|
METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION [10577]
|
Facility
|
IP
|
$41.06
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
1720344
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.85 |
| Max. Negotiated Rate |
$34.90 |
| Rate for Payer: Blue Shield of California Commercial |
$29.23
|
| Rate for Payer: Blue Shield of California Commercial |
$35.79
|
| Rate for Payer: Blue Shield of California Commercial |
$37.58
|
| Rate for Payer: Blue Shield of California EPN |
$25.74
|
| Rate for Payer: Blue Shield of California EPN |
$27.02
|
| Rate for Payer: Blue Shield of California EPN |
$21.02
|
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: Cash Price |
$18.48
|
| Rate for Payer: Cash Price |
$23.75
|
| Rate for Payer: Cigna of CA HMO |
$36.95
|
| Rate for Payer: Cigna of CA HMO |
$35.19
|
| Rate for Payer: Cigna of CA HMO |
$28.74
|
| Rate for Payer: Cigna of CA PPO |
$28.74
|
| Rate for Payer: Cigna of CA PPO |
$35.19
|
| Rate for Payer: Cigna of CA PPO |
$36.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.11
|
| Rate for Payer: Galaxy Health WC |
$42.73
|
| Rate for Payer: Galaxy Health WC |
$34.90
|
| Rate for Payer: Galaxy Health WC |
$44.86
|
| Rate for Payer: Global Benefits Group Commercial |
$31.67
|
| Rate for Payer: Global Benefits Group Commercial |
$24.64
|
| Rate for Payer: Global Benefits Group Commercial |
$30.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.67
|
| Rate for Payer: Multiplan Commercial |
$32.85
|
| Rate for Payer: Multiplan Commercial |
$40.22
|
| Rate for Payer: Multiplan Commercial |
$42.22
|
| Rate for Payer: Networks By Design Commercial |
$25.14
|
| Rate for Payer: Networks By Design Commercial |
$20.53
|
| Rate for Payer: Networks By Design Commercial |
$26.39
|
| Rate for Payer: Prime Health Services Commercial |
$34.90
|
| Rate for Payer: Prime Health Services Commercial |
$42.73
|
| Rate for Payer: Prime Health Services Commercial |
$44.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.50
|
| Rate for Payer: United Healthcare All Other HMO |
$18.54
|
| Rate for Payer: United Healthcare All Other HMO |
$15.14
|
| Rate for Payer: United Healthcare All Other HMO |
$19.47
|
| Rate for Payer: United Healthcare HMO Rider |
$19.04
|
| Rate for Payer: United Healthcare HMO Rider |
$14.81
|
| Rate for Payer: United Healthcare HMO Rider |
$18.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.42
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION [10578]
|
Facility
|
IP
|
$13.98
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
ERX10578
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$11.88 |
| Rate for Payer: Blue Shield of California Commercial |
$9.95
|
| Rate for Payer: Blue Shield of California EPN |
$7.16
|
| Rate for Payer: Cash Price |
$6.29
|
| Rate for Payer: Cigna of CA HMO |
$9.79
|
| Rate for Payer: Cigna of CA PPO |
$9.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.59
|
| Rate for Payer: Galaxy Health WC |
$11.88
|
| 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 Medi-Cal |
$5.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.36
|
| Rate for Payer: Multiplan Commercial |
$11.18
|
| Rate for Payer: Networks By Design Commercial |
$6.99
|
| Rate for Payer: Prime Health Services Commercial |
$11.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.28
|
| Rate for Payer: United Healthcare All Other HMO |
$5.16
|
| Rate for Payer: United Healthcare HMO Rider |
$5.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.61
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION [10578]
|
Facility
|
OP
|
$13.98
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
ERX10578
|
|
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: Alpha Care Medical Group Commercial/Exchange |
$11.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.69
|
| 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: Blue Distinction Transplant |
$8.39
|
| Rate for Payer: Blue Shield of California Commercial |
$10.30
|
| Rate for Payer: Blue Shield of California EPN |
$8.51
|
| Rate for Payer: Cash Price |
$6.29
|
| Rate for Payer: Cash Price |
$6.29
|
| Rate for Payer: Cigna of CA HMO |
$9.79
|
| Rate for Payer: Cigna of CA PPO |
$9.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.88
|
| Rate for Payer: Dignity Health Media |
$11.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.59
|
| Rate for Payer: Galaxy Health WC |
$11.88
|
| Rate for Payer: Global Benefits Group Commercial |
$8.39
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.36
|
| Rate for Payer: Multiplan Commercial |
$11.18
|
| Rate for Payer: Networks By Design Commercial |
$6.99
|
| Rate for Payer: Prime Health Services Commercial |
$11.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.99
|
| Rate for Payer: United Healthcare All Other HMO |
$6.99
|
| Rate for Payer: United Healthcare HMO Rider |
$6.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.88
|
| Rate for Payer: Vantage Medical Group Senior |
$11.88
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 2 GRAM INTRAVENOUS SOLUTION [10579]
|
Facility
|
OP
|
$113.10
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
ERX10579
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$96.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$36.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.50
|
| Rate for Payer: Blue Distinction Transplant |
$67.86
|
| Rate for Payer: Blue Shield of California Commercial |
$83.35
|
| Rate for Payer: Blue Shield of California EPN |
$8.51
|
| Rate for Payer: Cash Price |
$50.90
|
| Rate for Payer: Cash Price |
$50.90
|
| Rate for Payer: Cigna of CA HMO |
$79.17
|
| Rate for Payer: Cigna of CA PPO |
$79.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.14
|
| Rate for Payer: Dignity Health Media |
$96.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$45.24
|
| Rate for Payer: Galaxy Health WC |
$96.14
|
| Rate for Payer: Global Benefits Group Commercial |
$67.86
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$84.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.14
|
| Rate for Payer: Multiplan Commercial |
$90.48
|
| Rate for Payer: Networks By Design Commercial |
$56.55
|
| Rate for Payer: Prime Health Services Commercial |
$96.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.55
|
| Rate for Payer: United Healthcare All Other HMO |
$56.55
|
| Rate for Payer: United Healthcare HMO Rider |
$56.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.14
|
| Rate for Payer: Vantage Medical Group Senior |
$96.14
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 2 GRAM INTRAVENOUS SOLUTION [10579]
|
Facility
|
IP
|
$113.10
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
ERX10579
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.14 |
| Max. Negotiated Rate |
$96.14 |
| Rate for Payer: Blue Shield of California Commercial |
$80.53
|
| Rate for Payer: Blue Shield of California EPN |
$57.91
|
| Rate for Payer: Cash Price |
$50.90
|
| Rate for Payer: Cigna of CA HMO |
$79.17
|
| Rate for Payer: Cigna of CA PPO |
$79.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$45.24
|
| Rate for Payer: Galaxy Health WC |
$96.14
|
| Rate for Payer: Global Benefits Group Commercial |
$67.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.14
|
| Rate for Payer: Multiplan Commercial |
$90.48
|
| Rate for Payer: Networks By Design Commercial |
$56.55
|
| Rate for Payer: Prime Health Services Commercial |
$96.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.71
|
| Rate for Payer: United Healthcare All Other HMO |
$41.71
|
| Rate for Payer: United Healthcare HMO Rider |
$40.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.32
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 40 MG SOLUTION FOR INJECTION [10580]
|
Facility
|
OP
|
$7.30
|
|
|
Service Code
|
CPT J2920
|
| Hospital Charge Code |
ERX10580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$26.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$26.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.01
|
| Rate for Payer: Blue Distinction Transplant |
$4.38
|
| Rate for Payer: Blue Shield of California Commercial |
$5.38
|
| Rate for Payer: Blue Shield of California EPN |
$5.52
|
| Rate for Payer: Cash Price |
$3.29
|
| Rate for Payer: Cash Price |
$3.29
|
| Rate for Payer: Cigna of CA HMO |
$5.11
|
| Rate for Payer: Cigna of CA PPO |
$5.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.20
|
| Rate for Payer: Dignity Health Media |
$6.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.92
|
| Rate for Payer: Galaxy Health WC |
$6.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4.38
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.75
|
| Rate for Payer: Multiplan Commercial |
$5.84
|
| Rate for Payer: Networks By Design Commercial |
$3.65
|
| Rate for Payer: Prime Health Services Commercial |
$6.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.65
|
| Rate for Payer: United Healthcare All Other HMO |
$3.65
|
| Rate for Payer: United Healthcare HMO Rider |
$3.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.20
|
| Rate for Payer: Vantage Medical Group Senior |
$6.20
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 40 MG SOLUTION FOR INJECTION [10580]
|
Facility
|
IP
|
$7.30
|
|
|
Service Code
|
CPT J2920
|
| Hospital Charge Code |
ERX10580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$6.20 |
| Rate for Payer: Blue Shield of California Commercial |
$5.20
|
| Rate for Payer: Blue Shield of California EPN |
$3.74
|
| Rate for Payer: Cash Price |
$3.29
|
| Rate for Payer: Cigna of CA HMO |
$5.11
|
| Rate for Payer: Cigna of CA PPO |
$5.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.92
|
| Rate for Payer: Galaxy Health WC |
$6.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.75
|
| Rate for Payer: Multiplan Commercial |
$5.84
|
| Rate for Payer: Networks By Design Commercial |
$3.65
|
| Rate for Payer: Prime Health Services Commercial |
$6.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.76
|
| Rate for Payer: United Healthcare All Other HMO |
$2.69
|
| Rate for Payer: United Healthcare HMO Rider |
$2.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.41
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION [10581]
|
Facility
|
OP
|
$27.74
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
1720342
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.66 |
| 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 |
$23.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.26
|
| 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 |
$17.48
|
| Rate for Payer: Blue Distinction Transplant |
$15.84
|
| Rate for Payer: Blue Distinction Transplant |
$16.64
|
| Rate for Payer: Blue Shield of California Commercial |
$20.44
|
| Rate for Payer: Blue Shield of California Commercial |
$19.46
|
| Rate for Payer: Blue Shield of California Commercial |
$21.48
|
| 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 |
$13.11
|
| Rate for Payer: Cash Price |
$12.48
|
| Rate for Payer: Cash Price |
$12.48
|
| Rate for Payer: Cash Price |
$11.88
|
| Rate for Payer: Cash Price |
$13.11
|
| Rate for Payer: Cash Price |
$11.88
|
| Rate for Payer: Cigna of CA HMO |
$20.40
|
| Rate for Payer: Cigna of CA HMO |
$19.42
|
| Rate for Payer: Cigna of CA HMO |
$18.48
|
| Rate for Payer: Cigna of CA PPO |
$20.40
|
| Rate for Payer: Cigna of CA PPO |
$19.42
|
| Rate for Payer: Cigna of CA PPO |
$18.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.44
|
| Rate for Payer: Dignity Health Media |
$22.44
|
| Rate for Payer: Dignity Health Media |
$23.58
|
| Rate for Payer: Dignity Health Media |
$24.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.66
|
| Rate for Payer: Galaxy Health WC |
$24.77
|
| Rate for Payer: Galaxy Health WC |
$23.58
|
| Rate for Payer: Galaxy Health WC |
$22.44
|
| Rate for Payer: Global Benefits Group Commercial |
$17.48
|
| Rate for Payer: Global Benefits Group Commercial |
$16.64
|
| Rate for Payer: Global Benefits Group Commercial |
$15.84
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$21.86
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$20.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$19.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.34
|
| Rate for Payer: Multiplan Commercial |
$23.31
|
| Rate for Payer: Multiplan Commercial |
$21.12
|
| Rate for Payer: Multiplan Commercial |
$22.19
|
| Rate for Payer: Networks By Design Commercial |
$14.57
|
| Rate for Payer: Networks By Design Commercial |
$13.20
|
| Rate for Payer: Networks By Design Commercial |
$13.87
|
| Rate for Payer: Prime Health Services Commercial |
$22.44
|
| Rate for Payer: Prime Health Services Commercial |
$24.77
|
| Rate for Payer: Prime Health Services Commercial |
$23.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.20
|
| Rate for Payer: United Healthcare All Other HMO |
$14.57
|
| Rate for Payer: United Healthcare All Other HMO |
$13.87
|
| Rate for Payer: United Healthcare All Other HMO |
$13.20
|
| Rate for Payer: United Healthcare HMO Rider |
$13.20
|
| Rate for Payer: United Healthcare HMO Rider |
$14.57
|
| Rate for Payer: United Healthcare HMO Rider |
$13.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.44
|
| Rate for Payer: Vantage Medical Group Senior |
$24.77
|
| Rate for Payer: Vantage Medical Group Senior |
$22.44
|
| Rate for Payer: Vantage Medical Group Senior |
$23.58
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION [10581]
|
Facility
|
IP
|
$26.40
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
1720342
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.34 |
| Max. Negotiated Rate |
$22.44 |
| Rate for Payer: Blue Shield of California Commercial |
$18.80
|
| Rate for Payer: Blue Shield of California Commercial |
$19.75
|
| Rate for Payer: Blue Shield of California Commercial |
$20.75
|
| Rate for Payer: Blue Shield of California EPN |
$14.20
|
| Rate for Payer: Blue Shield of California EPN |
$14.92
|
| Rate for Payer: Blue Shield of California EPN |
$13.52
|
| Rate for Payer: Cash Price |
$12.48
|
| Rate for Payer: Cash Price |
$11.88
|
| Rate for Payer: Cash Price |
$13.11
|
| Rate for Payer: Cigna of CA HMO |
$20.40
|
| Rate for Payer: Cigna of CA HMO |
$19.42
|
| Rate for Payer: Cigna of CA HMO |
$18.48
|
| Rate for Payer: Cigna of CA PPO |
$18.48
|
| Rate for Payer: Cigna of CA PPO |
$19.42
|
| Rate for Payer: Cigna of CA PPO |
$20.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.10
|
| Rate for Payer: Galaxy Health WC |
$23.58
|
| Rate for Payer: Galaxy Health WC |
$22.44
|
| Rate for Payer: Galaxy Health WC |
$24.77
|
| Rate for Payer: Global Benefits Group Commercial |
$17.48
|
| Rate for Payer: Global Benefits Group Commercial |
$15.84
|
| Rate for Payer: Global Benefits Group Commercial |
$16.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$21.12
|
| Rate for Payer: Multiplan Commercial |
$22.19
|
| Rate for Payer: Multiplan Commercial |
$23.31
|
| Rate for Payer: Networks By Design Commercial |
$13.87
|
| Rate for Payer: Networks By Design Commercial |
$13.20
|
| Rate for Payer: Networks By Design Commercial |
$14.57
|
| Rate for Payer: Prime Health Services Commercial |
$22.44
|
| Rate for Payer: Prime Health Services Commercial |
$23.58
|
| Rate for Payer: Prime Health Services Commercial |
$24.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.97
|
| Rate for Payer: United Healthcare All Other HMO |
$10.23
|
| Rate for Payer: United Healthcare All Other HMO |
$9.74
|
| Rate for Payer: United Healthcare All Other HMO |
$10.75
|
| Rate for Payer: United Healthcare HMO Rider |
$10.51
|
| Rate for Payer: United Healthcare HMO Rider |
$9.53
|
| Rate for Payer: United Healthcare HMO Rider |
$10.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.62
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 1,000 MG/8 ML INTRAVENOUS SOLUTION [120963]
|
Facility
|
OP
|
$77.29
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
ERX120963
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$65.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$36.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$65.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.50
|
| Rate for Payer: Blue Distinction Transplant |
$46.37
|
| Rate for Payer: Blue Shield of California Commercial |
$56.96
|
| Rate for Payer: Blue Shield of California EPN |
$8.51
|
| Rate for Payer: Cash Price |
$34.78
|
| Rate for Payer: Cash Price |
$34.78
|
| Rate for Payer: Cigna of CA HMO |
$54.10
|
| Rate for Payer: Cigna of CA PPO |
$54.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$65.70
|
| Rate for Payer: Dignity Health Media |
$65.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$30.92
|
| Rate for Payer: Galaxy Health WC |
$65.70
|
| Rate for Payer: Global Benefits Group Commercial |
$46.37
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$57.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.55
|
| Rate for Payer: Multiplan Commercial |
$61.83
|
| Rate for Payer: Networks By Design Commercial |
$38.64
|
| Rate for Payer: Prime Health Services Commercial |
$65.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.64
|
| Rate for Payer: United Healthcare All Other HMO |
$38.64
|
| Rate for Payer: United Healthcare HMO Rider |
$38.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$65.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.70
|
| Rate for Payer: Vantage Medical Group Senior |
$65.70
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 1,000 MG/8 ML INTRAVENOUS SOLUTION [120963]
|
Facility
|
IP
|
$77.29
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
ERX120963
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.55 |
| Max. Negotiated Rate |
$65.70 |
| Rate for Payer: Blue Shield of California Commercial |
$55.03
|
| Rate for Payer: Blue Shield of California EPN |
$39.57
|
| Rate for Payer: Cash Price |
$34.78
|
| Rate for Payer: Cigna of CA HMO |
$54.10
|
| Rate for Payer: Cigna of CA PPO |
$54.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$30.92
|
| Rate for Payer: Galaxy Health WC |
$65.70
|
| Rate for Payer: Global Benefits Group Commercial |
$46.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.55
|
| Rate for Payer: Multiplan Commercial |
$61.83
|
| Rate for Payer: Networks By Design Commercial |
$38.64
|
| Rate for Payer: Prime Health Services Commercial |
$65.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.18
|
| Rate for Payer: United Healthcare All Other HMO |
$28.50
|
| Rate for Payer: United Healthcare HMO Rider |
$27.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.51
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION [120961]
|
Facility
|
OP
|
$11.68
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
ERX120961
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$36.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$36.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.50
|
| Rate for Payer: Blue Distinction Transplant |
$7.01
|
| Rate for Payer: Blue Shield of California Commercial |
$8.61
|
| Rate for Payer: Blue Shield of California EPN |
$8.51
|
| Rate for Payer: Cash Price |
$5.26
|
| Rate for Payer: Cash Price |
$5.26
|
| Rate for Payer: Cigna of CA HMO |
$8.18
|
| Rate for Payer: Cigna of CA PPO |
$8.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.93
|
| Rate for Payer: Dignity Health Media |
$9.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.67
|
| Rate for Payer: Galaxy Health WC |
$9.93
|
| Rate for Payer: Global Benefits Group Commercial |
$7.01
|
| 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 Medi-Cal |
$4.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.80
|
| Rate for Payer: Multiplan Commercial |
$9.34
|
| Rate for Payer: Networks By Design Commercial |
$5.84
|
| Rate for Payer: Prime Health Services Commercial |
$9.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.84
|
| Rate for Payer: United Healthcare All Other HMO |
$5.84
|
| Rate for Payer: United Healthcare HMO Rider |
$5.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.93
|
| Rate for Payer: Vantage Medical Group Senior |
$9.93
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION [120961]
|
Facility
|
IP
|
$11.68
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
ERX120961
|
|
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 EPN |
$5.98
|
| Rate for Payer: Cash Price |
$5.26
|
| Rate for Payer: Cigna of CA HMO |
$8.18
|
| Rate for Payer: Cigna of CA PPO |
$8.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.67
|
| Rate for Payer: Galaxy Health WC |
$9.93
|
| Rate for Payer: Global Benefits Group Commercial |
$7.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.80
|
| Rate for Payer: Multiplan Commercial |
$9.34
|
| Rate for Payer: Networks By Design Commercial |
$5.84
|
| Rate for Payer: Prime Health Services Commercial |
$9.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.41
|
| Rate for Payer: United Healthcare All Other HMO |
$4.31
|
| Rate for Payer: United Healthcare HMO Rider |
$4.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 40 MG/ML SOLUTION FOR INJECTION [120960]
|
Facility
|
IP
|
$7.26
|
|
|
Service Code
|
CPT J2920
|
| Hospital Charge Code |
ERX120960
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$6.17 |
| Rate for Payer: Blue Shield of California Commercial |
$5.17
|
| Rate for Payer: Blue Shield of California EPN |
$3.72
|
| Rate for Payer: Cash Price |
$3.27
|
| Rate for Payer: Cigna of CA HMO |
$5.08
|
| Rate for Payer: Cigna of CA PPO |
$5.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.90
|
| Rate for Payer: Galaxy Health WC |
$6.17
|
| Rate for Payer: Global Benefits Group Commercial |
$4.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.74
|
| Rate for Payer: Multiplan Commercial |
$5.81
|
| Rate for Payer: Networks By Design Commercial |
$3.63
|
| Rate for Payer: Prime Health Services Commercial |
$6.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.74
|
| Rate for Payer: United Healthcare All Other HMO |
$2.68
|
| Rate for Payer: United Healthcare HMO Rider |
$2.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.40
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 40 MG/ML SOLUTION FOR INJECTION [120960]
|
Facility
|
OP
|
$7.26
|
|
|
Service Code
|
CPT J2920
|
| Hospital Charge Code |
ERX120960
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$26.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$26.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.01
|
| Rate for Payer: Blue Distinction Transplant |
$4.36
|
| Rate for Payer: Blue Shield of California Commercial |
$5.35
|
| Rate for Payer: Blue Shield of California EPN |
$5.52
|
| Rate for Payer: Cash Price |
$3.27
|
| Rate for Payer: Cash Price |
$3.27
|
| Rate for Payer: Cigna of CA HMO |
$5.08
|
| Rate for Payer: Cigna of CA PPO |
$5.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.17
|
| Rate for Payer: Dignity Health Media |
$6.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.90
|
| Rate for Payer: Galaxy Health WC |
$6.17
|
| Rate for Payer: Global Benefits Group Commercial |
$4.36
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.74
|
| Rate for Payer: Multiplan Commercial |
$5.81
|
| Rate for Payer: Networks By Design Commercial |
$3.63
|
| Rate for Payer: Prime Health Services Commercial |
$6.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.63
|
| Rate for Payer: United Healthcare All Other HMO |
$3.63
|
| Rate for Payer: United Healthcare HMO Rider |
$3.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.17
|
| Rate for Payer: Vantage Medical Group Senior |
$6.17
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 500 MG/4 ML INTRAVENOUS SOLUTION [120962]
|
Facility
|
OP
|
$53.14
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
ERX120962
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$45.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$36.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.50
|
| Rate for Payer: Blue Distinction Transplant |
$31.88
|
| Rate for Payer: Blue Shield of California Commercial |
$39.16
|
| Rate for Payer: Blue Shield of California EPN |
$8.51
|
| Rate for Payer: Cash Price |
$23.91
|
| Rate for Payer: Cash Price |
$23.91
|
| Rate for Payer: Cigna of CA HMO |
$37.20
|
| Rate for Payer: Cigna of CA PPO |
$37.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.17
|
| Rate for Payer: Dignity Health Media |
$45.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.26
|
| Rate for Payer: Galaxy Health WC |
$45.17
|
| Rate for Payer: Global Benefits Group Commercial |
$31.88
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$39.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.75
|
| Rate for Payer: Multiplan Commercial |
$42.51
|
| Rate for Payer: Networks By Design Commercial |
$26.57
|
| Rate for Payer: Prime Health Services Commercial |
$45.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.57
|
| Rate for Payer: United Healthcare All Other HMO |
$26.57
|
| Rate for Payer: United Healthcare HMO Rider |
$26.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.17
|
| Rate for Payer: Vantage Medical Group Senior |
$45.17
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 500 MG/4 ML INTRAVENOUS SOLUTION [120962]
|
Facility
|
IP
|
$53.14
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
ERX120962
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$45.17 |
| Rate for Payer: Blue Shield of California Commercial |
$37.84
|
| Rate for Payer: Blue Shield of California EPN |
$27.21
|
| Rate for Payer: Cash Price |
$23.91
|
| Rate for Payer: Cigna of CA HMO |
$37.20
|
| Rate for Payer: Cigna of CA PPO |
$37.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.26
|
| Rate for Payer: Galaxy Health WC |
$45.17
|
| Rate for Payer: Global Benefits Group Commercial |
$31.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.75
|
| Rate for Payer: Multiplan Commercial |
$42.51
|
| Rate for Payer: Networks By Design Commercial |
$26.57
|
| Rate for Payer: Prime Health Services Commercial |
$45.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.07
|
| Rate for Payer: United Healthcare All Other HMO |
$19.60
|
| Rate for Payer: United Healthcare HMO Rider |
$19.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.54
|
|
|
METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM [118363]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 45802-174-53
|
| Hospital Charge Code |
NDG118363A
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Blue Distinction Transplant |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Media |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM [118363]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 45802-174-53
|
| Hospital Charge Code |
NDG118363A
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM [118363]
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 41167-0600-3
|
| Hospital Charge Code |
NDG118363A
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Blue Distinction Transplant |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Media |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM [118363]
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 4116706003
|
| Hospital Charge Code |
NDG118363A
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM [118363]
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 41167-0600-3
|
| Hospital Charge Code |
NDG118363A
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM [118363]
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 4116706003
|
| Hospital Charge Code |
NDG118363A
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Blue Distinction Transplant |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Media |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
METOCLOPRAMIDE 10 MG/10 ML ORAL SOLUTION [40877725]
|
Facility
|
IP
|
$0.65
|
|
|
Service Code
|
NDC 66689-031-01
|
| Hospital Charge Code |
1716072
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California EPN |
$0.33
|
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.46
|
| Rate for Payer: Cigna of CA PPO |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.55
|
| Rate for Payer: Global Benefits Group Commercial |
$0.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.52
|
| Rate for Payer: Networks By Design Commercial |
$0.42
|
| Rate for Payer: Prime Health Services Commercial |
$0.55
|
|
|
METOCLOPRAMIDE 10 MG/10 ML ORAL SOLUTION [40877725]
|
Facility
|
OP
|
$0.65
|
|
|
Service Code
|
NDC 66689-031-50
|
| Hospital Charge Code |
1716072
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.39
|
| Rate for Payer: Blue Distinction Transplant |
$0.39
|
| Rate for Payer: Blue Shield of California Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California EPN |
$0.38
|
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.46
|
| Rate for Payer: Cigna of CA PPO |
$0.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.55
|
| Rate for Payer: Dignity Health Media |
$0.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.55
|
| Rate for Payer: Global Benefits Group Commercial |
$0.39
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.52
|
| Rate for Payer: Networks By Design Commercial |
$0.42
|
| Rate for Payer: Prime Health Services Commercial |
$0.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.33
|
| Rate for Payer: United Healthcare All Other HMO |
$0.33
|
| Rate for Payer: United Healthcare HMO Rider |
$0.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: Vantage Medical Group Senior |
$0.55
|
|
