WARFARIN 6 MG TABLET [19434]
|
Facility
|
OP
|
$0.67
|
|
Service Code
|
NDC 0832-1217-01
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.37 |
Max. Negotiated Rate |
$0.54 |
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 |
$0.37
|
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.54
|
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 Commercial |
$0.50
|
|
WARFARIN 6 MG TABLET [19434]
|
Facility
|
OP
|
$0.67
|
|
Service Code
|
NDC 0832-1217-89
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.37 |
Max. Negotiated Rate |
$0.54 |
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 |
$0.37
|
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.54
|
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 Commercial |
$0.50
|
|
WARFARIN 6 MG TABLET [19434]
|
Facility
|
OP
|
$0.29
|
|
Service Code
|
NDC 65162-767-10
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.16 |
Max. Negotiated Rate |
$0.23 |
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.17
|
Rate for Payer: Aetna of CA Government/Medicare |
$0.17
|
Rate for Payer: Cash Price |
$0.16
|
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.23
|
Rate for Payer: Health Smart Auto/Commercial |
$0.17
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.17
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
Rate for Payer: Multiplan Commercial |
$0.22
|
|
WARFARIN 6 MG TABLET [19434]
|
Facility
|
IP
|
$0.67
|
|
Service Code
|
NDC 0832-1217-01
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.37 |
Max. Negotiated Rate |
$0.54 |
Rate for Payer: Cash Price |
$0.37
|
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial |
$0.50
|
|
WARFARIN 7.5 MG TABLET [8752]
|
Facility
|
IP
|
$0.70
|
|
Service Code
|
NDC 0832-1218-89
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.39 |
Max. Negotiated Rate |
$0.56 |
Rate for Payer: Cash Price |
$0.38
|
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.56
|
Rate for Payer: Health Smart Auto/Commercial |
$0.42
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
Rate for Payer: Multiplan Commercial |
$0.53
|
|
WARFARIN 7.5 MG TABLET [8752]
|
Facility
|
IP
|
$0.70
|
|
Service Code
|
NDC 0832-1218-01
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.39 |
Max. Negotiated Rate |
$0.56 |
Rate for Payer: Cash Price |
$0.38
|
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.56
|
Rate for Payer: Health Smart Auto/Commercial |
$0.42
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
Rate for Payer: Multiplan Commercial |
$0.53
|
|
WARFARIN 7.5 MG TABLET [8752]
|
Facility
|
OP
|
$0.70
|
|
Service Code
|
NDC 0832-1218-01
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.39 |
Max. Negotiated Rate |
$0.56 |
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.42
|
Rate for Payer: Aetna of CA Government/Medicare |
$0.42
|
Rate for Payer: Cash Price |
$0.38
|
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.56
|
Rate for Payer: Health Smart Auto/Commercial |
$0.42
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.42
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
Rate for Payer: Multiplan Commercial |
$0.53
|
|
WARFARIN 7.5 MG TABLET [8752]
|
Facility
|
OP
|
$0.70
|
|
Service Code
|
NDC 0832-1218-89
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.39 |
Max. Negotiated Rate |
$0.56 |
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.42
|
Rate for Payer: Aetna of CA Government/Medicare |
$0.42
|
Rate for Payer: Cash Price |
$0.38
|
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.56
|
Rate for Payer: Health Smart Auto/Commercial |
$0.42
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.42
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
Rate for Payer: Multiplan Commercial |
$0.53
|
|
WARFARIN CRUSHED TABLET IN WATER [40811664]
|
Facility
|
OP
|
$0.44
|
|
Service Code
|
NDC 0832-1211-01
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.24 |
Max. Negotiated Rate |
$0.35 |
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.26
|
Rate for Payer: Aetna of CA Government/Medicare |
$0.26
|
Rate for Payer: Cash Price |
$0.24
|
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.35
|
Rate for Payer: Health Smart Auto/Commercial |
$0.26
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.26
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
Rate for Payer: Multiplan Commercial |
$0.33
|
|
WARFARIN CRUSHED TABLET IN WATER [40811664]
|
Facility
|
OP
|
$0.44
|
|
Service Code
|
NDC 0832-1211-89
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.24 |
Max. Negotiated Rate |
$0.35 |
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.26
|
Rate for Payer: Aetna of CA Government/Medicare |
$0.26
|
Rate for Payer: Cash Price |
$0.24
|
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.35
|
Rate for Payer: Health Smart Auto/Commercial |
$0.26
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.26
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
Rate for Payer: Multiplan Commercial |
$0.33
|
|
WARFARIN CRUSHED TABLET IN WATER [40811664]
|
Facility
|
IP
|
$0.44
|
|
Service Code
|
NDC 0832-1211-89
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.24 |
Max. Negotiated Rate |
$0.35 |
Rate for Payer: Cash Price |
$0.24
|
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.35
|
Rate for Payer: Health Smart Auto/Commercial |
$0.26
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
Rate for Payer: Multiplan Commercial |
$0.33
|
|
WARFARIN CRUSHED TABLET IN WATER [40811664]
|
Facility
|
IP
|
$0.44
|
|
Service Code
|
NDC 0832-1211-01
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.24 |
Max. Negotiated Rate |
$0.35 |
Rate for Payer: Cash Price |
$0.24
|
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.35
|
Rate for Payer: Health Smart Auto/Commercial |
$0.26
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
Rate for Payer: Multiplan Commercial |
$0.33
|
|
WATER FOR INJECTION, BACTERIOSTATIC INJECTION SOLUTION [864]
|
Facility
|
IP
|
$0.25
|
|
Service Code
|
NDC 0409-3977-03
|
Hospital Charge Code |
901700004
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.14 |
Max. Negotiated Rate |
$0.20 |
Rate for Payer: Cash Price |
$0.14
|
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.20
|
Rate for Payer: Health Smart Auto/Commercial |
$0.15
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
Rate for Payer: Multiplan Commercial |
$0.19
|
|
WATER FOR INJECTION, BACTERIOSTATIC INJECTION SOLUTION [864]
|
Facility
|
OP
|
$0.25
|
|
Service Code
|
NDC 0409-3977-03
|
Hospital Charge Code |
901700004
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.14 |
Max. Negotiated Rate |
$0.20 |
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.15
|
Rate for Payer: Aetna of CA Government/Medicare |
$0.15
|
Rate for Payer: Cash Price |
$0.14
|
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.20
|
Rate for Payer: Health Smart Auto/Commercial |
$0.15
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.15
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
Rate for Payer: Multiplan Commercial |
$0.19
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION [11671]
|
Facility
|
OP
|
$0.39
|
|
Service Code
|
HCPCS A4216
|
Hospital Charge Code |
901700017
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$0.21 |
Max. Negotiated Rate |
$0.31 |
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.23
|
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.25
|
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.17
|
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.10
|
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.12
|
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.22
|
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.36
|
Rate for Payer: Aetna of CA Government/Medicare |
$0.36
|
Rate for Payer: Aetna of CA Government/Medicare |
$0.23
|
Rate for Payer: Aetna of CA Government/Medicare |
$0.12
|
Rate for Payer: Aetna of CA Government/Medicare |
$0.17
|
Rate for Payer: Aetna of CA Government/Medicare |
$0.22
|
Rate for Payer: Aetna of CA Government/Medicare |
$0.10
|
Rate for Payer: Aetna of CA Government/Medicare |
$0.25
|
Rate for Payer: Cash Price |
$0.22
|
Rate for Payer: Cash Price |
$0.33
|
Rate for Payer: Cash Price |
$0.21
|
Rate for Payer: Cash Price |
$0.11
|
Rate for Payer: Cash Price |
$0.09
|
Rate for Payer: Cash Price |
$0.23
|
Rate for Payer: Cash Price |
$0.16
|
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.30
|
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.48
|
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.16
|
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.33
|
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.23
|
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.14
|
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.31
|
Rate for Payer: Health Smart Auto/Commercial |
$0.22
|
Rate for Payer: Health Smart Auto/Commercial |
$0.10
|
Rate for Payer: Health Smart Auto/Commercial |
$0.12
|
Rate for Payer: Health Smart Auto/Commercial |
$0.17
|
Rate for Payer: Health Smart Auto/Commercial |
$0.23
|
Rate for Payer: Health Smart Auto/Commercial |
$0.25
|
Rate for Payer: Health Smart Auto/Commercial |
$0.36
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.22
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.36
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.23
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.17
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.25
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.12
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.10
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
Rate for Payer: Multiplan Commercial |
$0.45
|
Rate for Payer: Multiplan Commercial |
$0.28
|
Rate for Payer: Multiplan Commercial |
$0.31
|
Rate for Payer: Multiplan Commercial |
$0.13
|
Rate for Payer: Multiplan Commercial |
$0.22
|
Rate for Payer: Multiplan Commercial |
$0.29
|
Rate for Payer: Multiplan Commercial |
$0.15
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION [11671]
|
Facility
|
IP
|
$0.17
|
|
Service Code
|
HCPCS A4216
|
Hospital Charge Code |
901700017
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$0.09 |
Max. Negotiated Rate |
$0.14 |
Rate for Payer: Cash Price |
$0.09
|
Rate for Payer: Cash Price |
$0.33
|
Rate for Payer: Cash Price |
$0.23
|
Rate for Payer: Cash Price |
$0.16
|
Rate for Payer: Cash Price |
$0.11
|
Rate for Payer: Cash Price |
$0.21
|
Rate for Payer: Cash Price |
$0.22
|
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.31
|
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.30
|
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.16
|
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.14
|
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.33
|
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.23
|
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.48
|
Rate for Payer: Health Smart Auto/Commercial |
$0.22
|
Rate for Payer: Health Smart Auto/Commercial |
$0.10
|
Rate for Payer: Health Smart Auto/Commercial |
$0.12
|
Rate for Payer: Health Smart Auto/Commercial |
$0.17
|
Rate for Payer: Health Smart Auto/Commercial |
$0.23
|
Rate for Payer: Health Smart Auto/Commercial |
$0.25
|
Rate for Payer: Health Smart Auto/Commercial |
$0.36
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
Rate for Payer: Multiplan Commercial |
$0.22
|
Rate for Payer: Multiplan Commercial |
$0.45
|
Rate for Payer: Multiplan Commercial |
$0.31
|
Rate for Payer: Multiplan Commercial |
$0.29
|
Rate for Payer: Multiplan Commercial |
$0.15
|
Rate for Payer: Multiplan Commercial |
$0.13
|
Rate for Payer: Multiplan Commercial |
$0.28
|
|
WATER FOR INJECTION, STERILE INTRAVENOUS SOLUTION [28400]
|
Facility
|
OP
|
$0.01
|
|
Service Code
|
NDC 0264-7850-00
|
Hospital Charge Code |
901700004
|
Hospital Revenue Code
|
250
|
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: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$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 Commercial |
$0.01
|
|
WATER FOR INJECTION, STERILE INTRAVENOUS SOLUTION [28400]
|
Facility
|
IP
|
$0.02
|
|
Service Code
|
NDC 0264-7850-20
|
Hospital Charge Code |
901700004
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.01 |
Max. Negotiated Rate |
$0.02 |
Rate for Payer: Cash Price |
$0.01
|
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial |
$0.02
|
|
WATER FOR INJECTION, STERILE INTRAVENOUS SOLUTION [28400]
|
Facility
|
IP
|
$0.01
|
|
Service Code
|
NDC 0264-7850-00
|
Hospital Charge Code |
901700004
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.01 |
Max. Negotiated Rate |
$0.01 |
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial |
$0.01
|
|
WATER FOR INJECTION, STERILE INTRAVENOUS SOLUTION [28400]
|
Facility
|
IP
|
$0.01
|
|
Service Code
|
NDC 0264-7850-10
|
Hospital Charge Code |
901700004
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.01 |
Max. Negotiated Rate |
$0.01 |
Rate for Payer: Cash Price |
$0.01
|
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial |
$0.01
|
|
WATER FOR INJECTION, STERILE INTRAVENOUS SOLUTION [28400]
|
Facility
|
OP
|
$0.02
|
|
Service Code
|
NDC 0264-7850-20
|
Hospital Charge Code |
901700004
|
Hospital Revenue Code
|
250
|
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: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.02
|
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 Commercial |
$0.02
|
|
WATER FOR INJECTION, STERILE INTRAVENOUS SOLUTION [28400]
|
Facility
|
OP
|
$0.01
|
|
Service Code
|
NDC 0264-7850-10
|
Hospital Charge Code |
901700004
|
Hospital Revenue Code
|
250
|
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: Cash Price |
$0.01
|
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$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 Commercial |
$0.01
|
|
WATER FOR IRRIGATION, STERILE SOLUTION [7485]
|
Facility
|
IP
|
$0.01
|
|
Service Code
|
NDC 0264-2101-10
|
Hospital Charge Code |
901700004
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.01 |
Max. Negotiated Rate |
$0.01 |
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial |
$0.01
|
|
WATER FOR IRRIGATION, STERILE SOLUTION [7485]
|
Facility
|
OP
|
$0.01
|
|
Service Code
|
NDC 0264-2101-10
|
Hospital Charge Code |
901700004
|
Hospital Revenue Code
|
250
|
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: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$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 Commercial |
$0.01
|
|
WHITE PETROLATUM 41 % TOPICAL OINTMENT [115556]
|
Facility
|
OP
|
$0.12
|
|
Service Code
|
NDC 7214045231
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.07 |
Max. Negotiated Rate |
$0.10 |
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 |
$0.06
|
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.10
|
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 |
$0.07
|
Rate for Payer: Multiplan Commercial |
$0.09
|
|