|
METHYLPHENIDATE 5 MG TABLET [4988]
|
Facility
|
OP
|
$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: Aetna of CA HMO/PPO |
$1.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.19
|
| Rate for Payer: Blue Distinction Transplant |
$1.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1.47
|
| Rate for Payer: Blue Shield of California EPN |
$1.17
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.70
|
| Rate for Payer: Dignity Health Media |
$1.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.50
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1.70
|
|
|
METHYLPHENIDATE 5 MG TABLET [4988]
|
Facility
|
OP
|
$0.12
|
|
|
Service Code
|
NDC 0115-1800-01
|
| Hospital Charge Code |
1730105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.07
|
| Rate for Payer: Blue Distinction Transplant |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.10
|
| Rate for Payer: Dignity Health Media |
$0.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Vantage Medical Group Senior |
$0.10
|
|
|
METHYLPHENIDATE 5 MG TABLET [4988]
|
Facility
|
IP
|
$0.12
|
|
|
Service Code
|
NDC 0115-1800-01
|
| Hospital Charge Code |
1730105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR [28750]
|
Facility
|
IP
|
$6.22
|
|
|
Service Code
|
NDC 62175-310-37
|
| Hospital Charge Code |
1731016
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$5.29 |
| Rate for Payer: Blue Shield of California Commercial |
$4.43
|
| Rate for Payer: Blue Shield of California EPN |
$3.18
|
| Rate for Payer: Cash Price |
$2.80
|
| Rate for Payer: Cigna of CA HMO |
$4.35
|
| Rate for Payer: Cigna of CA PPO |
$4.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.49
|
| Rate for Payer: Galaxy Health WC |
$5.29
|
| Rate for Payer: Global Benefits Group Commercial |
$3.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.49
|
| Rate for Payer: Multiplan Commercial |
$4.98
|
| Rate for Payer: Networks By Design Commercial |
$4.04
|
| Rate for Payer: Prime Health Services Commercial |
$5.29
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR [28750]
|
Facility
|
IP
|
$9.34
|
|
|
Service Code
|
NDC 10147-0685-1
|
| Hospital Charge Code |
1731016
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$7.94 |
| Rate for Payer: Blue Shield of California Commercial |
$6.65
|
| Rate for Payer: Blue Shield of California EPN |
$4.78
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cigna of CA HMO |
$6.54
|
| Rate for Payer: Cigna of CA PPO |
$6.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.74
|
| Rate for Payer: Galaxy Health WC |
$7.94
|
| Rate for Payer: Global Benefits Group Commercial |
$5.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.24
|
| Rate for Payer: Multiplan Commercial |
$7.47
|
| Rate for Payer: Networks By Design Commercial |
$6.07
|
| Rate for Payer: Prime Health Services Commercial |
$7.94
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR [28750]
|
Facility
|
OP
|
$9.34
|
|
|
Service Code
|
NDC 10147-0685-1
|
| Hospital Charge Code |
1731016
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$7.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.56
|
| Rate for Payer: Blue Distinction Transplant |
$5.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6.88
|
| Rate for Payer: Blue Shield of California EPN |
$5.45
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cigna of CA HMO |
$6.54
|
| Rate for Payer: Cigna of CA PPO |
$6.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.94
|
| Rate for Payer: Dignity Health Media |
$7.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.74
|
| Rate for Payer: Galaxy Health WC |
$7.94
|
| Rate for Payer: Global Benefits Group Commercial |
$5.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.24
|
| Rate for Payer: Multiplan Commercial |
$7.47
|
| Rate for Payer: Networks By Design Commercial |
$6.07
|
| Rate for Payer: Prime Health Services Commercial |
$7.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.67
|
| Rate for Payer: United Healthcare All Other HMO |
$4.67
|
| Rate for Payer: United Healthcare HMO Rider |
$4.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.94
|
| Rate for Payer: Vantage Medical Group Senior |
$7.94
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR [28750]
|
Facility
|
IP
|
$15.48
|
|
|
Service Code
|
NDC 50458-585-01
|
| Hospital Charge Code |
1731016
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$13.16 |
| Rate for Payer: Blue Shield of California Commercial |
$11.02
|
| Rate for Payer: Blue Shield of California EPN |
$7.93
|
| Rate for Payer: Cash Price |
$6.97
|
| Rate for Payer: Cigna of CA HMO |
$10.84
|
| Rate for Payer: Cigna of CA PPO |
$10.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.19
|
| Rate for Payer: Galaxy Health WC |
$13.16
|
| Rate for Payer: Global Benefits Group Commercial |
$9.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.72
|
| Rate for Payer: Multiplan Commercial |
$12.38
|
| Rate for Payer: Networks By Design Commercial |
$10.06
|
| Rate for Payer: Prime Health Services Commercial |
$13.16
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR [28750]
|
Facility
|
OP
|
$6.22
|
|
|
Service Code
|
NDC 62175-310-37
|
| Hospital Charge Code |
1731016
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$5.29 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.71
|
| Rate for Payer: Blue Distinction Transplant |
$3.73
|
| Rate for Payer: Blue Shield of California Commercial |
$4.58
|
| Rate for Payer: Blue Shield of California EPN |
$3.63
|
| Rate for Payer: Cash Price |
$2.80
|
| Rate for Payer: Cigna of CA HMO |
$4.35
|
| Rate for Payer: Cigna of CA PPO |
$4.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.29
|
| Rate for Payer: Dignity Health Media |
$5.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.49
|
| Rate for Payer: Galaxy Health WC |
$5.29
|
| Rate for Payer: Global Benefits Group Commercial |
$3.73
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.49
|
| Rate for Payer: Multiplan Commercial |
$4.98
|
| Rate for Payer: Networks By Design Commercial |
$4.04
|
| Rate for Payer: Prime Health Services Commercial |
$5.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.11
|
| Rate for Payer: United Healthcare All Other HMO |
$3.11
|
| Rate for Payer: United Healthcare HMO Rider |
$3.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.29
|
| Rate for Payer: Vantage Medical Group Senior |
$5.29
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR [28750]
|
Facility
|
IP
|
$9.34
|
|
|
Service Code
|
NDC 9999-7068-51
|
| Hospital Charge Code |
1731016
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$7.94 |
| Rate for Payer: Blue Shield of California Commercial |
$6.65
|
| Rate for Payer: Blue Shield of California EPN |
$4.78
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cigna of CA HMO |
$6.54
|
| Rate for Payer: Cigna of CA PPO |
$6.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.74
|
| Rate for Payer: Galaxy Health WC |
$7.94
|
| Rate for Payer: Global Benefits Group Commercial |
$5.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.24
|
| Rate for Payer: Multiplan Commercial |
$7.47
|
| Rate for Payer: Networks By Design Commercial |
$6.07
|
| Rate for Payer: Prime Health Services Commercial |
$7.94
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR [28750]
|
Facility
|
OP
|
$15.48
|
|
|
Service Code
|
NDC 50458-585-01
|
| Hospital Charge Code |
1731016
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$13.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.22
|
| Rate for Payer: Blue Distinction Transplant |
$9.29
|
| Rate for Payer: Blue Shield of California Commercial |
$11.41
|
| Rate for Payer: Blue Shield of California EPN |
$9.04
|
| Rate for Payer: Cash Price |
$6.97
|
| Rate for Payer: Cigna of CA HMO |
$10.84
|
| Rate for Payer: Cigna of CA PPO |
$10.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.16
|
| Rate for Payer: Dignity Health Media |
$13.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.19
|
| Rate for Payer: Galaxy Health WC |
$13.16
|
| Rate for Payer: Global Benefits Group Commercial |
$9.29
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.72
|
| Rate for Payer: Multiplan Commercial |
$12.38
|
| Rate for Payer: Networks By Design Commercial |
$10.06
|
| Rate for Payer: Prime Health Services Commercial |
$13.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.74
|
| Rate for Payer: United Healthcare All Other HMO |
$7.74
|
| Rate for Payer: United Healthcare HMO Rider |
$7.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.16
|
| Rate for Payer: Vantage Medical Group Senior |
$13.16
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR [28750]
|
Facility
|
OP
|
$9.34
|
|
|
Service Code
|
NDC 9999-7068-51
|
| Hospital Charge Code |
1731016
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$7.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.56
|
| Rate for Payer: Blue Distinction Transplant |
$5.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6.88
|
| Rate for Payer: Blue Shield of California EPN |
$5.45
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cigna of CA HMO |
$6.54
|
| Rate for Payer: Cigna of CA PPO |
$6.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.94
|
| Rate for Payer: Dignity Health Media |
$7.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.74
|
| Rate for Payer: Galaxy Health WC |
$7.94
|
| Rate for Payer: Global Benefits Group Commercial |
$5.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.24
|
| Rate for Payer: Multiplan Commercial |
$7.47
|
| Rate for Payer: Networks By Design Commercial |
$6.07
|
| Rate for Payer: Prime Health Services Commercial |
$7.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.67
|
| Rate for Payer: United Healthcare All Other HMO |
$4.67
|
| Rate for Payer: United Healthcare HMO Rider |
$4.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.94
|
| Rate for Payer: Vantage Medical Group Senior |
$7.94
|
|
|
METHYLPHENIDATE ER 20 MG TABLET,EXTENDED RELEASE [4989]
|
Facility
|
OP
|
$2.02
|
|
|
Service Code
|
NDC 10702-076-06
|
| Hospital Charge Code |
1734066
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.20
|
| Rate for Payer: Blue Distinction Transplant |
$1.21
|
| Rate for Payer: Blue Shield of California Commercial |
$1.49
|
| Rate for Payer: Blue Shield of California EPN |
$1.18
|
| Rate for Payer: Cash Price |
$0.91
|
| Rate for Payer: Cigna of CA HMO |
$1.41
|
| Rate for Payer: Cigna of CA PPO |
$1.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.72
|
| Rate for Payer: Dignity Health Media |
$1.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.81
|
| Rate for Payer: Galaxy Health WC |
$1.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.21
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.62
|
| Rate for Payer: Networks By Design Commercial |
$1.31
|
| Rate for Payer: Prime Health Services Commercial |
$1.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.01
|
| Rate for Payer: United Healthcare All Other HMO |
$1.01
|
| Rate for Payer: United Healthcare HMO Rider |
$1.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.72
|
| Rate for Payer: Vantage Medical Group Senior |
$1.72
|
|
|
METHYLPHENIDATE ER 20 MG TABLET,EXTENDED RELEASE [4989]
|
Facility
|
IP
|
$2.02
|
|
|
Service Code
|
NDC 10702-076-06
|
| Hospital Charge Code |
1734066
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.72 |
| Rate for Payer: Blue Shield of California Commercial |
$1.44
|
| Rate for Payer: Blue Shield of California EPN |
$1.03
|
| Rate for Payer: Cash Price |
$0.91
|
| Rate for Payer: Cigna of CA HMO |
$1.41
|
| Rate for Payer: Cigna of CA PPO |
$1.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.81
|
| Rate for Payer: Galaxy Health WC |
$1.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.62
|
| Rate for Payer: Networks By Design Commercial |
$1.31
|
| Rate for Payer: Prime Health Services Commercial |
$1.72
|
|
|
METHYLPHENIDATE ER 27 MG TABLET,EXTENDED RELEASE 24 HR [32654]
|
Facility
|
OP
|
$15.87
|
|
|
Service Code
|
NDC 50458-588-01
|
| Hospital Charge Code |
1731019
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.81 |
| Max. Negotiated Rate |
$13.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.46
|
| Rate for Payer: Blue Distinction Transplant |
$9.52
|
| Rate for Payer: Blue Shield of California Commercial |
$11.70
|
| Rate for Payer: Blue Shield of California EPN |
$9.27
|
| Rate for Payer: Cash Price |
$7.14
|
| Rate for Payer: Cigna of CA HMO |
$11.11
|
| Rate for Payer: Cigna of CA PPO |
$11.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.49
|
| Rate for Payer: Dignity Health Media |
$13.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.35
|
| Rate for Payer: Galaxy Health WC |
$13.49
|
| Rate for Payer: Global Benefits Group Commercial |
$9.52
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.81
|
| Rate for Payer: Multiplan Commercial |
$12.70
|
| Rate for Payer: Networks By Design Commercial |
$10.32
|
| Rate for Payer: Prime Health Services Commercial |
$13.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.94
|
| Rate for Payer: United Healthcare All Other HMO |
$7.94
|
| Rate for Payer: United Healthcare HMO Rider |
$7.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.49
|
| Rate for Payer: Vantage Medical Group Senior |
$13.49
|
|
|
METHYLPHENIDATE ER 27 MG TABLET,EXTENDED RELEASE 24 HR [32654]
|
Facility
|
IP
|
$15.87
|
|
|
Service Code
|
NDC 50458-588-01
|
| Hospital Charge Code |
1731019
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.81 |
| Max. Negotiated Rate |
$13.49 |
| Rate for Payer: Blue Shield of California Commercial |
$11.30
|
| Rate for Payer: Blue Shield of California EPN |
$8.13
|
| Rate for Payer: Cash Price |
$7.14
|
| Rate for Payer: Cigna of CA HMO |
$11.11
|
| Rate for Payer: Cigna of CA PPO |
$11.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.35
|
| Rate for Payer: Galaxy Health WC |
$13.49
|
| Rate for Payer: Global Benefits Group Commercial |
$9.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.81
|
| Rate for Payer: Multiplan Commercial |
$12.70
|
| Rate for Payer: Networks By Design Commercial |
$10.32
|
| Rate for Payer: Prime Health Services Commercial |
$13.49
|
|
|
METHYLPHENIDATE ER 36 MG TABLET,EXTENDED RELEASE 24 HR [28751]
|
Facility
|
OP
|
$16.37
|
|
|
Service Code
|
NDC 50458-586-01
|
| Hospital Charge Code |
1731018
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$13.91 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.75
|
| Rate for Payer: Blue Distinction Transplant |
$9.82
|
| Rate for Payer: Blue Shield of California Commercial |
$12.06
|
| Rate for Payer: Blue Shield of California EPN |
$9.56
|
| Rate for Payer: Cash Price |
$7.37
|
| Rate for Payer: Cigna of CA HMO |
$11.46
|
| Rate for Payer: Cigna of CA PPO |
$11.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.91
|
| Rate for Payer: Dignity Health Media |
$13.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.55
|
| Rate for Payer: Galaxy Health WC |
$13.91
|
| Rate for Payer: Global Benefits Group Commercial |
$9.82
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.93
|
| Rate for Payer: Multiplan Commercial |
$13.10
|
| Rate for Payer: Networks By Design Commercial |
$10.64
|
| Rate for Payer: Prime Health Services Commercial |
$13.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.18
|
| Rate for Payer: United Healthcare All Other HMO |
$8.18
|
| Rate for Payer: United Healthcare HMO Rider |
$8.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.91
|
| Rate for Payer: Vantage Medical Group Senior |
$13.91
|
|
|
METHYLPHENIDATE ER 36 MG TABLET,EXTENDED RELEASE 24 HR [28751]
|
Facility
|
IP
|
$12.42
|
|
|
Service Code
|
NDC 68084-829-25
|
| Hospital Charge Code |
1731018
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$10.56 |
| Rate for Payer: Blue Shield of California Commercial |
$8.84
|
| Rate for Payer: Blue Shield of California EPN |
$6.36
|
| Rate for Payer: Cash Price |
$5.59
|
| Rate for Payer: Cigna of CA HMO |
$8.69
|
| Rate for Payer: Cigna of CA PPO |
$8.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.97
|
| Rate for Payer: Galaxy Health WC |
$10.56
|
| Rate for Payer: Global Benefits Group Commercial |
$7.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.98
|
| Rate for Payer: Multiplan Commercial |
$9.94
|
| Rate for Payer: Networks By Design Commercial |
$8.07
|
| Rate for Payer: Prime Health Services Commercial |
$10.56
|
|
|
METHYLPHENIDATE ER 36 MG TABLET,EXTENDED RELEASE 24 HR [28751]
|
Facility
|
OP
|
$12.42
|
|
|
Service Code
|
NDC 68084-829-95
|
| Hospital Charge Code |
1731018
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$10.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.40
|
| Rate for Payer: Blue Distinction Transplant |
$7.45
|
| Rate for Payer: Blue Shield of California Commercial |
$9.15
|
| Rate for Payer: Blue Shield of California EPN |
$7.25
|
| Rate for Payer: Cash Price |
$5.59
|
| Rate for Payer: Cigna of CA HMO |
$8.69
|
| Rate for Payer: Cigna of CA PPO |
$8.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.56
|
| Rate for Payer: Dignity Health Media |
$10.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.97
|
| Rate for Payer: Galaxy Health WC |
$10.56
|
| Rate for Payer: Global Benefits Group Commercial |
$7.45
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.98
|
| Rate for Payer: Multiplan Commercial |
$9.94
|
| Rate for Payer: Networks By Design Commercial |
$8.07
|
| Rate for Payer: Prime Health Services Commercial |
$10.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.21
|
| Rate for Payer: United Healthcare All Other HMO |
$6.21
|
| Rate for Payer: United Healthcare HMO Rider |
$6.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.56
|
| Rate for Payer: Vantage Medical Group Senior |
$10.56
|
|
|
METHYLPHENIDATE ER 36 MG TABLET,EXTENDED RELEASE 24 HR [28751]
|
Facility
|
IP
|
$16.37
|
|
|
Service Code
|
NDC 50458-586-01
|
| Hospital Charge Code |
1731018
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$13.91 |
| Rate for Payer: Blue Shield of California Commercial |
$11.66
|
| Rate for Payer: Blue Shield of California EPN |
$8.38
|
| Rate for Payer: Cash Price |
$7.37
|
| Rate for Payer: Cigna of CA HMO |
$11.46
|
| Rate for Payer: Cigna of CA PPO |
$11.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.55
|
| Rate for Payer: Galaxy Health WC |
$13.91
|
| Rate for Payer: Global Benefits Group Commercial |
$9.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.93
|
| Rate for Payer: Multiplan Commercial |
$13.10
|
| Rate for Payer: Networks By Design Commercial |
$10.64
|
| Rate for Payer: Prime Health Services Commercial |
$13.91
|
|
|
METHYLPHENIDATE ER 36 MG TABLET,EXTENDED RELEASE 24 HR [28751]
|
Facility
|
IP
|
$12.42
|
|
|
Service Code
|
NDC 68084-829-95
|
| Hospital Charge Code |
1731018
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$10.56 |
| Rate for Payer: Blue Shield of California Commercial |
$8.84
|
| Rate for Payer: Blue Shield of California EPN |
$6.36
|
| Rate for Payer: Cash Price |
$5.59
|
| Rate for Payer: Cigna of CA HMO |
$8.69
|
| Rate for Payer: Cigna of CA PPO |
$8.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.97
|
| Rate for Payer: Galaxy Health WC |
$10.56
|
| Rate for Payer: Global Benefits Group Commercial |
$7.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.98
|
| Rate for Payer: Multiplan Commercial |
$9.94
|
| Rate for Payer: Networks By Design Commercial |
$8.07
|
| Rate for Payer: Prime Health Services Commercial |
$10.56
|
|
|
METHYLPHENIDATE ER 36 MG TABLET,EXTENDED RELEASE 24 HR [28751]
|
Facility
|
OP
|
$12.42
|
|
|
Service Code
|
NDC 68084-829-25
|
| Hospital Charge Code |
1731018
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$10.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.40
|
| Rate for Payer: Blue Distinction Transplant |
$7.45
|
| Rate for Payer: Blue Shield of California Commercial |
$9.15
|
| Rate for Payer: Blue Shield of California EPN |
$7.25
|
| Rate for Payer: Cash Price |
$5.59
|
| Rate for Payer: Cigna of CA HMO |
$8.69
|
| Rate for Payer: Cigna of CA PPO |
$8.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.56
|
| Rate for Payer: Dignity Health Media |
$10.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.97
|
| Rate for Payer: Galaxy Health WC |
$10.56
|
| Rate for Payer: Global Benefits Group Commercial |
$7.45
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.98
|
| Rate for Payer: Multiplan Commercial |
$9.94
|
| Rate for Payer: Networks By Design Commercial |
$8.07
|
| Rate for Payer: Prime Health Services Commercial |
$10.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.21
|
| Rate for Payer: United Healthcare All Other HMO |
$6.21
|
| Rate for Payer: United Healthcare HMO Rider |
$6.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.56
|
| Rate for Payer: Vantage Medical Group Senior |
$10.56
|
|
|
METHYLPHENIDATE LA 20 MG BIPHASIC 50-50 CAPSULE,EXTENDED RELEASE [33198]
|
Facility
|
IP
|
$13.78
|
|
|
Service Code
|
NDC 0078-0370-05
|
| Hospital Charge Code |
1730090
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$11.71 |
| Rate for Payer: Blue Shield of California Commercial |
$9.81
|
| Rate for Payer: Blue Shield of California EPN |
$7.06
|
| Rate for Payer: Cash Price |
$6.20
|
| Rate for Payer: Cigna of CA HMO |
$9.65
|
| Rate for Payer: Cigna of CA PPO |
$9.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.51
|
| Rate for Payer: Galaxy Health WC |
$11.71
|
| Rate for Payer: Global Benefits Group Commercial |
$8.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.31
|
| Rate for Payer: Multiplan Commercial |
$11.02
|
| Rate for Payer: Networks By Design Commercial |
$8.96
|
| Rate for Payer: Prime Health Services Commercial |
$11.71
|
|
|
METHYLPHENIDATE LA 20 MG BIPHASIC 50-50 CAPSULE,EXTENDED RELEASE [33198]
|
Facility
|
OP
|
$13.78
|
|
|
Service Code
|
NDC 0078-0370-05
|
| Hospital Charge Code |
1730090
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$11.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.21
|
| Rate for Payer: Blue Distinction Transplant |
$8.27
|
| Rate for Payer: Blue Shield of California Commercial |
$10.16
|
| Rate for Payer: Blue Shield of California EPN |
$8.05
|
| Rate for Payer: Cash Price |
$6.20
|
| Rate for Payer: Cigna of CA HMO |
$9.65
|
| Rate for Payer: Cigna of CA PPO |
$9.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.71
|
| Rate for Payer: Dignity Health Media |
$11.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.51
|
| Rate for Payer: Galaxy Health WC |
$11.71
|
| Rate for Payer: Global Benefits Group Commercial |
$8.27
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.31
|
| Rate for Payer: Multiplan Commercial |
$11.02
|
| Rate for Payer: Networks By Design Commercial |
$8.96
|
| Rate for Payer: Prime Health Services Commercial |
$11.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.89
|
| Rate for Payer: United Healthcare All Other HMO |
$6.89
|
| Rate for Payer: United Healthcare HMO Rider |
$6.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.71
|
| Rate for Payer: Vantage Medical Group Senior |
$11.71
|
|
|
METHYLPREDNISOLONE 125 MG INJ. [4081205]
|
Facility
|
OP
|
$13.98
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
1720347
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$36.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$36.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.50
|
| Rate for Payer: Blue Distinction Transplant |
$5.47
|
| Rate for Payer: Blue Distinction Transplant |
$7.01
|
| Rate for Payer: Blue Distinction Transplant |
$8.39
|
| Rate for Payer: Blue Shield of California Commercial |
$10.30
|
| Rate for Payer: Blue Shield of California Commercial |
$8.61
|
| Rate for Payer: Blue Shield of California Commercial |
$6.72
|
| Rate for Payer: Blue Shield of California EPN |
$8.51
|
| Rate for Payer: Blue Shield of California EPN |
$8.51
|
| Rate for Payer: Blue Shield of California EPN |
$8.51
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Cash Price |
$6.29
|
| Rate for Payer: Cash Price |
$6.29
|
| Rate for Payer: Cash Price |
$5.26
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Cash Price |
$5.26
|
| Rate for Payer: Cigna of CA HMO |
$6.38
|
| Rate for Payer: Cigna of CA HMO |
$9.79
|
| Rate for Payer: Cigna of CA HMO |
$8.18
|
| Rate for Payer: Cigna of CA PPO |
$6.38
|
| Rate for Payer: Cigna of CA PPO |
$9.79
|
| Rate for Payer: Cigna of CA PPO |
$8.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.93
|
| Rate for Payer: Dignity Health Media |
$9.93
|
| Rate for Payer: Dignity Health Media |
$11.88
|
| Rate for Payer: Dignity Health Media |
$7.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.65
|
| Rate for Payer: Galaxy Health WC |
$7.75
|
| Rate for Payer: Galaxy Health WC |
$11.88
|
| Rate for Payer: Galaxy Health WC |
$9.93
|
| Rate for Payer: Global Benefits Group Commercial |
$5.47
|
| Rate for Payer: Global Benefits Group Commercial |
$8.39
|
| Rate for Payer: Global Benefits Group Commercial |
$7.01
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.84
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10.48
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.80
|
| Rate for Payer: Multiplan Commercial |
$7.30
|
| Rate for Payer: Multiplan Commercial |
$9.34
|
| Rate for Payer: Multiplan Commercial |
$11.18
|
| Rate for Payer: Networks By Design Commercial |
$4.56
|
| Rate for Payer: Networks By Design Commercial |
$5.84
|
| Rate for Payer: Networks By Design Commercial |
$6.99
|
| Rate for Payer: Prime Health Services Commercial |
$9.93
|
| Rate for Payer: Prime Health Services Commercial |
$7.75
|
| Rate for Payer: Prime Health Services Commercial |
$11.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.84
|
| Rate for Payer: United Healthcare All Other HMO |
$4.56
|
| Rate for Payer: United Healthcare All Other HMO |
$6.99
|
| Rate for Payer: United Healthcare All Other HMO |
$5.84
|
| Rate for Payer: United Healthcare HMO Rider |
$5.84
|
| Rate for Payer: United Healthcare HMO Rider |
$4.56
|
| Rate for Payer: United Healthcare HMO Rider |
$6.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.93
|
| Rate for Payer: Vantage Medical Group Senior |
$7.75
|
| Rate for Payer: Vantage Medical Group Senior |
$9.93
|
| Rate for Payer: Vantage Medical Group Senior |
$11.88
|
|
|
METHYLPREDNISOLONE 125 MG INJ. [4081205]
|
Facility
|
IP
|
$11.68
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
1720347
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$9.93 |
| Rate for Payer: Blue Shield of California Commercial |
$8.32
|
| Rate for Payer: Blue Shield of California Commercial |
$9.95
|
| Rate for Payer: Blue Shield of California Commercial |
$6.49
|
| Rate for Payer: Blue Shield of California EPN |
$7.16
|
| Rate for Payer: Blue Shield of California EPN |
$4.67
|
| Rate for Payer: Blue Shield of California EPN |
$5.98
|
| Rate for Payer: Cash Price |
$6.29
|
| Rate for Payer: Cash Price |
$5.26
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Cigna of CA HMO |
$6.38
|
| Rate for Payer: Cigna of CA HMO |
$9.79
|
| Rate for Payer: Cigna of CA HMO |
$8.18
|
| Rate for Payer: Cigna of CA PPO |
$8.18
|
| Rate for Payer: Cigna of CA PPO |
$9.79
|
| Rate for Payer: Cigna of CA PPO |
$6.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.59
|
| Rate for Payer: Galaxy Health WC |
$11.88
|
| Rate for Payer: Galaxy Health WC |
$9.93
|
| Rate for Payer: Galaxy Health WC |
$7.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5.47
|
| Rate for Payer: Global Benefits Group Commercial |
$7.01
|
| Rate for Payer: Global Benefits Group Commercial |
$8.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.19
|
| Rate for Payer: Multiplan Commercial |
$9.34
|
| Rate for Payer: Multiplan Commercial |
$11.18
|
| Rate for Payer: Multiplan Commercial |
$7.30
|
| Rate for Payer: Networks By Design Commercial |
$6.99
|
| Rate for Payer: Networks By Design Commercial |
$5.84
|
| Rate for Payer: Networks By Design Commercial |
$4.56
|
| Rate for Payer: Prime Health Services Commercial |
$9.93
|
| Rate for Payer: Prime Health Services Commercial |
$11.88
|
| Rate for Payer: Prime Health Services Commercial |
$7.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.41
|
| Rate for Payer: United Healthcare All Other HMO |
$5.16
|
| Rate for Payer: United Healthcare All Other HMO |
$4.31
|
| Rate for Payer: United Healthcare All Other HMO |
$3.36
|
| Rate for Payer: United Healthcare HMO Rider |
$3.29
|
| Rate for Payer: United Healthcare HMO Rider |
$4.21
|
| Rate for Payer: United Healthcare HMO Rider |
$5.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.01
|
|
