|
METHYLCELLULOSE (BULK) 1 % GEL [82599]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 3877930608
|
| 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
|
|
|
METHYLCELLULOSE (BULK) 1 % GEL [82599]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 5155207027
|
| 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
|
|
|
METHYLCELLULOSE (BULK) 1 % GEL [82599]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 3877930608
|
| 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
|
|
|
METHYLDOPA 250 MG TABLET [4982]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 5107920001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
|
|
METHYLDOPA 250 MG TABLET [4982]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 5107920001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.17
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
|
|
METHYLDOPA ORAL SUSPENSION COMPOUND 50 MG/ML [4080300]
|
Facility
|
IP
|
$1.54
|
|
|
Service Code
|
NDC 9994080300
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.31 |
| Rate for Payer: Adventist Health Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California Commercial |
$0.78
|
| Rate for Payer: Blue Shield of California Commercial |
$1.18
|
| Rate for Payer: Cash Price |
$0.69
|
| Rate for Payer: Cigna of CA HMO |
$1.08
|
| Rate for Payer: Cigna of CA PPO |
$1.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.62
|
| Rate for Payer: EPIC Health Plan Senior |
$0.62
|
| Rate for Payer: Galaxy Health WC |
$1.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Multiplan Commercial |
$1.23
|
| Rate for Payer: Networks By Design Commercial |
$1.00
|
| Rate for Payer: Prime Health Services Commercial |
$1.31
|
|
|
METHYLDOPA ORAL SUSPENSION COMPOUND 50 MG/ML [4080300]
|
Facility
|
OP
|
$1.54
|
|
|
Service Code
|
NDC 9994080300
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.31 |
| Rate for Payer: Adventist Health Commercial |
$0.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.99
|
| Rate for Payer: Cash Price |
$0.69
|
| Rate for Payer: Cigna of CA HMO |
$1.08
|
| Rate for Payer: Cigna of CA PPO |
$1.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.62
|
| Rate for Payer: EPIC Health Plan Senior |
$0.62
|
| Rate for Payer: Galaxy Health WC |
$1.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.08
|
| Rate for Payer: Multiplan Commercial |
$1.23
|
| Rate for Payer: Networks By Design Commercial |
$1.00
|
| Rate for Payer: Prime Health Services Commercial |
$1.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.77
|
| Rate for Payer: United Healthcare All Other HMO |
$0.77
|
| Rate for Payer: United Healthcare HMO Rider |
$0.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.31
|
| Rate for Payer: Vantage Medical Group Senior |
$1.31
|
|
|
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) INTRAVENOUS SOLUTION [4985]
|
Facility
|
OP
|
$25.20
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$35.42 |
| Rate for Payer: Adventist Health Commercial |
$5.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.66
|
| Rate for Payer: Cash Price |
$11.34
|
| Rate for Payer: Cash Price |
$11.34
|
| Rate for Payer: Cigna of CA HMO |
$17.64
|
| Rate for Payer: Cigna of CA PPO |
$17.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.94
|
| Rate for Payer: EPIC Health Plan Senior |
$11.96
|
| Rate for Payer: Galaxy Health WC |
$21.42
|
| Rate for Payer: Global Benefits Group Commercial |
$15.12
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$17.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.57
|
| Rate for Payer: Multiplan Commercial |
$20.16
|
| Rate for Payer: Networks By Design Commercial |
$12.60
|
| Rate for Payer: Prime Health Services Commercial |
$21.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.46
|
| Rate for Payer: United Healthcare All Other HMO |
$9.21
|
| Rate for Payer: United Healthcare HMO Rider |
$9.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.25
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.96
|
| Rate for Payer: Vantage Medical Group Senior |
$11.96
|
|
|
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) INTRAVENOUS SOLUTION [4985]
|
Facility
|
IP
|
$25.20
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.04 |
| Max. Negotiated Rate |
$21.42 |
| Rate for Payer: Adventist Health Commercial |
$5.04
|
| Rate for Payer: Blue Shield of California Commercial |
$12.78
|
| Rate for Payer: Blue Shield of California Commercial |
$19.38
|
| Rate for Payer: Cash Price |
$11.34
|
| Rate for Payer: Cigna of CA HMO |
$17.64
|
| Rate for Payer: Cigna of CA PPO |
$17.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.08
|
| Rate for Payer: EPIC Health Plan Senior |
$10.08
|
| Rate for Payer: Galaxy Health WC |
$21.42
|
| Rate for Payer: Global Benefits Group Commercial |
$15.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.05
|
| Rate for Payer: Multiplan Commercial |
$20.16
|
| Rate for Payer: Networks By Design Commercial |
$12.60
|
| Rate for Payer: Prime Health Services Commercial |
$21.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.46
|
| Rate for Payer: United Healthcare All Other HMO |
$9.21
|
| Rate for Payer: United Healthcare HMO Rider |
$9.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.25
|
|
|
METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION [215473]
|
Facility
|
OP
|
$14.40
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$35.42 |
| Rate for Payer: Adventist Health Commercial |
$3.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.47
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Multiplan Commercial |
$11.52
|
| Rate for Payer: Networks By Design Commercial |
$8.10
|
| Rate for Payer: Networks By Design Commercial |
$14.06
|
| Rate for Payer: Networks By Design Commercial |
$7.20
|
| Rate for Payer: Adventist Health Commercial |
$2.88
|
| Rate for Payer: Adventist Health Commercial |
$5.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.66
|
| Rate for Payer: Cash Price |
$12.66
|
| Rate for Payer: Cash Price |
$7.29
|
| Rate for Payer: Cash Price |
$7.29
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Cash Price |
$12.66
|
| Rate for Payer: Cigna of CA HMO |
$19.69
|
| Rate for Payer: Cigna of CA HMO |
$11.34
|
| Rate for Payer: Cigna of CA HMO |
$10.08
|
| Rate for Payer: Cigna of CA PPO |
$11.34
|
| Rate for Payer: Cigna of CA PPO |
$10.08
|
| Rate for Payer: Cigna of CA PPO |
$19.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.94
|
| Rate for Payer: EPIC Health Plan Senior |
$11.96
|
| Rate for Payer: EPIC Health Plan Senior |
$11.96
|
| Rate for Payer: EPIC Health Plan Senior |
$11.96
|
| Rate for Payer: Galaxy Health WC |
$13.77
|
| Rate for Payer: Galaxy Health WC |
$23.91
|
| Rate for Payer: Galaxy Health WC |
$12.24
|
| Rate for Payer: Global Benefits Group Commercial |
$8.64
|
| Rate for Payer: Global Benefits Group Commercial |
$16.88
|
| Rate for Payer: Global Benefits Group Commercial |
$9.72
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$17.83
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$17.83
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$17.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.57
|
| Rate for Payer: Multiplan Commercial |
$12.96
|
| Rate for Payer: Prime Health Services Commercial |
$12.24
|
| Rate for Payer: Prime Health Services Commercial |
$13.77
|
| Rate for Payer: Prime Health Services Commercial |
$23.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.08
|
| Rate for Payer: United Healthcare All Other HMO |
$5.26
|
| Rate for Payer: United Healthcare All Other HMO |
$5.92
|
| Rate for Payer: United Healthcare All Other HMO |
$10.28
|
| Rate for Payer: United Healthcare HMO Rider |
$5.15
|
| Rate for Payer: United Healthcare HMO Rider |
$5.79
|
| Rate for Payer: United Healthcare HMO Rider |
$10.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.31
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.87
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.87
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.96
|
| Rate for Payer: Vantage Medical Group Senior |
$11.96
|
| Rate for Payer: Vantage Medical Group Senior |
$11.96
|
| Rate for Payer: Vantage Medical Group Senior |
$11.96
|
|
|
METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION [215473]
|
Facility
|
IP
|
$14.40
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$12.24 |
| Rate for Payer: Adventist Health Commercial |
$2.88
|
| Rate for Payer: Adventist Health Commercial |
$3.24
|
| Rate for Payer: Adventist Health Commercial |
$5.63
|
| Rate for Payer: Blue Shield of California Commercial |
$8.21
|
| Rate for Payer: Blue Shield of California Commercial |
$11.07
|
| Rate for Payer: Blue Shield of California Commercial |
$7.30
|
| Rate for Payer: Blue Shield of California Commercial |
$21.63
|
| Rate for Payer: Blue Shield of California Commercial |
$14.26
|
| Rate for Payer: Blue Shield of California Commercial |
$12.46
|
| Rate for Payer: Cash Price |
$12.66
|
| Rate for Payer: Cash Price |
$7.29
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Cigna of CA HMO |
$19.69
|
| Rate for Payer: Cigna of CA HMO |
$11.34
|
| Rate for Payer: Cigna of CA HMO |
$10.08
|
| Rate for Payer: Cigna of CA PPO |
$10.08
|
| Rate for Payer: Cigna of CA PPO |
$19.69
|
| Rate for Payer: Cigna of CA PPO |
$11.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Senior |
$6.48
|
| Rate for Payer: EPIC Health Plan Senior |
$5.76
|
| Rate for Payer: EPIC Health Plan Senior |
$11.25
|
| Rate for Payer: Galaxy Health WC |
$23.91
|
| Rate for Payer: Galaxy Health WC |
$12.24
|
| Rate for Payer: Galaxy Health WC |
$13.77
|
| Rate for Payer: Global Benefits Group Commercial |
$9.72
|
| Rate for Payer: Global Benefits Group Commercial |
$8.64
|
| Rate for Payer: Global Benefits Group Commercial |
$16.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.75
|
| Rate for Payer: Multiplan Commercial |
$11.52
|
| Rate for Payer: Multiplan Commercial |
$12.96
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$8.10
|
| Rate for Payer: Networks By Design Commercial |
$14.06
|
| Rate for Payer: Networks By Design Commercial |
$7.20
|
| Rate for Payer: Prime Health Services Commercial |
$12.24
|
| Rate for Payer: Prime Health Services Commercial |
$13.77
|
| Rate for Payer: Prime Health Services Commercial |
$23.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.56
|
| Rate for Payer: United Healthcare All Other HMO |
$10.28
|
| Rate for Payer: United Healthcare All Other HMO |
$5.26
|
| Rate for Payer: United Healthcare All Other HMO |
$5.92
|
| Rate for Payer: United Healthcare HMO Rider |
$5.79
|
| Rate for Payer: United Healthcare HMO Rider |
$10.05
|
| Rate for Payer: United Healthcare HMO Rider |
$5.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.31
|
|
|
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION [10571]
|
Facility
|
IP
|
$38.11
|
|
|
Service Code
|
HCPCS J2210
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.62 |
| Max. Negotiated Rate |
$32.39 |
| Rate for Payer: Adventist Health Commercial |
$7.62
|
| Rate for Payer: Adventist Health Commercial |
$4.74
|
| Rate for Payer: Blue Shield of California Commercial |
$18.23
|
| Rate for Payer: Blue Shield of California Commercial |
$19.32
|
| Rate for Payer: Blue Shield of California Commercial |
$29.31
|
| Rate for Payer: Blue Shield of California Commercial |
$12.02
|
| Rate for Payer: Cash Price |
$10.67
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: Cigna of CA HMO |
$26.68
|
| Rate for Payer: Cigna of CA HMO |
$16.60
|
| Rate for Payer: Cigna of CA PPO |
$16.60
|
| Rate for Payer: Cigna of CA PPO |
$26.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.24
|
| Rate for Payer: EPIC Health Plan Senior |
$9.48
|
| Rate for Payer: EPIC Health Plan Senior |
$15.24
|
| Rate for Payer: Galaxy Health WC |
$20.15
|
| Rate for Payer: Galaxy Health WC |
$32.39
|
| Rate for Payer: Global Benefits Group Commercial |
$22.87
|
| Rate for Payer: Global Benefits Group Commercial |
$14.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.15
|
| Rate for Payer: Multiplan Commercial |
$18.97
|
| Rate for Payer: Multiplan Commercial |
$30.49
|
| Rate for Payer: Networks By Design Commercial |
$19.05
|
| Rate for Payer: Networks By Design Commercial |
$11.86
|
| Rate for Payer: Prime Health Services Commercial |
$32.39
|
| Rate for Payer: Prime Health Services Commercial |
$20.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.30
|
| Rate for Payer: United Healthcare All Other HMO |
$13.92
|
| Rate for Payer: United Healthcare All Other HMO |
$8.66
|
| Rate for Payer: United Healthcare HMO Rider |
$8.47
|
| Rate for Payer: United Healthcare HMO Rider |
$13.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.48
|
|
|
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION [10571]
|
Facility
|
OP
|
$23.71
|
|
|
Service Code
|
HCPCS J2210
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.74 |
| Max. Negotiated Rate |
$133.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$133.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$133.88
|
| Rate for Payer: Adventist Health Commercial |
$4.74
|
| Rate for Payer: Adventist Health Commercial |
$7.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.78
|
| Rate for Payer: Blue Shield of California Commercial |
$23.71
|
| Rate for Payer: Blue Shield of California Commercial |
$23.71
|
| Rate for Payer: Cash Price |
$10.67
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: Cash Price |
$10.67
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: Cigna of CA HMO |
$26.68
|
| Rate for Payer: Cigna of CA HMO |
$16.60
|
| Rate for Payer: Cigna of CA PPO |
$26.68
|
| Rate for Payer: Cigna of CA PPO |
$16.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.24
|
| Rate for Payer: EPIC Health Plan Senior |
$15.24
|
| Rate for Payer: EPIC Health Plan Senior |
$9.48
|
| Rate for Payer: Galaxy Health WC |
$32.39
|
| Rate for Payer: Galaxy Health WC |
$20.15
|
| Rate for Payer: Global Benefits Group Commercial |
$22.87
|
| Rate for Payer: Global Benefits Group Commercial |
$14.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.68
|
| Rate for Payer: Multiplan Commercial |
$30.49
|
| Rate for Payer: Multiplan Commercial |
$18.97
|
| Rate for Payer: Networks By Design Commercial |
$19.05
|
| Rate for Payer: Networks By Design Commercial |
$11.86
|
| Rate for Payer: Prime Health Services Commercial |
$20.15
|
| Rate for Payer: Prime Health Services Commercial |
$32.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.30
|
| Rate for Payer: United Healthcare All Other HMO |
$8.66
|
| Rate for Payer: United Healthcare All Other HMO |
$13.92
|
| Rate for Payer: United Healthcare HMO Rider |
$13.62
|
| Rate for Payer: United Healthcare HMO Rider |
$8.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.39
|
| Rate for Payer: Vantage Medical Group Senior |
$20.15
|
| Rate for Payer: Vantage Medical Group Senior |
$32.39
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
|
IP
|
$19.80
|
|
|
Service Code
|
NDC 6923816052
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$16.83 |
| Rate for Payer: Adventist Health Commercial |
$3.96
|
| Rate for Payer: Blue Shield of California Commercial |
$10.04
|
| Rate for Payer: Blue Shield of California Commercial |
$15.23
|
| Rate for Payer: Cash Price |
$8.91
|
| Rate for Payer: Cigna of CA HMO |
$13.86
|
| Rate for Payer: Cigna of CA PPO |
$13.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.92
|
| Rate for Payer: EPIC Health Plan Senior |
$7.92
|
| Rate for Payer: Galaxy Health WC |
$16.83
|
| Rate for Payer: Global Benefits Group Commercial |
$11.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.75
|
| Rate for Payer: Multiplan Commercial |
$15.84
|
| Rate for Payer: Networks By Design Commercial |
$12.87
|
| Rate for Payer: Prime Health Services Commercial |
$16.83
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
|
OP
|
$16.83
|
|
|
Service Code
|
NDC 7001078612
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$14.31 |
| Rate for Payer: Adventist Health Commercial |
$3.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.80
|
| Rate for Payer: Cash Price |
$7.57
|
| Rate for Payer: Cigna of CA HMO |
$11.78
|
| Rate for Payer: Cigna of CA PPO |
$11.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.73
|
| Rate for Payer: EPIC Health Plan Senior |
$6.73
|
| Rate for Payer: Galaxy Health WC |
$14.31
|
| Rate for Payer: Global Benefits Group Commercial |
$10.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.78
|
| Rate for Payer: Multiplan Commercial |
$13.46
|
| Rate for Payer: Networks By Design Commercial |
$10.94
|
| Rate for Payer: Prime Health Services Commercial |
$14.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.41
|
| Rate for Payer: United Healthcare All Other HMO |
$8.41
|
| Rate for Payer: United Healthcare HMO Rider |
$8.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Vantage Medical Group Senior |
$14.31
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
|
OP
|
$19.80
|
|
|
Service Code
|
NDC 6923816052
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$16.83 |
| Rate for Payer: Adventist Health Commercial |
$3.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.71
|
| Rate for Payer: Cash Price |
$8.91
|
| Rate for Payer: Cigna of CA HMO |
$13.86
|
| Rate for Payer: Cigna of CA PPO |
$13.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.92
|
| Rate for Payer: EPIC Health Plan Senior |
$7.92
|
| Rate for Payer: Galaxy Health WC |
$16.83
|
| Rate for Payer: Global Benefits Group Commercial |
$11.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.86
|
| Rate for Payer: Multiplan Commercial |
$15.84
|
| Rate for Payer: Networks By Design Commercial |
$12.87
|
| Rate for Payer: Prime Health Services Commercial |
$16.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.90
|
| Rate for Payer: United Healthcare All Other HMO |
$9.90
|
| Rate for Payer: United Healthcare HMO Rider |
$9.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.83
|
| Rate for Payer: Vantage Medical Group Senior |
$16.83
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
|
IP
|
$19.80
|
|
|
Service Code
|
NDC 6923816058
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$16.83 |
| Rate for Payer: Adventist Health Commercial |
$3.96
|
| Rate for Payer: Blue Shield of California Commercial |
$10.04
|
| Rate for Payer: Blue Shield of California Commercial |
$15.23
|
| Rate for Payer: Cash Price |
$8.91
|
| Rate for Payer: Cigna of CA HMO |
$13.86
|
| Rate for Payer: Cigna of CA PPO |
$13.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.92
|
| Rate for Payer: EPIC Health Plan Senior |
$7.92
|
| Rate for Payer: Galaxy Health WC |
$16.83
|
| Rate for Payer: Global Benefits Group Commercial |
$11.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.75
|
| Rate for Payer: Multiplan Commercial |
$15.84
|
| Rate for Payer: Networks By Design Commercial |
$12.87
|
| Rate for Payer: Prime Health Services Commercial |
$16.83
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
|
IP
|
$23.83
|
|
|
Service Code
|
NDC 0093365528
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.77 |
| Max. Negotiated Rate |
$20.26 |
| Rate for Payer: Adventist Health Commercial |
$4.77
|
| Rate for Payer: Blue Shield of California Commercial |
$12.08
|
| Rate for Payer: Blue Shield of California Commercial |
$18.33
|
| Rate for Payer: Cash Price |
$10.72
|
| Rate for Payer: Cigna of CA HMO |
$16.68
|
| Rate for Payer: Cigna of CA PPO |
$16.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.53
|
| Rate for Payer: EPIC Health Plan Senior |
$9.53
|
| Rate for Payer: Galaxy Health WC |
$20.26
|
| Rate for Payer: Global Benefits Group Commercial |
$14.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$19.06
|
| Rate for Payer: Networks By Design Commercial |
$15.49
|
| Rate for Payer: Prime Health Services Commercial |
$20.26
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
|
IP
|
$16.83
|
|
|
Service Code
|
NDC 7001078612
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$14.31 |
| Rate for Payer: Adventist Health Commercial |
$3.37
|
| Rate for Payer: Blue Shield of California Commercial |
$12.94
|
| Rate for Payer: Blue Shield of California Commercial |
$8.53
|
| Rate for Payer: Cash Price |
$7.57
|
| Rate for Payer: Cigna of CA HMO |
$11.78
|
| Rate for Payer: Cigna of CA PPO |
$11.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.73
|
| Rate for Payer: EPIC Health Plan Senior |
$6.73
|
| Rate for Payer: Galaxy Health WC |
$14.31
|
| Rate for Payer: Global Benefits Group Commercial |
$10.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.04
|
| Rate for Payer: Multiplan Commercial |
$13.46
|
| Rate for Payer: Networks By Design Commercial |
$10.94
|
| Rate for Payer: Prime Health Services Commercial |
$14.31
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
|
OP
|
$19.80
|
|
|
Service Code
|
NDC 6923816058
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$16.83 |
| Rate for Payer: Adventist Health Commercial |
$3.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.71
|
| Rate for Payer: Cash Price |
$8.91
|
| Rate for Payer: Cigna of CA HMO |
$13.86
|
| Rate for Payer: Cigna of CA PPO |
$13.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.92
|
| Rate for Payer: EPIC Health Plan Senior |
$7.92
|
| Rate for Payer: Galaxy Health WC |
$16.83
|
| Rate for Payer: Global Benefits Group Commercial |
$11.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.86
|
| Rate for Payer: Multiplan Commercial |
$15.84
|
| Rate for Payer: Networks By Design Commercial |
$12.87
|
| Rate for Payer: Prime Health Services Commercial |
$16.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.90
|
| Rate for Payer: United Healthcare All Other HMO |
$9.90
|
| Rate for Payer: United Healthcare HMO Rider |
$9.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.83
|
| Rate for Payer: Vantage Medical Group Senior |
$16.83
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
|
OP
|
$23.83
|
|
|
Service Code
|
NDC 0093365528
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.77 |
| Max. Negotiated Rate |
$20.26 |
| Rate for Payer: Adventist Health Commercial |
$4.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.29
|
| Rate for Payer: Cash Price |
$10.72
|
| Rate for Payer: Cigna of CA HMO |
$16.68
|
| Rate for Payer: Cigna of CA PPO |
$16.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.53
|
| Rate for Payer: EPIC Health Plan Senior |
$9.53
|
| Rate for Payer: Galaxy Health WC |
$20.26
|
| Rate for Payer: Global Benefits Group Commercial |
$14.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.68
|
| Rate for Payer: Multiplan Commercial |
$19.06
|
| Rate for Payer: Networks By Design Commercial |
$15.49
|
| Rate for Payer: Prime Health Services Commercial |
$20.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.91
|
| Rate for Payer: United Healthcare All Other HMO |
$11.91
|
| Rate for Payer: United Healthcare HMO Rider |
$11.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.26
|
| Rate for Payer: Vantage Medical Group Senior |
$20.26
|
|
|
METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SYRINGE [154475]
|
Facility
|
OP
|
$373.50
|
|
|
Service Code
|
HCPCS J2212
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$317.48 |
| Rate for Payer: Adventist Health Commercial |
$74.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$317.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$205.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$280.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.99
|
| Rate for Payer: Blue Shield of California Commercial |
$1.60
|
| Rate for Payer: Cash Price |
$168.08
|
| Rate for Payer: Cash Price |
$168.08
|
| Rate for Payer: Cigna of CA HMO |
$261.45
|
| Rate for Payer: Cigna of CA PPO |
$261.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$317.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$317.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$261.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.40
|
| Rate for Payer: EPIC Health Plan Senior |
$149.40
|
| Rate for Payer: Galaxy Health WC |
$317.48
|
| Rate for Payer: Global Benefits Group Commercial |
$224.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$237.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$135.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$220.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$261.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.45
|
| Rate for Payer: Multiplan Commercial |
$298.80
|
| Rate for Payer: Networks By Design Commercial |
$186.75
|
| Rate for Payer: Prime Health Services Commercial |
$317.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$224.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$224.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.17
|
| Rate for Payer: United Healthcare All Other HMO |
$136.44
|
| Rate for Payer: United Healthcare HMO Rider |
$133.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$122.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$317.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$317.48
|
| Rate for Payer: Vantage Medical Group Senior |
$317.48
|
|
|
METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SYRINGE [154475]
|
Facility
|
IP
|
$373.50
|
|
|
Service Code
|
HCPCS J2212
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.70 |
| Max. Negotiated Rate |
$317.48 |
| Rate for Payer: Cigna of CA PPO |
$261.45
|
| Rate for Payer: Adventist Health Commercial |
$74.70
|
| Rate for Payer: Blue Shield of California Commercial |
$189.36
|
| Rate for Payer: Blue Shield of California Commercial |
$287.22
|
| Rate for Payer: Cash Price |
$168.08
|
| Rate for Payer: Cigna of CA HMO |
$261.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$261.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.40
|
| Rate for Payer: EPIC Health Plan Senior |
$149.40
|
| Rate for Payer: Galaxy Health WC |
$317.48
|
| Rate for Payer: Global Benefits Group Commercial |
$224.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$237.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$220.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.64
|
| Rate for Payer: Multiplan Commercial |
$298.80
|
| Rate for Payer: Networks By Design Commercial |
$186.75
|
| Rate for Payer: Prime Health Services Commercial |
$317.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.17
|
| Rate for Payer: United Healthcare All Other HMO |
$136.44
|
| Rate for Payer: United Healthcare HMO Rider |
$133.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$122.32
|
|
|
METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS WRAP [40891651]
|
Facility
|
IP
|
$373.50
|
|
|
Service Code
|
HCPCS J2212
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.70 |
| Max. Negotiated Rate |
$317.48 |
| Rate for Payer: Adventist Health Commercial |
$74.70
|
| Rate for Payer: Blue Shield of California Commercial |
$189.36
|
| Rate for Payer: Blue Shield of California Commercial |
$287.22
|
| Rate for Payer: Cash Price |
$168.08
|
| Rate for Payer: Cigna of CA HMO |
$261.45
|
| Rate for Payer: Cigna of CA PPO |
$261.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$261.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.40
|
| Rate for Payer: EPIC Health Plan Senior |
$149.40
|
| Rate for Payer: Galaxy Health WC |
$317.48
|
| Rate for Payer: Global Benefits Group Commercial |
$224.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$237.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$220.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.64
|
| Rate for Payer: Multiplan Commercial |
$298.80
|
| Rate for Payer: Networks By Design Commercial |
$186.75
|
| Rate for Payer: Prime Health Services Commercial |
$317.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.17
|
| Rate for Payer: United Healthcare All Other HMO |
$136.44
|
| Rate for Payer: United Healthcare HMO Rider |
$133.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$122.32
|
|
|
METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS WRAP [40891651]
|
Facility
|
OP
|
$373.50
|
|
|
Service Code
|
HCPCS J2212
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$317.48 |
| Rate for Payer: Adventist Health Commercial |
$74.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$317.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$205.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$280.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.99
|
| Rate for Payer: Blue Shield of California Commercial |
$1.60
|
| Rate for Payer: Cash Price |
$168.08
|
| Rate for Payer: Cash Price |
$168.08
|
| Rate for Payer: Cigna of CA HMO |
$261.45
|
| Rate for Payer: Cigna of CA PPO |
$261.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$317.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$317.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$261.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.40
|
| Rate for Payer: EPIC Health Plan Senior |
$149.40
|
| Rate for Payer: Galaxy Health WC |
$317.48
|
| Rate for Payer: Global Benefits Group Commercial |
$224.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$237.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$135.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$220.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$261.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.45
|
| Rate for Payer: Multiplan Commercial |
$298.80
|
| Rate for Payer: Networks By Design Commercial |
$186.75
|
| Rate for Payer: Prime Health Services Commercial |
$317.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$224.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$224.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.17
|
| Rate for Payer: United Healthcare All Other HMO |
$136.44
|
| Rate for Payer: United Healthcare HMO Rider |
$133.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$122.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$317.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$317.48
|
| Rate for Payer: Vantage Medical Group Senior |
$317.48
|
|
