|
METHYLPREDNISOLONE SODIUM SUCCINATE 2 GRAM INTRAVENOUS SOLUTION [10579]
|
Facility
|
IP
|
$130.63
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.13 |
| Max. Negotiated Rate |
$111.04 |
| Rate for Payer: Adventist Health Commercial |
$26.13
|
| Rate for Payer: Blue Shield of California Commercial |
$96.40
|
| Rate for Payer: Blue Shield of California EPN |
$63.49
|
| Rate for Payer: Cash Price |
$71.85
|
| Rate for Payer: Cigna of CA HMO |
$91.44
|
| Rate for Payer: Cigna of CA PPO |
$91.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.25
|
| Rate for Payer: EPIC Health Plan Senior |
$52.25
|
| Rate for Payer: Galaxy Health WC |
$111.04
|
| Rate for Payer: Global Benefits Group Commercial |
$78.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$87.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$80.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.35
|
| Rate for Payer: Multiplan Commercial |
$104.50
|
| Rate for Payer: Networks By Design Commercial |
$65.31
|
| Rate for Payer: Prime Health Services Commercial |
$111.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.03
|
| Rate for Payer: United Healthcare All Other HMO |
$47.72
|
| Rate for Payer: United Healthcare HMO Rider |
$46.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.78
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 40 MG SOLUTION FOR INJECTION [10580]
|
Facility
|
IP
|
$7.30
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$6.21 |
| Rate for Payer: Adventist Health Commercial |
$1.46
|
| Rate for Payer: Blue Shield of California Commercial |
$5.39
|
| Rate for Payer: Blue Shield of California EPN |
$3.55
|
| Rate for Payer: Cash Price |
$4.01
|
| Rate for Payer: Cigna of CA HMO |
$5.11
|
| Rate for Payer: Cigna of CA PPO |
$5.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.92
|
| Rate for Payer: EPIC Health Plan Senior |
$2.92
|
| Rate for Payer: Galaxy Health WC |
$6.21
|
| Rate for Payer: Global Benefits Group Commercial |
$4.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.75
|
| Rate for Payer: Multiplan Commercial |
$5.84
|
| Rate for Payer: Networks By Design Commercial |
$3.65
|
| Rate for Payer: Prime Health Services Commercial |
$6.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.74
|
| Rate for Payer: United Healthcare All Other HMO |
$2.67
|
| Rate for Payer: United Healthcare HMO Rider |
$2.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.39
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 40 MG SOLUTION FOR INJECTION [10580]
|
Facility
|
OP
|
$7.30
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$8.99 |
| Rate for Payer: Adventist Health Commercial |
$1.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$4.01
|
| Rate for Payer: Cash Price |
$4.01
|
| Rate for Payer: Cigna of CA HMO |
$5.11
|
| Rate for Payer: Cigna of CA PPO |
$5.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: EPIC Health Plan Senior |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$6.21
|
| Rate for Payer: Global Benefits Group Commercial |
$4.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$5.84
|
| Rate for Payer: Networks By Design Commercial |
$3.65
|
| Rate for Payer: Prime Health Services Commercial |
$6.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.74
|
| Rate for Payer: United Healthcare All Other HMO |
$2.67
|
| Rate for Payer: United Healthcare HMO Rider |
$2.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.39
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Vantage Medical Group Senior |
$0.28
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION [10581]
|
Facility
|
IP
|
$26.40
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$22.44 |
| Rate for Payer: Adventist Health Commercial |
$5.28
|
| Rate for Payer: Adventist Health Commercial |
$5.55
|
| Rate for Payer: Adventist Health Commercial |
$5.83
|
| Rate for Payer: Blue Shield of California Commercial |
$20.47
|
| Rate for Payer: Blue Shield of California Commercial |
$21.51
|
| Rate for Payer: Blue Shield of California Commercial |
$19.48
|
| Rate for Payer: Blue Shield of California EPN |
$13.48
|
| Rate for Payer: Blue Shield of California EPN |
$12.83
|
| Rate for Payer: Blue Shield of California EPN |
$14.16
|
| Rate for Payer: Cash Price |
$15.26
|
| Rate for Payer: Cash Price |
$14.52
|
| Rate for Payer: Cash Price |
$16.02
|
| Rate for Payer: Cigna of CA HMO |
$19.42
|
| Rate for Payer: Cigna of CA HMO |
$18.48
|
| Rate for Payer: Cigna of CA HMO |
$20.40
|
| Rate for Payer: Cigna of CA PPO |
$19.42
|
| Rate for Payer: Cigna of CA PPO |
$18.48
|
| Rate for Payer: Cigna of CA PPO |
$20.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.66
|
| Rate for Payer: EPIC Health Plan Senior |
$11.66
|
| Rate for Payer: EPIC Health Plan Senior |
$10.56
|
| Rate for Payer: EPIC Health Plan Senior |
$11.10
|
| Rate for Payer: Galaxy Health WC |
$23.58
|
| Rate for Payer: Galaxy Health WC |
$22.44
|
| Rate for Payer: Galaxy Health WC |
$24.77
|
| Rate for Payer: Global Benefits Group Commercial |
$17.48
|
| Rate for Payer: Global Benefits Group Commercial |
$15.84
|
| Rate for Payer: Global Benefits Group Commercial |
$16.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$21.12
|
| Rate for Payer: Multiplan Commercial |
$22.19
|
| Rate for Payer: Multiplan Commercial |
$23.31
|
| Rate for Payer: Networks By Design Commercial |
$13.87
|
| Rate for Payer: Networks By Design Commercial |
$14.57
|
| Rate for Payer: Networks By Design Commercial |
$13.20
|
| Rate for Payer: Prime Health Services Commercial |
$22.44
|
| Rate for Payer: Prime Health Services Commercial |
$23.58
|
| Rate for Payer: Prime Health Services Commercial |
$24.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.94
|
| Rate for Payer: United Healthcare All Other HMO |
$10.64
|
| Rate for Payer: United Healthcare All Other HMO |
$9.64
|
| Rate for Payer: United Healthcare All Other HMO |
$10.13
|
| Rate for Payer: United Healthcare HMO Rider |
$9.91
|
| Rate for Payer: United Healthcare HMO Rider |
$10.41
|
| Rate for Payer: United Healthcare HMO Rider |
$9.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.08
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION [10581]
|
Facility
|
OP
|
$29.14
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$24.77 |
| Rate for Payer: Adventist Health Commercial |
$5.83
|
| Rate for Payer: Adventist Health Commercial |
$5.28
|
| Rate for Payer: Adventist Health Commercial |
$5.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$14.52
|
| Rate for Payer: Cash Price |
$15.26
|
| Rate for Payer: Cash Price |
$15.26
|
| Rate for Payer: Cash Price |
$14.52
|
| Rate for Payer: Cash Price |
$16.02
|
| Rate for Payer: Cash Price |
$16.02
|
| Rate for Payer: Cigna of CA HMO |
$19.42
|
| Rate for Payer: Cigna of CA HMO |
$18.48
|
| Rate for Payer: Cigna of CA HMO |
$20.40
|
| Rate for Payer: Cigna of CA PPO |
$18.48
|
| Rate for Payer: Cigna of CA PPO |
$19.42
|
| Rate for Payer: Cigna of CA PPO |
$20.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: EPIC Health Plan Senior |
$0.26
|
| Rate for Payer: EPIC Health Plan Senior |
$0.26
|
| Rate for Payer: EPIC Health Plan Senior |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$24.77
|
| Rate for Payer: Galaxy Health WC |
$22.44
|
| Rate for Payer: Galaxy Health WC |
$23.58
|
| Rate for Payer: Global Benefits Group Commercial |
$17.48
|
| Rate for Payer: Global Benefits Group Commercial |
$16.64
|
| Rate for Payer: Global Benefits Group Commercial |
$15.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$21.12
|
| Rate for Payer: Multiplan Commercial |
$22.19
|
| Rate for Payer: Multiplan Commercial |
$23.31
|
| Rate for Payer: Networks By Design Commercial |
$13.20
|
| Rate for Payer: Networks By Design Commercial |
$13.87
|
| Rate for Payer: Networks By Design Commercial |
$14.57
|
| Rate for Payer: Prime Health Services Commercial |
$23.58
|
| Rate for Payer: Prime Health Services Commercial |
$24.77
|
| Rate for Payer: Prime Health Services Commercial |
$22.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.94
|
| Rate for Payer: United Healthcare All Other HMO |
$9.64
|
| Rate for Payer: United Healthcare All Other HMO |
$10.64
|
| Rate for Payer: United Healthcare All Other HMO |
$10.13
|
| Rate for Payer: United Healthcare HMO Rider |
$9.91
|
| Rate for Payer: United Healthcare HMO Rider |
$9.44
|
| Rate for Payer: United Healthcare HMO Rider |
$10.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.26
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.26
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Vantage Medical Group Senior |
$0.28
|
| Rate for Payer: Vantage Medical Group Senior |
$0.28
|
| Rate for Payer: Vantage Medical Group Senior |
$0.28
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 1,000 MG/8 ML INTRAVENOUS SOLUTION [120963]
|
Facility
|
IP
|
$82.70
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.54 |
| Max. Negotiated Rate |
$70.30 |
| Rate for Payer: Adventist Health Commercial |
$16.54
|
| Rate for Payer: Blue Shield of California Commercial |
$61.03
|
| Rate for Payer: Blue Shield of California EPN |
$40.19
|
| Rate for Payer: Cash Price |
$45.49
|
| Rate for Payer: Cigna of CA HMO |
$57.89
|
| Rate for Payer: Cigna of CA PPO |
$57.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.08
|
| Rate for Payer: EPIC Health Plan Senior |
$33.08
|
| Rate for Payer: Galaxy Health WC |
$70.30
|
| Rate for Payer: Global Benefits Group Commercial |
$49.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$55.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.85
|
| Rate for Payer: Multiplan Commercial |
$66.16
|
| Rate for Payer: Networks By Design Commercial |
$41.35
|
| Rate for Payer: Prime Health Services Commercial |
$70.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.04
|
| Rate for Payer: United Healthcare All Other HMO |
$30.21
|
| Rate for Payer: United Healthcare HMO Rider |
$29.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.08
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 1,000 MG/8 ML INTRAVENOUS SOLUTION [120963]
|
Facility
|
OP
|
$82.70
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$70.30 |
| Rate for Payer: Adventist Health Commercial |
$16.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$54.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$45.49
|
| Rate for Payer: Cash Price |
$45.49
|
| Rate for Payer: Cigna of CA HMO |
$57.89
|
| Rate for Payer: Cigna of CA PPO |
$57.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: EPIC Health Plan Senior |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$70.30
|
| Rate for Payer: Global Benefits Group Commercial |
$49.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$55.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$66.16
|
| Rate for Payer: Networks By Design Commercial |
$41.35
|
| Rate for Payer: Prime Health Services Commercial |
$70.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.04
|
| Rate for Payer: United Healthcare All Other HMO |
$30.21
|
| Rate for Payer: United Healthcare HMO Rider |
$29.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Vantage Medical Group Senior |
$0.28
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION [120961]
|
Facility
|
OP
|
$12.50
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$10.62 |
| Rate for Payer: Adventist Health Commercial |
$2.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$6.88
|
| Rate for Payer: Cash Price |
$6.88
|
| Rate for Payer: Cigna of CA HMO |
$8.75
|
| Rate for Payer: Cigna of CA PPO |
$8.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: EPIC Health Plan Senior |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$10.62
|
| Rate for Payer: Global Benefits Group Commercial |
$7.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$10.00
|
| Rate for Payer: Networks By Design Commercial |
$6.25
|
| Rate for Payer: Prime Health Services Commercial |
$10.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.69
|
| Rate for Payer: United Healthcare All Other HMO |
$4.57
|
| Rate for Payer: United Healthcare HMO Rider |
$4.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Vantage Medical Group Senior |
$0.28
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION [120961]
|
Facility
|
IP
|
$12.50
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$10.62 |
| Rate for Payer: Adventist Health Commercial |
$2.50
|
| Rate for Payer: Blue Shield of California Commercial |
$9.22
|
| Rate for Payer: Blue Shield of California EPN |
$6.08
|
| Rate for Payer: Cash Price |
$6.88
|
| Rate for Payer: Cigna of CA HMO |
$8.75
|
| Rate for Payer: Cigna of CA PPO |
$8.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5.00
|
| Rate for Payer: Galaxy Health WC |
$10.62
|
| Rate for Payer: Global Benefits Group Commercial |
$7.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$10.00
|
| Rate for Payer: Networks By Design Commercial |
$6.25
|
| Rate for Payer: Prime Health Services Commercial |
$10.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.69
|
| Rate for Payer: United Healthcare All Other HMO |
$4.57
|
| Rate for Payer: United Healthcare HMO Rider |
$4.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.09
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 40 MG/ML SOLUTION FOR INJECTION [120960]
|
Facility
|
OP
|
$7.76
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$8.99 |
| Rate for Payer: Adventist Health Commercial |
$1.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$4.27
|
| Rate for Payer: Cash Price |
$4.27
|
| Rate for Payer: Cigna of CA HMO |
$5.43
|
| Rate for Payer: Cigna of CA PPO |
$5.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: EPIC Health Plan Senior |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$6.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$6.21
|
| Rate for Payer: Networks By Design Commercial |
$3.88
|
| Rate for Payer: Prime Health Services Commercial |
$6.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.91
|
| Rate for Payer: United Healthcare All Other HMO |
$2.83
|
| Rate for Payer: United Healthcare HMO Rider |
$2.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Vantage Medical Group Senior |
$0.28
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 40 MG/ML SOLUTION FOR INJECTION [120960]
|
Facility
|
IP
|
$7.76
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$6.60 |
| Rate for Payer: Adventist Health Commercial |
$1.55
|
| Rate for Payer: Blue Shield of California Commercial |
$5.73
|
| Rate for Payer: Blue Shield of California EPN |
$3.77
|
| Rate for Payer: Cash Price |
$4.27
|
| Rate for Payer: Cigna of CA HMO |
$5.43
|
| Rate for Payer: Cigna of CA PPO |
$5.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.10
|
| Rate for Payer: EPIC Health Plan Senior |
$3.10
|
| Rate for Payer: Galaxy Health WC |
$6.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.86
|
| Rate for Payer: Multiplan Commercial |
$6.21
|
| Rate for Payer: Networks By Design Commercial |
$3.88
|
| Rate for Payer: Prime Health Services Commercial |
$6.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.91
|
| Rate for Payer: United Healthcare All Other HMO |
$2.83
|
| Rate for Payer: United Healthcare HMO Rider |
$2.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.54
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 500 MG/4 ML INTRAVENOUS SOLUTION [120962]
|
Facility
|
IP
|
$56.86
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.37 |
| Max. Negotiated Rate |
$48.33 |
| Rate for Payer: Adventist Health Commercial |
$11.37
|
| Rate for Payer: Blue Shield of California Commercial |
$41.96
|
| Rate for Payer: Blue Shield of California EPN |
$27.63
|
| Rate for Payer: Cash Price |
$31.27
|
| Rate for Payer: Cigna of CA HMO |
$39.80
|
| Rate for Payer: Cigna of CA PPO |
$39.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.74
|
| Rate for Payer: EPIC Health Plan Senior |
$22.74
|
| Rate for Payer: Galaxy Health WC |
$48.33
|
| Rate for Payer: Global Benefits Group Commercial |
$34.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.65
|
| Rate for Payer: Multiplan Commercial |
$45.49
|
| Rate for Payer: Networks By Design Commercial |
$28.43
|
| Rate for Payer: Prime Health Services Commercial |
$48.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.34
|
| Rate for Payer: United Healthcare All Other HMO |
$20.77
|
| Rate for Payer: United Healthcare HMO Rider |
$20.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.62
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 500 MG/4 ML INTRAVENOUS SOLUTION [120962]
|
Facility
|
OP
|
$56.86
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$48.33 |
| Rate for Payer: Adventist Health Commercial |
$11.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$31.27
|
| Rate for Payer: Cash Price |
$31.27
|
| Rate for Payer: Cigna of CA HMO |
$39.80
|
| Rate for Payer: Cigna of CA PPO |
$39.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: EPIC Health Plan Senior |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$48.33
|
| Rate for Payer: Global Benefits Group Commercial |
$34.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$45.49
|
| Rate for Payer: Networks By Design Commercial |
$28.43
|
| Rate for Payer: Prime Health Services Commercial |
$48.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.34
|
| Rate for Payer: United Healthcare All Other HMO |
$20.77
|
| Rate for Payer: United Healthcare HMO Rider |
$20.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Vantage Medical Group Senior |
$0.28
|
|
|
METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM [118363]
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 4116706003
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM [118363]
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 41167-0600-3
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM [118363]
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 41167-0600-3
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM [118363]
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 4116706003
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM [118363]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 45802-174-53
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM [118363]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 45802-174-53
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
METOCLOPRAMIDE 10 MG/10 ML ORAL SOLUTION [40877725]
|
Facility
|
OP
|
$0.49
|
|
|
Service Code
|
NDC 0121-1576-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.30
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$0.39
|
| Rate for Payer: Networks By Design Commercial |
$0.32
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.25
|
| Rate for Payer: United Healthcare All Other HMO |
$0.25
|
| Rate for Payer: United Healthcare HMO Rider |
$0.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.42
|
| Rate for Payer: Vantage Medical Group Senior |
$0.42
|
|
|
METOCLOPRAMIDE 10 MG/10 ML ORAL SOLUTION [40877725]
|
Facility
|
IP
|
$0.49
|
|
|
Service Code
|
NDC 0121-1576-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.39
|
| Rate for Payer: Networks By Design Commercial |
$0.32
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
|
|
METOCLOPRAMIDE 10 MG TABLET [5005]
|
Facility
|
OP
|
$0.96
|
|
|
Service Code
|
NDC 51079-888-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: Adventist Health Commercial |
$0.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.59
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: Cigna of CA HMO |
$0.67
|
| Rate for Payer: Cigna of CA PPO |
$0.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: EPIC Health Plan Senior |
$0.38
|
| Rate for Payer: Galaxy Health WC |
$0.82
|
| Rate for Payer: Global Benefits Group Commercial |
$0.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.67
|
| Rate for Payer: Multiplan Commercial |
$0.77
|
| Rate for Payer: Networks By Design Commercial |
$0.62
|
| Rate for Payer: Prime Health Services Commercial |
$0.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.48
|
| Rate for Payer: United Healthcare All Other HMO |
$0.48
|
| Rate for Payer: United Healthcare HMO Rider |
$0.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.82
|
| Rate for Payer: Vantage Medical Group Senior |
$0.82
|
|
|
METOCLOPRAMIDE 10 MG TABLET [5005]
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
NDC 0093-2203-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
|
|
METOCLOPRAMIDE 10 MG TABLET [5005]
|
Facility
|
IP
|
$0.96
|
|
|
Service Code
|
NDC 51079-888-20
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: Adventist Health Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.71
|
| Rate for Payer: Blue Shield of California EPN |
$0.47
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: Cigna of CA HMO |
$0.67
|
| Rate for Payer: Cigna of CA PPO |
$0.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: EPIC Health Plan Senior |
$0.38
|
| Rate for Payer: Galaxy Health WC |
$0.82
|
| Rate for Payer: Global Benefits Group Commercial |
$0.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.77
|
| Rate for Payer: Networks By Design Commercial |
$0.62
|
| Rate for Payer: Prime Health Services Commercial |
$0.82
|
|
|
METOCLOPRAMIDE 10 MG TABLET [5005]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 0093-2203-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
