MEDROXYPROGESTERONE 10 MG TABLET [4854]
|
Facility
OP
|
$0.32
|
|
Service Code
|
NDC 59762-3742-2
|
Hospital Charge Code |
1710307
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.08 |
Max. Negotiated Rate |
$0.27 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.21
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.27
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.18
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.18
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.19
|
Rate for Payer: BCBS Transplant Transplant |
$0.19
|
Rate for Payer: Blue Shield of California Commercial |
$0.24
|
Rate for Payer: Blue Shield of California EPN |
$0.19
|
Rate for Payer: Cash Price |
$0.14
|
Rate for Payer: Cigna of CA HMO |
$0.22
|
Rate for Payer: Cigna of CA PPO |
$0.22
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.27
|
Rate for Payer: Dignity Health Media |
$0.27
|
Rate for Payer: Dignity Health Medi-Cal |
$0.27
|
Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
Rate for Payer: EPIC Health Plan Transplant |
$0.13
|
Rate for Payer: Galaxy Health WC |
$0.27
|
Rate for Payer: Global Benefits Group Commercial |
$0.19
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.24
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
Rate for Payer: Multiplan Commercial |
$0.26
|
Rate for Payer: Networks By Design Commercial |
$0.21
|
Rate for Payer: Prime Health Services Commercial |
$0.27
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.19
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.19
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.19
|
Rate for Payer: United Healthcare All Other Commercial |
$0.16
|
Rate for Payer: United Healthcare All Other HMO |
$0.16
|
Rate for Payer: United Healthcare HMO Rider |
$0.16
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.27
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.27
|
Rate for Payer: Vantage Medical Group Senior |
$0.27
|
|
MEDROXYPROGESTERONE 10 MG TABLET [4854]
|
Facility
OP
|
$1.68
|
|
Service Code
|
NDC 60687-105-21
|
Hospital Charge Code |
1710307
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.40 |
Max. Negotiated Rate |
$1.43 |
Rate for Payer: Aetna of CA HMO/PPO |
$1.10
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.43
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.92
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.92
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.00
|
Rate for Payer: BCBS Transplant Transplant |
$1.01
|
Rate for Payer: Blue Shield of California Commercial |
$1.24
|
Rate for Payer: Blue Shield of California EPN |
$0.98
|
Rate for Payer: Cash Price |
$0.76
|
Rate for Payer: Cigna of CA HMO |
$1.18
|
Rate for Payer: Cigna of CA PPO |
$1.18
|
Rate for Payer: Dignity Health Commercial/Exchange |
$1.43
|
Rate for Payer: Dignity Health Media |
$1.43
|
Rate for Payer: Dignity Health Medi-Cal |
$1.43
|
Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
Rate for Payer: EPIC Health Plan Transplant |
$0.67
|
Rate for Payer: Galaxy Health WC |
$1.43
|
Rate for Payer: Global Benefits Group Commercial |
$1.01
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.26
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.12
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.64
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
Rate for Payer: Multiplan Commercial |
$1.34
|
Rate for Payer: Networks By Design Commercial |
$1.09
|
Rate for Payer: Prime Health Services Commercial |
$1.43
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.01
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.01
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.01
|
Rate for Payer: United Healthcare All Other Commercial |
$0.84
|
Rate for Payer: United Healthcare All Other HMO |
$0.84
|
Rate for Payer: United Healthcare HMO Rider |
$0.84
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.84
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.43
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$1.43
|
Rate for Payer: Vantage Medical Group Senior |
$1.43
|
|
MEDROXYPROGESTERONE 10 MG TABLET [4854]
|
Facility
OP
|
$0.32
|
|
Service Code
|
NDC 59762-0056-1
|
Hospital Charge Code |
1710307
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.08 |
Max. Negotiated Rate |
$0.27 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.21
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.27
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.18
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.18
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.19
|
Rate for Payer: BCBS Transplant Transplant |
$0.19
|
Rate for Payer: Blue Shield of California Commercial |
$0.24
|
Rate for Payer: Blue Shield of California EPN |
$0.19
|
Rate for Payer: Cash Price |
$0.14
|
Rate for Payer: Cigna of CA HMO |
$0.22
|
Rate for Payer: Cigna of CA PPO |
$0.22
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.27
|
Rate for Payer: Dignity Health Media |
$0.27
|
Rate for Payer: Dignity Health Medi-Cal |
$0.27
|
Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
Rate for Payer: EPIC Health Plan Transplant |
$0.13
|
Rate for Payer: Galaxy Health WC |
$0.27
|
Rate for Payer: Global Benefits Group Commercial |
$0.19
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.24
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
Rate for Payer: Multiplan Commercial |
$0.26
|
Rate for Payer: Networks By Design Commercial |
$0.21
|
Rate for Payer: Prime Health Services Commercial |
$0.27
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.19
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.19
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.19
|
Rate for Payer: United Healthcare All Other Commercial |
$0.16
|
Rate for Payer: United Healthcare All Other HMO |
$0.16
|
Rate for Payer: United Healthcare HMO Rider |
$0.16
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.27
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.27
|
Rate for Payer: Vantage Medical Group Senior |
$0.27
|
|
MEDROXYPROGESTERONE 10 MG TABLET [4854]
|
Facility
IP
|
$0.32
|
|
Service Code
|
NDC 0555-0779-02
|
Hospital Charge Code |
1710307
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.08 |
Max. Negotiated Rate |
$0.27 |
Rate for Payer: Blue Shield of California Commercial |
$0.23
|
Rate for Payer: Blue Shield of California EPN |
$0.16
|
Rate for Payer: Cash Price |
$0.14
|
Rate for Payer: Cigna of CA HMO |
$0.22
|
Rate for Payer: Cigna of CA PPO |
$0.22
|
Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
Rate for Payer: Galaxy Health WC |
$0.27
|
Rate for Payer: Global Benefits Group Commercial |
$0.19
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
Rate for Payer: Multiplan Commercial |
$0.26
|
Rate for Payer: Networks By Design Commercial |
$0.21
|
Rate for Payer: Prime Health Services Commercial |
$0.27
|
|
MEDROXYPROGESTERONE 10 MG TABLET [4854]
|
Facility
IP
|
$1.68
|
|
Service Code
|
NDC 60687-105-11
|
Hospital Charge Code |
1710307
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.40 |
Max. Negotiated Rate |
$1.43 |
Rate for Payer: Blue Shield of California Commercial |
$1.20
|
Rate for Payer: Blue Shield of California EPN |
$0.86
|
Rate for Payer: Cash Price |
$0.76
|
Rate for Payer: Cigna of CA HMO |
$1.18
|
Rate for Payer: Cigna of CA PPO |
$1.18
|
Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
Rate for Payer: Galaxy Health WC |
$1.43
|
Rate for Payer: Global Benefits Group Commercial |
$1.01
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.12
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.64
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
Rate for Payer: Multiplan Commercial |
$1.34
|
Rate for Payer: Networks By Design Commercial |
$1.09
|
Rate for Payer: Prime Health Services Commercial |
$1.43
|
|
MEDROXYPROGESTERONE 10 MG TABLET [4854]
|
Facility
OP
|
$1.68
|
|
Service Code
|
NDC 60687-105-11
|
Hospital Charge Code |
1710307
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.40 |
Max. Negotiated Rate |
$1.43 |
Rate for Payer: Aetna of CA HMO/PPO |
$1.10
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.43
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.92
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.92
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.00
|
Rate for Payer: BCBS Transplant Transplant |
$1.01
|
Rate for Payer: Blue Shield of California Commercial |
$1.24
|
Rate for Payer: Blue Shield of California EPN |
$0.98
|
Rate for Payer: Cash Price |
$0.76
|
Rate for Payer: Cigna of CA HMO |
$1.18
|
Rate for Payer: Cigna of CA PPO |
$1.18
|
Rate for Payer: Dignity Health Commercial/Exchange |
$1.43
|
Rate for Payer: Dignity Health Media |
$1.43
|
Rate for Payer: Dignity Health Medi-Cal |
$1.43
|
Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
Rate for Payer: EPIC Health Plan Transplant |
$0.67
|
Rate for Payer: Galaxy Health WC |
$1.43
|
Rate for Payer: Global Benefits Group Commercial |
$1.01
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.26
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.12
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.64
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
Rate for Payer: Multiplan Commercial |
$1.34
|
Rate for Payer: Networks By Design Commercial |
$1.09
|
Rate for Payer: Prime Health Services Commercial |
$1.43
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.01
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.01
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.01
|
Rate for Payer: United Healthcare All Other Commercial |
$0.84
|
Rate for Payer: United Healthcare All Other HMO |
$0.84
|
Rate for Payer: United Healthcare HMO Rider |
$0.84
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.84
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.43
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$1.43
|
Rate for Payer: Vantage Medical Group Senior |
$1.43
|
|
MEDROXYPROGESTERONE 10 MG TABLET [4854]
|
Facility
OP
|
$0.32
|
|
Service Code
|
NDC 0555-0779-02
|
Hospital Charge Code |
1710307
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.08 |
Max. Negotiated Rate |
$0.27 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.21
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.27
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.18
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.18
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.19
|
Rate for Payer: BCBS Transplant Transplant |
$0.19
|
Rate for Payer: Blue Shield of California Commercial |
$0.24
|
Rate for Payer: Blue Shield of California EPN |
$0.19
|
Rate for Payer: Cash Price |
$0.14
|
Rate for Payer: Cigna of CA HMO |
$0.22
|
Rate for Payer: Cigna of CA PPO |
$0.22
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.27
|
Rate for Payer: Dignity Health Media |
$0.27
|
Rate for Payer: Dignity Health Medi-Cal |
$0.27
|
Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
Rate for Payer: EPIC Health Plan Transplant |
$0.13
|
Rate for Payer: Galaxy Health WC |
$0.27
|
Rate for Payer: Global Benefits Group Commercial |
$0.19
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.24
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
Rate for Payer: Multiplan Commercial |
$0.26
|
Rate for Payer: Networks By Design Commercial |
$0.21
|
Rate for Payer: Prime Health Services Commercial |
$0.27
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.19
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.19
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.19
|
Rate for Payer: United Healthcare All Other Commercial |
$0.16
|
Rate for Payer: United Healthcare All Other HMO |
$0.16
|
Rate for Payer: United Healthcare HMO Rider |
$0.16
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.27
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.27
|
Rate for Payer: Vantage Medical Group Senior |
$0.27
|
|
MEDROXYPROGESTERONE 10 MG TABLET [4854]
|
Facility
IP
|
$0.32
|
|
Service Code
|
NDC 59762-3742-2
|
Hospital Charge Code |
1710307
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.08 |
Max. Negotiated Rate |
$0.27 |
Rate for Payer: Blue Shield of California Commercial |
$0.23
|
Rate for Payer: Blue Shield of California EPN |
$0.16
|
Rate for Payer: Cash Price |
$0.14
|
Rate for Payer: Cigna of CA HMO |
$0.22
|
Rate for Payer: Cigna of CA PPO |
$0.22
|
Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
Rate for Payer: Galaxy Health WC |
$0.27
|
Rate for Payer: Global Benefits Group Commercial |
$0.19
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
Rate for Payer: Multiplan Commercial |
$0.26
|
Rate for Payer: Networks By Design Commercial |
$0.21
|
Rate for Payer: Prime Health Services Commercial |
$0.27
|
|
MEDROXYPROGESTERONE 10 MG TABLET [4854]
|
Facility
IP
|
$1.68
|
|
Service Code
|
NDC 60687-105-21
|
Hospital Charge Code |
1710307
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.40 |
Max. Negotiated Rate |
$1.43 |
Rate for Payer: Blue Shield of California Commercial |
$1.20
|
Rate for Payer: Blue Shield of California EPN |
$0.86
|
Rate for Payer: Cash Price |
$0.76
|
Rate for Payer: Cigna of CA HMO |
$1.18
|
Rate for Payer: Cigna of CA PPO |
$1.18
|
Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
Rate for Payer: Galaxy Health WC |
$1.43
|
Rate for Payer: Global Benefits Group Commercial |
$1.01
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.12
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.64
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
Rate for Payer: Multiplan Commercial |
$1.34
|
Rate for Payer: Networks By Design Commercial |
$1.09
|
Rate for Payer: Prime Health Services Commercial |
$1.43
|
|
MEDROXYPROGESTERONE 10 MG TABLET [4854]
|
Facility
IP
|
$0.32
|
|
Service Code
|
NDC 59762-0056-1
|
Hospital Charge Code |
1710307
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.08 |
Max. Negotiated Rate |
$0.27 |
Rate for Payer: Blue Shield of California Commercial |
$0.23
|
Rate for Payer: Blue Shield of California EPN |
$0.16
|
Rate for Payer: Cash Price |
$0.14
|
Rate for Payer: Cigna of CA HMO |
$0.22
|
Rate for Payer: Cigna of CA PPO |
$0.22
|
Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
Rate for Payer: Galaxy Health WC |
$0.27
|
Rate for Payer: Global Benefits Group Commercial |
$0.19
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
Rate for Payer: Multiplan Commercial |
$0.26
|
Rate for Payer: Networks By Design Commercial |
$0.21
|
Rate for Payer: Prime Health Services Commercial |
$0.27
|
|
MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR SYRINGE [114250]
|
Facility
OP
|
$66.00
|
|
Service Code
|
CPT J1050
|
Hospital Charge Code |
1712590
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.41 |
Max. Negotiated Rate |
$56.10 |
Rate for Payer: Cigna of CA HMO |
$46.20
|
Rate for Payer: Cigna of CA HMO |
$60.48
|
Rate for Payer: Cigna of CA PPO |
$46.20
|
Rate for Payer: Cigna of CA PPO |
$60.48
|
Rate for Payer: Aetna of CA HMO/PPO |
$3.36
|
Rate for Payer: Aetna of CA HMO/PPO |
$3.36
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$56.10
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$73.44
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$47.52
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$36.30
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$47.52
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$36.30
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.41
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.41
|
Rate for Payer: BCBS Transplant Transplant |
$51.84
|
Rate for Payer: BCBS Transplant Transplant |
$39.60
|
Rate for Payer: Blue Shield of California Commercial |
$48.64
|
Rate for Payer: Blue Shield of California Commercial |
$63.68
|
Rate for Payer: Blue Shield of California EPN |
$0.65
|
Rate for Payer: Blue Shield of California EPN |
$0.65
|
Rate for Payer: Cash Price |
$29.70
|
Rate for Payer: Cash Price |
$29.70
|
Rate for Payer: Cash Price |
$38.88
|
Rate for Payer: Cash Price |
$38.88
|
Rate for Payer: Dignity Health Commercial/Exchange |
$73.44
|
Rate for Payer: Dignity Health Commercial/Exchange |
$56.10
|
Rate for Payer: Dignity Health Media |
$73.44
|
Rate for Payer: Dignity Health Media |
$56.10
|
Rate for Payer: Dignity Health Medi-Cal |
$73.44
|
Rate for Payer: Dignity Health Medi-Cal |
$56.10
|
Rate for Payer: EPIC Health Plan Commercial |
$26.40
|
Rate for Payer: EPIC Health Plan Commercial |
$34.56
|
Rate for Payer: EPIC Health Plan Transplant |
$34.56
|
Rate for Payer: EPIC Health Plan Transplant |
$26.40
|
Rate for Payer: Galaxy Health WC |
$56.10
|
Rate for Payer: Galaxy Health WC |
$73.44
|
Rate for Payer: Global Benefits Group Commercial |
$39.60
|
Rate for Payer: Global Benefits Group Commercial |
$51.84
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$64.80
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$49.50
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.02
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.63
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.56
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.56
|
Rate for Payer: LLUH Dept of Risk Management WC |
$15.84
|
Rate for Payer: LLUH Dept of Risk Management WC |
$20.74
|
Rate for Payer: Multiplan Commercial |
$69.12
|
Rate for Payer: Multiplan Commercial |
$52.80
|
Rate for Payer: Networks By Design Commercial |
$33.00
|
Rate for Payer: Networks By Design Commercial |
$43.20
|
Rate for Payer: Prime Health Services Commercial |
$73.44
|
Rate for Payer: Prime Health Services Commercial |
$56.10
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.60
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.84
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.60
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.84
|
Rate for Payer: United Healthcare All Other Commercial |
$43.20
|
Rate for Payer: United Healthcare All Other Commercial |
$33.00
|
Rate for Payer: United Healthcare All Other HMO |
$43.20
|
Rate for Payer: United Healthcare All Other HMO |
$33.00
|
Rate for Payer: United Healthcare HMO Rider |
$43.20
|
Rate for Payer: United Healthcare HMO Rider |
$33.00
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$43.20
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$33.00
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$73.44
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.10
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$56.10
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$73.44
|
Rate for Payer: Vantage Medical Group Senior |
$56.10
|
Rate for Payer: Vantage Medical Group Senior |
$73.44
|
|
MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR SYRINGE [114250]
|
Facility
IP
|
$86.40
|
|
Service Code
|
CPT J1050
|
Hospital Charge Code |
1712590
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$20.74 |
Max. Negotiated Rate |
$73.44 |
Rate for Payer: Blue Shield of California Commercial |
$61.52
|
Rate for Payer: Blue Shield of California Commercial |
$46.99
|
Rate for Payer: Blue Shield of California EPN |
$33.79
|
Rate for Payer: Blue Shield of California EPN |
$44.24
|
Rate for Payer: Cash Price |
$29.70
|
Rate for Payer: Cash Price |
$38.88
|
Rate for Payer: Cigna of CA HMO |
$60.48
|
Rate for Payer: Cigna of CA HMO |
$46.20
|
Rate for Payer: Cigna of CA PPO |
$60.48
|
Rate for Payer: Cigna of CA PPO |
$46.20
|
Rate for Payer: EPIC Health Plan Commercial |
$26.40
|
Rate for Payer: EPIC Health Plan Commercial |
$34.56
|
Rate for Payer: EPIC Health Plan Transplant |
$26.40
|
Rate for Payer: EPIC Health Plan Transplant |
$34.56
|
Rate for Payer: Galaxy Health WC |
$73.44
|
Rate for Payer: Galaxy Health WC |
$56.10
|
Rate for Payer: Global Benefits Group Commercial |
$39.60
|
Rate for Payer: Global Benefits Group Commercial |
$51.84
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.02
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.63
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.92
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.15
|
Rate for Payer: LLUH Dept of Risk Management WC |
$15.84
|
Rate for Payer: LLUH Dept of Risk Management WC |
$20.74
|
Rate for Payer: Multiplan Commercial |
$52.80
|
Rate for Payer: Multiplan Commercial |
$69.12
|
Rate for Payer: Networks By Design Commercial |
$43.20
|
Rate for Payer: Networks By Design Commercial |
$33.00
|
Rate for Payer: Prime Health Services Commercial |
$56.10
|
Rate for Payer: Prime Health Services Commercial |
$73.44
|
|
MEDROXYPROGESTERONE 2.5 MG TABLET [4855]
|
Facility
OP
|
$0.17
|
|
Service Code
|
NDC 0555-0872-02
|
Hospital Charge Code |
1711061
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.04 |
Max. Negotiated Rate |
$0.14 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.11
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.14
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.09
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.09
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
Rate for Payer: BCBS Transplant Transplant |
$0.10
|
Rate for Payer: Blue Shield of California Commercial |
$0.13
|
Rate for Payer: Blue Shield of California EPN |
$0.10
|
Rate for Payer: Cash Price |
$0.08
|
Rate for Payer: Cigna of CA HMO |
$0.12
|
Rate for Payer: Cigna of CA PPO |
$0.12
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
Rate for Payer: Dignity Health Media |
$0.14
|
Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
Rate for Payer: EPIC Health Plan Transplant |
$0.07
|
Rate for Payer: Galaxy Health WC |
$0.14
|
Rate for Payer: Global Benefits Group Commercial |
$0.10
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.13
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
Rate for Payer: Multiplan Commercial |
$0.14
|
Rate for Payer: Networks By Design Commercial |
$0.11
|
Rate for Payer: Prime Health Services Commercial |
$0.14
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.10
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
Rate for Payer: United Healthcare All Other HMO |
$0.09
|
Rate for Payer: United Healthcare HMO Rider |
$0.09
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
MEDROXYPROGESTERONE 2.5 MG TABLET [4855]
|
Facility
OP
|
$0.17
|
|
Service Code
|
NDC 59762-0055-1
|
Hospital Charge Code |
1711061
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.04 |
Max. Negotiated Rate |
$0.14 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.11
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.14
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.09
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.09
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
Rate for Payer: BCBS Transplant Transplant |
$0.10
|
Rate for Payer: Blue Shield of California Commercial |
$0.13
|
Rate for Payer: Blue Shield of California EPN |
$0.10
|
Rate for Payer: Cash Price |
$0.08
|
Rate for Payer: Cigna of CA HMO |
$0.12
|
Rate for Payer: Cigna of CA PPO |
$0.12
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
Rate for Payer: Dignity Health Media |
$0.14
|
Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
Rate for Payer: EPIC Health Plan Transplant |
$0.07
|
Rate for Payer: Galaxy Health WC |
$0.14
|
Rate for Payer: Global Benefits Group Commercial |
$0.10
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.13
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
Rate for Payer: Multiplan Commercial |
$0.14
|
Rate for Payer: Networks By Design Commercial |
$0.11
|
Rate for Payer: Prime Health Services Commercial |
$0.14
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.10
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
Rate for Payer: United Healthcare All Other HMO |
$0.09
|
Rate for Payer: United Healthcare HMO Rider |
$0.09
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
MEDROXYPROGESTERONE 2.5 MG TABLET [4855]
|
Facility
IP
|
$0.17
|
|
Service Code
|
NDC 0555-0872-02
|
Hospital Charge Code |
1711061
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.04 |
Max. Negotiated Rate |
$0.14 |
Rate for Payer: Blue Shield of California Commercial |
$0.12
|
Rate for Payer: Blue Shield of California EPN |
$0.09
|
Rate for Payer: Cash Price |
$0.08
|
Rate for Payer: Cigna of CA HMO |
$0.12
|
Rate for Payer: Cigna of CA PPO |
$0.12
|
Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
Rate for Payer: Galaxy Health WC |
$0.14
|
Rate for Payer: Global Benefits Group Commercial |
$0.10
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
Rate for Payer: Multiplan Commercial |
$0.14
|
Rate for Payer: Networks By Design Commercial |
$0.11
|
Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
MEDROXYPROGESTERONE 2.5 MG TABLET [4855]
|
Facility
IP
|
$0.17
|
|
Service Code
|
NDC 59762-0055-1
|
Hospital Charge Code |
1711061
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.04 |
Max. Negotiated Rate |
$0.14 |
Rate for Payer: Blue Shield of California Commercial |
$0.12
|
Rate for Payer: Blue Shield of California EPN |
$0.09
|
Rate for Payer: Cash Price |
$0.08
|
Rate for Payer: Cigna of CA HMO |
$0.12
|
Rate for Payer: Cigna of CA PPO |
$0.12
|
Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
Rate for Payer: Galaxy Health WC |
$0.14
|
Rate for Payer: Global Benefits Group Commercial |
$0.10
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
Rate for Payer: Multiplan Commercial |
$0.14
|
Rate for Payer: Networks By Design Commercial |
$0.11
|
Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
MEGESTROL 20 MG TABLET [4870]
|
Facility
OP
|
$0.23
|
|
Service Code
|
CPT S0179
|
Hospital Charge Code |
1711291
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.06 |
Max. Negotiated Rate |
$2.11 |
Rate for Payer: Aetna of CA HMO/PPO |
$1.18
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.20
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.13
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.13
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.11
|
Rate for Payer: BCBS Transplant Transplant |
$0.14
|
Rate for Payer: Blue Shield of California Commercial |
$0.17
|
Rate for Payer: Blue Shield of California EPN |
$0.13
|
Rate for Payer: Cash Price |
$0.10
|
Rate for Payer: Cash Price |
$0.10
|
Rate for Payer: Cigna of CA HMO |
$0.16
|
Rate for Payer: Cigna of CA PPO |
$0.16
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
Rate for Payer: Dignity Health Media |
$0.20
|
Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
Rate for Payer: EPIC Health Plan Transplant |
$0.09
|
Rate for Payer: Galaxy Health WC |
$0.20
|
Rate for Payer: Global Benefits Group Commercial |
$0.14
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.17
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
Rate for Payer: Multiplan Commercial |
$0.18
|
Rate for Payer: Networks By Design Commercial |
$0.15
|
Rate for Payer: Prime Health Services Commercial |
$0.20
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.14
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
Rate for Payer: United Healthcare All Other HMO |
$0.12
|
Rate for Payer: United Healthcare HMO Rider |
$0.12
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
MEGESTROL 20 MG TABLET [4870]
|
Facility
IP
|
$0.23
|
|
Service Code
|
CPT S0179
|
Hospital Charge Code |
1711291
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.06 |
Max. Negotiated Rate |
$0.20 |
Rate for Payer: Blue Shield of California Commercial |
$0.16
|
Rate for Payer: Blue Shield of California EPN |
$0.12
|
Rate for Payer: Cash Price |
$0.10
|
Rate for Payer: Cigna of CA HMO |
$0.16
|
Rate for Payer: Cigna of CA PPO |
$0.16
|
Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
Rate for Payer: Galaxy Health WC |
$0.20
|
Rate for Payer: Global Benefits Group Commercial |
$0.14
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
Rate for Payer: Multiplan Commercial |
$0.18
|
Rate for Payer: Networks By Design Commercial |
$0.15
|
Rate for Payer: Prime Health Services Commercial |
$0.20
|
|
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION [197668]
|
Facility
OP
|
$0.45
|
|
Service Code
|
CPT S0179
|
Hospital Charge Code |
1716080
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.11 |
Max. Negotiated Rate |
$2.11 |
Rate for Payer: Aetna of CA HMO/PPO |
$1.18
|
Rate for Payer: Aetna of CA HMO/PPO |
$1.18
|
Rate for Payer: Aetna of CA HMO/PPO |
$1.18
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.37
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.36
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.38
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.24
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.25
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.23
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.23
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.24
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.25
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.11
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.11
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.11
|
Rate for Payer: BCBS Transplant Transplant |
$0.25
|
Rate for Payer: BCBS Transplant Transplant |
$0.27
|
Rate for Payer: BCBS Transplant Transplant |
$0.26
|
Rate for Payer: Blue Shield of California Commercial |
$0.33
|
Rate for Payer: Blue Shield of California Commercial |
$0.31
|
Rate for Payer: Blue Shield of California Commercial |
$0.32
|
Rate for Payer: Blue Shield of California EPN |
$0.25
|
Rate for Payer: Blue Shield of California EPN |
$0.26
|
Rate for Payer: Blue Shield of California EPN |
$0.25
|
Rate for Payer: Cash Price |
$0.20
|
Rate for Payer: Cash Price |
$0.19
|
Rate for Payer: Cash Price |
$0.19
|
Rate for Payer: Cash Price |
$0.19
|
Rate for Payer: Cash Price |
$0.19
|
Rate for Payer: Cash Price |
$0.20
|
Rate for Payer: Cigna of CA HMO |
$0.30
|
Rate for Payer: Cigna of CA HMO |
$0.29
|
Rate for Payer: Cigna of CA HMO |
$0.32
|
Rate for Payer: Cigna of CA PPO |
$0.29
|
Rate for Payer: Cigna of CA PPO |
$0.32
|
Rate for Payer: Cigna of CA PPO |
$0.30
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.36
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.38
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.37
|
Rate for Payer: Dignity Health Media |
$0.38
|
Rate for Payer: Dignity Health Media |
$0.36
|
Rate for Payer: Dignity Health Media |
$0.37
|
Rate for Payer: Dignity Health Medi-Cal |
$0.36
|
Rate for Payer: Dignity Health Medi-Cal |
$0.38
|
Rate for Payer: Dignity Health Medi-Cal |
$0.37
|
Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
Rate for Payer: EPIC Health Plan Transplant |
$0.18
|
Rate for Payer: EPIC Health Plan Transplant |
$0.17
|
Rate for Payer: EPIC Health Plan Transplant |
$0.17
|
Rate for Payer: Galaxy Health WC |
$0.38
|
Rate for Payer: Galaxy Health WC |
$0.37
|
Rate for Payer: Galaxy Health WC |
$0.36
|
Rate for Payer: Global Benefits Group Commercial |
$0.27
|
Rate for Payer: Global Benefits Group Commercial |
$0.26
|
Rate for Payer: Global Benefits Group Commercial |
$0.25
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.34
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.32
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.32
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.29
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.28
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.30
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.17
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
Rate for Payer: Multiplan Commercial |
$0.34
|
Rate for Payer: Multiplan Commercial |
$0.36
|
Rate for Payer: Multiplan Commercial |
$0.34
|
Rate for Payer: Networks By Design Commercial |
$0.27
|
Rate for Payer: Networks By Design Commercial |
$0.29
|
Rate for Payer: Networks By Design Commercial |
$0.28
|
Rate for Payer: Prime Health Services Commercial |
$0.37
|
Rate for Payer: Prime Health Services Commercial |
$0.36
|
Rate for Payer: Prime Health Services Commercial |
$0.38
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.26
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.27
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.25
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.25
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.26
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.27
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.27
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.25
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.26
|
Rate for Payer: United Healthcare All Other Commercial |
$0.22
|
Rate for Payer: United Healthcare All Other Commercial |
$0.23
|
Rate for Payer: United Healthcare All Other Commercial |
$0.21
|
Rate for Payer: United Healthcare All Other HMO |
$0.21
|
Rate for Payer: United Healthcare All Other HMO |
$0.22
|
Rate for Payer: United Healthcare All Other HMO |
$0.23
|
Rate for Payer: United Healthcare HMO Rider |
$0.23
|
Rate for Payer: United Healthcare HMO Rider |
$0.21
|
Rate for Payer: United Healthcare HMO Rider |
$0.22
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.21
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.22
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.23
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.38
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.37
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.36
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.38
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.36
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.37
|
Rate for Payer: Vantage Medical Group Senior |
$0.38
|
Rate for Payer: Vantage Medical Group Senior |
$0.36
|
Rate for Payer: Vantage Medical Group Senior |
$0.37
|
|
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION [197668]
|
Facility
IP
|
$0.43
|
|
Service Code
|
CPT S0179
|
Hospital Charge Code |
1716080
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.10 |
Max. Negotiated Rate |
$0.37 |
Rate for Payer: Cigna of CA HMO |
$0.29
|
Rate for Payer: Cigna of CA PPO |
$0.32
|
Rate for Payer: Cigna of CA PPO |
$0.30
|
Rate for Payer: Cigna of CA PPO |
$0.29
|
Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
Rate for Payer: Galaxy Health WC |
$0.37
|
Rate for Payer: Galaxy Health WC |
$0.36
|
Rate for Payer: Galaxy Health WC |
$0.38
|
Rate for Payer: Blue Shield of California Commercial |
$0.31
|
Rate for Payer: Blue Shield of California Commercial |
$0.30
|
Rate for Payer: Blue Shield of California Commercial |
$0.32
|
Rate for Payer: Blue Shield of California EPN |
$0.23
|
Rate for Payer: Blue Shield of California EPN |
$0.22
|
Rate for Payer: Blue Shield of California EPN |
$0.22
|
Rate for Payer: Cash Price |
$0.20
|
Rate for Payer: Cash Price |
$0.19
|
Rate for Payer: Cash Price |
$0.19
|
Rate for Payer: Cigna of CA HMO |
$0.30
|
Rate for Payer: Cigna of CA HMO |
$0.32
|
Rate for Payer: Global Benefits Group Commercial |
$0.25
|
Rate for Payer: Global Benefits Group Commercial |
$0.26
|
Rate for Payer: Global Benefits Group Commercial |
$0.27
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.28
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.29
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.30
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.17
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
Rate for Payer: Multiplan Commercial |
$0.34
|
Rate for Payer: Multiplan Commercial |
$0.34
|
Rate for Payer: Multiplan Commercial |
$0.36
|
Rate for Payer: Networks By Design Commercial |
$0.28
|
Rate for Payer: Networks By Design Commercial |
$0.29
|
Rate for Payer: Networks By Design Commercial |
$0.27
|
Rate for Payer: Prime Health Services Commercial |
$0.36
|
Rate for Payer: Prime Health Services Commercial |
$0.37
|
Rate for Payer: Prime Health Services Commercial |
$0.38
|
|
MEGESTROL 400 MG/10 ML (40 MG/ML) ORAL SUSPENSION [10521]
|
Facility
IP
|
$0.15
|
|
Service Code
|
CPT S0179
|
Hospital Charge Code |
1715125
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.04 |
Max. Negotiated Rate |
$0.13 |
Rate for Payer: Blue Shield of California Commercial |
$0.11
|
Rate for Payer: Blue Shield of California Commercial |
$0.13
|
Rate for Payer: Blue Shield of California EPN |
$0.09
|
Rate for Payer: Blue Shield of California EPN |
$0.08
|
Rate for Payer: Cash Price |
$0.07
|
Rate for Payer: Cash Price |
$0.08
|
Rate for Payer: Cigna of CA HMO |
$0.13
|
Rate for Payer: Cigna of CA HMO |
$0.11
|
Rate for Payer: Cigna of CA PPO |
$0.11
|
Rate for Payer: Cigna of CA PPO |
$0.13
|
Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
Rate for Payer: EPIC Health Plan Transplant |
$0.07
|
Rate for Payer: Galaxy Health WC |
$0.13
|
Rate for Payer: Galaxy Health WC |
$0.15
|
Rate for Payer: Global Benefits Group Commercial |
$0.11
|
Rate for Payer: Global Benefits Group Commercial |
$0.09
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.12
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.10
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
Rate for Payer: Multiplan Commercial |
$0.14
|
Rate for Payer: Multiplan Commercial |
$0.12
|
Rate for Payer: Networks By Design Commercial |
$0.08
|
Rate for Payer: Networks By Design Commercial |
$0.09
|
Rate for Payer: Prime Health Services Commercial |
$0.13
|
Rate for Payer: Prime Health Services Commercial |
$0.15
|
|
MEGESTROL 400 MG/10 ML (40 MG/ML) ORAL SUSPENSION [10521]
|
Facility
OP
|
$0.15
|
|
Service Code
|
CPT S0179
|
Hospital Charge Code |
1715125
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.04 |
Max. Negotiated Rate |
$2.11 |
Rate for Payer: Aetna of CA HMO/PPO |
$1.18
|
Rate for Payer: Aetna of CA HMO/PPO |
$1.18
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.15
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.13
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.08
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.10
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.10
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.08
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.11
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.11
|
Rate for Payer: BCBS Transplant Transplant |
$0.09
|
Rate for Payer: BCBS Transplant Transplant |
$0.11
|
Rate for Payer: Blue Shield of California Commercial |
$0.11
|
Rate for Payer: Blue Shield of California Commercial |
$0.13
|
Rate for Payer: Blue Shield of California EPN |
$0.18
|
Rate for Payer: Blue Shield of California EPN |
$0.18
|
Rate for Payer: Cash Price |
$0.07
|
Rate for Payer: Cash Price |
$0.08
|
Rate for Payer: Cash Price |
$0.07
|
Rate for Payer: Cash Price |
$0.08
|
Rate for Payer: Cigna of CA HMO |
$0.13
|
Rate for Payer: Cigna of CA HMO |
$0.11
|
Rate for Payer: Cigna of CA PPO |
$0.11
|
Rate for Payer: Cigna of CA PPO |
$0.13
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.13
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.15
|
Rate for Payer: Dignity Health Media |
$0.15
|
Rate for Payer: Dignity Health Media |
$0.13
|
Rate for Payer: Dignity Health Medi-Cal |
$0.15
|
Rate for Payer: Dignity Health Medi-Cal |
$0.13
|
Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
Rate for Payer: EPIC Health Plan Transplant |
$0.07
|
Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
Rate for Payer: Galaxy Health WC |
$0.13
|
Rate for Payer: Galaxy Health WC |
$0.15
|
Rate for Payer: Global Benefits Group Commercial |
$0.11
|
Rate for Payer: Global Benefits Group Commercial |
$0.09
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.11
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.14
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.12
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.10
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
Rate for Payer: Multiplan Commercial |
$0.12
|
Rate for Payer: Multiplan Commercial |
$0.14
|
Rate for Payer: Networks By Design Commercial |
$0.08
|
Rate for Payer: Networks By Design Commercial |
$0.09
|
Rate for Payer: Prime Health Services Commercial |
$0.15
|
Rate for Payer: Prime Health Services Commercial |
$0.13
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.11
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.09
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.11
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.09
|
Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
Rate for Payer: United Healthcare All Other HMO |
$0.08
|
Rate for Payer: United Healthcare All Other HMO |
$0.09
|
Rate for Payer: United Healthcare HMO Rider |
$0.08
|
Rate for Payer: United Healthcare HMO Rider |
$0.09
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.15
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.13
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.13
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.15
|
Rate for Payer: Vantage Medical Group Senior |
$0.13
|
Rate for Payer: Vantage Medical Group Senior |
$0.15
|
|
MEGESTROL 40 MG TABLET [4871]
|
Facility
OP
|
$0.28
|
|
Service Code
|
CPT S0179
|
Hospital Charge Code |
1711292
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.07 |
Max. Negotiated Rate |
$2.11 |
Rate for Payer: Aetna of CA HMO/PPO |
$1.18
|
Rate for Payer: Aetna of CA HMO/PPO |
$1.18
|
Rate for Payer: Aetna of CA HMO/PPO |
$1.18
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.32
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.24
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.71
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.15
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.46
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.21
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.15
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.21
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.46
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.11
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.11
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.11
|
Rate for Payer: BCBS Transplant Transplant |
$0.50
|
Rate for Payer: BCBS Transplant Transplant |
$0.23
|
Rate for Payer: BCBS Transplant Transplant |
$0.17
|
Rate for Payer: Blue Shield of California Commercial |
$0.28
|
Rate for Payer: Blue Shield of California Commercial |
$0.62
|
Rate for Payer: Blue Shield of California Commercial |
$0.21
|
Rate for Payer: Blue Shield of California EPN |
$0.49
|
Rate for Payer: Blue Shield of California EPN |
$0.16
|
Rate for Payer: Blue Shield of California EPN |
$0.22
|
Rate for Payer: Cash Price |
$0.17
|
Rate for Payer: Cash Price |
$0.13
|
Rate for Payer: Cash Price |
$0.13
|
Rate for Payer: Cash Price |
$0.38
|
Rate for Payer: Cash Price |
$0.38
|
Rate for Payer: Cash Price |
$0.17
|
Rate for Payer: Cigna of CA HMO |
$0.20
|
Rate for Payer: Cigna of CA HMO |
$0.59
|
Rate for Payer: Cigna of CA HMO |
$0.27
|
Rate for Payer: Cigna of CA PPO |
$0.20
|
Rate for Payer: Cigna of CA PPO |
$0.59
|
Rate for Payer: Cigna of CA PPO |
$0.27
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.71
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.24
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.32
|
Rate for Payer: Dignity Health Media |
$0.24
|
Rate for Payer: Dignity Health Media |
$0.32
|
Rate for Payer: Dignity Health Media |
$0.71
|
Rate for Payer: Dignity Health Medi-Cal |
$0.24
|
Rate for Payer: Dignity Health Medi-Cal |
$0.71
|
Rate for Payer: Dignity Health Medi-Cal |
$0.32
|
Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
Rate for Payer: EPIC Health Plan Commercial |
$0.34
|
Rate for Payer: EPIC Health Plan Transplant |
$0.34
|
Rate for Payer: EPIC Health Plan Transplant |
$0.11
|
Rate for Payer: EPIC Health Plan Transplant |
$0.15
|
Rate for Payer: Galaxy Health WC |
$0.71
|
Rate for Payer: Galaxy Health WC |
$0.24
|
Rate for Payer: Galaxy Health WC |
$0.32
|
Rate for Payer: Global Benefits Group Commercial |
$0.23
|
Rate for Payer: Global Benefits Group Commercial |
$0.17
|
Rate for Payer: Global Benefits Group Commercial |
$0.50
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.29
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.21
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.63
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.19
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.25
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.56
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.32
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
Rate for Payer: Multiplan Commercial |
$0.67
|
Rate for Payer: Multiplan Commercial |
$0.22
|
Rate for Payer: Multiplan Commercial |
$0.30
|
Rate for Payer: Networks By Design Commercial |
$0.25
|
Rate for Payer: Networks By Design Commercial |
$0.55
|
Rate for Payer: Networks By Design Commercial |
$0.18
|
Rate for Payer: Prime Health Services Commercial |
$0.24
|
Rate for Payer: Prime Health Services Commercial |
$0.71
|
Rate for Payer: Prime Health Services Commercial |
$0.32
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.23
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.50
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.17
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.50
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.17
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.23
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.23
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.17
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.50
|
Rate for Payer: United Healthcare All Other Commercial |
$0.19
|
Rate for Payer: United Healthcare All Other Commercial |
$0.42
|
Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
Rate for Payer: United Healthcare All Other HMO |
$0.14
|
Rate for Payer: United Healthcare All Other HMO |
$0.42
|
Rate for Payer: United Healthcare All Other HMO |
$0.19
|
Rate for Payer: United Healthcare HMO Rider |
$0.14
|
Rate for Payer: United Healthcare HMO Rider |
$0.42
|
Rate for Payer: United Healthcare HMO Rider |
$0.19
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.42
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.19
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.14
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.71
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.24
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.32
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.32
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.71
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.24
|
Rate for Payer: Vantage Medical Group Senior |
$0.32
|
Rate for Payer: Vantage Medical Group Senior |
$0.24
|
Rate for Payer: Vantage Medical Group Senior |
$0.71
|
|
MEGESTROL 40 MG TABLET [4871]
|
Facility
IP
|
$0.28
|
|
Service Code
|
CPT S0179
|
Hospital Charge Code |
1711292
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.07 |
Max. Negotiated Rate |
$0.24 |
Rate for Payer: Blue Shield of California Commercial |
$0.20
|
Rate for Payer: Blue Shield of California Commercial |
$0.60
|
Rate for Payer: Blue Shield of California Commercial |
$0.27
|
Rate for Payer: Blue Shield of California EPN |
$0.14
|
Rate for Payer: Blue Shield of California EPN |
$0.43
|
Rate for Payer: Blue Shield of California EPN |
$0.19
|
Rate for Payer: Cash Price |
$0.13
|
Rate for Payer: Cash Price |
$0.38
|
Rate for Payer: Cash Price |
$0.17
|
Rate for Payer: Cigna of CA HMO |
$0.27
|
Rate for Payer: Cigna of CA HMO |
$0.20
|
Rate for Payer: Cigna of CA HMO |
$0.59
|
Rate for Payer: Cigna of CA PPO |
$0.27
|
Rate for Payer: Cigna of CA PPO |
$0.20
|
Rate for Payer: Cigna of CA PPO |
$0.59
|
Rate for Payer: EPIC Health Plan Commercial |
$0.34
|
Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
Rate for Payer: Galaxy Health WC |
$0.32
|
Rate for Payer: Galaxy Health WC |
$0.24
|
Rate for Payer: Galaxy Health WC |
$0.71
|
Rate for Payer: Global Benefits Group Commercial |
$0.50
|
Rate for Payer: Global Benefits Group Commercial |
$0.17
|
Rate for Payer: Global Benefits Group Commercial |
$0.23
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.56
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.19
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.25
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.32
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
Rate for Payer: Multiplan Commercial |
$0.30
|
Rate for Payer: Multiplan Commercial |
$0.22
|
Rate for Payer: Multiplan Commercial |
$0.67
|
Rate for Payer: Networks By Design Commercial |
$0.18
|
Rate for Payer: Networks By Design Commercial |
$0.55
|
Rate for Payer: Networks By Design Commercial |
$0.25
|
Rate for Payer: Prime Health Services Commercial |
$0.32
|
Rate for Payer: Prime Health Services Commercial |
$0.24
|
Rate for Payer: Prime Health Services Commercial |
$0.71
|
|
MEGESTROL 625 MG/5 ML (125 MG/ML) ORAL SUSPENSION [41912]
|
Facility
OP
|
$3.19
|
|
Service Code
|
CPT S0179
|
Hospital Charge Code |
1715192
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.77 |
Max. Negotiated Rate |
$2.71 |
Rate for Payer: EPIC Health Plan Transplant |
$1.28
|
Rate for Payer: Galaxy Health WC |
$2.71
|
Rate for Payer: Aetna of CA HMO/PPO |
$1.18
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.71
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.75
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.75
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.11
|
Rate for Payer: BCBS Transplant Transplant |
$1.91
|
Rate for Payer: Blue Shield of California Commercial |
$2.35
|
Rate for Payer: Blue Shield of California EPN |
$1.86
|
Rate for Payer: Cash Price |
$1.44
|
Rate for Payer: Cash Price |
$1.44
|
Rate for Payer: Cigna of CA HMO |
$2.23
|
Rate for Payer: Cigna of CA PPO |
$2.23
|
Rate for Payer: Dignity Health Commercial/Exchange |
$2.71
|
Rate for Payer: Dignity Health Media |
$2.71
|
Rate for Payer: Dignity Health Medi-Cal |
$2.71
|
Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
Rate for Payer: Global Benefits Group Commercial |
$1.91
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.39
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.13
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.22
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
Rate for Payer: Multiplan Commercial |
$2.55
|
Rate for Payer: Networks By Design Commercial |
$2.07
|
Rate for Payer: Prime Health Services Commercial |
$2.71
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.91
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.91
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.91
|
Rate for Payer: United Healthcare All Other Commercial |
$1.60
|
Rate for Payer: United Healthcare All Other HMO |
$1.60
|
Rate for Payer: United Healthcare HMO Rider |
$1.60
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$1.60
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.71
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$2.71
|
Rate for Payer: Vantage Medical Group Senior |
$2.71
|
|