|
MORPHINE ER 60 MG TABLET,EXTENDED RELEASE [20922]
|
Facility
OP
|
$2.98
|
|
|
Service Code
|
NDC 0406-8380-01
|
| Hospital Charge Code |
1730073
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.53
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.76
|
| Rate for Payer: BCBS Transplant Transplant |
$1.79
|
| Rate for Payer: Blue Shield of California Commercial |
$1.87
|
| Rate for Payer: Blue Shield of California EPN |
$1.46
|
| Rate for Payer: Cash Price |
$1.34
|
| Rate for Payer: Central Health Plan Commercial |
$2.38
|
| Rate for Payer: Cigna of CA HMO |
$2.09
|
| Rate for Payer: Cigna of CA PPO |
$2.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.19
|
| Rate for Payer: Galaxy Health WC |
$2.53
|
| Rate for Payer: Global Benefits Group Commercial |
$1.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.68
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.24
|
| Rate for Payer: IEHP medi-cal |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.60
|
| Rate for Payer: Multiplan Commercial |
$2.24
|
| Rate for Payer: Networks By Design Commercial |
$1.94
|
| Rate for Payer: Prime Health Services Commercial |
$2.53
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.79
|
| Rate for Payer: Riverside University Health MISP |
$1.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.49
|
| Rate for Payer: United Healthcare All Other HMO |
$1.49
|
| Rate for Payer: United Healthcare HMO Rider |
$1.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.53
|
| Rate for Payer: Vantage Medical Group Senior |
$2.53
|
|
|
MORPHINE ER 60 MG TABLET,EXTENDED RELEASE [20922]
|
Facility
IP
|
$3.72
|
|
|
Service Code
|
NDC 0406-8380-23
|
| Hospital Charge Code |
1730073
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2.79
|
| Rate for Payer: Blue Shield of California EPN |
$1.99
|
| Rate for Payer: Cash Price |
$1.67
|
| Rate for Payer: Cash Price |
$1.67
|
| Rate for Payer: Central Health Plan Commercial |
$2.98
|
| Rate for Payer: Cigna of CA HMO |
$2.60
|
| Rate for Payer: Cigna of CA PPO |
$2.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.49
|
| Rate for Payer: Galaxy Health WC |
$3.16
|
| Rate for Payer: Global Benefits Group Commercial |
$2.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$2.79
|
| Rate for Payer: Networks By Design Commercial |
$2.42
|
| Rate for Payer: Prime Health Services Commercial |
$3.16
|
|
|
MORPHINE ER 60 MG TABLET,EXTENDED RELEASE [20922]
|
Facility
OP
|
$3.72
|
|
|
Service Code
|
NDC 0406-8380-23
|
| Hospital Charge Code |
1730073
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$3.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.20
|
| Rate for Payer: BCBS Transplant Transplant |
$2.23
|
| Rate for Payer: Blue Shield of California Commercial |
$2.34
|
| Rate for Payer: Blue Shield of California EPN |
$1.82
|
| Rate for Payer: Cash Price |
$1.67
|
| Rate for Payer: Central Health Plan Commercial |
$2.98
|
| Rate for Payer: Cigna of CA HMO |
$2.60
|
| Rate for Payer: Cigna of CA PPO |
$2.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.49
|
| Rate for Payer: Galaxy Health WC |
$3.16
|
| Rate for Payer: Global Benefits Group Commercial |
$2.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.35
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.79
|
| Rate for Payer: IEHP medi-cal |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$2.79
|
| Rate for Payer: Networks By Design Commercial |
$2.42
|
| Rate for Payer: Prime Health Services Commercial |
$3.16
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.23
|
| Rate for Payer: Riverside University Health MISP |
$1.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1.86
|
| Rate for Payer: United Healthcare HMO Rider |
$1.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.16
|
| Rate for Payer: Vantage Medical Group Senior |
$3.16
|
|
|
MORPHINE ER 60 MG TABLET,EXTENDED RELEASE [20922]
|
Facility
IP
|
$3.73
|
|
|
Service Code
|
NDC 0406-8380-62
|
| Hospital Charge Code |
1730073
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2.80
|
| Rate for Payer: Blue Shield of California EPN |
$1.99
|
| Rate for Payer: Cash Price |
$1.68
|
| Rate for Payer: Cash Price |
$1.68
|
| Rate for Payer: Central Health Plan Commercial |
$2.98
|
| Rate for Payer: Cigna of CA HMO |
$2.61
|
| Rate for Payer: Cigna of CA PPO |
$2.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.49
|
| Rate for Payer: Galaxy Health WC |
$3.17
|
| Rate for Payer: Global Benefits Group Commercial |
$2.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$2.80
|
| Rate for Payer: Networks By Design Commercial |
$2.42
|
| Rate for Payer: Prime Health Services Commercial |
$3.17
|
|
|
MORPHINE ER 60 MG TABLET,EXTENDED RELEASE [20922]
|
Facility
OP
|
$3.73
|
|
|
Service Code
|
NDC 0406-8380-62
|
| Hospital Charge Code |
1730073
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$3.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.20
|
| Rate for Payer: BCBS Transplant Transplant |
$2.24
|
| Rate for Payer: Blue Shield of California Commercial |
$2.35
|
| Rate for Payer: Blue Shield of California EPN |
$1.82
|
| Rate for Payer: Cash Price |
$1.68
|
| Rate for Payer: Central Health Plan Commercial |
$2.98
|
| Rate for Payer: Cigna of CA HMO |
$2.61
|
| Rate for Payer: Cigna of CA PPO |
$2.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.49
|
| Rate for Payer: Galaxy Health WC |
$3.17
|
| Rate for Payer: Global Benefits Group Commercial |
$2.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.36
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.80
|
| Rate for Payer: IEHP medi-cal |
$1.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$2.80
|
| Rate for Payer: Networks By Design Commercial |
$2.42
|
| Rate for Payer: Prime Health Services Commercial |
$3.17
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.24
|
| Rate for Payer: Riverside University Health MISP |
$1.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1.86
|
| Rate for Payer: United Healthcare HMO Rider |
$1.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.17
|
| Rate for Payer: Vantage Medical Group Senior |
$3.17
|
|
|
MORPHINE ER 60 MG TABLET,EXTENDED RELEASE [20922]
|
Facility
IP
|
$2.98
|
|
|
Service Code
|
NDC 0406-8380-01
|
| Hospital Charge Code |
1730073
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2.24
|
| Rate for Payer: Blue Shield of California EPN |
$1.59
|
| Rate for Payer: Cash Price |
$1.34
|
| Rate for Payer: Cash Price |
$1.34
|
| Rate for Payer: Central Health Plan Commercial |
$2.38
|
| Rate for Payer: Cigna of CA HMO |
$2.09
|
| Rate for Payer: Cigna of CA PPO |
$2.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.19
|
| Rate for Payer: Galaxy Health WC |
$2.53
|
| Rate for Payer: Global Benefits Group Commercial |
$1.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.60
|
| Rate for Payer: Multiplan Commercial |
$2.24
|
| Rate for Payer: Networks By Design Commercial |
$1.94
|
| Rate for Payer: Prime Health Services Commercial |
$2.53
|
|
|
MORPHINE (PF) 10 MG/ML INJECTION SOLUTION [77009]
|
Facility
OP
|
$12.48
|
|
|
Service Code
|
CPT J2270
|
| Hospital Charge Code |
1737060
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$28.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$28.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.61
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.87
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.40
|
| Rate for Payer: BCBS Transplant Transplant |
$7.49
|
| Rate for Payer: BCBS Transplant Transplant |
$7.49
|
| Rate for Payer: Blue Shield of California Commercial |
$3.06
|
| Rate for Payer: Blue Shield of California Commercial |
$3.06
|
| Rate for Payer: Blue Shield of California EPN |
$2.78
|
| Rate for Payer: Blue Shield of California EPN |
$2.78
|
| Rate for Payer: Cash Price |
$5.62
|
| Rate for Payer: Cash Price |
$5.62
|
| Rate for Payer: Cash Price |
$5.62
|
| Rate for Payer: Cash Price |
$5.62
|
| Rate for Payer: Central Health Plan Commercial |
$9.98
|
| Rate for Payer: Central Health Plan Commercial |
$9.99
|
| Rate for Payer: Cigna of CA HMO |
$8.74
|
| Rate for Payer: Cigna of CA HMO |
$8.74
|
| Rate for Payer: Cigna of CA PPO |
$8.74
|
| Rate for Payer: Cigna of CA PPO |
$8.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.99
|
| Rate for Payer: Galaxy Health WC |
$10.62
|
| Rate for Payer: Galaxy Health WC |
$10.61
|
| Rate for Payer: Global Benefits Group Commercial |
$7.49
|
| Rate for Payer: Global Benefits Group Commercial |
$7.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.37
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.36
|
| Rate for Payer: IEHP medi-cal |
$3.24
|
| Rate for Payer: IEHP medi-cal |
$3.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Multiplan Commercial |
$9.37
|
| Rate for Payer: Multiplan Commercial |
$9.36
|
| Rate for Payer: Networks By Design Commercial |
$6.24
|
| Rate for Payer: Networks By Design Commercial |
$6.24
|
| Rate for Payer: Prime Health Services Commercial |
$10.61
|
| Rate for Payer: Prime Health Services Commercial |
$10.62
|
| Rate for Payer: Riverside University Health MISP |
$5.00
|
| Rate for Payer: Riverside University Health MISP |
$4.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.24
|
| Rate for Payer: United Healthcare All Other HMO |
$6.24
|
| Rate for Payer: United Healthcare All Other HMO |
$6.24
|
| Rate for Payer: United Healthcare HMO Rider |
$6.24
|
| Rate for Payer: United Healthcare HMO Rider |
$6.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.62
|
| Rate for Payer: Vantage Medical Group Senior |
$10.61
|
| Rate for Payer: Vantage Medical Group Senior |
$10.62
|
|
|
MORPHINE (PF) 10 MG/ML INJECTION SOLUTION [77009]
|
Facility
IP
|
$12.49
|
|
|
Service Code
|
CPT J2270
|
| Hospital Charge Code |
1737060
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$9.36
|
| Rate for Payer: Blue Shield of California Commercial |
$9.37
|
| Rate for Payer: Blue Shield of California EPN |
$6.67
|
| Rate for Payer: Blue Shield of California EPN |
$6.66
|
| Rate for Payer: Cash Price |
$5.62
|
| Rate for Payer: Cash Price |
$5.62
|
| Rate for Payer: Cash Price |
$5.62
|
| Rate for Payer: Cash Price |
$5.62
|
| Rate for Payer: Central Health Plan Commercial |
$9.99
|
| Rate for Payer: Central Health Plan Commercial |
$9.98
|
| Rate for Payer: Cigna of CA HMO |
$8.74
|
| Rate for Payer: Cigna of CA HMO |
$8.74
|
| Rate for Payer: Cigna of CA PPO |
$8.74
|
| Rate for Payer: Cigna of CA PPO |
$8.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.00
|
| Rate for Payer: Galaxy Health WC |
$10.62
|
| Rate for Payer: Galaxy Health WC |
$10.61
|
| Rate for Payer: Global Benefits Group Commercial |
$7.49
|
| Rate for Payer: Global Benefits Group Commercial |
$7.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Multiplan Commercial |
$9.37
|
| Rate for Payer: Multiplan Commercial |
$9.36
|
| Rate for Payer: Networks By Design Commercial |
$6.24
|
| Rate for Payer: Networks By Design Commercial |
$6.24
|
| Rate for Payer: Prime Health Services Commercial |
$10.61
|
| Rate for Payer: Prime Health Services Commercial |
$10.62
|
|
|
MORPHINE (PF) 1 MG/2 ML INTRAVENOUS SYRINGE [212745]
|
Facility
OP
|
$2.62
|
|
|
Service Code
|
CPT J2270
|
| Hospital Charge Code |
NDG212745
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$28.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$28.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.40
|
| Rate for Payer: BCBS Transplant Transplant |
$1.72
|
| Rate for Payer: BCBS Transplant Transplant |
$1.57
|
| Rate for Payer: Blue Shield of California Commercial |
$3.06
|
| Rate for Payer: Blue Shield of California Commercial |
$3.06
|
| Rate for Payer: Blue Shield of California EPN |
$2.78
|
| Rate for Payer: Blue Shield of California EPN |
$2.78
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Central Health Plan Commercial |
$2.30
|
| Rate for Payer: Central Health Plan Commercial |
$2.10
|
| Rate for Payer: Cigna of CA HMO |
$1.83
|
| Rate for Payer: Cigna of CA HMO |
$2.01
|
| Rate for Payer: Cigna of CA PPO |
$1.83
|
| Rate for Payer: Cigna of CA PPO |
$2.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.15
|
| Rate for Payer: Galaxy Health WC |
$2.23
|
| Rate for Payer: Galaxy Health WC |
$2.44
|
| Rate for Payer: Global Benefits Group Commercial |
$1.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.36
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.96
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.15
|
| Rate for Payer: IEHP medi-cal |
$3.24
|
| Rate for Payer: IEHP medi-cal |
$3.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$1.96
|
| Rate for Payer: Multiplan Commercial |
$2.15
|
| Rate for Payer: Networks By Design Commercial |
$1.44
|
| Rate for Payer: Networks By Design Commercial |
$1.31
|
| Rate for Payer: Prime Health Services Commercial |
$2.23
|
| Rate for Payer: Prime Health Services Commercial |
$2.44
|
| Rate for Payer: Riverside University Health MISP |
$1.15
|
| Rate for Payer: Riverside University Health MISP |
$1.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.31
|
| Rate for Payer: United Healthcare All Other HMO |
$1.31
|
| Rate for Payer: United Healthcare All Other HMO |
$1.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2.23
|
| Rate for Payer: Vantage Medical Group Senior |
$2.44
|
|
|
MORPHINE (PF) 1 MG/2 ML INTRAVENOUS SYRINGE [212745]
|
Facility
IP
|
$2.62
|
|
|
Service Code
|
CPT J2270
|
| Hospital Charge Code |
NDG212745
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.96
|
| Rate for Payer: Blue Shield of California Commercial |
$2.15
|
| Rate for Payer: Blue Shield of California EPN |
$1.40
|
| Rate for Payer: Blue Shield of California EPN |
$1.53
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Central Health Plan Commercial |
$2.30
|
| Rate for Payer: Central Health Plan Commercial |
$2.10
|
| Rate for Payer: Cigna of CA HMO |
$2.01
|
| Rate for Payer: Cigna of CA HMO |
$1.83
|
| Rate for Payer: Cigna of CA PPO |
$1.83
|
| Rate for Payer: Cigna of CA PPO |
$2.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.05
|
| Rate for Payer: Galaxy Health WC |
$2.23
|
| Rate for Payer: Galaxy Health WC |
$2.44
|
| Rate for Payer: Global Benefits Group Commercial |
$1.57
|
| Rate for Payer: Global Benefits Group Commercial |
$1.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$2.15
|
| Rate for Payer: Multiplan Commercial |
$1.96
|
| Rate for Payer: Networks By Design Commercial |
$1.31
|
| Rate for Payer: Networks By Design Commercial |
$1.44
|
| Rate for Payer: Prime Health Services Commercial |
$2.23
|
| Rate for Payer: Prime Health Services Commercial |
$2.44
|
|
|
MORPHINE (PF) 1 MG/ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SOLUTION [154492]
|
Facility
OP
|
$0.14
|
|
|
Service Code
|
CPT J2270
|
| Hospital Charge Code |
NDG30851
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$28.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$28.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.40
|
| Rate for Payer: BCBS Transplant Transplant |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$3.06
|
| Rate for Payer: Blue Shield of California EPN |
$2.78
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.13
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.11
|
| Rate for Payer: IEHP medi-cal |
$3.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
| Rate for Payer: Riverside University Health MISP |
$0.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.12
|
|
|
MORPHINE (PF) 1 MG/ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SOLUTION [154492]
|
Facility
IP
|
$0.14
|
|
|
Service Code
|
CPT J2270
|
| Hospital Charge Code |
NDG30851
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
|
|
MORPHINE (PF) 1 MG/ML INJECTION SOLUTION [15852]
|
Facility
OP
|
$1.09
|
|
|
Service Code
|
CPT J2270
|
| Hospital Charge Code |
1737040
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$28.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$28.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.40
|
| Rate for Payer: BCBS Transplant Transplant |
$0.65
|
| Rate for Payer: Blue Shield of California Commercial |
$3.06
|
| Rate for Payer: Blue Shield of California EPN |
$2.78
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Central Health Plan Commercial |
$0.87
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.93
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.98
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.82
|
| Rate for Payer: IEHP medi-cal |
$3.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
| Rate for Payer: Networks By Design Commercial |
$0.55
|
| Rate for Payer: Prime Health Services Commercial |
$0.93
|
| Rate for Payer: Riverside University Health MISP |
$0.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.55
|
| Rate for Payer: United Healthcare All Other HMO |
$0.55
|
| Rate for Payer: United Healthcare HMO Rider |
$0.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.93
|
| Rate for Payer: Vantage Medical Group Senior |
$0.93
|
|
|
MORPHINE (PF) 1 MG/ML INJECTION SOLUTION [15852]
|
Facility
IP
|
$1.09
|
|
|
Service Code
|
CPT J2270
|
| Hospital Charge Code |
1737040
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.82
|
| Rate for Payer: Blue Shield of California EPN |
$0.58
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Central Health Plan Commercial |
$0.87
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.93
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
| Rate for Payer: Networks By Design Commercial |
$0.55
|
| Rate for Payer: Prime Health Services Commercial |
$0.93
|
|
|
MORPHINE (PF) 50 MG/50 ML(1 MG/ML) IN 0.9% SOD.CHLORIDE IV PCA SYRINGE [214839]
|
Facility
OP
|
$0.17
|
|
|
Service Code
|
CPT J2270
|
| Hospital Charge Code |
1737072
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$28.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$28.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.40
|
| Rate for Payer: BCBS Transplant Transplant |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$3.06
|
| Rate for Payer: Blue Shield of California EPN |
$2.78
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Central Health Plan Commercial |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.12
|
| Rate for Payer: Cigna of CA PPO |
$0.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.15
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.13
|
| Rate for Payer: IEHP medi-cal |
$3.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Riverside University Health MISP |
$0.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
MORPHINE (PF) 50 MG/50 ML(1 MG/ML) IN 0.9% SOD.CHLORIDE IV PCA SYRINGE [214839]
|
Facility
IP
|
$0.17
|
|
|
Service Code
|
CPT J2270
|
| Hospital Charge Code |
1737072
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Central Health Plan Commercial |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.12
|
| Rate for Payer: Cigna of CA PPO |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
|
MOUTH PROCEDURES WITH CC/MCC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 137
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
|
|
MOUTH PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 138
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS [35699]
|
Facility
OP
|
$14.00
|
|
|
Service Code
|
NDC 0781-7135-93
|
| Hospital Charge Code |
1740334
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$12.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.27
|
| Rate for Payer: BCBS Transplant Transplant |
$8.40
|
| Rate for Payer: Blue Shield of California Commercial |
$8.81
|
| Rate for Payer: Blue Shield of California EPN |
$6.85
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Central Health Plan Commercial |
$11.20
|
| Rate for Payer: Cigna of CA HMO |
$9.80
|
| Rate for Payer: Cigna of CA PPO |
$9.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.60
|
| Rate for Payer: Galaxy Health WC |
$11.90
|
| Rate for Payer: Global Benefits Group Commercial |
$8.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10.50
|
| Rate for Payer: IEHP medi-cal |
$4.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.80
|
| Rate for Payer: Multiplan Commercial |
$10.50
|
| Rate for Payer: Networks By Design Commercial |
$9.10
|
| Rate for Payer: Prime Health Services Commercial |
$11.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8.40
|
| Rate for Payer: Riverside University Health MISP |
$5.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.90
|
| Rate for Payer: Vantage Medical Group Senior |
$11.90
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS [35699]
|
Facility
OP
|
$6.00
|
|
|
Service Code
|
NDC 68180-422-01
|
| Hospital Charge Code |
1740334
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.54
|
| Rate for Payer: BCBS Transplant Transplant |
$3.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3.77
|
| Rate for Payer: Blue Shield of California EPN |
$2.93
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Central Health Plan Commercial |
$4.80
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.50
|
| Rate for Payer: IEHP medi-cal |
$2.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.60
|
| Rate for Payer: Riverside University Health MISP |
$2.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$5.10
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS [35699]
|
Facility
IP
|
$6.00
|
|
|
Service Code
|
NDC 68180-422-01
|
| Hospital Charge Code |
1740334
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$4.50
|
| Rate for Payer: Blue Shield of California EPN |
$3.20
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Central Health Plan Commercial |
$4.80
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS [35699]
|
Facility
IP
|
$14.00
|
|
|
Service Code
|
NDC 0781-7135-93
|
| Hospital Charge Code |
1740334
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$10.50
|
| Rate for Payer: Blue Shield of California EPN |
$7.48
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Central Health Plan Commercial |
$11.20
|
| Rate for Payer: Cigna of CA HMO |
$9.80
|
| Rate for Payer: Cigna of CA PPO |
$9.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.60
|
| Rate for Payer: Galaxy Health WC |
$11.90
|
| Rate for Payer: Global Benefits Group Commercial |
$8.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.80
|
| Rate for Payer: Multiplan Commercial |
$10.50
|
| Rate for Payer: Networks By Design Commercial |
$9.10
|
| Rate for Payer: Prime Health Services Commercial |
$11.90
|
|
|
MOXIFLOXACIN 0.5 % VISCOUS EYE DROPS [108159]
|
Facility
IP
|
$67.88
|
|
|
Service Code
|
NDC 0065-0006-03
|
| Hospital Charge Code |
NDG108159
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.58 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$50.91
|
| Rate for Payer: Blue Shield of California EPN |
$36.25
|
| Rate for Payer: Cash Price |
$30.55
|
| Rate for Payer: Cash Price |
$30.55
|
| Rate for Payer: Central Health Plan Commercial |
$54.30
|
| Rate for Payer: Cigna of CA HMO |
$47.52
|
| Rate for Payer: Cigna of CA PPO |
$47.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.15
|
| Rate for Payer: Galaxy Health WC |
$57.70
|
| Rate for Payer: Global Benefits Group Commercial |
$40.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$61.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.58
|
| Rate for Payer: Multiplan Commercial |
$50.91
|
| Rate for Payer: Networks By Design Commercial |
$44.12
|
| Rate for Payer: Prime Health Services Commercial |
$57.70
|
|
|
MOXIFLOXACIN 0.5 % VISCOUS EYE DROPS [108159]
|
Facility
OP
|
$67.88
|
|
|
Service Code
|
NDC 0065-0006-03
|
| Hospital Charge Code |
NDG108159
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.58 |
| Max. Negotiated Rate |
$61.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$41.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$57.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$37.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$37.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$32.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.10
|
| Rate for Payer: BCBS Transplant Transplant |
$40.73
|
| Rate for Payer: Blue Shield of California Commercial |
$42.70
|
| Rate for Payer: Blue Shield of California EPN |
$33.19
|
| Rate for Payer: Cash Price |
$30.55
|
| Rate for Payer: Central Health Plan Commercial |
$54.30
|
| Rate for Payer: Cigna of CA HMO |
$47.52
|
| Rate for Payer: Cigna of CA PPO |
$47.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$27.15
|
| Rate for Payer: Galaxy Health WC |
$57.70
|
| Rate for Payer: Global Benefits Group Commercial |
$40.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$61.09
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$50.91
|
| Rate for Payer: IEHP medi-cal |
$23.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.58
|
| Rate for Payer: Multiplan Commercial |
$50.91
|
| Rate for Payer: Networks By Design Commercial |
$44.12
|
| Rate for Payer: Prime Health Services Commercial |
$57.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$40.73
|
| Rate for Payer: Riverside University Health MISP |
$27.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.94
|
| Rate for Payer: United Healthcare All Other HMO |
$33.94
|
| Rate for Payer: United Healthcare HMO Rider |
$33.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$57.70
|
| Rate for Payer: Vantage Medical Group Senior |
$57.70
|
|
|
MOXIFLOXACIN 400 MG/250 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK [31906]
|
Facility
OP
|
$0.25
|
|
|
Service Code
|
CPT J2280
|
| Hospital Charge Code |
1753535
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$58.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$58.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$58.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.80
|
| Rate for Payer: BCBS Transplant Transplant |
$0.15
|
| Rate for Payer: BCBS Transplant Transplant |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$15.17
|
| Rate for Payer: Blue Shield of California Commercial |
$15.17
|
| Rate for Payer: Blue Shield of California EPN |
$13.79
|
| Rate for Payer: Blue Shield of California EPN |
$13.79
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Central Health Plan Commercial |
$0.20
|
| Rate for Payer: Central Health Plan Commercial |
$0.17
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Galaxy Health WC |
$0.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.23
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.16
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.19
|
| Rate for Payer: IEHP medi-cal |
$8.78
|
| Rate for Payer: IEHP medi-cal |
$8.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.13
|
| Rate for Payer: Prime Health Services Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
| Rate for Payer: Riverside University Health MISP |
$0.10
|
| Rate for Payer: Riverside University Health MISP |
$0.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Vantage Medical Group Senior |
$0.18
|
| Rate for Payer: Vantage Medical Group Senior |
$0.21
|
|
