|
BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE [31576]
|
Facility
|
IP
|
$21.89
|
|
|
Service Code
|
NDC 5107902003
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$16.42 |
| Rate for Payer: Adventist Health Commercial |
$4.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.10
|
| Rate for Payer: Cash Price |
$9.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.82
|
| Rate for Payer: Heritage Provider Network Senior |
$14.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.47
|
| Rate for Payer: Multiplan Commercial |
$16.42
|
|
|
BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE [31576]
|
Facility
|
OP
|
$21.89
|
|
|
Service Code
|
NDC 5107902003
|
| 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 Non-Gatekeeper |
$13.53
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$10.95
|
| 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 |
$9.85
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$10.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE [31576]
|
Facility
|
OP
|
$2.67
|
|
|
Service Code
|
NDC 6838272001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.27 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.65
|
| Rate for Payer: Adventist Health Commercial |
$0.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1.63
|
| Rate for Payer: Blue Shield of California EPN |
$1.30
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.65
|
| Rate for Payer: Heritage Provider Network Senior |
$1.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.87
|
| Rate for Payer: Multiplan Commercial |
$2.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.07
|
| Rate for Payer: TriValley Medical Group Senior |
$1.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.27
|
| Rate for Payer: Vantage Medical Group Senior |
$2.27
|
|
|
BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE [31576]
|
Facility
|
IP
|
$1.18
|
|
|
Service Code
|
NDC 0574985510
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.89 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.76
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.80
|
| Rate for Payer: Heritage Provider Network Senior |
$0.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$0.89
|
|
|
BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE [31576]
|
Facility
|
IP
|
$2.67
|
|
|
Service Code
|
NDC 6838272001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Adventist Health Commercial |
$0.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.72
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.81
|
| Rate for Payer: Heritage Provider Network Senior |
$1.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.67
|
| Rate for Payer: Multiplan Commercial |
$2.00
|
|
|
BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE [31576]
|
Facility
|
IP
|
$16.20
|
|
|
Service Code
|
NDC 6068759632
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$12.15 |
| Rate for Payer: Adventist Health Commercial |
$3.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.43
|
| Rate for Payer: Cash Price |
$7.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.97
|
| Rate for Payer: Heritage Provider Network Senior |
$10.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.05
|
| Rate for Payer: Multiplan Commercial |
$12.15
|
|
|
BUDESONIDE-FORMOTEROL HFA 160 MCG-4.5 MCG/ACTUATION AEROSOL INHALER [81454]
|
Facility
|
IP
|
$31.84
|
|
|
Service Code
|
NDC 0186037028
|
| 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: Aetna of CA Non-Gatekeeper |
$20.50
|
| Rate for Payer: Cash Price |
$14.33
|
| 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 Foundation Hospitals 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 0186037028
|
| 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 Non-Gatekeeper |
$19.68
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$15.93
|
| 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 |
$14.33
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$15.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
IP
|
$24.07
|
|
|
Service Code
|
NDC 0186037228
|
| 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: Aetna of CA Non-Gatekeeper |
$15.50
|
| Rate for Payer: Cash Price |
$10.83
|
| 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 Foundation Hospitals 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 0186037220
|
| 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: Aetna of CA Non-Gatekeeper |
$15.53
|
| Rate for Payer: Cash Price |
$10.85
|
| 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 Foundation Hospitals 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
|
$24.07
|
|
|
Service Code
|
NDC 0186037228
|
| 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 Non-Gatekeeper |
$14.88
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$12.04
|
| 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 |
$10.83
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$11.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
OP
|
$24.11
|
|
|
Service Code
|
NDC 0186037220
|
| 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 Non-Gatekeeper |
$14.90
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$12.06
|
| 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 |
$10.85
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$11.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
IP
|
$0.78
|
|
|
Service Code
|
HCPCS J1939
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.23
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.42
|
| 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 |
$0.31
|
| Rate for Payer: Heritage Provider Network Senior |
$0.27
|
| Rate for Payer: Heritage Provider Network Senior |
$0.18
|
| Rate for Payer: Heritage Provider Network Senior |
$0.12
|
| Rate for Payer: Heritage Provider Network Senior |
$0.17
|
| Rate for Payer: Heritage Provider Network Senior |
$0.42
|
| Rate for Payer: Heritage Provider Network Senior |
$0.31
|
| Rate for Payer: Heritage Provider Network Senior |
$0.36
|
| Rate for Payer: Heritage Provider Network Senior |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| 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 |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.51
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.68
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.09
|
| 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+ |
$0.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.12
|
| 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+ |
$0.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.26
|
|
|
BUMETANIDE 0.25 MG/ML INJECTION SOLUTION [9308]
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
HCPCS J1939
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$2.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.29
|
| 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: 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 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: Blue Shield of California EPN |
$1.01
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.27
|
| 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 |
$0.17
|
| 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 |
$0.12
|
| 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 |
$0.27
|
| Rate for Payer: Heritage Provider Network Senior |
$0.12
|
| Rate for Payer: Heritage Provider Network Senior |
$0.15
|
| Rate for Payer: Heritage Provider Network Senior |
$0.18
|
| Rate for Payer: Heritage Provider Network Senior |
$0.17
|
| Rate for Payer: Heritage Provider Network Senior |
$0.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.68
|
| Rate for Payer: Multiplan Commercial |
$0.51
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.23
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.10
|
| 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 |
$0.23
|
| Rate for Payer: TriValley Medical Group Senior |
$0.13
|
| Rate for Payer: TriValley Medical Group Senior |
$0.10
|
| Rate for Payer: TriValley Medical Group Senior |
$0.27
|
| Rate for Payer: TriValley Medical Group Senior |
$0.31
|
| Rate for Payer: TriValley Medical Group Senior |
$0.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.33
|
| 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 |
$0.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.13
|
| 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+ |
$0.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: Vantage Medical Group Senior |
$0.58
|
| Rate for Payer: Vantage Medical Group Senior |
$0.66
|
| Rate for Payer: Vantage Medical Group Senior |
$0.28
|
| Rate for Payer: Vantage Medical Group Senior |
$0.49
|
| Rate for Payer: Vantage Medical Group Senior |
$0.77
|
| Rate for Payer: Vantage Medical Group Senior |
$0.22
|
| Rate for Payer: Vantage Medical Group Senior |
$0.33
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
|
BUMETANIDE 0.5 MG TABLET [9309]
|
Facility
|
OP
|
$0.54
|
|
|
Service Code
|
NDC 0185012805
|
| 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 Non-Gatekeeper |
$0.33
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$0.27
|
| 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 |
$0.24
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$0.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
OP
|
$0.41
|
|
|
Service Code
|
NDC 4279911901
|
| 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 Non-Gatekeeper |
$0.25
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$0.21
|
| 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 |
$0.18
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
IP
|
$0.41
|
|
|
Service Code
|
NDC 6923814891
|
| 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: Aetna of CA Non-Gatekeeper |
$0.26
|
| Rate for Payer: Cash Price |
$0.18
|
| 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 Foundation Hospitals 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 6923814891
|
| 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 Non-Gatekeeper |
$0.25
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$0.21
|
| 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 |
$0.18
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
IP
|
$0.41
|
|
|
Service Code
|
NDC 4279911901
|
| 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: Aetna of CA Non-Gatekeeper |
$0.26
|
| Rate for Payer: Cash Price |
$0.18
|
| 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 Foundation Hospitals 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
|
$1.52
|
|
|
Service Code
|
NDC 5026813011
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.14 |
| Rate for Payer: Adventist Health Commercial |
$0.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.98
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.03
|
| Rate for Payer: Heritage Provider Network Senior |
$1.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$1.14
|
|
|
BUMETANIDE 0.5 MG TABLET [9309]
|
Facility
|
IP
|
$0.54
|
|
|
Service Code
|
NDC 0185012805
|
| 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: Aetna of CA Non-Gatekeeper |
$0.35
|
| Rate for Payer: Cash Price |
$0.24
|
| 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 Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
|
|
BUMETANIDE 0.5 MG TABLET [9309]
|
Facility
|
OP
|
$1.52
|
|
|
Service Code
|
NDC 5026813011
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.29 |
| Rate for Payer: Adventist Health Commercial |
$0.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.76
|
| Rate for Payer: Blue Shield of California Commercial |
$0.93
|
| Rate for Payer: Blue Shield of California EPN |
$0.74
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.94
|
| Rate for Payer: Heritage Provider Network Senior |
$0.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.06
|
| Rate for Payer: Multiplan Commercial |
$1.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.61
|
| Rate for Payer: TriValley Medical Group Senior |
$0.61
|
| 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 |
$1.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.29
|
| Rate for Payer: Vantage Medical Group Senior |
$1.29
|
|
|
BUMETANIDE 1 MG TABLET [9310]
|
Facility
|
OP
|
$0.41
|
|
|
Service Code
|
NDC 0832054111
|
| 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 Non-Gatekeeper |
$0.25
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$0.21
|
| 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 |
$0.18
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
IP
|
$1.30
|
|
|
Service Code
|
NDC 6068738411
|
| 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: Aetna of CA Non-Gatekeeper |
$0.84
|
| Rate for Payer: Cash Price |
$0.59
|
| 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 Foundation Hospitals 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 0185012901
|
| 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: Aetna of CA Non-Gatekeeper |
$0.35
|
| Rate for Payer: Cash Price |
$0.24
|
| 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 Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
|
