|
MENTAL ILLNESS DIAGNOSIS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$37,121.52
|
|
|
Service Code
|
APR-DRG 7403
|
| Min. Negotiated Rate |
$29,648.37 |
| Max. Negotiated Rate |
$37,121.52 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29,648.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37,121.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33,213.99
|
|
|
MENTAL ILLNESS DIAGNOSIS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$12,109.31
|
|
|
Service Code
|
APR-DRG 7401
|
| Min. Negotiated Rate |
$9,671.51 |
| Max. Negotiated Rate |
$12,109.31 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9,671.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,109.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,834.64
|
|
|
MENTAL ILLNESS DIAGNOSIS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$86,515.51
|
|
|
Service Code
|
APR-DRG 7404
|
| Min. Negotiated Rate |
$69,098.57 |
| Max. Negotiated Rate |
$86,515.51 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$69,098.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$86,515.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$77,408.62
|
|
|
MENTHOL 0.44 %-ZINC OXIDE 20.6 % TOPICAL OINTMENT [91352]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 1013570104
|
| 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 |
$0.03
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
|
|
MENTHOL 0.44 %-ZINC OXIDE 20.6 % TOPICAL OINTMENT [91352]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 1013570104
|
| 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 Commercial |
$0.03
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
|
|
MENTHOL 0.44 %-ZINC OXIDE 20.6 % TOPICAL OINTMENT IN PACKET [197109]
|
Facility
|
IP
|
$0.14
|
|
|
Service Code
|
NDC 0799000105
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
|
|
MENTHOL 0.44 %-ZINC OXIDE 20.6 % TOPICAL OINTMENT IN PACKET [197109]
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
NDC 0799000105
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.12
|
|
|
MEPERIDINE 50 MG/ML INJECTION SOLUTION [110376]
|
Facility
|
IP
|
$32.77
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.55 |
| Max. Negotiated Rate |
$27.85 |
| Rate for Payer: Adventist Health Commercial |
$6.55
|
| Rate for Payer: Blue Shield of California Commercial |
$16.61
|
| Rate for Payer: Blue Shield of California Commercial |
$25.20
|
| Rate for Payer: Cash Price |
$14.75
|
| Rate for Payer: Cigna of CA HMO |
$22.94
|
| Rate for Payer: Cigna of CA PPO |
$22.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.11
|
| Rate for Payer: EPIC Health Plan Senior |
$13.11
|
| Rate for Payer: Galaxy Health WC |
$27.85
|
| Rate for Payer: Global Benefits Group Commercial |
$19.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.86
|
| Rate for Payer: Multiplan Commercial |
$26.22
|
| Rate for Payer: Networks By Design Commercial |
$16.39
|
| Rate for Payer: Prime Health Services Commercial |
$27.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.30
|
| Rate for Payer: United Healthcare All Other HMO |
$11.97
|
| Rate for Payer: United Healthcare HMO Rider |
$11.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.73
|
|
|
MEPERIDINE 50 MG/ML INJECTION SOLUTION [110376]
|
Facility
|
OP
|
$32.77
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$63.77 |
| Rate for Payer: Adventist Health Commercial |
$6.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$63.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.49
|
| Rate for Payer: Blue Shield of California Commercial |
$7.33
|
| Rate for Payer: Cash Price |
$14.75
|
| Rate for Payer: Cash Price |
$14.75
|
| Rate for Payer: Cigna of CA HMO |
$22.94
|
| Rate for Payer: Cigna of CA PPO |
$22.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.11
|
| Rate for Payer: EPIC Health Plan Senior |
$13.11
|
| Rate for Payer: Galaxy Health WC |
$27.85
|
| Rate for Payer: Global Benefits Group Commercial |
$19.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.94
|
| Rate for Payer: Multiplan Commercial |
$26.22
|
| Rate for Payer: Networks By Design Commercial |
$16.39
|
| Rate for Payer: Prime Health Services Commercial |
$27.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.30
|
| Rate for Payer: United Healthcare All Other HMO |
$11.97
|
| Rate for Payer: United Healthcare HMO Rider |
$11.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.85
|
| Rate for Payer: Vantage Medical Group Senior |
$27.85
|
|
|
MEPERIDINE (PF) 25 MG/ML INJECTION SOLUTION [117787]
|
Facility
|
IP
|
$3.04
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$2.58 |
| Rate for Payer: Adventist Health Commercial |
$0.61
|
| Rate for Payer: Blue Shield of California Commercial |
$1.54
|
| Rate for Payer: Blue Shield of California Commercial |
$2.34
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Cigna of CA HMO |
$2.13
|
| Rate for Payer: Cigna of CA PPO |
$2.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.22
|
| Rate for Payer: EPIC Health Plan Senior |
$1.22
|
| Rate for Payer: Galaxy Health WC |
$2.58
|
| Rate for Payer: Global Benefits Group Commercial |
$1.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.73
|
| Rate for Payer: Multiplan Commercial |
$2.43
|
| Rate for Payer: Networks By Design Commercial |
$1.52
|
| Rate for Payer: Prime Health Services Commercial |
$2.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.14
|
| Rate for Payer: United Healthcare All Other HMO |
$1.11
|
| Rate for Payer: United Healthcare HMO Rider |
$1.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.00
|
|
|
MEPERIDINE (PF) 25 MG/ML INJECTION SOLUTION [117787]
|
Facility
|
OP
|
$3.04
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$63.77 |
| Rate for Payer: Adventist Health Commercial |
$0.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$63.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.49
|
| Rate for Payer: Blue Shield of California Commercial |
$7.33
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Cigna of CA HMO |
$2.13
|
| Rate for Payer: Cigna of CA PPO |
$2.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.22
|
| Rate for Payer: EPIC Health Plan Senior |
$1.22
|
| Rate for Payer: Galaxy Health WC |
$2.58
|
| Rate for Payer: Global Benefits Group Commercial |
$1.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.13
|
| Rate for Payer: Multiplan Commercial |
$2.43
|
| Rate for Payer: Networks By Design Commercial |
$1.52
|
| Rate for Payer: Prime Health Services Commercial |
$2.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.14
|
| Rate for Payer: United Healthcare All Other HMO |
$1.11
|
| Rate for Payer: United Healthcare HMO Rider |
$1.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.58
|
| Rate for Payer: Vantage Medical Group Senior |
$2.58
|
|
|
MEPERIDINE (PF) 50 MG/ML INJECTION SOLUTION [4904]
|
Facility
|
OP
|
$3.17
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$63.77 |
| Rate for Payer: Adventist Health Commercial |
$0.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$63.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.49
|
| Rate for Payer: Blue Shield of California Commercial |
$7.33
|
| Rate for Payer: Cash Price |
$1.43
|
| Rate for Payer: Cash Price |
$1.43
|
| Rate for Payer: Cigna of CA HMO |
$2.22
|
| Rate for Payer: Cigna of CA PPO |
$2.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.27
|
| Rate for Payer: EPIC Health Plan Senior |
$1.27
|
| Rate for Payer: Galaxy Health WC |
$2.69
|
| Rate for Payer: Global Benefits Group Commercial |
$1.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.22
|
| Rate for Payer: Multiplan Commercial |
$2.54
|
| Rate for Payer: Networks By Design Commercial |
$1.58
|
| Rate for Payer: Prime Health Services Commercial |
$2.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.19
|
| Rate for Payer: United Healthcare All Other HMO |
$1.16
|
| Rate for Payer: United Healthcare HMO Rider |
$1.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2.69
|
|
|
MEPERIDINE (PF) 50 MG/ML INJECTION SOLUTION [4904]
|
Facility
|
IP
|
$3.17
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: Adventist Health Commercial |
$0.63
|
| Rate for Payer: Blue Shield of California Commercial |
$1.61
|
| Rate for Payer: Blue Shield of California Commercial |
$2.44
|
| Rate for Payer: Cash Price |
$1.43
|
| Rate for Payer: Cigna of CA HMO |
$2.22
|
| Rate for Payer: Cigna of CA PPO |
$2.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.27
|
| Rate for Payer: EPIC Health Plan Senior |
$1.27
|
| Rate for Payer: Galaxy Health WC |
$2.69
|
| Rate for Payer: Global Benefits Group Commercial |
$1.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$2.54
|
| Rate for Payer: Networks By Design Commercial |
$1.58
|
| Rate for Payer: Prime Health Services Commercial |
$2.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.19
|
| Rate for Payer: United Healthcare All Other HMO |
$1.16
|
| Rate for Payer: United Healthcare HMO Rider |
$1.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.04
|
|
|
MEPIVACAINE (PF) 15 MG/ML (1.5 %) INJECTION SOLUTION [10529]
|
Facility
|
OP
|
$0.69
|
|
|
Service Code
|
HCPCS J0670
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$35.60 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3.29
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Cigna of CA HMO |
$0.48
|
| Rate for Payer: Cigna of CA PPO |
$0.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: EPIC Health Plan Senior |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.59
|
| Rate for Payer: Global Benefits Group Commercial |
$0.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$0.55
|
| Rate for Payer: Networks By Design Commercial |
$0.35
|
| Rate for Payer: Prime Health Services Commercial |
$0.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.26
|
| 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 |
$0.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.59
|
| Rate for Payer: Vantage Medical Group Senior |
$0.59
|
|
|
MEPIVACAINE (PF) 15 MG/ML (1.5 %) INJECTION SOLUTION [10529]
|
Facility
|
IP
|
$0.69
|
|
|
Service Code
|
HCPCS J0670
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California Commercial |
$0.53
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Cigna of CA HMO |
$0.48
|
| Rate for Payer: Cigna of CA PPO |
$0.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: EPIC Health Plan Senior |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.59
|
| Rate for Payer: Global Benefits Group Commercial |
$0.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.55
|
| Rate for Payer: Networks By Design Commercial |
$0.35
|
| Rate for Payer: Prime Health Services Commercial |
$0.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.26
|
| 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 |
$0.23
|
|
|
MEPIVACAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION [105638]
|
Facility
|
OP
|
$0.84
|
|
|
Service Code
|
HCPCS J0670
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$35.60 |
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3.29
|
| Rate for Payer: Cash Price |
$0.38
|
| Rate for Payer: Cash Price |
$0.38
|
| Rate for Payer: Cigna of CA HMO |
$0.59
|
| Rate for Payer: Cigna of CA PPO |
$0.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.34
|
| Rate for Payer: EPIC Health Plan Senior |
$0.34
|
| Rate for Payer: Galaxy Health WC |
$0.71
|
| Rate for Payer: Global Benefits Group Commercial |
$0.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.59
|
| Rate for Payer: Multiplan Commercial |
$0.67
|
| Rate for Payer: Networks By Design Commercial |
$0.42
|
| Rate for Payer: Prime Health Services Commercial |
$0.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.32
|
| Rate for Payer: United Healthcare All Other HMO |
$0.31
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.71
|
| Rate for Payer: Vantage Medical Group Senior |
$0.71
|
|
|
MEPIVACAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION [105638]
|
Facility
|
IP
|
$0.84
|
|
|
Service Code
|
HCPCS J0670
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.71 |
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$0.65
|
| Rate for Payer: Cash Price |
$0.38
|
| Rate for Payer: Cigna of CA HMO |
$0.59
|
| Rate for Payer: Cigna of CA PPO |
$0.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.34
|
| Rate for Payer: EPIC Health Plan Senior |
$0.34
|
| Rate for Payer: Galaxy Health WC |
$0.71
|
| Rate for Payer: Global Benefits Group Commercial |
$0.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.67
|
| Rate for Payer: Networks By Design Commercial |
$0.42
|
| Rate for Payer: Prime Health Services Commercial |
$0.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.32
|
| Rate for Payer: United Healthcare All Other HMO |
$0.31
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.28
|
|
|
MEPIVACAINE (PF) 30 MG/ML (3 %) INJECTION SOLUTION [4081086]
|
Facility
|
OP
|
$1.27
|
|
|
Service Code
|
HCPCS J0670
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$35.60 |
| Rate for Payer: Adventist Health Commercial |
$0.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3.29
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: Cigna of CA HMO |
$0.89
|
| Rate for Payer: Cigna of CA PPO |
$0.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.51
|
| Rate for Payer: EPIC Health Plan Senior |
$0.51
|
| Rate for Payer: Galaxy Health WC |
$1.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.89
|
| Rate for Payer: Multiplan Commercial |
$1.02
|
| Rate for Payer: Networks By Design Commercial |
$0.64
|
| Rate for Payer: Prime Health Services Commercial |
$1.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.48
|
| Rate for Payer: United Healthcare All Other HMO |
$0.46
|
| Rate for Payer: United Healthcare HMO Rider |
$0.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.08
|
| Rate for Payer: Vantage Medical Group Senior |
$1.08
|
|
|
MEPIVACAINE (PF) 30 MG/ML (3 %) INJECTION SOLUTION [4081086]
|
Facility
|
IP
|
$1.27
|
|
|
Service Code
|
HCPCS J0670
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Adventist Health Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California Commercial |
$0.64
|
| Rate for Payer: Blue Shield of California Commercial |
$0.98
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: Cigna of CA HMO |
$0.89
|
| Rate for Payer: Cigna of CA PPO |
$0.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.51
|
| Rate for Payer: EPIC Health Plan Senior |
$0.51
|
| Rate for Payer: Galaxy Health WC |
$1.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$1.02
|
| Rate for Payer: Networks By Design Commercial |
$0.64
|
| Rate for Payer: Prime Health Services Commercial |
$1.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.48
|
| Rate for Payer: United Healthcare All Other HMO |
$0.46
|
| Rate for Payer: United Healthcare HMO Rider |
$0.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.42
|
|
|
MEPOLIZUMAB 100 MG SUBCUTANEOUS SOLUTION [211796]
|
Facility
|
IP
|
$4,498.06
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$899.61 |
| Max. Negotiated Rate |
$3,823.35 |
| Rate for Payer: Adventist Health Commercial |
$899.61
|
| Rate for Payer: Blue Shield of California Commercial |
$2,280.52
|
| Rate for Payer: Blue Shield of California Commercial |
$3,459.01
|
| Rate for Payer: Cash Price |
$2,024.13
|
| Rate for Payer: Cigna of CA HMO |
$3,148.64
|
| Rate for Payer: Cigna of CA PPO |
$3,148.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,148.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,799.22
|
| Rate for Payer: EPIC Health Plan Senior |
$1,799.22
|
| Rate for Payer: Galaxy Health WC |
$3,823.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,698.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,856.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,653.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,079.53
|
| Rate for Payer: Multiplan Commercial |
$3,598.45
|
| Rate for Payer: Networks By Design Commercial |
$2,249.03
|
| Rate for Payer: Prime Health Services Commercial |
$3,823.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,688.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1,643.14
|
| Rate for Payer: United Healthcare HMO Rider |
$1,607.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,473.11
|
|
|
MEPOLIZUMAB 100 MG SUBCUTANEOUS SOLUTION [211796]
|
Facility
|
OP
|
$4,498.06
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.28 |
| Max. Negotiated Rate |
$3,823.35 |
| Rate for Payer: Adventist Health Commercial |
$899.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$192.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.74
|
| Rate for Payer: Blue Shield of California Commercial |
$41.56
|
| Rate for Payer: Cash Price |
$2,024.13
|
| Rate for Payer: Cash Price |
$2,024.13
|
| Rate for Payer: Cigna of CA HMO |
$3,148.64
|
| Rate for Payer: Cigna of CA PPO |
$3,148.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,148.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.26
|
| Rate for Payer: EPIC Health Plan Senior |
$35.51
|
| Rate for Payer: Galaxy Health WC |
$3,823.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,698.84
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$52.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$32.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,856.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$69.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$45.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,079.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$40.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$43.26
|
| Rate for Payer: Multiplan Commercial |
$3,598.45
|
| Rate for Payer: Networks By Design Commercial |
$2,249.03
|
| Rate for Payer: Prime Health Services Commercial |
$3,823.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,698.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,698.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,688.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1,643.14
|
| Rate for Payer: United Healthcare HMO Rider |
$1,607.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,473.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$32.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.51
|
| Rate for Payer: Vantage Medical Group Senior |
$35.51
|
|
|
MERCAPTOPURINE 25 MG 1/2 TAB [192268]
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
HCPCS S0108
|
| Hospital Charge Code |
901700032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$17.69 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.68
|
| Rate for Payer: Blue Shield of California Commercial |
$2.94
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Senior |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.40
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.00
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.75
|
| Rate for Payer: United Healthcare All Other HMO |
$0.73
|
| Rate for Payer: United Healthcare HMO Rider |
$0.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1.70
|
|
|
MERCAPTOPURINE 25 MG 1/2 TAB [192268]
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
HCPCS S0108
|
| Hospital Charge Code |
901700032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1.54
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Senior |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.00
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.75
|
| Rate for Payer: United Healthcare All Other HMO |
$0.73
|
| Rate for Payer: United Healthcare HMO Rider |
$0.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.66
|
|
|
MERCAPTOPURINE 50 MG TABLET [10531]
|
Facility
|
OP
|
$3.80
|
|
|
Service Code
|
HCPCS S0108
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$17.69 |
| Rate for Payer: Adventist Health Commercial |
$0.76
|
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.68
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cigna of CA HMO |
$1.67
|
| Rate for Payer: Cigna of CA HMO |
$2.66
|
| Rate for Payer: Cigna of CA PPO |
$2.66
|
| Rate for Payer: Cigna of CA PPO |
$1.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Senior |
$0.96
|
| Rate for Payer: EPIC Health Plan Senior |
$1.52
|
| Rate for Payer: Galaxy Health WC |
$3.23
|
| Rate for Payer: Galaxy Health WC |
$2.03
|
| Rate for Payer: Global Benefits Group Commercial |
$2.28
|
| Rate for Payer: Global Benefits Group Commercial |
$1.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.67
|
| Rate for Payer: Multiplan Commercial |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$3.04
|
| Rate for Payer: Networks By Design Commercial |
$2.47
|
| Rate for Payer: Networks By Design Commercial |
$1.55
|
| Rate for Payer: Prime Health Services Commercial |
$3.23
|
| Rate for Payer: Prime Health Services Commercial |
$2.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.90
|
| Rate for Payer: United Healthcare All Other HMO |
$1.20
|
| Rate for Payer: United Healthcare All Other HMO |
$1.90
|
| Rate for Payer: United Healthcare HMO Rider |
$1.20
|
| Rate for Payer: United Healthcare HMO Rider |
$1.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.23
|
| Rate for Payer: Vantage Medical Group Senior |
$3.23
|
| Rate for Payer: Vantage Medical Group Senior |
$2.03
|
|
|
MERCAPTOPURINE 50 MG TABLET [10531]
|
Facility
|
IP
|
$2.39
|
|
|
Service Code
|
HCPCS S0108
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.03 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Adventist Health Commercial |
$0.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1.21
|
| Rate for Payer: Blue Shield of California Commercial |
$1.93
|
| Rate for Payer: Blue Shield of California Commercial |
$2.92
|
| Rate for Payer: Blue Shield of California Commercial |
$1.84
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cigna of CA HMO |
$1.67
|
| Rate for Payer: Cigna of CA HMO |
$2.66
|
| Rate for Payer: Cigna of CA PPO |
$1.67
|
| Rate for Payer: Cigna of CA PPO |
$2.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Senior |
$1.52
|
| Rate for Payer: EPIC Health Plan Senior |
$0.96
|
| Rate for Payer: Galaxy Health WC |
$3.23
|
| Rate for Payer: Galaxy Health WC |
$2.03
|
| Rate for Payer: Global Benefits Group Commercial |
$2.28
|
| Rate for Payer: Global Benefits Group Commercial |
$1.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.91
|
| Rate for Payer: Multiplan Commercial |
$3.04
|
| Rate for Payer: Multiplan Commercial |
$1.91
|
| Rate for Payer: Networks By Design Commercial |
$2.47
|
| Rate for Payer: Networks By Design Commercial |
$1.55
|
| Rate for Payer: Prime Health Services Commercial |
$2.03
|
| Rate for Payer: Prime Health Services Commercial |
$3.23
|
|
