|
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) INTRAVENOUS SOLUTION [4985]
|
Facility
|
OP
|
$25.20
|
|
|
Service Code
|
CPT Q9968
|
| Hospital Charge Code |
1720296
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$121.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$121.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.55
|
| Rate for Payer: Blue Distinction Transplant |
$15.12
|
| Rate for Payer: Blue Shield of California Commercial |
$18.57
|
| Rate for Payer: Blue Shield of California EPN |
$14.72
|
| 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 |
$11.92
|
| Rate for Payer: Dignity Health Media |
$7.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.73
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.95
|
| Rate for Payer: Galaxy Health WC |
$21.42
|
| Rate for Payer: Global Benefits Group Commercial |
$15.12
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$18.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.04
|
| Rate for Payer: Heritage Provider Network Transplant |
$13.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$12.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.65
|
| 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 |
$12.60
|
| Rate for Payer: United Healthcare All Other HMO |
$12.60
|
| Rate for Payer: United Healthcare HMO Rider |
$12.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.74
|
| Rate for Payer: Vantage Medical Group Senior |
$7.95
|
|
|
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) INTRAVENOUS SOLUTION [4985]
|
Facility
|
IP
|
$25.20
|
|
|
Service Code
|
CPT Q9968
|
| Hospital Charge Code |
1720296
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$21.42 |
| Rate for Payer: Blue Shield of California Commercial |
$17.94
|
| Rate for Payer: Blue Shield of California EPN |
$12.90
|
| 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: EPIC Health Plan Commercial |
$10.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.08
|
| Rate for Payer: Galaxy Health WC |
$21.42
|
| Rate for Payer: Global Benefits Group Commercial |
$15.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.60
|
| 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 |
$9.52
|
| Rate for Payer: United Healthcare All Other HMO |
$9.29
|
| Rate for Payer: United Healthcare HMO Rider |
$9.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.32
|
|
|
METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION [215473]
|
Facility
|
OP
|
$28.13
|
|
|
Service Code
|
CPT Q9968
|
| Hospital Charge Code |
NDG215473
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$121.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$121.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$121.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.55
|
| Rate for Payer: Blue Distinction Transplant |
$18.75
|
| Rate for Payer: Blue Distinction Transplant |
$16.88
|
| Rate for Payer: Blue Shield of California Commercial |
$23.03
|
| Rate for Payer: Blue Shield of California Commercial |
$20.73
|
| Rate for Payer: Blue Shield of California EPN |
$16.43
|
| Rate for Payer: Blue Shield of California EPN |
$18.25
|
| Rate for Payer: Cash Price |
$14.06
|
| Rate for Payer: Cash Price |
$12.66
|
| Rate for Payer: Cash Price |
$14.06
|
| Rate for Payer: Cash Price |
$12.66
|
| Rate for Payer: Cigna of CA HMO |
$19.69
|
| Rate for Payer: Cigna of CA HMO |
$21.88
|
| Rate for Payer: Cigna of CA PPO |
$21.88
|
| Rate for Payer: Cigna of CA PPO |
$19.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.92
|
| Rate for Payer: Dignity Health Media |
$7.95
|
| Rate for Payer: Dignity Health Media |
$7.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.73
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7.95
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.95
|
| Rate for Payer: Galaxy Health WC |
$23.91
|
| Rate for Payer: Galaxy Health WC |
$26.56
|
| Rate for Payer: Global Benefits Group Commercial |
$18.75
|
| Rate for Payer: Global Benefits Group Commercial |
$16.88
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$23.44
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$21.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.04
|
| Rate for Payer: Heritage Provider Network Transplant |
$13.04
|
| Rate for Payer: Heritage Provider Network Transplant |
$13.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$12.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$12.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.65
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Multiplan Commercial |
$25.00
|
| Rate for Payer: Networks By Design Commercial |
$15.62
|
| Rate for Payer: Networks By Design Commercial |
$14.06
|
| Rate for Payer: Prime Health Services Commercial |
$26.56
|
| 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 |
$18.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.06
|
| Rate for Payer: United Healthcare All Other HMO |
$14.06
|
| Rate for Payer: United Healthcare All Other HMO |
$15.62
|
| Rate for Payer: United Healthcare HMO Rider |
$14.06
|
| Rate for Payer: United Healthcare HMO Rider |
$15.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.74
|
| Rate for Payer: Vantage Medical Group Senior |
$7.95
|
| Rate for Payer: Vantage Medical Group Senior |
$7.95
|
|
|
METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION [215473]
|
Facility
|
IP
|
$28.13
|
|
|
Service Code
|
CPT Q9968
|
| Hospital Charge Code |
NDG215473
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$23.91 |
| Rate for Payer: Blue Shield of California Commercial |
$20.03
|
| Rate for Payer: Blue Shield of California Commercial |
$22.25
|
| Rate for Payer: Blue Shield of California EPN |
$14.40
|
| Rate for Payer: Blue Shield of California EPN |
$16.00
|
| Rate for Payer: Cash Price |
$12.66
|
| Rate for Payer: Cash Price |
$14.06
|
| Rate for Payer: Cigna of CA HMO |
$19.69
|
| Rate for Payer: Cigna of CA HMO |
$21.88
|
| Rate for Payer: Cigna of CA PPO |
$21.88
|
| Rate for Payer: Cigna of CA PPO |
$19.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.50
|
| Rate for Payer: Galaxy Health WC |
$23.91
|
| Rate for Payer: Galaxy Health WC |
$26.56
|
| Rate for Payer: Global Benefits Group Commercial |
$18.75
|
| Rate for Payer: Global Benefits Group Commercial |
$16.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Multiplan Commercial |
$25.00
|
| Rate for Payer: Networks By Design Commercial |
$14.06
|
| Rate for Payer: Networks By Design Commercial |
$15.62
|
| Rate for Payer: Prime Health Services Commercial |
$23.91
|
| Rate for Payer: Prime Health Services Commercial |
$26.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.80
|
| Rate for Payer: United Healthcare All Other HMO |
$10.37
|
| Rate for Payer: United Healthcare All Other HMO |
$11.52
|
| Rate for Payer: United Healthcare HMO Rider |
$10.15
|
| Rate for Payer: United Healthcare HMO Rider |
$11.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.31
|
|
|
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION [10571]
|
Facility
|
IP
|
$23.71
|
|
|
Service Code
|
CPT J2210
|
| Hospital Charge Code |
1720284
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.69 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Blue Shield of California Commercial |
$16.88
|
| Rate for Payer: Blue Shield of California Commercial |
$25.06
|
| Rate for Payer: Blue Shield of California EPN |
$12.14
|
| Rate for Payer: Blue Shield of California EPN |
$18.02
|
| Rate for Payer: Cash Price |
$10.67
|
| Rate for Payer: Cash Price |
$15.84
|
| Rate for Payer: Cigna of CA HMO |
$16.60
|
| Rate for Payer: Cigna of CA HMO |
$24.64
|
| Rate for Payer: Cigna of CA PPO |
$24.64
|
| Rate for Payer: Cigna of CA PPO |
$16.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.08
|
| Rate for Payer: Galaxy Health WC |
$20.15
|
| Rate for Payer: Galaxy Health WC |
$29.92
|
| Rate for Payer: Global Benefits Group Commercial |
$21.12
|
| Rate for Payer: Global Benefits Group Commercial |
$14.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.45
|
| Rate for Payer: Multiplan Commercial |
$18.97
|
| Rate for Payer: Multiplan Commercial |
$28.16
|
| Rate for Payer: Networks By Design Commercial |
$11.86
|
| Rate for Payer: Networks By Design Commercial |
$17.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.15
|
| Rate for Payer: Prime Health Services Commercial |
$29.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.29
|
| Rate for Payer: United Healthcare All Other HMO |
$8.74
|
| Rate for Payer: United Healthcare All Other HMO |
$12.98
|
| Rate for Payer: United Healthcare HMO Rider |
$8.55
|
| Rate for Payer: United Healthcare HMO Rider |
$12.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.62
|
|
|
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION [10571]
|
Facility
|
OP
|
$23.71
|
|
|
Service Code
|
CPT J2210
|
| Hospital Charge Code |
1720284
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.69 |
| Max. Negotiated Rate |
$123.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$123.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$123.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.32
|
| Rate for Payer: Blue Distinction Transplant |
$14.23
|
| Rate for Payer: Blue Distinction Transplant |
$21.12
|
| Rate for Payer: Blue Shield of California Commercial |
$17.47
|
| Rate for Payer: Blue Shield of California Commercial |
$25.94
|
| Rate for Payer: Blue Shield of California EPN |
$23.71
|
| Rate for Payer: Blue Shield of California EPN |
$23.71
|
| Rate for Payer: Cash Price |
$15.84
|
| Rate for Payer: Cash Price |
$15.84
|
| Rate for Payer: Cash Price |
$10.67
|
| Rate for Payer: Cash Price |
$10.67
|
| Rate for Payer: Cigna of CA HMO |
$16.60
|
| Rate for Payer: Cigna of CA HMO |
$24.64
|
| Rate for Payer: Cigna of CA PPO |
$16.60
|
| Rate for Payer: Cigna of CA PPO |
$24.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.15
|
| Rate for Payer: Dignity Health Media |
$29.92
|
| Rate for Payer: Dignity Health Media |
$20.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.08
|
| Rate for Payer: Galaxy Health WC |
$20.15
|
| Rate for Payer: Galaxy Health WC |
$29.92
|
| Rate for Payer: Global Benefits Group Commercial |
$21.12
|
| Rate for Payer: Global Benefits Group Commercial |
$14.23
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$26.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$17.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.69
|
| Rate for Payer: Multiplan Commercial |
$28.16
|
| Rate for Payer: Multiplan Commercial |
$18.97
|
| Rate for Payer: Networks By Design Commercial |
$11.86
|
| Rate for Payer: Networks By Design Commercial |
$17.60
|
| Rate for Payer: Prime Health Services Commercial |
$29.92
|
| Rate for Payer: Prime Health Services Commercial |
$20.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.60
|
| Rate for Payer: United Healthcare All Other HMO |
$17.60
|
| Rate for Payer: United Healthcare All Other HMO |
$11.86
|
| Rate for Payer: United Healthcare HMO Rider |
$17.60
|
| Rate for Payer: United Healthcare HMO Rider |
$11.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.92
|
| Rate for Payer: Vantage Medical Group Senior |
$29.92
|
| Rate for Payer: Vantage Medical Group Senior |
$20.15
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
|
IP
|
$19.80
|
|
|
Service Code
|
NDC 69238-1605-8
|
| Hospital Charge Code |
1710513
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$16.83 |
| Rate for Payer: Blue Shield of California Commercial |
$14.10
|
| Rate for Payer: Blue Shield of California EPN |
$10.14
|
| 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: EPIC Health Plan Commercial |
$7.92
|
| Rate for Payer: Galaxy Health WC |
$16.83
|
| Rate for Payer: Global Benefits Group Commercial |
$11.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.54
|
| Rate for Payer: 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
|
$19.80
|
|
|
Service Code
|
NDC 69238-1605-8
|
| Hospital Charge Code |
1710513
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$16.83 |
| 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 |
$10.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.80
|
| Rate for Payer: Blue Distinction Transplant |
$11.88
|
| Rate for Payer: Blue Shield of California Commercial |
$14.59
|
| Rate for Payer: Blue Shield of California EPN |
$11.56
|
| 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 Media |
$16.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.92
|
| Rate for Payer: Galaxy Health WC |
$16.83
|
| Rate for Payer: Global Benefits Group Commercial |
$11.88
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$14.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.54
|
| Rate for Payer: 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
|
| 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
|
$74.66
|
|
|
Service Code
|
NDC 27437-050-56
|
| Hospital Charge Code |
1710513
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$63.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$48.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.48
|
| Rate for Payer: Blue Distinction Transplant |
$44.80
|
| Rate for Payer: Blue Shield of California Commercial |
$55.02
|
| Rate for Payer: Blue Shield of California EPN |
$43.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna of CA HMO |
$52.26
|
| Rate for Payer: Cigna of CA PPO |
$52.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63.46
|
| Rate for Payer: Dignity Health Media |
$63.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$63.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$29.86
|
| Rate for Payer: Galaxy Health WC |
$63.46
|
| Rate for Payer: Global Benefits Group Commercial |
$44.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$56.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.92
|
| Rate for Payer: Multiplan Commercial |
$59.73
|
| Rate for Payer: Networks By Design Commercial |
$48.53
|
| Rate for Payer: Prime Health Services Commercial |
$63.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.33
|
| Rate for Payer: United Healthcare All Other HMO |
$37.33
|
| Rate for Payer: United Healthcare HMO Rider |
$37.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$63.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.46
|
| Rate for Payer: Vantage Medical Group Senior |
$63.46
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
|
OP
|
$23.83
|
|
|
Service Code
|
NDC 0093-3655-28
|
| Hospital Charge Code |
1710513
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$20.26 |
| 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 |
$13.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.20
|
| Rate for Payer: Blue Distinction Transplant |
$14.30
|
| Rate for Payer: Blue Shield of California Commercial |
$17.56
|
| Rate for Payer: Blue Shield of California EPN |
$13.92
|
| 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 Media |
$20.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.53
|
| Rate for Payer: Galaxy Health WC |
$20.26
|
| Rate for Payer: Global Benefits Group Commercial |
$14.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$17.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.08
|
| Rate for Payer: 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
|
| 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 |
$11.92
|
| Rate for Payer: United Healthcare All Other HMO |
$11.92
|
| Rate for Payer: United Healthcare HMO Rider |
$11.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.92
|
| 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
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
|
IP
|
$64.50
|
|
|
Service Code
|
NDC 43386-140-28
|
| Hospital Charge Code |
1710513
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$15.48 |
| Max. Negotiated Rate |
$54.82 |
| Rate for Payer: Blue Shield of California Commercial |
$45.92
|
| Rate for Payer: Blue Shield of California EPN |
$33.02
|
| Rate for Payer: Cash Price |
$29.03
|
| Rate for Payer: Cigna of CA HMO |
$45.15
|
| Rate for Payer: Cigna of CA PPO |
$45.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.80
|
| Rate for Payer: Galaxy Health WC |
$54.82
|
| Rate for Payer: Global Benefits Group Commercial |
$38.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.48
|
| Rate for Payer: Multiplan Commercial |
$51.60
|
| Rate for Payer: Networks By Design Commercial |
$41.92
|
| Rate for Payer: Prime Health Services Commercial |
$54.82
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
|
IP
|
$74.66
|
|
|
Service Code
|
NDC 27437-050-56
|
| Hospital Charge Code |
1710513
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$63.46 |
| Rate for Payer: Blue Shield of California Commercial |
$53.16
|
| Rate for Payer: Blue Shield of California EPN |
$38.23
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna of CA HMO |
$52.26
|
| Rate for Payer: Cigna of CA PPO |
$52.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.86
|
| Rate for Payer: Galaxy Health WC |
$63.46
|
| Rate for Payer: Global Benefits Group Commercial |
$44.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.92
|
| Rate for Payer: Multiplan Commercial |
$59.73
|
| Rate for Payer: Networks By Design Commercial |
$48.53
|
| Rate for Payer: Prime Health Services Commercial |
$63.46
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
|
IP
|
$19.80
|
|
|
Service Code
|
NDC 69238-1605-2
|
| Hospital Charge Code |
1710513
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$16.83 |
| Rate for Payer: Blue Shield of California Commercial |
$14.10
|
| Rate for Payer: Blue Shield of California EPN |
$10.14
|
| 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: EPIC Health Plan Commercial |
$7.92
|
| Rate for Payer: Galaxy Health WC |
$16.83
|
| Rate for Payer: Global Benefits Group Commercial |
$11.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.54
|
| Rate for Payer: 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
|
$64.50
|
|
|
Service Code
|
NDC 43386-140-28
|
| Hospital Charge Code |
1710513
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$15.48 |
| Max. Negotiated Rate |
$54.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$42.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.43
|
| Rate for Payer: Blue Distinction Transplant |
$38.70
|
| Rate for Payer: Blue Shield of California Commercial |
$47.54
|
| Rate for Payer: Blue Shield of California EPN |
$37.67
|
| Rate for Payer: Cash Price |
$29.03
|
| Rate for Payer: Cigna of CA HMO |
$45.15
|
| Rate for Payer: Cigna of CA PPO |
$45.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.82
|
| Rate for Payer: Dignity Health Media |
$54.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.80
|
| Rate for Payer: Galaxy Health WC |
$54.82
|
| Rate for Payer: Global Benefits Group Commercial |
$38.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$48.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.48
|
| Rate for Payer: Multiplan Commercial |
$51.60
|
| Rate for Payer: Networks By Design Commercial |
$41.92
|
| Rate for Payer: Prime Health Services Commercial |
$54.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.25
|
| Rate for Payer: United Healthcare All Other HMO |
$32.25
|
| Rate for Payer: United Healthcare HMO Rider |
$32.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$54.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.82
|
| Rate for Payer: Vantage Medical Group Senior |
$54.82
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
|
OP
|
$19.80
|
|
|
Service Code
|
NDC 69238-1605-2
|
| Hospital Charge Code |
1710513
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$16.83 |
| 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 |
$10.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.80
|
| Rate for Payer: Blue Distinction Transplant |
$11.88
|
| Rate for Payer: Blue Shield of California Commercial |
$14.59
|
| Rate for Payer: Blue Shield of California EPN |
$11.56
|
| 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 Media |
$16.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.92
|
| Rate for Payer: Galaxy Health WC |
$16.83
|
| Rate for Payer: Global Benefits Group Commercial |
$11.88
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$14.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.54
|
| Rate for Payer: 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.90
|
| Rate for Payer: United Healthcare All Other HMO |
$9.90
|
| Rate for Payer: United Healthcare HMO Rider |
$9.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.83
|
| Rate for Payer: Vantage Medical Group Senior |
$16.83
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
|
IP
|
$23.83
|
|
|
Service Code
|
NDC 0093-3655-28
|
| Hospital Charge Code |
1710513
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$20.26 |
| Rate for Payer: Blue Shield of California Commercial |
$16.97
|
| Rate for Payer: Blue Shield of California EPN |
$12.20
|
| 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: EPIC Health Plan Commercial |
$9.53
|
| Rate for Payer: Galaxy Health WC |
$20.26
|
| Rate for Payer: Global Benefits Group Commercial |
$14.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$19.06
|
| Rate for Payer: Networks By Design Commercial |
$15.49
|
| Rate for Payer: Prime Health Services Commercial |
$20.26
|
|
|
METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SYRINGE [154475]
|
Facility
|
OP
|
$307.70
|
|
|
Service Code
|
CPT J2212
|
| Hospital Charge Code |
NDG154575
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$261.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.83
|
| Rate for Payer: Blue Distinction Transplant |
$184.62
|
| Rate for Payer: Blue Shield of California Commercial |
$226.77
|
| Rate for Payer: Blue Shield of California EPN |
$1.25
|
| Rate for Payer: Cash Price |
$138.47
|
| Rate for Payer: Cash Price |
$138.47
|
| Rate for Payer: Cigna of CA HMO |
$215.39
|
| Rate for Payer: Cigna of CA PPO |
$215.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.80
|
| Rate for Payer: Dignity Health Media |
$1.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.20
|
| Rate for Payer: Galaxy Health WC |
$261.54
|
| Rate for Payer: Global Benefits Group Commercial |
$184.62
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$230.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.97
|
| Rate for Payer: Heritage Provider Network Transplant |
$1.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$205.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.61
|
| Rate for Payer: Multiplan Commercial |
$246.16
|
| Rate for Payer: Networks By Design Commercial |
$153.85
|
| Rate for Payer: Prime Health Services Commercial |
$261.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$184.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$184.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.85
|
| Rate for Payer: United Healthcare All Other HMO |
$153.85
|
| Rate for Payer: United Healthcare HMO Rider |
$153.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$153.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1.20
|
|
|
METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SYRINGE [154475]
|
Facility
|
IP
|
$307.70
|
|
|
Service Code
|
CPT J2212
|
| Hospital Charge Code |
NDG154575
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.85 |
| Max. Negotiated Rate |
$261.54 |
| Rate for Payer: Blue Shield of California Commercial |
$219.08
|
| Rate for Payer: Blue Shield of California EPN |
$157.54
|
| Rate for Payer: Cash Price |
$138.47
|
| Rate for Payer: Cigna of CA HMO |
$215.39
|
| Rate for Payer: Cigna of CA PPO |
$215.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$123.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$123.08
|
| Rate for Payer: Galaxy Health WC |
$261.54
|
| Rate for Payer: Global Benefits Group Commercial |
$184.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$205.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.85
|
| Rate for Payer: Multiplan Commercial |
$246.16
|
| Rate for Payer: Networks By Design Commercial |
$153.85
|
| Rate for Payer: Prime Health Services Commercial |
$261.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.19
|
| Rate for Payer: United Healthcare All Other HMO |
$113.48
|
| Rate for Payer: United Healthcare HMO Rider |
$111.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$101.54
|
|
|
METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS WRAP [40891651]
|
Facility
|
IP
|
$307.70
|
|
|
Service Code
|
CPT J2212
|
| Hospital Charge Code |
1720998
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.85 |
| Max. Negotiated Rate |
$261.54 |
| Rate for Payer: Blue Shield of California Commercial |
$219.08
|
| Rate for Payer: Blue Shield of California EPN |
$157.54
|
| Rate for Payer: Cash Price |
$138.47
|
| Rate for Payer: Cigna of CA HMO |
$215.39
|
| Rate for Payer: Cigna of CA PPO |
$215.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$123.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$123.08
|
| Rate for Payer: Galaxy Health WC |
$261.54
|
| Rate for Payer: Global Benefits Group Commercial |
$184.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$205.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.85
|
| Rate for Payer: Multiplan Commercial |
$246.16
|
| Rate for Payer: Networks By Design Commercial |
$153.85
|
| Rate for Payer: Prime Health Services Commercial |
$261.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.19
|
| Rate for Payer: United Healthcare All Other HMO |
$113.48
|
| Rate for Payer: United Healthcare HMO Rider |
$111.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$101.54
|
|
|
METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS WRAP [40891651]
|
Facility
|
OP
|
$307.70
|
|
|
Service Code
|
CPT J2212
|
| Hospital Charge Code |
1720998
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$261.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.83
|
| Rate for Payer: Blue Distinction Transplant |
$184.62
|
| Rate for Payer: Blue Shield of California Commercial |
$226.77
|
| Rate for Payer: Blue Shield of California EPN |
$1.25
|
| Rate for Payer: Cash Price |
$138.47
|
| Rate for Payer: Cash Price |
$138.47
|
| Rate for Payer: Cigna of CA HMO |
$215.39
|
| Rate for Payer: Cigna of CA PPO |
$215.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.80
|
| Rate for Payer: Dignity Health Media |
$1.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.20
|
| Rate for Payer: Galaxy Health WC |
$261.54
|
| Rate for Payer: Global Benefits Group Commercial |
$184.62
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$230.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.97
|
| Rate for Payer: Heritage Provider Network Transplant |
$1.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$205.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.61
|
| Rate for Payer: Multiplan Commercial |
$246.16
|
| Rate for Payer: Networks By Design Commercial |
$153.85
|
| Rate for Payer: Prime Health Services Commercial |
$261.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$184.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$184.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.85
|
| Rate for Payer: United Healthcare All Other HMO |
$153.85
|
| Rate for Payer: United Healthcare HMO Rider |
$153.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$153.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1.20
|
|
|
METHYLPHENIDATE 10 MG TABLET [4986]
|
Facility
|
IP
|
$0.16
|
|
|
Service Code
|
NDC 16729-479-01
|
| Hospital Charge Code |
1730103
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
|
METHYLPHENIDATE 10 MG TABLET [4986]
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
NDC 16729-479-01
|
| Hospital Charge Code |
1730103
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
| Rate for Payer: Blue Distinction Transplant |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Media |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
METHYLPHENIDATE 20 MG TABLET [4987]
|
Facility
|
IP
|
$1.87
|
|
|
Service Code
|
NDC 0078-0441-05
|
| Hospital Charge Code |
1730104
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$1.59 |
| Rate for Payer: Blue Shield of California Commercial |
$1.33
|
| Rate for Payer: Blue Shield of California EPN |
$0.96
|
| Rate for Payer: Cash Price |
$0.84
|
| Rate for Payer: Cigna of CA HMO |
$1.31
|
| Rate for Payer: Cigna of CA PPO |
$1.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.75
|
| Rate for Payer: Galaxy Health WC |
$1.59
|
| Rate for Payer: Global Benefits Group Commercial |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: Networks By Design Commercial |
$1.22
|
| Rate for Payer: Prime Health Services Commercial |
$1.59
|
|
|
METHYLPHENIDATE 20 MG TABLET [4987]
|
Facility
|
OP
|
$1.87
|
|
|
Service Code
|
NDC 0078-0441-05
|
| Hospital Charge Code |
1730104
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$1.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.11
|
| Rate for Payer: Blue Distinction Transplant |
$1.12
|
| Rate for Payer: Blue Shield of California Commercial |
$1.38
|
| Rate for Payer: Blue Shield of California EPN |
$1.09
|
| Rate for Payer: Cash Price |
$0.84
|
| Rate for Payer: Cigna of CA HMO |
$1.31
|
| Rate for Payer: Cigna of CA PPO |
$1.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.59
|
| Rate for Payer: Dignity Health Media |
$1.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.75
|
| Rate for Payer: Galaxy Health WC |
$1.59
|
| Rate for Payer: Global Benefits Group Commercial |
$1.12
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: Networks By Design Commercial |
$1.22
|
| Rate for Payer: Prime Health Services Commercial |
$1.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.94
|
| Rate for Payer: United Healthcare All Other HMO |
$0.94
|
| Rate for Payer: United Healthcare HMO Rider |
$0.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.59
|
| Rate for Payer: Vantage Medical Group Senior |
$1.59
|
|
|
METHYLPHENIDATE 5 MG TABLET [4988]
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 68084-805-21
|
| Hospital Charge Code |
1730105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Blue Shield of California Commercial |
$1.42
|
| Rate for Payer: Blue Shield of California EPN |
$1.02
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.30
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
|
