|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
|
OP
|
$16.83
|
|
|
Service Code
|
NDC 70010-786-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$14.31 |
| Rate for Payer: Adventist Health Commercial |
$3.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.34
|
| Rate for Payer: Cash Price |
$9.26
|
| Rate for Payer: Cigna of CA HMO |
$11.78
|
| Rate for Payer: Cigna of CA PPO |
$11.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.73
|
| Rate for Payer: EPIC Health Plan Senior |
$6.73
|
| Rate for Payer: Galaxy Health WC |
$14.31
|
| Rate for Payer: Global Benefits Group Commercial |
$10.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.78
|
| Rate for Payer: Multiplan Commercial |
$13.46
|
| Rate for Payer: Networks By Design Commercial |
$10.94
|
| Rate for Payer: Prime Health Services Commercial |
$14.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.41
|
| Rate for Payer: United Healthcare All Other HMO |
$8.41
|
| Rate for Payer: United Healthcare HMO Rider |
$8.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Vantage Medical Group Senior |
$14.31
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
|
IP
|
$16.83
|
|
|
Service Code
|
NDC 70010-786-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$14.31 |
| Rate for Payer: Adventist Health Commercial |
$3.37
|
| Rate for Payer: Blue Shield of California Commercial |
$12.42
|
| Rate for Payer: Blue Shield of California EPN |
$8.18
|
| Rate for Payer: Cash Price |
$9.26
|
| Rate for Payer: Cigna of CA HMO |
$11.78
|
| Rate for Payer: Cigna of CA PPO |
$11.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.73
|
| Rate for Payer: EPIC Health Plan Senior |
$6.73
|
| Rate for Payer: Galaxy Health WC |
$14.31
|
| Rate for Payer: Global Benefits Group Commercial |
$10.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.04
|
| Rate for Payer: Multiplan Commercial |
$13.46
|
| Rate for Payer: Networks By Design Commercial |
$10.94
|
| Rate for Payer: Prime Health Services Commercial |
$14.31
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
|
OP
|
$19.80
|
|
|
Service Code
|
NDC 69238-1605-2
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$16.83 |
| Rate for Payer: Adventist Health Commercial |
$3.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.16
|
| Rate for Payer: Cash Price |
$10.89
|
| Rate for Payer: Cigna of CA HMO |
$13.86
|
| Rate for Payer: Cigna of CA PPO |
$13.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.92
|
| Rate for Payer: EPIC Health Plan Senior |
$7.92
|
| Rate for Payer: Galaxy Health WC |
$16.83
|
| Rate for Payer: Global Benefits Group Commercial |
$11.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.86
|
| Rate for Payer: Multiplan Commercial |
$15.84
|
| Rate for Payer: Networks By Design Commercial |
$12.87
|
| Rate for Payer: Prime Health Services Commercial |
$16.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.90
|
| Rate for Payer: United Healthcare All Other HMO |
$9.90
|
| Rate for Payer: United Healthcare HMO Rider |
$9.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.83
|
| Rate for Payer: Vantage Medical Group Senior |
$16.83
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
|
OP
|
$19.80
|
|
|
Service Code
|
NDC 69238-1605-8
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$16.83 |
| Rate for Payer: Adventist Health Commercial |
$3.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.16
|
| Rate for Payer: Cash Price |
$10.89
|
| Rate for Payer: Cigna of CA HMO |
$13.86
|
| Rate for Payer: Cigna of CA PPO |
$13.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.92
|
| Rate for Payer: EPIC Health Plan Senior |
$7.92
|
| Rate for Payer: Galaxy Health WC |
$16.83
|
| Rate for Payer: Global Benefits Group Commercial |
$11.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.86
|
| Rate for Payer: Multiplan Commercial |
$15.84
|
| Rate for Payer: Networks By Design Commercial |
$12.87
|
| Rate for Payer: Prime Health Services Commercial |
$16.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.90
|
| Rate for Payer: United Healthcare All Other HMO |
$9.90
|
| Rate for Payer: United Healthcare HMO Rider |
$9.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.83
|
| Rate for Payer: Vantage Medical Group Senior |
$16.83
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
|
IP
|
$23.83
|
|
|
Service Code
|
NDC 0093-3655-28
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.77 |
| Max. Negotiated Rate |
$20.26 |
| Rate for Payer: Adventist Health Commercial |
$4.77
|
| Rate for Payer: Blue Shield of California Commercial |
$17.59
|
| Rate for Payer: Blue Shield of California EPN |
$11.58
|
| Rate for Payer: Cash Price |
$13.11
|
| Rate for Payer: Cigna of CA HMO |
$16.68
|
| Rate for Payer: Cigna of CA PPO |
$16.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.53
|
| Rate for Payer: EPIC Health Plan Senior |
$9.53
|
| Rate for Payer: Galaxy Health WC |
$20.26
|
| Rate for Payer: Global Benefits Group Commercial |
$14.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$19.06
|
| Rate for Payer: Networks By Design Commercial |
$15.49
|
| Rate for Payer: Prime Health Services Commercial |
$20.26
|
|
|
METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SYRINGE [154475]
|
Facility
|
IP
|
$339.86
|
|
|
Service Code
|
HCPCS J2212
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.97 |
| Max. Negotiated Rate |
$288.88 |
| Rate for Payer: Adventist Health Commercial |
$67.97
|
| Rate for Payer: Blue Shield of California Commercial |
$250.82
|
| Rate for Payer: Blue Shield of California EPN |
$165.17
|
| Rate for Payer: Cash Price |
$186.92
|
| Rate for Payer: Cigna of CA HMO |
$237.90
|
| Rate for Payer: Cigna of CA PPO |
$237.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.94
|
| Rate for Payer: EPIC Health Plan Senior |
$135.94
|
| Rate for Payer: Galaxy Health WC |
$288.88
|
| Rate for Payer: Global Benefits Group Commercial |
$203.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$210.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.57
|
| Rate for Payer: Multiplan Commercial |
$271.89
|
| Rate for Payer: Networks By Design Commercial |
$169.93
|
| Rate for Payer: Prime Health Services Commercial |
$288.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.55
|
| Rate for Payer: United Healthcare All Other HMO |
$124.15
|
| Rate for Payer: United Healthcare HMO Rider |
$121.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.30
|
|
|
METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SYRINGE [154475]
|
Facility
|
OP
|
$339.86
|
|
|
Service Code
|
HCPCS J2212
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$288.88 |
| Rate for Payer: Adventist Health Commercial |
$67.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$222.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$288.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$186.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$254.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1.60
|
| Rate for Payer: Blue Shield of California EPN |
$1.60
|
| Rate for Payer: Cash Price |
$186.92
|
| Rate for Payer: Cash Price |
$186.92
|
| Rate for Payer: Cigna of CA HMO |
$237.90
|
| Rate for Payer: Cigna of CA PPO |
$237.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$288.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$288.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$288.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.94
|
| Rate for Payer: EPIC Health Plan Senior |
$135.94
|
| Rate for Payer: Galaxy Health WC |
$288.88
|
| Rate for Payer: Global Benefits Group Commercial |
$203.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$210.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$237.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$237.90
|
| Rate for Payer: Multiplan Commercial |
$271.89
|
| Rate for Payer: Networks By Design Commercial |
$169.93
|
| Rate for Payer: Prime Health Services Commercial |
$288.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$203.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$203.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.55
|
| Rate for Payer: United Healthcare All Other HMO |
$124.15
|
| Rate for Payer: United Healthcare HMO Rider |
$121.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$288.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$288.88
|
| Rate for Payer: Vantage Medical Group Senior |
$288.88
|
|
|
METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS WRAP [40891651]
|
Facility
|
IP
|
$339.86
|
|
|
Service Code
|
HCPCS J2212
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.97 |
| Max. Negotiated Rate |
$288.88 |
| Rate for Payer: Adventist Health Commercial |
$67.97
|
| Rate for Payer: Blue Shield of California Commercial |
$250.82
|
| Rate for Payer: Blue Shield of California EPN |
$165.17
|
| Rate for Payer: Cash Price |
$186.92
|
| Rate for Payer: Cigna of CA HMO |
$237.90
|
| Rate for Payer: Cigna of CA PPO |
$237.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.94
|
| Rate for Payer: EPIC Health Plan Senior |
$135.94
|
| Rate for Payer: Galaxy Health WC |
$288.88
|
| Rate for Payer: Global Benefits Group Commercial |
$203.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$210.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.57
|
| Rate for Payer: Multiplan Commercial |
$271.89
|
| Rate for Payer: Networks By Design Commercial |
$169.93
|
| Rate for Payer: Prime Health Services Commercial |
$288.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.55
|
| Rate for Payer: United Healthcare All Other HMO |
$124.15
|
| Rate for Payer: United Healthcare HMO Rider |
$121.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.30
|
|
|
METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS WRAP [40891651]
|
Facility
|
OP
|
$339.86
|
|
|
Service Code
|
HCPCS J2212
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$288.88 |
| Rate for Payer: Adventist Health Commercial |
$67.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$222.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$288.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$186.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$254.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1.60
|
| Rate for Payer: Blue Shield of California EPN |
$1.60
|
| Rate for Payer: Cash Price |
$186.92
|
| Rate for Payer: Cash Price |
$186.92
|
| Rate for Payer: Cigna of CA HMO |
$237.90
|
| Rate for Payer: Cigna of CA PPO |
$237.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$288.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$288.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$288.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.94
|
| Rate for Payer: EPIC Health Plan Senior |
$135.94
|
| Rate for Payer: Galaxy Health WC |
$288.88
|
| Rate for Payer: Global Benefits Group Commercial |
$203.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$210.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$237.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$237.90
|
| Rate for Payer: Multiplan Commercial |
$271.89
|
| Rate for Payer: Networks By Design Commercial |
$169.93
|
| Rate for Payer: Prime Health Services Commercial |
$288.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$203.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$203.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.55
|
| Rate for Payer: United Healthcare All Other HMO |
$124.15
|
| Rate for Payer: United Healthcare HMO Rider |
$121.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$288.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$288.88
|
| Rate for Payer: Vantage Medical Group Senior |
$288.88
|
|
|
METHYLPHENIDATE 5 MG TABLET [4988]
|
Facility
|
IP
|
$0.12
|
|
|
Service Code
|
NDC 0115-1800-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
|
|
METHYLPHENIDATE 5 MG TABLET [4988]
|
Facility
|
OP
|
$2.46
|
|
|
Service Code
|
NDC 68084-805-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$2.09 |
| Rate for Payer: Adventist Health Commercial |
$0.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.51
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cigna of CA HMO |
$1.72
|
| Rate for Payer: Cigna of CA PPO |
$1.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.98
|
| Rate for Payer: EPIC Health Plan Senior |
$0.98
|
| Rate for Payer: Galaxy Health WC |
$2.09
|
| Rate for Payer: Global Benefits Group Commercial |
$1.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.72
|
| Rate for Payer: Multiplan Commercial |
$1.97
|
| Rate for Payer: Networks By Design Commercial |
$1.60
|
| Rate for Payer: Prime Health Services Commercial |
$2.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1.23
|
| Rate for Payer: United Healthcare HMO Rider |
$1.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2.09
|
|
|
METHYLPHENIDATE 5 MG TABLET [4988]
|
Facility
|
OP
|
$0.12
|
|
|
Service Code
|
NDC 0115-1800-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.07
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Vantage Medical Group Senior |
$0.10
|
|
|
METHYLPHENIDATE 5 MG TABLET [4988]
|
Facility
|
IP
|
$2.46
|
|
|
Service Code
|
NDC 68084-805-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$2.09 |
| Rate for Payer: Adventist Health Commercial |
$0.49
|
| Rate for Payer: Blue Shield of California Commercial |
$1.82
|
| Rate for Payer: Blue Shield of California EPN |
$1.20
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cigna of CA HMO |
$1.72
|
| Rate for Payer: Cigna of CA PPO |
$1.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.98
|
| Rate for Payer: EPIC Health Plan Senior |
$0.98
|
| Rate for Payer: Galaxy Health WC |
$2.09
|
| Rate for Payer: Global Benefits Group Commercial |
$1.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: Multiplan Commercial |
$1.97
|
| Rate for Payer: Networks By Design Commercial |
$1.60
|
| Rate for Payer: Prime Health Services Commercial |
$2.09
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR [28750]
|
Facility
|
OP
|
$15.48
|
|
|
Service Code
|
NDC 50458-585-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$13.16 |
| Rate for Payer: Adventist Health Commercial |
$3.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.51
|
| Rate for Payer: Cash Price |
$8.51
|
| Rate for Payer: Cigna of CA HMO |
$10.84
|
| Rate for Payer: Cigna of CA PPO |
$10.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.19
|
| Rate for Payer: EPIC Health Plan Senior |
$6.19
|
| Rate for Payer: Galaxy Health WC |
$13.16
|
| Rate for Payer: Global Benefits Group Commercial |
$9.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.84
|
| Rate for Payer: Multiplan Commercial |
$12.38
|
| Rate for Payer: Networks By Design Commercial |
$10.06
|
| Rate for Payer: Prime Health Services Commercial |
$13.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.74
|
| Rate for Payer: United Healthcare All Other HMO |
$7.74
|
| Rate for Payer: United Healthcare HMO Rider |
$7.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.16
|
| Rate for Payer: Vantage Medical Group Senior |
$13.16
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR [28750]
|
Facility
|
OP
|
$6.22
|
|
|
Service Code
|
NDC 62175-310-37
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$5.29 |
| Rate for Payer: Adventist Health Commercial |
$1.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.82
|
| Rate for Payer: Cash Price |
$3.42
|
| Rate for Payer: Cigna of CA HMO |
$4.35
|
| Rate for Payer: Cigna of CA PPO |
$4.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.49
|
| Rate for Payer: EPIC Health Plan Senior |
$2.49
|
| Rate for Payer: Galaxy Health WC |
$5.29
|
| Rate for Payer: Global Benefits Group Commercial |
$3.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.35
|
| Rate for Payer: Multiplan Commercial |
$4.98
|
| Rate for Payer: Networks By Design Commercial |
$4.04
|
| Rate for Payer: Prime Health Services Commercial |
$5.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.11
|
| Rate for Payer: United Healthcare All Other HMO |
$3.11
|
| Rate for Payer: United Healthcare HMO Rider |
$3.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.29
|
| Rate for Payer: Vantage Medical Group Senior |
$5.29
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR [28750]
|
Facility
|
IP
|
$9.34
|
|
|
Service Code
|
NDC 9999-7068-51
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$7.94 |
| Rate for Payer: Adventist Health Commercial |
$1.87
|
| Rate for Payer: Blue Shield of California Commercial |
$6.89
|
| Rate for Payer: Blue Shield of California EPN |
$4.54
|
| Rate for Payer: Cash Price |
$5.14
|
| Rate for Payer: Cigna of CA HMO |
$6.54
|
| Rate for Payer: Cigna of CA PPO |
$6.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.74
|
| Rate for Payer: EPIC Health Plan Senior |
$3.74
|
| Rate for Payer: Galaxy Health WC |
$7.94
|
| Rate for Payer: Global Benefits Group Commercial |
$5.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.24
|
| Rate for Payer: Multiplan Commercial |
$7.47
|
| Rate for Payer: Networks By Design Commercial |
$6.07
|
| Rate for Payer: Prime Health Services Commercial |
$7.94
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR [28750]
|
Facility
|
IP
|
$15.48
|
|
|
Service Code
|
NDC 50458-585-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$13.16 |
| Rate for Payer: Adventist Health Commercial |
$3.10
|
| Rate for Payer: Blue Shield of California Commercial |
$11.42
|
| Rate for Payer: Blue Shield of California EPN |
$7.52
|
| Rate for Payer: Cash Price |
$8.51
|
| Rate for Payer: Cigna of CA HMO |
$10.84
|
| Rate for Payer: Cigna of CA PPO |
$10.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.19
|
| Rate for Payer: EPIC Health Plan Senior |
$6.19
|
| Rate for Payer: Galaxy Health WC |
$13.16
|
| Rate for Payer: Global Benefits Group Commercial |
$9.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.72
|
| Rate for Payer: Multiplan Commercial |
$12.38
|
| Rate for Payer: Networks By Design Commercial |
$10.06
|
| Rate for Payer: Prime Health Services Commercial |
$13.16
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR [28750]
|
Facility
|
IP
|
$6.22
|
|
|
Service Code
|
NDC 62175-310-37
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$5.29 |
| Rate for Payer: Adventist Health Commercial |
$1.24
|
| Rate for Payer: Blue Shield of California Commercial |
$4.59
|
| Rate for Payer: Blue Shield of California EPN |
$3.02
|
| Rate for Payer: Cash Price |
$3.42
|
| Rate for Payer: Cigna of CA HMO |
$4.35
|
| Rate for Payer: Cigna of CA PPO |
$4.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.49
|
| Rate for Payer: EPIC Health Plan Senior |
$2.49
|
| Rate for Payer: Galaxy Health WC |
$5.29
|
| Rate for Payer: Global Benefits Group Commercial |
$3.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.49
|
| Rate for Payer: Multiplan Commercial |
$4.98
|
| Rate for Payer: Networks By Design Commercial |
$4.04
|
| Rate for Payer: Prime Health Services Commercial |
$5.29
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR [28750]
|
Facility
|
OP
|
$9.34
|
|
|
Service Code
|
NDC 9999-7068-51
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$7.94 |
| Rate for Payer: Adventist Health Commercial |
$1.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.74
|
| Rate for Payer: Cash Price |
$5.14
|
| Rate for Payer: Cigna of CA HMO |
$6.54
|
| Rate for Payer: Cigna of CA PPO |
$6.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.74
|
| Rate for Payer: EPIC Health Plan Senior |
$3.74
|
| Rate for Payer: Galaxy Health WC |
$7.94
|
| Rate for Payer: Global Benefits Group Commercial |
$5.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.54
|
| Rate for Payer: Multiplan Commercial |
$7.47
|
| Rate for Payer: Networks By Design Commercial |
$6.07
|
| Rate for Payer: Prime Health Services Commercial |
$7.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.67
|
| Rate for Payer: United Healthcare All Other HMO |
$4.67
|
| Rate for Payer: United Healthcare HMO Rider |
$4.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.94
|
| Rate for Payer: Vantage Medical Group Senior |
$7.94
|
|
|
METHYLPHENIDATE ER 20 MG TABLET,EXTENDED RELEASE [4989]
|
Facility
|
IP
|
$2.02
|
|
|
Service Code
|
NDC 10702-076-06
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.72 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1.49
|
| Rate for Payer: Blue Shield of California EPN |
$0.98
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Cigna of CA HMO |
$1.41
|
| Rate for Payer: Cigna of CA PPO |
$1.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.81
|
| Rate for Payer: EPIC Health Plan Senior |
$0.81
|
| Rate for Payer: Galaxy Health WC |
$1.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.62
|
| Rate for Payer: Networks By Design Commercial |
$1.31
|
| Rate for Payer: Prime Health Services Commercial |
$1.72
|
|
|
METHYLPHENIDATE ER 20 MG TABLET,EXTENDED RELEASE [4989]
|
Facility
|
OP
|
$2.02
|
|
|
Service Code
|
NDC 10702-076-06
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.72 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.24
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Cigna of CA HMO |
$1.41
|
| Rate for Payer: Cigna of CA PPO |
$1.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.81
|
| Rate for Payer: EPIC Health Plan Senior |
$0.81
|
| Rate for Payer: Galaxy Health WC |
$1.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.41
|
| Rate for Payer: Multiplan Commercial |
$1.62
|
| Rate for Payer: Networks By Design Commercial |
$1.31
|
| Rate for Payer: Prime Health Services Commercial |
$1.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.01
|
| Rate for Payer: United Healthcare All Other HMO |
$1.01
|
| Rate for Payer: United Healthcare HMO Rider |
$1.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.72
|
| Rate for Payer: Vantage Medical Group Senior |
$1.72
|
|
|
METHYLPHENIDATE ER 27 MG TABLET,EXTENDED RELEASE 24 HR [32654]
|
Facility
|
IP
|
$15.87
|
|
|
Service Code
|
NDC 50458-588-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$13.49 |
| Rate for Payer: Adventist Health Commercial |
$3.17
|
| Rate for Payer: Blue Shield of California Commercial |
$11.71
|
| Rate for Payer: Blue Shield of California EPN |
$7.71
|
| Rate for Payer: Cash Price |
$8.73
|
| Rate for Payer: Cigna of CA HMO |
$11.11
|
| Rate for Payer: Cigna of CA PPO |
$11.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.35
|
| Rate for Payer: EPIC Health Plan Senior |
$6.35
|
| Rate for Payer: Galaxy Health WC |
$13.49
|
| Rate for Payer: Global Benefits Group Commercial |
$9.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.81
|
| Rate for Payer: Multiplan Commercial |
$12.70
|
| Rate for Payer: Networks By Design Commercial |
$10.32
|
| Rate for Payer: Prime Health Services Commercial |
$13.49
|
|
|
METHYLPHENIDATE ER 27 MG TABLET,EXTENDED RELEASE 24 HR [32654]
|
Facility
|
OP
|
$15.87
|
|
|
Service Code
|
NDC 50458-588-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$13.49 |
| Rate for Payer: Adventist Health Commercial |
$3.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.75
|
| Rate for Payer: Cash Price |
$8.73
|
| Rate for Payer: Cigna of CA HMO |
$11.11
|
| Rate for Payer: Cigna of CA PPO |
$11.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.35
|
| Rate for Payer: EPIC Health Plan Senior |
$6.35
|
| Rate for Payer: Galaxy Health WC |
$13.49
|
| Rate for Payer: Global Benefits Group Commercial |
$9.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.11
|
| Rate for Payer: Multiplan Commercial |
$12.70
|
| Rate for Payer: Networks By Design Commercial |
$10.32
|
| Rate for Payer: Prime Health Services Commercial |
$13.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.93
|
| Rate for Payer: United Healthcare All Other HMO |
$7.93
|
| Rate for Payer: United Healthcare HMO Rider |
$7.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.49
|
| Rate for Payer: Vantage Medical Group Senior |
$13.49
|
|
|
METHYLPHENIDATE ER 36 MG TABLET,EXTENDED RELEASE 24 HR [28751]
|
Facility
|
OP
|
$16.37
|
|
|
Service Code
|
NDC 50458-586-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$13.91 |
| Rate for Payer: Adventist Health Commercial |
$3.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.05
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO |
$11.46
|
| Rate for Payer: Cigna of CA PPO |
$11.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.55
|
| Rate for Payer: EPIC Health Plan Senior |
$6.55
|
| Rate for Payer: Galaxy Health WC |
$13.91
|
| Rate for Payer: Global Benefits Group Commercial |
$9.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.46
|
| Rate for Payer: Multiplan Commercial |
$13.10
|
| Rate for Payer: Networks By Design Commercial |
$10.64
|
| Rate for Payer: Prime Health Services Commercial |
$13.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.19
|
| Rate for Payer: United Healthcare All Other HMO |
$8.19
|
| Rate for Payer: United Healthcare HMO Rider |
$8.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.91
|
| Rate for Payer: Vantage Medical Group Senior |
$13.91
|
|
|
METHYLPHENIDATE ER 36 MG TABLET,EXTENDED RELEASE 24 HR [28751]
|
Facility
|
IP
|
$16.37
|
|
|
Service Code
|
NDC 50458-586-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$13.91 |
| Rate for Payer: Adventist Health Commercial |
$3.27
|
| Rate for Payer: Blue Shield of California Commercial |
$12.08
|
| Rate for Payer: Blue Shield of California EPN |
$7.96
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO |
$11.46
|
| Rate for Payer: Cigna of CA PPO |
$11.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.55
|
| Rate for Payer: EPIC Health Plan Senior |
$6.55
|
| Rate for Payer: Galaxy Health WC |
$13.91
|
| Rate for Payer: Global Benefits Group Commercial |
$9.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.93
|
| Rate for Payer: Multiplan Commercial |
$13.10
|
| Rate for Payer: Networks By Design Commercial |
$10.64
|
| Rate for Payer: Prime Health Services Commercial |
$13.91
|
|
