|
BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE [31576]
|
Facility
|
OP
|
$21.89
|
|
|
Service Code
|
NDC 51079-020-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$18.61 |
| Rate for Payer: Adventist Health Commercial |
$4.38
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.42
|
| Rate for Payer: Blue Shield of California Commercial |
$13.35
|
| Rate for Payer: Blue Shield of California EPN |
$10.68
|
| Rate for Payer: Cash Price |
$12.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.61
|
| Rate for Payer: Dignity Health Senior |
$18.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.55
|
| Rate for Payer: Heritage Provider Network Senior |
$13.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.32
|
| Rate for Payer: Multiplan Commercial |
$16.42
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.76
|
| Rate for Payer: TriValley Medical Group Senior |
$8.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.61
|
| Rate for Payer: Vantage Medical Group Senior |
$18.61
|
|
|
BUDESONIDE-FORMOTEROL HFA 160 MCG-4.5 MCG/ACTUATION AEROSOL INHALER [81454]
|
Facility
|
IP
|
$31.84
|
|
|
Service Code
|
NDC 0186-0370-28
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.76 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Adventist Health Commercial |
$6.37
|
| Rate for Payer: Cash Price |
$17.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.56
|
| Rate for Payer: Heritage Provider Network Senior |
$21.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.96
|
| Rate for Payer: Multiplan Commercial |
$23.88
|
|
|
BUDESONIDE-FORMOTEROL HFA 160 MCG-4.5 MCG/ACTUATION AEROSOL INHALER [81454]
|
Facility
|
OP
|
$31.84
|
|
|
Service Code
|
NDC 0186-0370-28
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.76 |
| Max. Negotiated Rate |
$27.06 |
| Rate for Payer: Adventist Health Commercial |
$6.37
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.88
|
| Rate for Payer: Blue Shield of California Commercial |
$19.42
|
| Rate for Payer: Blue Shield of California EPN |
$15.54
|
| Rate for Payer: Cash Price |
$17.51
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.06
|
| Rate for Payer: Dignity Health Senior |
$27.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.71
|
| Rate for Payer: Heritage Provider Network Senior |
$19.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.29
|
| Rate for Payer: Multiplan Commercial |
$23.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.74
|
| Rate for Payer: TriValley Medical Group Senior |
$12.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.06
|
| Rate for Payer: Vantage Medical Group Senior |
$27.06
|
|
|
BUDESONIDE-FORMOTEROL HFA 80 MCG-4.5 MCG/ACTUATION AEROSOL INHALER [81453]
|
Facility
|
OP
|
$24.07
|
|
|
Service Code
|
NDC 0186-0372-28
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.36 |
| Max. Negotiated Rate |
$20.46 |
| Rate for Payer: Adventist Health Commercial |
$4.81
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.05
|
| Rate for Payer: Blue Shield of California Commercial |
$14.68
|
| Rate for Payer: Blue Shield of California EPN |
$11.75
|
| Rate for Payer: Cash Price |
$13.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.46
|
| Rate for Payer: Dignity Health Senior |
$20.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.90
|
| Rate for Payer: Heritage Provider Network Senior |
$14.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.85
|
| Rate for Payer: Multiplan Commercial |
$18.05
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.63
|
| Rate for Payer: TriValley Medical Group Senior |
$9.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.46
|
| Rate for Payer: Vantage Medical Group Senior |
$20.46
|
|
|
BUDESONIDE-FORMOTEROL HFA 80 MCG-4.5 MCG/ACTUATION AEROSOL INHALER [81453]
|
Facility
|
IP
|
$24.07
|
|
|
Service Code
|
NDC 0186-0372-28
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.36 |
| Max. Negotiated Rate |
$18.05 |
| Rate for Payer: Adventist Health Commercial |
$4.81
|
| Rate for Payer: Cash Price |
$13.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.30
|
| Rate for Payer: Heritage Provider Network Senior |
$16.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.02
|
| Rate for Payer: Multiplan Commercial |
$18.05
|
|
|
BUDESONIDE-FORMOTEROL HFA 80 MCG-4.5 MCG/ACTUATION AEROSOL INHALER [81453]
|
Facility
|
IP
|
$24.11
|
|
|
Service Code
|
NDC 0186-0372-20
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.36 |
| Max. Negotiated Rate |
$18.08 |
| Rate for Payer: Adventist Health Commercial |
$4.82
|
| Rate for Payer: Cash Price |
$13.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.32
|
| Rate for Payer: Heritage Provider Network Senior |
$16.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.03
|
| Rate for Payer: Multiplan Commercial |
$18.08
|
|
|
BUDESONIDE-FORMOTEROL HFA 80 MCG-4.5 MCG/ACTUATION AEROSOL INHALER [81453]
|
Facility
|
OP
|
$24.11
|
|
|
Service Code
|
NDC 0186-0372-20
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.36 |
| Max. Negotiated Rate |
$20.49 |
| Rate for Payer: Adventist Health Commercial |
$4.82
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.08
|
| Rate for Payer: Blue Shield of California Commercial |
$14.71
|
| Rate for Payer: Blue Shield of California EPN |
$11.77
|
| Rate for Payer: Cash Price |
$13.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.49
|
| Rate for Payer: Dignity Health Senior |
$20.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.92
|
| Rate for Payer: Heritage Provider Network Senior |
$14.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.88
|
| Rate for Payer: Multiplan Commercial |
$18.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.64
|
| Rate for Payer: TriValley Medical Group Senior |
$9.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.49
|
| Rate for Payer: Vantage Medical Group Senior |
$20.49
|
|
|
BUMETANIDE 0.25 MG/ML INJECTION SOLUTION [9308]
|
Facility
|
OP
|
$0.39
|
|
|
Service Code
|
HCPCS J1939
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$2.20 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.49
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.36
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.42
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.18
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.27
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.19
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1.01
|
| Rate for Payer: Blue Shield of California EPN |
$1.01
|
| Rate for Payer: Blue Shield of California EPN |
$1.01
|
| Rate for Payer: Blue Shield of California EPN |
$1.01
|
| Rate for Payer: Blue Shield of California EPN |
$1.01
|
| Rate for Payer: Blue Shield of California EPN |
$1.01
|
| Rate for Payer: Blue Shield of California EPN |
$1.01
|
| Rate for Payer: Blue Shield of California EPN |
$1.01
|
| Rate for Payer: Cash Price |
$0.38
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.38
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.23
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.67
|
| Rate for Payer: Dignity Health Senior |
$0.67
|
| Rate for Payer: Dignity Health Senior |
$0.67
|
| Rate for Payer: Dignity Health Senior |
$0.67
|
| Rate for Payer: Dignity Health Senior |
$0.67
|
| Rate for Payer: Dignity Health Senior |
$0.67
|
| Rate for Payer: Dignity Health Senior |
$0.67
|
| Rate for Payer: Dignity Health Senior |
$0.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Medicare |
$0.61
|
| Rate for Payer: EPIC Health Plan Medicare |
$0.61
|
| Rate for Payer: EPIC Health Plan Medicare |
$0.61
|
| Rate for Payer: EPIC Health Plan Medicare |
$0.61
|
| Rate for Payer: EPIC Health Plan Medicare |
$0.61
|
| Rate for Payer: EPIC Health Plan Medicare |
$0.61
|
| Rate for Payer: EPIC Health Plan Medicare |
$0.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.24
|
| Rate for Payer: Heritage Provider Network Senior |
$0.17
|
| Rate for Payer: Heritage Provider Network Senior |
$0.24
|
| Rate for Payer: Heritage Provider Network Senior |
$0.15
|
| Rate for Payer: Heritage Provider Network Senior |
$0.31
|
| Rate for Payer: Heritage Provider Network Senior |
$0.42
|
| Rate for Payer: Heritage Provider Network Senior |
$0.36
|
| Rate for Payer: Heritage Provider Network Senior |
$0.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.77
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: Multiplan Commercial |
$0.68
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$0.51
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.31
|
| Rate for Payer: TriValley Medical Group Senior |
$0.13
|
| Rate for Payer: TriValley Medical Group Senior |
$0.14
|
| Rate for Payer: TriValley Medical Group Senior |
$0.16
|
| Rate for Payer: TriValley Medical Group Senior |
$0.20
|
| Rate for Payer: TriValley Medical Group Senior |
$0.31
|
| Rate for Payer: TriValley Medical Group Senior |
$0.27
|
| Rate for Payer: TriValley Medical Group Senior |
$0.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.67
|
| Rate for Payer: Vantage Medical Group Senior |
$0.67
|
| Rate for Payer: Vantage Medical Group Senior |
$0.67
|
| Rate for Payer: Vantage Medical Group Senior |
$0.67
|
| Rate for Payer: Vantage Medical Group Senior |
$0.67
|
| Rate for Payer: Vantage Medical Group Senior |
$0.67
|
| Rate for Payer: Vantage Medical Group Senior |
$0.67
|
| Rate for Payer: Vantage Medical Group Senior |
$0.67
|
|
|
BUMETANIDE 0.25 MG/ML INJECTION SOLUTION [9308]
|
Facility
|
IP
|
$0.68
|
|
|
Service Code
|
HCPCS J1939
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.38
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.23
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.31
|
| Rate for Payer: Heritage Provider Network Senior |
$0.36
|
| Rate for Payer: Heritage Provider Network Senior |
$0.31
|
| Rate for Payer: Heritage Provider Network Senior |
$0.24
|
| Rate for Payer: Heritage Provider Network Senior |
$0.42
|
| Rate for Payer: Heritage Provider Network Senior |
$0.18
|
| Rate for Payer: Heritage Provider Network Senior |
$0.15
|
| Rate for Payer: Heritage Provider Network Senior |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.51
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$0.68
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.11
|
|
|
BUMETANIDE 0.5 MG TABLET [9309]
|
Facility
|
OP
|
$0.41
|
|
|
Service Code
|
NDC 42799-119-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.31
|
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.35
|
| Rate for Payer: Dignity Health Senior |
$0.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.25
|
| Rate for Payer: Heritage Provider Network Senior |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.35
|
| Rate for Payer: Vantage Medical Group Senior |
$0.35
|
|
|
BUMETANIDE 0.5 MG TABLET [9309]
|
Facility
|
OP
|
$0.54
|
|
|
Service Code
|
NDC 0185-0128-05
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.41
|
| Rate for Payer: Blue Shield of California Commercial |
$0.33
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.46
|
| Rate for Payer: Dignity Health Senior |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.33
|
| Rate for Payer: Heritage Provider Network Senior |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.22
|
| Rate for Payer: TriValley Medical Group Senior |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.46
|
| Rate for Payer: Vantage Medical Group Senior |
$0.46
|
|
|
BUMETANIDE 0.5 MG TABLET [9309]
|
Facility
|
IP
|
$0.41
|
|
|
Service Code
|
NDC 42799-119-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.28
|
| Rate for Payer: Heritage Provider Network Senior |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.31
|
|
|
BUMETANIDE 0.5 MG TABLET [9309]
|
Facility
|
IP
|
$1.51
|
|
|
Service Code
|
NDC 50268-130-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.13 |
| Rate for Payer: Adventist Health Commercial |
$0.30
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.02
|
| Rate for Payer: Heritage Provider Network Senior |
$1.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$1.13
|
|
|
BUMETANIDE 0.5 MG TABLET [9309]
|
Facility
|
IP
|
$0.41
|
|
|
Service Code
|
NDC 69238-1489-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.28
|
| Rate for Payer: Heritage Provider Network Senior |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.31
|
|
|
BUMETANIDE 0.5 MG TABLET [9309]
|
Facility
|
OP
|
$0.41
|
|
|
Service Code
|
NDC 69238-1489-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.31
|
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.35
|
| Rate for Payer: Dignity Health Senior |
$0.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.25
|
| Rate for Payer: Heritage Provider Network Senior |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.35
|
| Rate for Payer: Vantage Medical Group Senior |
$0.35
|
|
|
BUMETANIDE 0.5 MG TABLET [9309]
|
Facility
|
OP
|
$1.51
|
|
|
Service Code
|
NDC 50268-130-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.28 |
| Rate for Payer: Adventist Health Commercial |
$0.30
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.92
|
| Rate for Payer: Blue Shield of California EPN |
$0.74
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.28
|
| Rate for Payer: Dignity Health Senior |
$1.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.93
|
| Rate for Payer: Heritage Provider Network Senior |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.06
|
| Rate for Payer: Multiplan Commercial |
$1.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.60
|
| Rate for Payer: TriValley Medical Group Senior |
$0.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.28
|
| Rate for Payer: Vantage Medical Group Senior |
$1.28
|
|
|
BUMETANIDE 0.5 MG TABLET [9309]
|
Facility
|
IP
|
$0.54
|
|
|
Service Code
|
NDC 0185-0128-05
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.37
|
| Rate for Payer: Heritage Provider Network Senior |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
|
|
BUMETANIDE 1 MG TABLET [9310]
|
Facility
|
IP
|
$1.30
|
|
|
Service Code
|
NDC 60687-384-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Cash Price |
$0.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.88
|
| Rate for Payer: Heritage Provider Network Senior |
$0.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Multiplan Commercial |
$0.98
|
|
|
BUMETANIDE 1 MG TABLET [9310]
|
Facility
|
IP
|
$0.54
|
|
|
Service Code
|
NDC 0185-0129-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.37
|
| Rate for Payer: Heritage Provider Network Senior |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
|
|
BUMETANIDE 1 MG TABLET [9310]
|
Facility
|
OP
|
$1.30
|
|
|
Service Code
|
NDC 60687-384-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.98
|
| Rate for Payer: Blue Shield of California Commercial |
$0.79
|
| Rate for Payer: Blue Shield of California EPN |
$0.63
|
| Rate for Payer: Cash Price |
$0.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.10
|
| Rate for Payer: Dignity Health Senior |
$1.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.80
|
| Rate for Payer: Heritage Provider Network Senior |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.91
|
| Rate for Payer: Multiplan Commercial |
$0.98
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.52
|
| Rate for Payer: TriValley Medical Group Senior |
$0.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1.10
|
|
|
BUMETANIDE 1 MG TABLET [9310]
|
Facility
|
IP
|
$1.30
|
|
|
Service Code
|
NDC 60687-384-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Cash Price |
$0.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.88
|
| Rate for Payer: Heritage Provider Network Senior |
$0.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Multiplan Commercial |
$0.98
|
|
|
BUMETANIDE 1 MG TABLET [9310]
|
Facility
|
OP
|
$0.41
|
|
|
Service Code
|
NDC 42799-120-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.31
|
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.35
|
| Rate for Payer: Dignity Health Senior |
$0.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.25
|
| Rate for Payer: Heritage Provider Network Senior |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.35
|
| Rate for Payer: Vantage Medical Group Senior |
$0.35
|
|
|
BUMETANIDE 1 MG TABLET [9310]
|
Facility
|
OP
|
$0.54
|
|
|
Service Code
|
NDC 0185-0129-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.41
|
| Rate for Payer: Blue Shield of California Commercial |
$0.33
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.46
|
| Rate for Payer: Dignity Health Senior |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.33
|
| Rate for Payer: Heritage Provider Network Senior |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.22
|
| Rate for Payer: TriValley Medical Group Senior |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.46
|
| Rate for Payer: Vantage Medical Group Senior |
$0.46
|
|
|
BUMETANIDE 1 MG TABLET [9310]
|
Facility
|
OP
|
$1.30
|
|
|
Service Code
|
NDC 60687-384-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.98
|
| Rate for Payer: Blue Shield of California Commercial |
$0.79
|
| Rate for Payer: Blue Shield of California EPN |
$0.63
|
| Rate for Payer: Cash Price |
$0.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.10
|
| Rate for Payer: Dignity Health Senior |
$1.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.80
|
| Rate for Payer: Heritage Provider Network Senior |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.91
|
| Rate for Payer: Multiplan Commercial |
$0.98
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.52
|
| Rate for Payer: TriValley Medical Group Senior |
$0.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1.10
|
|
|
BUMETANIDE 1 MG TABLET [9310]
|
Facility
|
IP
|
$0.41
|
|
|
Service Code
|
NDC 42799-120-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.28
|
| Rate for Payer: Heritage Provider Network Senior |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.31
|
|
