|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
OP
|
$19.80
|
|
|
Service Code
|
NDC 69238-1605-8
|
| Hospital Charge Code |
1710513
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$16.83 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.80
|
| Rate for Payer: BCBS Transplant Transplant |
$11.88
|
| Rate for Payer: Blue Shield of California Commercial |
$14.59
|
| Rate for Payer: Blue Shield of California EPN |
$11.56
|
| Rate for Payer: Cash Price |
$8.91
|
| Rate for Payer: Cigna of CA HMO |
$13.86
|
| Rate for Payer: Cigna of CA PPO |
$13.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.83
|
| Rate for Payer: Dignity Health Media |
$16.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.92
|
| Rate for Payer: Galaxy Health WC |
$16.83
|
| Rate for Payer: Global Benefits Group Commercial |
$11.88
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.75
|
| Rate for Payer: Multiplan Commercial |
$15.84
|
| Rate for Payer: Networks By Design Commercial |
$12.87
|
| Rate for Payer: Prime Health Services Commercial |
$16.83
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$11.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.90
|
| Rate for Payer: United Healthcare All Other HMO |
$9.90
|
| Rate for Payer: United Healthcare HMO Rider |
$9.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.83
|
| Rate for Payer: Vantage Medical Group Senior |
$16.83
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
IP
|
$74.66
|
|
|
Service Code
|
NDC 27437-050-56
|
| Hospital Charge Code |
1710513
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$63.46 |
| Rate for Payer: Blue Shield of California Commercial |
$53.16
|
| Rate for Payer: Blue Shield of California EPN |
$38.23
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna of CA HMO |
$52.26
|
| Rate for Payer: Cigna of CA PPO |
$52.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.86
|
| Rate for Payer: Galaxy Health WC |
$63.46
|
| Rate for Payer: Global Benefits Group Commercial |
$44.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.92
|
| Rate for Payer: Multiplan Commercial |
$59.73
|
| Rate for Payer: Networks By Design Commercial |
$48.53
|
| Rate for Payer: Prime Health Services Commercial |
$63.46
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
OP
|
$19.80
|
|
|
Service Code
|
NDC 69238-1605-2
|
| Hospital Charge Code |
1710513
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$16.83 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.80
|
| Rate for Payer: BCBS Transplant Transplant |
$11.88
|
| Rate for Payer: Blue Shield of California Commercial |
$14.59
|
| Rate for Payer: Blue Shield of California EPN |
$11.56
|
| Rate for Payer: Cash Price |
$8.91
|
| Rate for Payer: Cigna of CA HMO |
$13.86
|
| Rate for Payer: Cigna of CA PPO |
$13.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.83
|
| Rate for Payer: Dignity Health Media |
$16.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.92
|
| Rate for Payer: Galaxy Health WC |
$16.83
|
| Rate for Payer: Global Benefits Group Commercial |
$11.88
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.75
|
| Rate for Payer: Multiplan Commercial |
$15.84
|
| Rate for Payer: Networks By Design Commercial |
$12.87
|
| Rate for Payer: Prime Health Services Commercial |
$16.83
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$11.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.90
|
| Rate for Payer: United Healthcare All Other HMO |
$9.90
|
| Rate for Payer: United Healthcare HMO Rider |
$9.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.83
|
| Rate for Payer: Vantage Medical Group Senior |
$16.83
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
IP
|
$64.50
|
|
|
Service Code
|
NDC 43386-140-28
|
| Hospital Charge Code |
1710513
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$15.48 |
| Max. Negotiated Rate |
$54.82 |
| Rate for Payer: Blue Shield of California Commercial |
$45.92
|
| Rate for Payer: Blue Shield of California EPN |
$33.02
|
| Rate for Payer: Cash Price |
$29.03
|
| Rate for Payer: Cigna of CA HMO |
$45.15
|
| Rate for Payer: Cigna of CA PPO |
$45.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.80
|
| Rate for Payer: Galaxy Health WC |
$54.82
|
| Rate for Payer: Global Benefits Group Commercial |
$38.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.48
|
| Rate for Payer: Multiplan Commercial |
$51.60
|
| Rate for Payer: Networks By Design Commercial |
$41.92
|
| Rate for Payer: Prime Health Services Commercial |
$54.82
|
|
|
METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SYRINGE [154475]
|
Facility
OP
|
$307.70
|
|
|
Service Code
|
CPT J2212
|
| Hospital Charge Code |
NDG154575
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$261.54 |
| Rate for Payer: IEHP Medicare Advantage |
$1.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.83
|
| Rate for Payer: BCBS Transplant Transplant |
$184.62
|
| Rate for Payer: Blue Shield of California Commercial |
$226.77
|
| Rate for Payer: Blue Shield of California EPN |
$1.25
|
| Rate for Payer: Cash Price |
$138.47
|
| Rate for Payer: Cash Price |
$138.47
|
| Rate for Payer: Cigna of CA HMO |
$215.39
|
| Rate for Payer: Cigna of CA PPO |
$215.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.80
|
| Rate for Payer: Dignity Health Media |
$1.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.20
|
| Rate for Payer: Galaxy Health WC |
$261.54
|
| Rate for Payer: Global Benefits Group Commercial |
$184.62
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$230.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.97
|
| Rate for Payer: Heritage Provider Network Transplant |
$1.97
|
| Rate for Payer: IEHP Medi-Cal |
$1.95
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$205.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.61
|
| Rate for Payer: Multiplan Commercial |
$246.16
|
| Rate for Payer: Networks By Design Commercial |
$153.85
|
| Rate for Payer: Prime Health Services Commercial |
$261.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$184.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$184.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.85
|
| Rate for Payer: United Healthcare All Other HMO |
$153.85
|
| Rate for Payer: United Healthcare HMO Rider |
$153.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$153.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1.20
|
|
|
METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SYRINGE [154475]
|
Facility
IP
|
$307.70
|
|
|
Service Code
|
CPT J2212
|
| Hospital Charge Code |
NDG154575
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.85 |
| Max. Negotiated Rate |
$261.54 |
| Rate for Payer: Blue Shield of California Commercial |
$219.08
|
| Rate for Payer: Blue Shield of California EPN |
$157.54
|
| Rate for Payer: Cash Price |
$138.47
|
| Rate for Payer: Cigna of CA HMO |
$215.39
|
| Rate for Payer: Cigna of CA PPO |
$215.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$123.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$123.08
|
| Rate for Payer: Galaxy Health WC |
$261.54
|
| Rate for Payer: Global Benefits Group Commercial |
$184.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$205.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.85
|
| Rate for Payer: Multiplan Commercial |
$246.16
|
| Rate for Payer: Networks By Design Commercial |
$153.85
|
| Rate for Payer: Prime Health Services Commercial |
$261.54
|
|
|
METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS WRAP [40891651]
|
Facility
OP
|
$307.70
|
|
|
Service Code
|
CPT J2212
|
| Hospital Charge Code |
1720998
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$261.54 |
| Rate for Payer: Networks By Design Commercial |
$153.85
|
| Rate for Payer: Multiplan Commercial |
$246.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.83
|
| Rate for Payer: BCBS Transplant Transplant |
$184.62
|
| Rate for Payer: Blue Shield of California Commercial |
$226.77
|
| Rate for Payer: Blue Shield of California EPN |
$1.25
|
| Rate for Payer: Cash Price |
$138.47
|
| Rate for Payer: Cash Price |
$138.47
|
| Rate for Payer: Cigna of CA HMO |
$215.39
|
| Rate for Payer: Cigna of CA PPO |
$215.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.80
|
| Rate for Payer: Dignity Health Media |
$1.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.20
|
| Rate for Payer: Galaxy Health WC |
$261.54
|
| Rate for Payer: Global Benefits Group Commercial |
$184.62
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$230.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.97
|
| Rate for Payer: Heritage Provider Network Transplant |
$1.97
|
| Rate for Payer: IEHP Medi-Cal |
$1.95
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1.95
|
| Rate for Payer: IEHP Medicare Advantage |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$205.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.61
|
| Rate for Payer: Prime Health Services Commercial |
$261.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$184.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$184.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.85
|
| Rate for Payer: United Healthcare All Other HMO |
$153.85
|
| Rate for Payer: United Healthcare HMO Rider |
$153.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$153.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1.20
|
|
|
METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS WRAP [40891651]
|
Facility
IP
|
$307.70
|
|
|
Service Code
|
CPT J2212
|
| Hospital Charge Code |
1720998
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.85 |
| Max. Negotiated Rate |
$261.54 |
| Rate for Payer: Blue Shield of California Commercial |
$219.08
|
| Rate for Payer: Blue Shield of California EPN |
$157.54
|
| Rate for Payer: Cash Price |
$138.47
|
| Rate for Payer: Cigna of CA HMO |
$215.39
|
| Rate for Payer: Cigna of CA PPO |
$215.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$123.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$123.08
|
| Rate for Payer: Galaxy Health WC |
$261.54
|
| Rate for Payer: Global Benefits Group Commercial |
$184.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$205.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.85
|
| Rate for Payer: Multiplan Commercial |
$246.16
|
| Rate for Payer: Networks By Design Commercial |
$153.85
|
| Rate for Payer: Prime Health Services Commercial |
$261.54
|
|
|
METHYLPHENIDATE 10 MG TABLET [4986]
|
Facility
OP
|
$0.16
|
|
|
Service Code
|
NDC 16729-479-01
|
| Hospital Charge Code |
1730103
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: 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 |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Media |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: 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 |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
METHYLPHENIDATE 10 MG TABLET [4986]
|
Facility
IP
|
$0.16
|
|
|
Service Code
|
NDC 16729-479-01
|
| Hospital Charge Code |
1730103
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
|
METHYLPHENIDATE 20 MG TABLET [4987]
|
Facility
IP
|
$1.87
|
|
|
Service Code
|
NDC 0078-0441-05
|
| Hospital Charge Code |
1730104
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$1.59 |
| Rate for Payer: Blue Shield of California Commercial |
$1.33
|
| Rate for Payer: Blue Shield of California EPN |
$0.96
|
| Rate for Payer: Cash Price |
$0.84
|
| Rate for Payer: Cigna of CA HMO |
$1.31
|
| Rate for Payer: Cigna of CA PPO |
$1.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.75
|
| Rate for Payer: Galaxy Health WC |
$1.59
|
| Rate for Payer: Global Benefits Group Commercial |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: Networks By Design Commercial |
$1.22
|
| Rate for Payer: Prime Health Services Commercial |
$1.59
|
|
|
METHYLPHENIDATE 20 MG TABLET [4987]
|
Facility
OP
|
$1.87
|
|
|
Service Code
|
NDC 0078-0441-05
|
| Hospital Charge Code |
1730104
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$1.59 |
| Rate for Payer: BCBS Transplant Transplant |
$1.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.11
|
| Rate for Payer: Blue Shield of California Commercial |
$1.38
|
| Rate for Payer: Blue Shield of California EPN |
$1.09
|
| Rate for Payer: Cash Price |
$0.84
|
| Rate for Payer: Cigna of CA HMO |
$1.31
|
| Rate for Payer: Cigna of CA PPO |
$1.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.59
|
| Rate for Payer: Dignity Health Media |
$1.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.75
|
| Rate for Payer: Galaxy Health WC |
$1.59
|
| Rate for Payer: Global Benefits Group Commercial |
$1.12
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: Networks By Design Commercial |
$1.22
|
| Rate for Payer: Prime Health Services Commercial |
$1.59
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.94
|
| Rate for Payer: United Healthcare All Other HMO |
$0.94
|
| Rate for Payer: United Healthcare HMO Rider |
$0.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.59
|
| Rate for Payer: Vantage Medical Group Senior |
$1.59
|
|
|
METHYLPHENIDATE 5 MG TABLET [4988]
|
Facility
OP
|
$0.12
|
|
|
Service Code
|
NDC 0115-1800-01
|
| Hospital Charge Code |
1730105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.07
|
| Rate for Payer: BCBS Transplant Transplant |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.10
|
| Rate for Payer: Dignity Health Media |
$0.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Vantage Medical Group Senior |
$0.10
|
|
|
METHYLPHENIDATE 5 MG TABLET [4988]
|
Facility
IP
|
$0.12
|
|
|
Service Code
|
NDC 0115-1800-01
|
| Hospital Charge Code |
1730105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
|
|
METHYLPHENIDATE 5 MG TABLET [4988]
|
Facility
OP
|
$2.00
|
|
|
Service Code
|
NDC 68084-805-21
|
| Hospital Charge Code |
1730105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.19
|
| Rate for Payer: BCBS Transplant Transplant |
$1.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1.47
|
| Rate for Payer: Blue Shield of California EPN |
$1.17
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.70
|
| Rate for Payer: Dignity Health Media |
$1.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.30
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1.70
|
|
|
METHYLPHENIDATE 5 MG TABLET [4988]
|
Facility
IP
|
$2.00
|
|
|
Service Code
|
NDC 68084-805-21
|
| Hospital Charge Code |
1730105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Blue Shield of California Commercial |
$1.42
|
| Rate for Payer: Blue Shield of California EPN |
$1.02
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.30
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR [28750]
|
Facility
IP
|
$15.48
|
|
|
Service Code
|
NDC 50458-585-01
|
| Hospital Charge Code |
1731016
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$13.16 |
| Rate for Payer: Blue Shield of California Commercial |
$11.02
|
| Rate for Payer: Blue Shield of California EPN |
$7.93
|
| Rate for Payer: Cash Price |
$6.97
|
| Rate for Payer: Cigna of CA HMO |
$10.84
|
| Rate for Payer: Cigna of CA PPO |
$10.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.19
|
| Rate for Payer: Galaxy Health WC |
$13.16
|
| Rate for Payer: Global Benefits Group Commercial |
$9.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.72
|
| Rate for Payer: Multiplan Commercial |
$12.38
|
| Rate for Payer: Networks By Design Commercial |
$10.06
|
| Rate for Payer: Prime Health Services Commercial |
$13.16
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR [28750]
|
Facility
OP
|
$9.34
|
|
|
Service Code
|
NDC 10147-0685-1
|
| Hospital Charge Code |
1731016
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$7.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.94
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.56
|
| Rate for Payer: BCBS Transplant Transplant |
$5.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6.88
|
| Rate for Payer: Blue Shield of California EPN |
$5.45
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cigna of CA HMO |
$6.54
|
| Rate for Payer: Cigna of CA PPO |
$6.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.94
|
| Rate for Payer: Dignity Health Media |
$7.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.74
|
| Rate for Payer: Galaxy Health WC |
$7.94
|
| Rate for Payer: Global Benefits Group Commercial |
$5.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.24
|
| Rate for Payer: Multiplan Commercial |
$7.47
|
| Rate for Payer: Networks By Design Commercial |
$6.07
|
| Rate for Payer: Prime Health Services Commercial |
$7.94
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.67
|
| Rate for Payer: United Healthcare All Other HMO |
$4.67
|
| Rate for Payer: United Healthcare HMO Rider |
$4.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.94
|
| Rate for Payer: Vantage Medical Group Senior |
$7.94
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR [28750]
|
Facility
OP
|
$6.22
|
|
|
Service Code
|
NDC 62175-310-37
|
| Hospital Charge Code |
1731016
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$5.29 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.29
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.42
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.71
|
| Rate for Payer: BCBS Transplant Transplant |
$3.73
|
| Rate for Payer: Blue Shield of California Commercial |
$4.58
|
| Rate for Payer: Blue Shield of California EPN |
$3.63
|
| Rate for Payer: Cash Price |
$2.80
|
| Rate for Payer: Cigna of CA HMO |
$4.35
|
| Rate for Payer: Cigna of CA PPO |
$4.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.29
|
| Rate for Payer: Dignity Health Media |
$5.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.49
|
| Rate for Payer: Galaxy Health WC |
$5.29
|
| Rate for Payer: Global Benefits Group Commercial |
$3.73
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.49
|
| Rate for Payer: Multiplan Commercial |
$4.98
|
| Rate for Payer: Networks By Design Commercial |
$4.04
|
| Rate for Payer: Prime Health Services Commercial |
$5.29
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.11
|
| Rate for Payer: United Healthcare All Other HMO |
$3.11
|
| Rate for Payer: United Healthcare HMO Rider |
$3.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.29
|
| Rate for Payer: Vantage Medical Group Senior |
$5.29
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR [28750]
|
Facility
OP
|
$15.48
|
|
|
Service Code
|
NDC 50458-585-01
|
| Hospital Charge Code |
1731016
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$13.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.22
|
| Rate for Payer: BCBS Transplant Transplant |
$9.29
|
| Rate for Payer: Blue Shield of California Commercial |
$11.41
|
| Rate for Payer: Blue Shield of California EPN |
$9.04
|
| Rate for Payer: Cash Price |
$6.97
|
| Rate for Payer: Cigna of CA HMO |
$10.84
|
| Rate for Payer: Cigna of CA PPO |
$10.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.16
|
| Rate for Payer: Dignity Health Media |
$13.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.19
|
| Rate for Payer: Galaxy Health WC |
$13.16
|
| Rate for Payer: Global Benefits Group Commercial |
$9.29
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.72
|
| Rate for Payer: Multiplan Commercial |
$12.38
|
| Rate for Payer: Networks By Design Commercial |
$10.06
|
| Rate for Payer: Prime Health Services Commercial |
$13.16
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.74
|
| Rate for Payer: United Healthcare All Other HMO |
$7.74
|
| Rate for Payer: United Healthcare HMO Rider |
$7.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.16
|
| Rate for Payer: Vantage Medical Group Senior |
$13.16
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR [28750]
|
Facility
IP
|
$9.34
|
|
|
Service Code
|
NDC 10147-0685-1
|
| Hospital Charge Code |
1731016
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$7.94 |
| Rate for Payer: Blue Shield of California Commercial |
$6.65
|
| Rate for Payer: Blue Shield of California EPN |
$4.78
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cigna of CA HMO |
$6.54
|
| Rate for Payer: Cigna of CA PPO |
$6.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.74
|
| Rate for Payer: Galaxy Health WC |
$7.94
|
| Rate for Payer: Global Benefits Group Commercial |
$5.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.24
|
| Rate for Payer: Multiplan Commercial |
$7.47
|
| Rate for Payer: Networks By Design Commercial |
$6.07
|
| Rate for Payer: Prime Health Services Commercial |
$7.94
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR [28750]
|
Facility
IP
|
$6.22
|
|
|
Service Code
|
NDC 62175-310-37
|
| Hospital Charge Code |
1731016
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$5.29 |
| Rate for Payer: Blue Shield of California Commercial |
$4.43
|
| Rate for Payer: Blue Shield of California EPN |
$3.18
|
| Rate for Payer: Cash Price |
$2.80
|
| Rate for Payer: Cigna of CA HMO |
$4.35
|
| Rate for Payer: Cigna of CA PPO |
$4.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.49
|
| Rate for Payer: Galaxy Health WC |
$5.29
|
| Rate for Payer: Global Benefits Group Commercial |
$3.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.49
|
| Rate for Payer: Multiplan Commercial |
$4.98
|
| Rate for Payer: Networks By Design Commercial |
$4.04
|
| Rate for Payer: Prime Health Services Commercial |
$5.29
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR [28750]
|
Facility
OP
|
$9.34
|
|
|
Service Code
|
NDC 9999-7068-51
|
| Hospital Charge Code |
1731016
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$7.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.94
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.56
|
| Rate for Payer: BCBS Transplant Transplant |
$5.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6.88
|
| Rate for Payer: Blue Shield of California EPN |
$5.45
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cigna of CA HMO |
$6.54
|
| Rate for Payer: Cigna of CA PPO |
$6.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.94
|
| Rate for Payer: Dignity Health Media |
$7.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.74
|
| Rate for Payer: Galaxy Health WC |
$7.94
|
| Rate for Payer: Global Benefits Group Commercial |
$5.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.24
|
| Rate for Payer: Multiplan Commercial |
$7.47
|
| Rate for Payer: Networks By Design Commercial |
$6.07
|
| Rate for Payer: Prime Health Services Commercial |
$7.94
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.67
|
| Rate for Payer: United Healthcare All Other HMO |
$4.67
|
| Rate for Payer: United Healthcare HMO Rider |
$4.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.94
|
| Rate for Payer: Vantage Medical Group Senior |
$7.94
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR [28750]
|
Facility
IP
|
$9.34
|
|
|
Service Code
|
NDC 9999-7068-51
|
| Hospital Charge Code |
1731016
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$7.94 |
| Rate for Payer: Blue Shield of California Commercial |
$6.65
|
| Rate for Payer: Blue Shield of California EPN |
$4.78
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cigna of CA HMO |
$6.54
|
| Rate for Payer: Cigna of CA PPO |
$6.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.74
|
| Rate for Payer: Galaxy Health WC |
$7.94
|
| Rate for Payer: Global Benefits Group Commercial |
$5.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.24
|
| Rate for Payer: Multiplan Commercial |
$7.47
|
| Rate for Payer: Networks By Design Commercial |
$6.07
|
| Rate for Payer: Prime Health Services Commercial |
$7.94
|
|
|
METHYLPHENIDATE ER 20 MG TABLET,EXTENDED RELEASE [4989]
|
Facility
IP
|
$2.02
|
|
|
Service Code
|
NDC 10702-076-06
|
| Hospital Charge Code |
1734066
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.72 |
| Rate for Payer: Blue Shield of California Commercial |
$1.44
|
| Rate for Payer: Blue Shield of California EPN |
$1.03
|
| Rate for Payer: Cash Price |
$0.91
|
| Rate for Payer: Cigna of CA HMO |
$1.41
|
| Rate for Payer: Cigna of CA PPO |
$1.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.81
|
| Rate for Payer: Galaxy Health WC |
$1.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.62
|
| Rate for Payer: Networks By Design Commercial |
$1.31
|
| Rate for Payer: Prime Health Services Commercial |
$1.72
|
|
