
NDC 0406-8315-23
|
Hospital Charge Code |
1730085
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.56 |
Max. Negotiated Rate |
$0.76 |
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.61
|
Rate for Payer: Aetna of CA Government/Medicare |
$0.61
|
Rate for Payer: Cash Price |
$0.45
|
Rate for Payer: Health Smart Auto/Commercial |
$0.61
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.61
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.76
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE [20920]
|
Facility
|
IP
|
$1.01
|
|
Service Code
|
NDC 0406-8315-23
|
Hospital Charge Code |
1730085
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.56 |
Max. Negotiated Rate |
$0.81 |
Rate for Payer: Cash Price |
$0.45
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.81
|
Rate for Payer: Health Smart Auto/Commercial |
$0.61
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.76
|
|
MORPHINE ER 20 MG CAPSULE,EXTENDED RELEASE PELLETS [27870]
|
Facility
|
OP
|
$5.02
|
|
Service Code
|
NDC 0228-3502-06
|
Hospital Charge Code |
1730162
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$2.76 |
Max. Negotiated Rate |
$3.76 |
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$3.01
|
Rate for Payer: Aetna of CA Government/Medicare |
$3.01
|
Rate for Payer: Cash Price |
$2.26
|
Rate for Payer: Health Smart Auto/Commercial |
$3.01
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$3.01
|
Rate for Payer: LLUH Dept of Risk Management WC |
$2.76
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$3.76
|
|
MORPHINE ER 20 MG CAPSULE,EXTENDED RELEASE PELLETS [27870]
|
Facility
|
IP
|
$5.02
|
|
Service Code
|
NDC 0228-3502-06
|
Hospital Charge Code |
1730162
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$2.76 |
Max. Negotiated Rate |
$4.02 |
Rate for Payer: Cash Price |
$2.26
|
Rate for Payer: Cigna of CA HMO/PPO |
$4.02
|
Rate for Payer: Health Smart Auto/Commercial |
$3.01
|
Rate for Payer: LLUH Dept of Risk Management WC |
$2.76
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$3.76
|
|
MORPHINE ER 30 MG CAPSULE,EXTENDED RELEASE PELLETS [27871]
|
Facility
|
OP
|
$5.46
|
|
Service Code
|
NDC 0228-3503-06
|
Hospital Charge Code |
1730163
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$3.00 |
Max. Negotiated Rate |
$4.10 |
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$3.28
|
Rate for Payer: Aetna of CA Government/Medicare |
$3.28
|
Rate for Payer: Cash Price |
$2.46
|
Rate for Payer: Health Smart Auto/Commercial |
$3.28
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$3.28
|
Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$4.10
|
|
MORPHINE ER 30 MG CAPSULE,EXTENDED RELEASE PELLETS [27871]
|
Facility
|
IP
|
$5.46
|
|
Service Code
|
NDC 0228-3503-06
|
Hospital Charge Code |
1730163
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$3.00 |
Max. Negotiated Rate |
$4.37 |
Rate for Payer: Cash Price |
$2.46
|
Rate for Payer: Cigna of CA HMO/PPO |
$4.37
|
Rate for Payer: Health Smart Auto/Commercial |
$3.28
|
Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$4.10
|
|
MORPHINE ER 30 MG TABLET,EXTENDED RELEASE [20921]
|
Facility
|
IP
|
$1.48
|
|
Service Code
|
NDC 68084-158-01
|
Hospital Charge Code |
1730076
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.81 |
Max. Negotiated Rate |
$1.18 |
Rate for Payer: Cash Price |
$0.67
|
Rate for Payer: Cigna of CA HMO/PPO |
$1.18
|
Rate for Payer: Health Smart Auto/Commercial |
$0.89
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.11
|
|
MORPHINE ER 30 MG TABLET,EXTENDED RELEASE [20921]
|
Facility
|
OP
|
$1.91
|
|
Service Code
|
NDC 0406-8330-62
|
Hospital Charge Code |
1730076
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$1.05 |
Max. Negotiated Rate |
$1.43 |
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.15
|
Rate for Payer: Aetna of CA Government/Medicare |
$1.15
|
Rate for Payer: Cash Price |
$0.86
|
Rate for Payer: Health Smart Auto/Commercial |
$1.15
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.15
|
Rate for Payer: LLUH Dept of Risk Management WC |
$1.05
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.43
|
|
MORPHINE ER 30 MG TABLET,EXTENDED RELEASE [20921]
|
Facility
|
IP
|
$1.91
|
|
Service Code
|
NDC 0406-8330-62
|
Hospital Charge Code |
1730076
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$1.05 |
Max. Negotiated Rate |
$1.53 |
Rate for Payer: Cash Price |
$0.86
|
Rate for Payer: Cigna of CA HMO/PPO |
$1.53
|
Rate for Payer: Health Smart Auto/Commercial |
$1.15
|
Rate for Payer: LLUH Dept of Risk Management WC |
$1.05
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.43
|
|
MORPHINE ER 30 MG TABLET,EXTENDED RELEASE [20921]
|
Facility
|
IP
|
$1.91
|
|
Service Code
|
NDC 0406-8330-23
|
Hospital Charge Code |
1730076
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$1.05 |
Max. Negotiated Rate |
$1.53 |
Rate for Payer: Cash Price |
$0.86
|
Rate for Payer: Cigna of CA HMO/PPO |
$1.53
|
Rate for Payer: Health Smart Auto/Commercial |
$1.15
|
Rate for Payer: LLUH Dept of Risk Management WC |
$1.05
|
Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.43
|
|