|
MORPHINE ER 60 MG TABLET,EXTENDED RELEASE [20922]
|
Facility
|
IP
|
$4.06
|
|
|
Service Code
|
NDC 0406-8380-62
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$3.04 |
| Rate for Payer: Adventist Health Commercial |
$0.81
|
| Rate for Payer: Cash Price |
$2.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.75
|
| Rate for Payer: Heritage Provider Network Senior |
$2.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: Multiplan Commercial |
$3.04
|
|
|
MORPHINE ER 60 MG TABLET,EXTENDED RELEASE [20922]
|
Facility
|
IP
|
$3.72
|
|
|
Service Code
|
NDC 0406-8380-23
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$2.79 |
| Rate for Payer: Adventist Health Commercial |
$0.74
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.52
|
| Rate for Payer: Heritage Provider Network Senior |
$2.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.93
|
| Rate for Payer: Multiplan Commercial |
$2.79
|
|
|
MORPHINE ER 60 MG TABLET,EXTENDED RELEASE [20922]
|
Facility
|
OP
|
$4.06
|
|
|
Service Code
|
NDC 0406-8380-62
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$3.45 |
| Rate for Payer: Adventist Health Commercial |
$0.81
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.04
|
| Rate for Payer: Blue Shield of California Commercial |
$2.48
|
| Rate for Payer: Blue Shield of California EPN |
$1.98
|
| Rate for Payer: Cash Price |
$2.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.45
|
| Rate for Payer: Dignity Health Senior |
$3.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.51
|
| Rate for Payer: Heritage Provider Network Senior |
$2.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.84
|
| Rate for Payer: Multiplan Commercial |
$3.04
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.62
|
| Rate for Payer: TriValley Medical Group Senior |
$1.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.45
|
| Rate for Payer: Vantage Medical Group Senior |
$3.45
|
|
|
MORPHINE ER 60 MG TABLET,EXTENDED RELEASE [20922]
|
Facility
|
OP
|
$3.72
|
|
|
Service Code
|
NDC 0406-8380-23
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$3.16 |
| Rate for Payer: Adventist Health Commercial |
$0.74
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.79
|
| Rate for Payer: Blue Shield of California Commercial |
$2.27
|
| Rate for Payer: Blue Shield of California EPN |
$1.82
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.16
|
| Rate for Payer: Dignity Health Senior |
$3.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.30
|
| Rate for Payer: Heritage Provider Network Senior |
$2.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.60
|
| Rate for Payer: Multiplan Commercial |
$2.79
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.49
|
| Rate for Payer: TriValley Medical Group Senior |
$1.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.16
|
| 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
|
OP
|
$2.98
|
|
|
Service Code
|
NDC 0406-8380-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.53 |
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.23
|
| Rate for Payer: Blue Shield of California Commercial |
$1.82
|
| Rate for Payer: Blue Shield of California EPN |
$1.45
|
| Rate for Payer: Cash Price |
$1.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.53
|
| Rate for Payer: Dignity Health Senior |
$2.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.84
|
| Rate for Payer: Heritage Provider Network Senior |
$1.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.09
|
| Rate for Payer: Multiplan Commercial |
$2.23
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.19
|
| Rate for Payer: TriValley Medical Group Senior |
$1.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.53
|
| 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
|
$2.98
|
|
|
Service Code
|
NDC 0406-8380-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.23 |
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Cash Price |
$1.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.02
|
| Rate for Payer: Heritage Provider Network Senior |
$2.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$2.23
|
|
|
MORPHINE PCA CLINICIAN BOLUS [4083522]
|
Facility
|
IP
|
$3.66
|
|
|
Service Code
|
NDC 63323-451-00
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.75 |
| Rate for Payer: Adventist Health Commercial |
$0.73
|
| Rate for Payer: Cash Price |
$2.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.48
|
| Rate for Payer: Heritage Provider Network Senior |
$2.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.92
|
| Rate for Payer: Multiplan Commercial |
$2.75
|
|
|
MORPHINE PCA CLINICIAN BOLUS [4083522]
|
Facility
|
OP
|
$3.66
|
|
|
Service Code
|
NDC 63323-451-01
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$3.11 |
| Rate for Payer: Adventist Health Commercial |
$0.73
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.75
|
| Rate for Payer: Blue Shield of California Commercial |
$2.23
|
| Rate for Payer: Blue Shield of California EPN |
$1.79
|
| Rate for Payer: Cash Price |
$2.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.11
|
| Rate for Payer: Dignity Health Senior |
$3.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.27
|
| Rate for Payer: Heritage Provider Network Senior |
$2.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.56
|
| Rate for Payer: Multiplan Commercial |
$2.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.11
|
| Rate for Payer: Vantage Medical Group Senior |
$3.11
|
|
|
MORPHINE PCA CLINICIAN BOLUS [4083522]
|
Facility
|
IP
|
$3.06
|
|
|
Service Code
|
NDC 9999-1922-78
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: Adventist Health Commercial |
$0.61
|
| Rate for Payer: Cash Price |
$1.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.07
|
| Rate for Payer: Heritage Provider Network Senior |
$2.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: Multiplan Commercial |
$2.29
|
|
|
MORPHINE PCA CLINICIAN BOLUS [4083522]
|
Facility
|
IP
|
$3.66
|
|
|
Service Code
|
NDC 63323-451-01
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.75 |
| Rate for Payer: Adventist Health Commercial |
$0.73
|
| Rate for Payer: Cash Price |
$2.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.48
|
| Rate for Payer: Heritage Provider Network Senior |
$2.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.92
|
| Rate for Payer: Multiplan Commercial |
$2.75
|
|
|
MORPHINE PCA CLINICIAN BOLUS [4083522]
|
Facility
|
OP
|
$3.66
|
|
|
Service Code
|
NDC 63323-451-00
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$3.11 |
| Rate for Payer: Adventist Health Commercial |
$0.73
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.75
|
| Rate for Payer: Blue Shield of California Commercial |
$2.23
|
| Rate for Payer: Blue Shield of California EPN |
$1.79
|
| Rate for Payer: Cash Price |
$2.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.11
|
| Rate for Payer: Dignity Health Senior |
$3.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.27
|
| Rate for Payer: Heritage Provider Network Senior |
$2.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.56
|
| Rate for Payer: Multiplan Commercial |
$2.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.11
|
| Rate for Payer: Vantage Medical Group Senior |
$3.11
|
|
|
MORPHINE PCA CLINICIAN BOLUS [4083522]
|
Facility
|
OP
|
$3.06
|
|
|
Service Code
|
NDC 9999-1922-78
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Adventist Health Commercial |
$0.61
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.29
|
| Rate for Payer: Blue Shield of California Commercial |
$1.87
|
| Rate for Payer: Blue Shield of California EPN |
$1.49
|
| Rate for Payer: Cash Price |
$1.68
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.60
|
| Rate for Payer: Dignity Health Senior |
$2.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.89
|
| Rate for Payer: Heritage Provider Network Senior |
$1.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.14
|
| Rate for Payer: Multiplan Commercial |
$2.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.60
|
| Rate for Payer: Vantage Medical Group Senior |
$2.60
|
|
|
MORPHINE (PF) 10 MG/ML INJECTION SOLUTION [77009]
|
Facility
|
OP
|
$13.61
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$11.57 |
| Rate for Payer: Adventist Health Commercial |
$2.72
|
| Rate for Payer: Adventist Health Commercial |
$2.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.67
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2.60
|
| Rate for Payer: Blue Shield of California EPN |
$2.60
|
| Rate for Payer: Blue Shield of California EPN |
$2.60
|
| Rate for Payer: Cash Price |
$7.49
|
| Rate for Payer: Cash Price |
$6.86
|
| Rate for Payer: Cash Price |
$6.86
|
| Rate for Payer: Cash Price |
$7.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.57
|
| Rate for Payer: Dignity Health Senior |
$10.61
|
| Rate for Payer: Dignity Health Senior |
$11.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.78
|
| Rate for Payer: Heritage Provider Network Senior |
$5.78
|
| Rate for Payer: Heritage Provider Network Senior |
$6.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.53
|
| Rate for Payer: Multiplan Commercial |
$10.21
|
| Rate for Payer: Multiplan Commercial |
$9.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.44
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.99
|
| Rate for Payer: TriValley Medical Group Senior |
$4.99
|
| Rate for Payer: TriValley Medical Group Senior |
$5.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.57
|
| Rate for Payer: Vantage Medical Group Senior |
$10.61
|
| Rate for Payer: Vantage Medical Group Senior |
$11.57
|
|
|
MORPHINE (PF) 10 MG/ML INJECTION SOLUTION [77009]
|
Facility
|
IP
|
$12.48
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$9.36 |
| Rate for Payer: Adventist Health Commercial |
$2.50
|
| Rate for Payer: Adventist Health Commercial |
$2.72
|
| Rate for Payer: Cash Price |
$7.49
|
| Rate for Payer: Cash Price |
$6.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.78
|
| Rate for Payer: Heritage Provider Network Senior |
$5.78
|
| Rate for Payer: Heritage Provider Network Senior |
$6.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: Multiplan Commercial |
$10.21
|
| Rate for Payer: Multiplan Commercial |
$9.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.13
|
|
|
MORPHINE (PF) 1 MG/2 ML INTRAVENOUS SYRINGE [212745]
|
Facility
|
IP
|
$2.62
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$1.97 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Adventist Health Commercial |
$0.57
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.21
|
| Rate for Payer: Heritage Provider Network Senior |
$1.21
|
| Rate for Payer: Heritage Provider Network Senior |
$1.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$2.15
|
| Rate for Payer: Multiplan Commercial |
$1.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.87
|
|
|
MORPHINE (PF) 1 MG/2 ML INTRAVENOUS SYRINGE [212745]
|
Facility
|
OP
|
$2.87
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$6.60 |
| Rate for Payer: Adventist Health Commercial |
$0.57
|
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2.60
|
| Rate for Payer: Blue Shield of California EPN |
$2.60
|
| Rate for Payer: Blue Shield of California EPN |
$2.60
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.44
|
| Rate for Payer: Dignity Health Senior |
$2.23
|
| Rate for Payer: Dignity Health Senior |
$2.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.21
|
| Rate for Payer: Heritage Provider Network Senior |
$1.21
|
| Rate for Payer: Heritage Provider Network Senior |
$1.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.01
|
| Rate for Payer: Multiplan Commercial |
$2.15
|
| Rate for Payer: Multiplan Commercial |
$1.97
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.15
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.05
|
| Rate for Payer: TriValley Medical Group Senior |
$1.05
|
| Rate for Payer: TriValley Medical Group Senior |
$1.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.23
|
| 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/ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SOLUTION [154492]
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$6.60 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2.60
|
| Rate for Payer: Blue Shield of California EPN |
$2.60
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.12
|
| Rate for Payer: Dignity Health Senior |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Senior |
$0.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.12
|
| 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
|
HCPCS J2270
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Senior |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.05
|
|
|
MORPHINE (PF) 1 MG/ML INJECTION SOLUTION [15852]
|
Facility
|
OP
|
$2.52
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$6.60 |
| Rate for Payer: Adventist Health Commercial |
$0.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2.60
|
| Rate for Payer: Blue Shield of California EPN |
$2.60
|
| Rate for Payer: Cash Price |
$1.38
|
| Rate for Payer: Cash Price |
$1.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.14
|
| Rate for Payer: Dignity Health Senior |
$2.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.17
|
| Rate for Payer: Heritage Provider Network Senior |
$1.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.76
|
| Rate for Payer: Multiplan Commercial |
$1.89
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.01
|
| Rate for Payer: TriValley Medical Group Senior |
$1.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.14
|
| Rate for Payer: Vantage Medical Group Senior |
$2.14
|
|
|
MORPHINE (PF) 1 MG/ML INJECTION SOLUTION [15852]
|
Facility
|
IP
|
$2.52
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$1.89 |
| Rate for Payer: Adventist Health Commercial |
$0.50
|
| Rate for Payer: Cash Price |
$1.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.17
|
| Rate for Payer: Heritage Provider Network Senior |
$1.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.63
|
| Rate for Payer: Multiplan Commercial |
$1.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.83
|
|
|
MORPHINE (PF) 50 MG/50 ML(1 MG/ML) IN 0.9% SOD.CHLORIDE IV PCA SYRINGE [214839]
|
Facility
|
OP
|
$0.17
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$6.60 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2.60
|
| Rate for Payer: Blue Shield of California EPN |
$2.60
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: Dignity Health Senior |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Senior |
$0.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
| 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
|
HCPCS J2270
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Senior |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.06
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS [35699]
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
NDC 0781-7135-93
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$11.90 |
| Rate for Payer: Adventist Health Commercial |
$2.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.50
|
| Rate for Payer: Blue Shield of California Commercial |
$8.54
|
| Rate for Payer: Blue Shield of California EPN |
$6.83
|
| Rate for Payer: Cash Price |
$7.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.90
|
| Rate for Payer: Dignity Health Senior |
$11.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.67
|
| Rate for Payer: Heritage Provider Network Senior |
$8.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.80
|
| Rate for Payer: Multiplan Commercial |
$10.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.60
|
| Rate for Payer: TriValley Medical Group Senior |
$5.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.90
|
| 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
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 68180-422-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.06
|
| Rate for Payer: Heritage Provider Network Senior |
$4.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS [35699]
|
Facility
|
OP
|
$4.64
|
|
|
Service Code
|
NDC 72266-158-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$3.94 |
| Rate for Payer: Adventist Health Commercial |
$0.93
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.48
|
| Rate for Payer: Blue Shield of California Commercial |
$2.83
|
| Rate for Payer: Blue Shield of California EPN |
$2.26
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.94
|
| Rate for Payer: Dignity Health Senior |
$3.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.87
|
| Rate for Payer: Heritage Provider Network Senior |
$2.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.25
|
| Rate for Payer: Multiplan Commercial |
$3.48
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.86
|
| Rate for Payer: TriValley Medical Group Senior |
$1.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.94
|
| Rate for Payer: Vantage Medical Group Senior |
$3.94
|
|
