|
METFORMIN 500 MG TABLET [10544]
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 2315510201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| 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 |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.04
|
| 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 |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.04
|
|
|
METFORMIN 500 MG TABLET [10544]
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 7001006301
|
| 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 |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$0.02
|
| 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 |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
METFORMIN 850 MG TABLET [14719]
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
NDC 6068714311
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Dignity Health Medi-Cal |
$0.22
|
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: Networks By Design Commercial |
$0.17
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Vantage Medical Group Senior |
$0.22
|
|
|
METFORMIN 850 MG TABLET [14719]
|
Facility
|
IP
|
$0.26
|
|
|
Service Code
|
NDC 6068714301
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: Networks By Design Commercial |
$0.17
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
|
|
METFORMIN 850 MG TABLET [14719]
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
NDC 6068714301
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: Networks By Design Commercial |
$0.17
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Vantage Medical Group Senior |
$0.22
|
|
|
METFORMIN 850 MG TABLET [14719]
|
Facility
|
IP
|
$0.26
|
|
|
Service Code
|
NDC 6068714311
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: Networks By Design Commercial |
$0.17
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
|
|
METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR [28995]
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 7001049101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
|
METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR [28995]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 7001049101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| 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 Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
|
|
METFORMIN ER 750 MG TABLET,EXTENDED RELEASE 24 HR [35771]
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
NDC 7638512901
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: Networks By Design Commercial |
$0.17
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Vantage Medical Group Senior |
$0.22
|
|
|
METFORMIN ER 750 MG TABLET,EXTENDED RELEASE 24 HR [35771]
|
Facility
|
IP
|
$0.26
|
|
|
Service Code
|
NDC 7638512901
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: Networks By Design Commercial |
$0.17
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
|
|
METHACHOLINE 0 MG TO 48 MG/3 ML (0 MG TO 16 MG/ML) NEBULIZATION SOLN [228989]
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
NDC 6428111005
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4.56
|
| Rate for Payer: Blue Shield of California Commercial |
$6.92
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cigna of CA HMO |
$6.30
|
| Rate for Payer: Cigna of CA PPO |
$6.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3.60
|
| Rate for Payer: Galaxy Health WC |
$7.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: Networks By Design Commercial |
$5.85
|
| Rate for Payer: Prime Health Services Commercial |
$7.65
|
|
|
METHACHOLINE 0 MG TO 48 MG/3 ML (0 MG TO 16 MG/ML) NEBULIZATION SOLN [228989]
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
NDC 6428111005
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.78
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cigna of CA HMO |
$6.30
|
| Rate for Payer: Cigna of CA PPO |
$6.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3.60
|
| Rate for Payer: Galaxy Health WC |
$7.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: Networks By Design Commercial |
$5.85
|
| Rate for Payer: Prime Health Services Commercial |
$7.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.65
|
| Rate for Payer: Vantage Medical Group Senior |
$7.65
|
|
|
METHACHOLINE 0 MG TO 48 MG/3 ML (0 MG TO 16 MG/ML) NEBULIZATION SOLN [228989]
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
NDC 6937454206
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.78
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cigna of CA HMO |
$6.30
|
| Rate for Payer: Cigna of CA PPO |
$6.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3.60
|
| Rate for Payer: Galaxy Health WC |
$7.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: Networks By Design Commercial |
$5.85
|
| Rate for Payer: Prime Health Services Commercial |
$7.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.65
|
| Rate for Payer: Vantage Medical Group Senior |
$7.65
|
|
|
METHACHOLINE 0 MG TO 48 MG/3 ML (0 MG TO 16 MG/ML) NEBULIZATION SOLN [228989]
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
NDC 6428111006
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4.56
|
| Rate for Payer: Blue Shield of California Commercial |
$6.92
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cigna of CA HMO |
$6.30
|
| Rate for Payer: Cigna of CA PPO |
$6.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3.60
|
| Rate for Payer: Galaxy Health WC |
$7.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: Networks By Design Commercial |
$5.85
|
| Rate for Payer: Prime Health Services Commercial |
$7.65
|
|
|
METHACHOLINE 0 MG TO 48 MG/3 ML (0 MG TO 16 MG/ML) NEBULIZATION SOLN [228989]
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
NDC 6428111006
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.78
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cigna of CA HMO |
$6.30
|
| Rate for Payer: Cigna of CA PPO |
$6.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3.60
|
| Rate for Payer: Galaxy Health WC |
$7.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: Networks By Design Commercial |
$5.85
|
| Rate for Payer: Prime Health Services Commercial |
$7.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.65
|
| Rate for Payer: Vantage Medical Group Senior |
$7.65
|
|
|
METHACHOLINE 0 MG TO 48 MG/3 ML (0 MG TO 16 MG/ML) NEBULIZATION SOLN [228989]
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
NDC 6937454206
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4.56
|
| Rate for Payer: Blue Shield of California Commercial |
$6.92
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cigna of CA HMO |
$6.30
|
| Rate for Payer: Cigna of CA PPO |
$6.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3.60
|
| Rate for Payer: Galaxy Health WC |
$7.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: Networks By Design Commercial |
$5.85
|
| Rate for Payer: Prime Health Services Commercial |
$7.65
|
|
|
METHACHOLINE CHLORIDE 100 MG SOLUTION FOR INHALATION [27032]
|
Facility
|
IP
|
$109.20
|
|
|
Service Code
|
HCPCS J7674
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.84 |
| Max. Negotiated Rate |
$92.82 |
| Rate for Payer: Adventist Health Commercial |
$21.84
|
| Rate for Payer: Blue Shield of California Commercial |
$55.36
|
| Rate for Payer: Blue Shield of California Commercial |
$83.97
|
| Rate for Payer: Cash Price |
$49.14
|
| Rate for Payer: Cigna of CA HMO |
$76.44
|
| Rate for Payer: Cigna of CA PPO |
$76.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$76.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.68
|
| Rate for Payer: EPIC Health Plan Senior |
$43.68
|
| Rate for Payer: Galaxy Health WC |
$92.82
|
| Rate for Payer: Global Benefits Group Commercial |
$65.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.21
|
| Rate for Payer: Multiplan Commercial |
$87.36
|
| Rate for Payer: Networks By Design Commercial |
$54.60
|
| Rate for Payer: Prime Health Services Commercial |
$92.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.98
|
| Rate for Payer: United Healthcare All Other HMO |
$39.89
|
| Rate for Payer: United Healthcare HMO Rider |
$39.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.76
|
|
|
METHACHOLINE CHLORIDE 100 MG SOLUTION FOR INHALATION [27032]
|
Facility
|
OP
|
$109.20
|
|
|
Service Code
|
HCPCS J7674
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$92.82 |
| Rate for Payer: Adventist Health Commercial |
$21.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$92.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$81.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1.00
|
| Rate for Payer: Cash Price |
$49.14
|
| Rate for Payer: Cash Price |
$49.14
|
| Rate for Payer: Cigna of CA HMO |
$76.44
|
| Rate for Payer: Cigna of CA PPO |
$76.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$92.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$92.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$76.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.68
|
| Rate for Payer: EPIC Health Plan Senior |
$43.68
|
| Rate for Payer: Galaxy Health WC |
$92.82
|
| Rate for Payer: Global Benefits Group Commercial |
$65.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$76.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$76.44
|
| Rate for Payer: Multiplan Commercial |
$87.36
|
| Rate for Payer: Networks By Design Commercial |
$54.60
|
| Rate for Payer: Prime Health Services Commercial |
$92.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$65.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.98
|
| Rate for Payer: United Healthcare All Other HMO |
$39.89
|
| Rate for Payer: United Healthcare HMO Rider |
$39.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$92.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$92.82
|
| Rate for Payer: Vantage Medical Group Senior |
$92.82
|
|
|
METHADONE 10 MG/5 ML ORAL SOLUTION [4951]
|
Facility
|
OP
|
$0.13
|
|
|
Service Code
|
HCPCS S0109
|
| Hospital Charge Code |
901700032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$1.93 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.78
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.09
|
| Rate for Payer: Cigna of CA PPO |
$0.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.21
|
| 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 |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.11
|
| 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 |
$0.05
|
| 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 |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: Vantage Medical Group Senior |
$0.11
|
|
|
METHADONE 10 MG/5 ML ORAL SOLUTION [4951]
|
Facility
|
IP
|
$0.13
|
|
|
Service Code
|
HCPCS S0109
|
| Hospital Charge Code |
901700032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.11 |
| 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 |
$0.10
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.09
|
| Rate for Payer: Cigna of CA PPO |
$0.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.08
|
| 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 |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.11
|
| 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 |
$0.04
|
|
|
METHADONE 10 MG/ML INJECTION. [4081195]
|
Facility
|
OP
|
$21.60
|
|
|
Service Code
|
HCPCS J1230
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$131.52 |
| Rate for Payer: Galaxy Health WC |
$23.96
|
| Rate for Payer: Galaxy Health WC |
$18.36
|
| Rate for Payer: EPIC Health Plan Senior |
$8.64
|
| Rate for Payer: Adventist Health Commercial |
$4.32
|
| Rate for Payer: Adventist Health Commercial |
$5.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.32
|
| Rate for Payer: Blue Shield of California Commercial |
$25.65
|
| Rate for Payer: Blue Shield of California Commercial |
$25.65
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cash Price |
$12.69
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cash Price |
$12.69
|
| Rate for Payer: Cigna of CA HMO |
$19.73
|
| Rate for Payer: Cigna of CA HMO |
$15.12
|
| Rate for Payer: Cigna of CA PPO |
$19.73
|
| Rate for Payer: Cigna of CA PPO |
$15.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.28
|
| Rate for Payer: EPIC Health Plan Senior |
$11.28
|
| Rate for Payer: Global Benefits Group Commercial |
$16.91
|
| Rate for Payer: Global Benefits Group Commercial |
$12.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.73
|
| Rate for Payer: Multiplan Commercial |
$22.55
|
| Rate for Payer: Multiplan Commercial |
$17.28
|
| Rate for Payer: Networks By Design Commercial |
$14.10
|
| Rate for Payer: Networks By Design Commercial |
$10.80
|
| Rate for Payer: Prime Health Services Commercial |
$18.36
|
| Rate for Payer: Prime Health Services Commercial |
$23.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.58
|
| Rate for Payer: United Healthcare All Other HMO |
$7.89
|
| Rate for Payer: United Healthcare All Other HMO |
$10.30
|
| Rate for Payer: United Healthcare HMO Rider |
$10.08
|
| Rate for Payer: United Healthcare HMO Rider |
$7.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.96
|
| Rate for Payer: Vantage Medical Group Senior |
$18.36
|
| Rate for Payer: Vantage Medical Group Senior |
$23.96
|
|
|
METHADONE 10 MG/ML INJECTION. [4081195]
|
Facility
|
IP
|
$28.19
|
|
|
Service Code
|
HCPCS J1230
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.64 |
| Max. Negotiated Rate |
$23.96 |
| Rate for Payer: Adventist Health Commercial |
$5.64
|
| Rate for Payer: Adventist Health Commercial |
$4.32
|
| Rate for Payer: Blue Shield of California Commercial |
$16.61
|
| Rate for Payer: Blue Shield of California Commercial |
$14.29
|
| Rate for Payer: Blue Shield of California Commercial |
$21.68
|
| Rate for Payer: Blue Shield of California Commercial |
$10.95
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cash Price |
$12.69
|
| Rate for Payer: Cigna of CA HMO |
$19.73
|
| Rate for Payer: Cigna of CA HMO |
$15.12
|
| Rate for Payer: Cigna of CA PPO |
$15.12
|
| Rate for Payer: Cigna of CA PPO |
$19.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.28
|
| Rate for Payer: EPIC Health Plan Senior |
$8.64
|
| Rate for Payer: EPIC Health Plan Senior |
$11.28
|
| Rate for Payer: Galaxy Health WC |
$18.36
|
| Rate for Payer: Galaxy Health WC |
$23.96
|
| Rate for Payer: Global Benefits Group Commercial |
$16.91
|
| Rate for Payer: Global Benefits Group Commercial |
$12.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.77
|
| Rate for Payer: Multiplan Commercial |
$17.28
|
| Rate for Payer: Multiplan Commercial |
$22.55
|
| Rate for Payer: Networks By Design Commercial |
$14.10
|
| Rate for Payer: Networks By Design Commercial |
$10.80
|
| Rate for Payer: Prime Health Services Commercial |
$23.96
|
| Rate for Payer: Prime Health Services Commercial |
$18.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.58
|
| Rate for Payer: United Healthcare All Other HMO |
$10.30
|
| Rate for Payer: United Healthcare All Other HMO |
$7.89
|
| Rate for Payer: United Healthcare HMO Rider |
$7.72
|
| Rate for Payer: United Healthcare HMO Rider |
$10.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.23
|
|
|
METHADONE 10 MG/ML INJECTION SOLUTION [10546]
|
Facility
|
IP
|
$24.60
|
|
|
Service Code
|
HCPCS J1230
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.92 |
| Max. Negotiated Rate |
$20.91 |
| Rate for Payer: Adventist Health Commercial |
$4.92
|
| Rate for Payer: Adventist Health Commercial |
$5.13
|
| Rate for Payer: Adventist Health Commercial |
$5.64
|
| Rate for Payer: Blue Shield of California Commercial |
$19.72
|
| Rate for Payer: Blue Shield of California Commercial |
$12.47
|
| Rate for Payer: Blue Shield of California Commercial |
$18.92
|
| Rate for Payer: Blue Shield of California Commercial |
$21.68
|
| Rate for Payer: Blue Shield of California Commercial |
$14.29
|
| Rate for Payer: Blue Shield of California Commercial |
$13.00
|
| Rate for Payer: Cash Price |
$12.69
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cash Price |
$11.07
|
| Rate for Payer: Cigna of CA HMO |
$19.73
|
| Rate for Payer: Cigna of CA HMO |
$17.95
|
| Rate for Payer: Cigna of CA HMO |
$17.22
|
| Rate for Payer: Cigna of CA PPO |
$17.22
|
| Rate for Payer: Cigna of CA PPO |
$19.73
|
| Rate for Payer: Cigna of CA PPO |
$17.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.84
|
| Rate for Payer: EPIC Health Plan Senior |
$10.26
|
| Rate for Payer: EPIC Health Plan Senior |
$9.84
|
| Rate for Payer: EPIC Health Plan Senior |
$11.28
|
| Rate for Payer: Galaxy Health WC |
$23.96
|
| Rate for Payer: Galaxy Health WC |
$20.91
|
| Rate for Payer: Galaxy Health WC |
$21.80
|
| Rate for Payer: Global Benefits Group Commercial |
$15.39
|
| Rate for Payer: Global Benefits Group Commercial |
$14.76
|
| Rate for Payer: Global Benefits Group Commercial |
$16.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.77
|
| Rate for Payer: Multiplan Commercial |
$19.68
|
| Rate for Payer: Multiplan Commercial |
$20.52
|
| Rate for Payer: Multiplan Commercial |
$22.55
|
| Rate for Payer: Networks By Design Commercial |
$12.82
|
| Rate for Payer: Networks By Design Commercial |
$14.10
|
| Rate for Payer: Networks By Design Commercial |
$12.30
|
| Rate for Payer: Prime Health Services Commercial |
$20.91
|
| Rate for Payer: Prime Health Services Commercial |
$21.80
|
| Rate for Payer: Prime Health Services Commercial |
$23.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.58
|
| Rate for Payer: United Healthcare All Other HMO |
$10.30
|
| Rate for Payer: United Healthcare All Other HMO |
$8.99
|
| Rate for Payer: United Healthcare All Other HMO |
$9.37
|
| Rate for Payer: United Healthcare HMO Rider |
$9.17
|
| Rate for Payer: United Healthcare HMO Rider |
$10.08
|
| Rate for Payer: United Healthcare HMO Rider |
$8.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.40
|
|
|
METHADONE 10 MG/ML INJECTION SOLUTION [10546]
|
Facility
|
OP
|
$25.65
|
|
|
Service Code
|
HCPCS J1230
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$131.52 |
| Rate for Payer: Galaxy Health WC |
$23.96
|
| Rate for Payer: Galaxy Health WC |
$20.91
|
| Rate for Payer: Adventist Health Commercial |
$5.13
|
| Rate for Payer: Adventist Health Commercial |
$4.92
|
| Rate for Payer: Adventist Health Commercial |
$5.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.32
|
| Rate for Payer: Blue Shield of California Commercial |
$25.65
|
| Rate for Payer: Blue Shield of California Commercial |
$25.65
|
| Rate for Payer: Blue Shield of California Commercial |
$25.65
|
| Rate for Payer: Cash Price |
$12.69
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cash Price |
$11.07
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cash Price |
$12.69
|
| Rate for Payer: Cash Price |
$11.07
|
| Rate for Payer: Cigna of CA HMO |
$19.73
|
| Rate for Payer: Cigna of CA HMO |
$17.95
|
| Rate for Payer: Cigna of CA HMO |
$17.22
|
| Rate for Payer: Cigna of CA PPO |
$17.22
|
| Rate for Payer: Cigna of CA PPO |
$19.73
|
| Rate for Payer: Cigna of CA PPO |
$17.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.28
|
| Rate for Payer: EPIC Health Plan Senior |
$11.28
|
| Rate for Payer: EPIC Health Plan Senior |
$9.84
|
| Rate for Payer: EPIC Health Plan Senior |
$10.26
|
| Rate for Payer: Galaxy Health WC |
$21.80
|
| Rate for Payer: Global Benefits Group Commercial |
$15.39
|
| Rate for Payer: Global Benefits Group Commercial |
$14.76
|
| Rate for Payer: Global Benefits Group Commercial |
$16.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.95
|
| Rate for Payer: Multiplan Commercial |
$20.52
|
| Rate for Payer: Multiplan Commercial |
$22.55
|
| Rate for Payer: Multiplan Commercial |
$19.68
|
| Rate for Payer: Networks By Design Commercial |
$14.10
|
| Rate for Payer: Networks By Design Commercial |
$12.82
|
| Rate for Payer: Networks By Design Commercial |
$12.30
|
| Rate for Payer: Prime Health Services Commercial |
$23.96
|
| Rate for Payer: Prime Health Services Commercial |
$20.91
|
| Rate for Payer: Prime Health Services Commercial |
$21.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.23
|
| Rate for Payer: United Healthcare All Other HMO |
$10.30
|
| Rate for Payer: United Healthcare All Other HMO |
$9.37
|
| Rate for Payer: United Healthcare All Other HMO |
$8.99
|
| Rate for Payer: United Healthcare HMO Rider |
$8.79
|
| Rate for Payer: United Healthcare HMO Rider |
$10.08
|
| Rate for Payer: United Healthcare HMO Rider |
$9.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.96
|
| Rate for Payer: Vantage Medical Group Senior |
$20.91
|
| Rate for Payer: Vantage Medical Group Senior |
$23.96
|
| Rate for Payer: Vantage Medical Group Senior |
$21.80
|
|
|
METHADONE 10 MG/ML INTRAVENOUS SYRINGE [153564]
|
Facility
|
IP
|
$21.60
|
|
|
Service Code
|
HCPCS J1230
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.32 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Networks By Design Commercial |
$10.80
|
| Rate for Payer: Adventist Health Commercial |
$4.32
|
| Rate for Payer: Blue Shield of California Commercial |
$10.95
|
| Rate for Payer: Blue Shield of California Commercial |
$16.61
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cigna of CA HMO |
$15.12
|
| Rate for Payer: Cigna of CA PPO |
$15.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.64
|
| Rate for Payer: EPIC Health Plan Senior |
$8.64
|
| Rate for Payer: Galaxy Health WC |
$18.36
|
| Rate for Payer: Global Benefits Group Commercial |
$12.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.18
|
| Rate for Payer: Multiplan Commercial |
$17.28
|
| Rate for Payer: Prime Health Services Commercial |
$18.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.11
|
| Rate for Payer: United Healthcare All Other HMO |
$7.89
|
| Rate for Payer: United Healthcare HMO Rider |
$7.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.07
|
|
