|
METHOXSALEN 20 MCG/ML INJECTION SOLUTION [24933]
|
Facility
|
OP
|
$75.72
|
|
|
Service Code
|
NDC 64067-216-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.14 |
| Max. Negotiated Rate |
$68.15 |
| Rate for Payer: Adventist Health Commercial |
$15.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$56.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.47
|
| Rate for Payer: Blue Shield of California Commercial |
$46.26
|
| Rate for Payer: Blue Shield of California EPN |
$30.21
|
| Rate for Payer: Cash Price |
$41.65
|
| Rate for Payer: Central Health Plan Commercial |
$60.58
|
| Rate for Payer: Cigna of CA HMO |
$48.46
|
| Rate for Payer: Cigna of CA PPO |
$56.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.29
|
| Rate for Payer: EPIC Health Plan Senior |
$30.29
|
| Rate for Payer: Galaxy Health WC |
$64.36
|
| Rate for Payer: Global Benefits Group Commercial |
$45.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.15
|
| Rate for Payer: InnovAge PACE Commercial |
$37.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.00
|
| Rate for Payer: Multiplan Commercial |
$56.79
|
| Rate for Payer: Networks By Design Commercial |
$49.22
|
| Rate for Payer: Prime Health Services Commercial |
$64.36
|
| Rate for Payer: Riverside University Health System MISP |
$30.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.86
|
| Rate for Payer: United Healthcare All Other HMO |
$37.86
|
| Rate for Payer: United Healthcare HMO Rider |
$37.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.36
|
| Rate for Payer: Vantage Medical Group Senior |
$64.36
|
|
|
METHOXSALEN 20 MCG/ML INJECTION SOLUTION [24933]
|
Facility
|
IP
|
$75.72
|
|
|
Service Code
|
NDC 64067-216-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.14 |
| Max. Negotiated Rate |
$68.15 |
| Rate for Payer: Adventist Health Commercial |
$15.14
|
| Rate for Payer: Blue Shield of California Commercial |
$58.53
|
| Rate for Payer: Blue Shield of California EPN |
$38.16
|
| Rate for Payer: Cash Price |
$41.65
|
| Rate for Payer: Central Health Plan Commercial |
$60.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.29
|
| Rate for Payer: EPIC Health Plan Senior |
$30.29
|
| Rate for Payer: Galaxy Health WC |
$64.36
|
| Rate for Payer: Global Benefits Group Commercial |
$45.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.14
|
| Rate for Payer: Multiplan Commercial |
$56.79
|
| Rate for Payer: Networks By Design Commercial |
$49.22
|
| Rate for Payer: Prime Health Services Commercial |
$64.36
|
|
|
METHYLCELLULOSE (BULK) 1 % GEL [82599]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 5155207027
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.04
|
| Rate for Payer: InnovAge PACE Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Riverside University Health System MISP |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
METHYLCELLULOSE (BULK) 1 % GEL [82599]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 5155207027
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
METHYLCELLULOSE (BULK) 1 % GEL [82599]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 38779-30608
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.04
|
| Rate for Payer: InnovAge PACE Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Riverside University Health System MISP |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
METHYLCELLULOSE (BULK) 1 % GEL [82599]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 38779-30608
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
METHYLDOPA 250 MG TABLET [4982]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 51079-200-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Central Health Plan Commercial |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
|
|
METHYLDOPA 250 MG TABLET [4982]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 51079-200-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Central Health Plan Commercial |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.20
|
| Rate for Payer: InnovAge PACE Commercial |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
| Rate for Payer: Riverside University Health System MISP |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
|
|
METHYLDOPA ORAL SUSPENSION COMPOUND 50 MG/ML [4080300]
|
Facility
|
IP
|
$1.54
|
|
|
Service Code
|
NDC 9994-0803-00
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.39 |
| Rate for Payer: Adventist Health Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California Commercial |
$1.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.78
|
| Rate for Payer: Cash Price |
$0.85
|
| Rate for Payer: Central Health Plan Commercial |
$1.23
|
| Rate for Payer: Cigna of CA HMO |
$1.08
|
| Rate for Payer: Cigna of CA PPO |
$1.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.62
|
| Rate for Payer: EPIC Health Plan Senior |
$0.62
|
| Rate for Payer: Galaxy Health WC |
$1.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$1.16
|
| Rate for Payer: Networks By Design Commercial |
$1.00
|
| Rate for Payer: Prime Health Services Commercial |
$1.31
|
|
|
METHYLDOPA ORAL SUSPENSION COMPOUND 50 MG/ML [4080300]
|
Facility
|
OP
|
$1.54
|
|
|
Service Code
|
NDC 9994-0803-00
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.39 |
| Rate for Payer: Adventist Health Commercial |
$0.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.90
|
| Rate for Payer: Blue Shield of California Commercial |
$0.94
|
| Rate for Payer: Blue Shield of California EPN |
$0.61
|
| Rate for Payer: Cash Price |
$0.85
|
| Rate for Payer: Central Health Plan Commercial |
$1.23
|
| Rate for Payer: Cigna of CA HMO |
$1.08
|
| Rate for Payer: Cigna of CA PPO |
$1.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.62
|
| Rate for Payer: EPIC Health Plan Senior |
$0.62
|
| Rate for Payer: Galaxy Health WC |
$1.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.39
|
| Rate for Payer: InnovAge PACE Commercial |
$0.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.08
|
| Rate for Payer: Multiplan Commercial |
$1.16
|
| Rate for Payer: Networks By Design Commercial |
$1.00
|
| Rate for Payer: Prime Health Services Commercial |
$1.31
|
| Rate for Payer: Riverside University Health System MISP |
$0.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.77
|
| Rate for Payer: United Healthcare All Other HMO |
$0.77
|
| Rate for Payer: United Healthcare HMO Rider |
$0.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.31
|
| Rate for Payer: Vantage Medical Group Senior |
$1.31
|
|
|
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) INTRAVENOUS SOLUTION [4985]
|
Facility
|
IP
|
$25.20
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.04 |
| Max. Negotiated Rate |
$22.68 |
| Rate for Payer: Adventist Health Commercial |
$5.04
|
| Rate for Payer: Blue Shield of California Commercial |
$19.48
|
| Rate for Payer: Blue Shield of California EPN |
$12.70
|
| Rate for Payer: Cash Price |
$13.86
|
| Rate for Payer: Central Health Plan Commercial |
$20.16
|
| Rate for Payer: Cigna of CA HMO |
$17.64
|
| Rate for Payer: Cigna of CA PPO |
$17.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.08
|
| Rate for Payer: EPIC Health Plan Senior |
$10.08
|
| Rate for Payer: Galaxy Health WC |
$21.42
|
| Rate for Payer: Global Benefits Group Commercial |
$15.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.04
|
| Rate for Payer: Multiplan Commercial |
$18.90
|
| Rate for Payer: Networks By Design Commercial |
$12.60
|
| Rate for Payer: Prime Health Services Commercial |
$21.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.46
|
| Rate for Payer: United Healthcare All Other HMO |
$9.21
|
| Rate for Payer: United Healthcare HMO Rider |
$9.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.25
|
|
|
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) INTRAVENOUS SOLUTION [4985]
|
Facility
|
OP
|
$25.20
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.04 |
| Max. Negotiated Rate |
$35.42 |
| Rate for Payer: Adventist Health Commercial |
$5.04
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.80
|
| Rate for Payer: Blue Shield of California Commercial |
$15.40
|
| Rate for Payer: Blue Shield of California EPN |
$10.05
|
| Rate for Payer: Cash Price |
$13.86
|
| Rate for Payer: Cash Price |
$13.86
|
| Rate for Payer: Central Health Plan Commercial |
$20.16
|
| Rate for Payer: Cigna of CA HMO |
$17.64
|
| Rate for Payer: Cigna of CA PPO |
$17.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.61
|
| Rate for Payer: EPIC Health Plan Senior |
$7.86
|
| Rate for Payer: Galaxy Health WC |
$21.42
|
| Rate for Payer: Global Benefits Group Commercial |
$15.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.68
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.86
|
| Rate for Payer: InnovAge PACE Commercial |
$11.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.53
|
| Rate for Payer: Multiplan Commercial |
$18.90
|
| Rate for Payer: Networks By Design Commercial |
$12.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.86
|
| Rate for Payer: Prime Health Services Commercial |
$21.42
|
| Rate for Payer: Prime Health Services Medicare |
$8.33
|
| Rate for Payer: Riverside University Health System MISP |
$8.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.46
|
| Rate for Payer: United Healthcare All Other HMO |
$9.21
|
| Rate for Payer: United Healthcare HMO Rider |
$9.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.25
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.64
|
| Rate for Payer: Vantage Medical Group Senior |
$8.64
|
|
|
METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION [215473]
|
Facility
|
IP
|
$28.13
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.63 |
| Max. Negotiated Rate |
$25.32 |
| Rate for Payer: Adventist Health Commercial |
$5.63
|
| Rate for Payer: Adventist Health Commercial |
$3.24
|
| Rate for Payer: Blue Shield of California Commercial |
$21.74
|
| Rate for Payer: Blue Shield of California Commercial |
$12.52
|
| Rate for Payer: Blue Shield of California EPN |
$8.16
|
| Rate for Payer: Blue Shield of California EPN |
$14.18
|
| Rate for Payer: Cash Price |
$15.47
|
| Rate for Payer: Cash Price |
$8.91
|
| Rate for Payer: Central Health Plan Commercial |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$12.96
|
| Rate for Payer: Cigna of CA HMO |
$11.34
|
| Rate for Payer: Cigna of CA HMO |
$19.69
|
| Rate for Payer: Cigna of CA PPO |
$11.34
|
| Rate for Payer: Cigna of CA PPO |
$19.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.25
|
| Rate for Payer: EPIC Health Plan Senior |
$6.48
|
| Rate for Payer: EPIC Health Plan Senior |
$11.25
|
| Rate for Payer: Galaxy Health WC |
$13.77
|
| Rate for Payer: Galaxy Health WC |
$23.91
|
| Rate for Payer: Global Benefits Group Commercial |
$16.88
|
| Rate for Payer: Global Benefits Group Commercial |
$9.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.24
|
| Rate for Payer: Multiplan Commercial |
$12.15
|
| Rate for Payer: Multiplan Commercial |
$21.10
|
| Rate for Payer: Networks By Design Commercial |
$8.10
|
| Rate for Payer: Networks By Design Commercial |
$14.06
|
| Rate for Payer: Prime Health Services Commercial |
$23.91
|
| Rate for Payer: Prime Health Services Commercial |
$13.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.56
|
| Rate for Payer: United Healthcare All Other HMO |
$10.28
|
| Rate for Payer: United Healthcare All Other HMO |
$5.92
|
| Rate for Payer: United Healthcare HMO Rider |
$5.79
|
| Rate for Payer: United Healthcare HMO Rider |
$10.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.21
|
|
|
METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION [215473]
|
Facility
|
OP
|
$28.13
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.63 |
| Max. Negotiated Rate |
$35.42 |
| Rate for Payer: Adventist Health Commercial |
$5.63
|
| Rate for Payer: Adventist Health Commercial |
$3.24
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.86
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.51
|
| Rate for Payer: Blue Shield of California Commercial |
$17.19
|
| Rate for Payer: Blue Shield of California Commercial |
$9.90
|
| Rate for Payer: Blue Shield of California EPN |
$11.22
|
| Rate for Payer: Blue Shield of California EPN |
$6.46
|
| Rate for Payer: Cash Price |
$8.91
|
| Rate for Payer: Cash Price |
$15.47
|
| Rate for Payer: Cash Price |
$8.91
|
| Rate for Payer: Cash Price |
$15.47
|
| Rate for Payer: Central Health Plan Commercial |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$12.96
|
| Rate for Payer: Cigna of CA HMO |
$11.34
|
| Rate for Payer: Cigna of CA HMO |
$19.69
|
| Rate for Payer: Cigna of CA PPO |
$19.69
|
| Rate for Payer: Cigna of CA PPO |
$11.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.61
|
| Rate for Payer: EPIC Health Plan Senior |
$7.86
|
| Rate for Payer: EPIC Health Plan Senior |
$7.86
|
| Rate for Payer: Galaxy Health WC |
$13.77
|
| Rate for Payer: Galaxy Health WC |
$23.91
|
| Rate for Payer: Global Benefits Group Commercial |
$16.88
|
| Rate for Payer: Global Benefits Group Commercial |
$9.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.32
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.89
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.86
|
| Rate for Payer: InnovAge PACE Commercial |
$11.79
|
| Rate for Payer: InnovAge PACE Commercial |
$11.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.53
|
| Rate for Payer: Multiplan Commercial |
$12.15
|
| Rate for Payer: Multiplan Commercial |
$21.10
|
| Rate for Payer: Networks By Design Commercial |
$14.06
|
| Rate for Payer: Networks By Design Commercial |
$8.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.86
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.86
|
| Rate for Payer: Prime Health Services Commercial |
$13.77
|
| Rate for Payer: Prime Health Services Commercial |
$23.91
|
| Rate for Payer: Prime Health Services Medicare |
$8.33
|
| Rate for Payer: Prime Health Services Medicare |
$8.33
|
| Rate for Payer: Riverside University Health System MISP |
$8.64
|
| Rate for Payer: Riverside University Health System MISP |
$8.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.08
|
| Rate for Payer: United Healthcare All Other HMO |
$10.28
|
| Rate for Payer: United Healthcare All Other HMO |
$5.92
|
| Rate for Payer: United Healthcare HMO Rider |
$5.79
|
| Rate for Payer: United Healthcare HMO Rider |
$10.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.31
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.86
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.64
|
| Rate for Payer: Vantage Medical Group Senior |
$8.64
|
| Rate for Payer: Vantage Medical Group Senior |
$8.64
|
|
|
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION [10571]
|
Facility
|
OP
|
$23.71
|
|
|
Service Code
|
HCPCS J2210
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.74 |
| Max. Negotiated Rate |
$49.93 |
| Rate for Payer: Adventist Health Commercial |
$4.74
|
| Rate for Payer: Adventist Health Commercial |
$7.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$43.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$43.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.33
|
| Rate for Payer: Blue Shield of California Commercial |
$26.08
|
| Rate for Payer: Blue Shield of California Commercial |
$26.08
|
| Rate for Payer: Blue Shield of California EPN |
$23.71
|
| Rate for Payer: Blue Shield of California EPN |
$23.71
|
| Rate for Payer: Cash Price |
$13.04
|
| Rate for Payer: Cash Price |
$13.04
|
| Rate for Payer: Cash Price |
$20.64
|
| Rate for Payer: Cash Price |
$20.64
|
| Rate for Payer: Central Health Plan Commercial |
$18.97
|
| Rate for Payer: Central Health Plan Commercial |
$30.03
|
| Rate for Payer: Cigna of CA HMO |
$26.28
|
| Rate for Payer: Cigna of CA HMO |
$16.60
|
| Rate for Payer: Cigna of CA PPO |
$26.28
|
| Rate for Payer: Cigna of CA PPO |
$16.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.48
|
| Rate for Payer: EPIC Health Plan Senior |
$9.48
|
| Rate for Payer: EPIC Health Plan Senior |
$15.02
|
| Rate for Payer: Galaxy Health WC |
$31.91
|
| Rate for Payer: Galaxy Health WC |
$20.15
|
| Rate for Payer: Global Benefits Group Commercial |
$22.52
|
| Rate for Payer: Global Benefits Group Commercial |
$14.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.29
|
| Rate for Payer: InnovAge PACE Commercial |
$11.86
|
| Rate for Payer: InnovAge PACE Commercial |
$18.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.60
|
| Rate for Payer: Multiplan Commercial |
$17.78
|
| Rate for Payer: Multiplan Commercial |
$28.16
|
| Rate for Payer: Networks By Design Commercial |
$18.77
|
| Rate for Payer: Networks By Design Commercial |
$11.86
|
| Rate for Payer: Prime Health Services Commercial |
$31.91
|
| Rate for Payer: Prime Health Services Commercial |
$20.15
|
| Rate for Payer: Riverside University Health System MISP |
$9.48
|
| Rate for Payer: Riverside University Health System MISP |
$15.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.90
|
| Rate for Payer: United Healthcare All Other HMO |
$8.66
|
| Rate for Payer: United Healthcare All Other HMO |
$13.71
|
| Rate for Payer: United Healthcare HMO Rider |
$8.47
|
| Rate for Payer: United Healthcare HMO Rider |
$13.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.91
|
| Rate for Payer: Vantage Medical Group Senior |
$20.15
|
| Rate for Payer: Vantage Medical Group Senior |
$31.91
|
|
|
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION [10571]
|
Facility
|
IP
|
$37.54
|
|
|
Service Code
|
HCPCS J2210
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.51 |
| Max. Negotiated Rate |
$33.79 |
| Rate for Payer: Adventist Health Commercial |
$7.51
|
| Rate for Payer: Adventist Health Commercial |
$4.74
|
| Rate for Payer: Blue Shield of California Commercial |
$29.02
|
| Rate for Payer: Blue Shield of California Commercial |
$18.33
|
| Rate for Payer: Blue Shield of California EPN |
$11.95
|
| Rate for Payer: Blue Shield of California EPN |
$18.92
|
| Rate for Payer: Cash Price |
$20.64
|
| Rate for Payer: Cash Price |
$13.04
|
| Rate for Payer: Central Health Plan Commercial |
$30.03
|
| Rate for Payer: Central Health Plan Commercial |
$18.97
|
| Rate for Payer: Cigna of CA HMO |
$16.60
|
| Rate for Payer: Cigna of CA HMO |
$26.28
|
| Rate for Payer: Cigna of CA PPO |
$16.60
|
| Rate for Payer: Cigna of CA PPO |
$26.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.02
|
| Rate for Payer: EPIC Health Plan Senior |
$9.48
|
| Rate for Payer: EPIC Health Plan Senior |
$15.02
|
| Rate for Payer: Galaxy Health WC |
$20.15
|
| Rate for Payer: Galaxy Health WC |
$31.91
|
| Rate for Payer: Global Benefits Group Commercial |
$22.52
|
| Rate for Payer: Global Benefits Group Commercial |
$14.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.74
|
| Rate for Payer: Multiplan Commercial |
$17.78
|
| Rate for Payer: Multiplan Commercial |
$28.16
|
| Rate for Payer: Networks By Design Commercial |
$11.86
|
| Rate for Payer: Networks By Design Commercial |
$18.77
|
| Rate for Payer: Prime Health Services Commercial |
$31.91
|
| Rate for Payer: Prime Health Services Commercial |
$20.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.09
|
| Rate for Payer: United Healthcare All Other HMO |
$13.71
|
| Rate for Payer: United Healthcare All Other HMO |
$8.66
|
| Rate for Payer: United Healthcare HMO Rider |
$8.47
|
| Rate for Payer: United Healthcare HMO Rider |
$13.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.29
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
|
IP
|
$16.83
|
|
|
Service Code
|
NDC 70010-786-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$15.15 |
| Rate for Payer: Adventist Health Commercial |
$3.37
|
| Rate for Payer: Blue Shield of California Commercial |
$13.01
|
| Rate for Payer: Blue Shield of California EPN |
$8.48
|
| Rate for Payer: Cash Price |
$9.26
|
| Rate for Payer: Central Health Plan Commercial |
$13.46
|
| Rate for Payer: Cigna of CA HMO |
$11.78
|
| Rate for Payer: Cigna of CA PPO |
$11.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.73
|
| Rate for Payer: EPIC Health Plan Senior |
$6.73
|
| Rate for Payer: Galaxy Health WC |
$14.31
|
| Rate for Payer: Global Benefits Group Commercial |
$10.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.37
|
| Rate for Payer: Multiplan Commercial |
$12.62
|
| Rate for Payer: Networks By Design Commercial |
$10.94
|
| Rate for Payer: Prime Health Services Commercial |
$14.31
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
|
OP
|
$19.80
|
|
|
Service Code
|
NDC 69238-1605-8
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$17.82 |
| Rate for Payer: Adventist Health Commercial |
$3.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.63
|
| Rate for Payer: Blue Shield of California Commercial |
$12.10
|
| Rate for Payer: Blue Shield of California EPN |
$7.90
|
| Rate for Payer: Cash Price |
$10.89
|
| Rate for Payer: Central Health Plan Commercial |
$15.84
|
| 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 Medi-Cal |
$16.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.92
|
| Rate for Payer: EPIC Health Plan Senior |
$7.92
|
| Rate for Payer: Galaxy Health WC |
$16.83
|
| Rate for Payer: Global Benefits Group Commercial |
$11.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.82
|
| Rate for Payer: InnovAge PACE Commercial |
$9.90
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$12.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.86
|
| Rate for Payer: Multiplan Commercial |
$14.85
|
| Rate for Payer: Networks By Design Commercial |
$12.87
|
| Rate for Payer: Prime Health Services Commercial |
$16.83
|
| Rate for Payer: Riverside University Health System MISP |
$7.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.90
|
| Rate for Payer: United Healthcare All Other HMO |
$9.90
|
| Rate for Payer: United Healthcare HMO Rider |
$9.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.83
|
| Rate for Payer: Vantage Medical Group Senior |
$16.83
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
|
OP
|
$16.83
|
|
|
Service Code
|
NDC 70010-786-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$15.15 |
| Rate for Payer: Adventist Health Commercial |
$3.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.88
|
| Rate for Payer: Blue Shield of California Commercial |
$10.28
|
| Rate for Payer: Blue Shield of California EPN |
$6.72
|
| Rate for Payer: Cash Price |
$9.26
|
| Rate for Payer: Central Health Plan Commercial |
$13.46
|
| Rate for Payer: Cigna of CA HMO |
$11.78
|
| Rate for Payer: Cigna of CA PPO |
$11.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.73
|
| Rate for Payer: EPIC Health Plan Senior |
$6.73
|
| Rate for Payer: Galaxy Health WC |
$14.31
|
| Rate for Payer: Global Benefits Group Commercial |
$10.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.15
|
| Rate for Payer: InnovAge PACE Commercial |
$8.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.78
|
| Rate for Payer: Multiplan Commercial |
$12.62
|
| Rate for Payer: Networks By Design Commercial |
$10.94
|
| Rate for Payer: Prime Health Services Commercial |
$14.31
|
| Rate for Payer: Riverside University Health System MISP |
$6.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.41
|
| Rate for Payer: United Healthcare All Other HMO |
$8.41
|
| Rate for Payer: United Healthcare HMO Rider |
$8.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Vantage Medical Group Senior |
$14.31
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
|
OP
|
$19.80
|
|
|
Service Code
|
NDC 69238-1605-2
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$17.82 |
| Rate for Payer: Adventist Health Commercial |
$3.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.63
|
| Rate for Payer: Blue Shield of California Commercial |
$12.10
|
| Rate for Payer: Blue Shield of California EPN |
$7.90
|
| Rate for Payer: Cash Price |
$10.89
|
| Rate for Payer: Central Health Plan Commercial |
$15.84
|
| 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 Medi-Cal |
$16.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.92
|
| Rate for Payer: EPIC Health Plan Senior |
$7.92
|
| Rate for Payer: Galaxy Health WC |
$16.83
|
| Rate for Payer: Global Benefits Group Commercial |
$11.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.82
|
| Rate for Payer: InnovAge PACE Commercial |
$9.90
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$12.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.86
|
| Rate for Payer: Multiplan Commercial |
$14.85
|
| Rate for Payer: Networks By Design Commercial |
$12.87
|
| Rate for Payer: Prime Health Services Commercial |
$16.83
|
| Rate for Payer: Riverside University Health System MISP |
$7.92
|
| 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
|
$19.80
|
|
|
Service Code
|
NDC 69238-1605-8
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$17.82 |
| Rate for Payer: Adventist Health Commercial |
$3.96
|
| Rate for Payer: Blue Shield of California Commercial |
$15.31
|
| Rate for Payer: Blue Shield of California EPN |
$9.98
|
| Rate for Payer: Cash Price |
$10.89
|
| Rate for Payer: Central Health Plan Commercial |
$15.84
|
| Rate for Payer: Cigna of CA HMO |
$13.86
|
| Rate for Payer: Cigna of CA PPO |
$13.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.92
|
| Rate for Payer: EPIC Health Plan Senior |
$7.92
|
| Rate for Payer: Galaxy Health WC |
$16.83
|
| Rate for Payer: Global Benefits Group Commercial |
$11.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.82
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$12.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.96
|
| Rate for Payer: Multiplan Commercial |
$14.85
|
| Rate for Payer: Networks By Design Commercial |
$12.87
|
| Rate for Payer: Prime Health Services Commercial |
$16.83
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
|
IP
|
$19.80
|
|
|
Service Code
|
NDC 69238-1605-2
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$17.82 |
| Rate for Payer: Adventist Health Commercial |
$3.96
|
| Rate for Payer: Blue Shield of California Commercial |
$15.31
|
| Rate for Payer: Blue Shield of California EPN |
$9.98
|
| Rate for Payer: Cash Price |
$10.89
|
| Rate for Payer: Central Health Plan Commercial |
$15.84
|
| Rate for Payer: Cigna of CA HMO |
$13.86
|
| Rate for Payer: Cigna of CA PPO |
$13.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.92
|
| Rate for Payer: EPIC Health Plan Senior |
$7.92
|
| Rate for Payer: Galaxy Health WC |
$16.83
|
| Rate for Payer: Global Benefits Group Commercial |
$11.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.82
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$12.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.96
|
| Rate for Payer: Multiplan Commercial |
$14.85
|
| Rate for Payer: Networks By Design Commercial |
$12.87
|
| Rate for Payer: Prime Health Services Commercial |
$16.83
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
|
OP
|
$23.83
|
|
|
Service Code
|
NDC 0093-3655-28
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.77 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Adventist Health Commercial |
$4.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14.56
|
| Rate for Payer: Blue Shield of California EPN |
$9.51
|
| Rate for Payer: Cash Price |
$13.11
|
| Rate for Payer: Central Health Plan Commercial |
$19.06
|
| Rate for Payer: Cigna of CA HMO |
$16.68
|
| Rate for Payer: Cigna of CA PPO |
$16.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.53
|
| Rate for Payer: EPIC Health Plan Senior |
$9.53
|
| Rate for Payer: Galaxy Health WC |
$20.26
|
| Rate for Payer: Global Benefits Group Commercial |
$14.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.45
|
| Rate for Payer: InnovAge PACE Commercial |
$11.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.68
|
| Rate for Payer: Multiplan Commercial |
$17.87
|
| Rate for Payer: Networks By Design Commercial |
$15.49
|
| Rate for Payer: Prime Health Services Commercial |
$20.26
|
| Rate for Payer: Riverside University Health System MISP |
$9.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.91
|
| Rate for Payer: United Healthcare All Other HMO |
$11.91
|
| Rate for Payer: United Healthcare HMO Rider |
$11.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.26
|
| Rate for Payer: Vantage Medical Group Senior |
$20.26
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
|
IP
|
$23.83
|
|
|
Service Code
|
NDC 0093-3655-28
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.77 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Adventist Health Commercial |
$4.77
|
| Rate for Payer: Blue Shield of California Commercial |
$18.42
|
| Rate for Payer: Blue Shield of California EPN |
$12.01
|
| Rate for Payer: Cash Price |
$13.11
|
| Rate for Payer: Central Health Plan Commercial |
$19.06
|
| Rate for Payer: Cigna of CA HMO |
$16.68
|
| Rate for Payer: Cigna of CA PPO |
$16.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.53
|
| Rate for Payer: EPIC Health Plan Senior |
$9.53
|
| Rate for Payer: Galaxy Health WC |
$20.26
|
| Rate for Payer: Global Benefits Group Commercial |
$14.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.77
|
| Rate for Payer: Multiplan Commercial |
$17.87
|
| Rate for Payer: Networks By Design Commercial |
$15.49
|
| Rate for Payer: Prime Health Services Commercial |
$20.26
|
|
|
METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SYRINGE [154475]
|
Facility
|
IP
|
$339.86
|
|
|
Service Code
|
HCPCS J2212
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.97 |
| Max. Negotiated Rate |
$305.87 |
| Rate for Payer: Adventist Health Commercial |
$67.97
|
| Rate for Payer: Blue Shield of California Commercial |
$262.71
|
| Rate for Payer: Blue Shield of California EPN |
$171.29
|
| Rate for Payer: Cash Price |
$186.92
|
| Rate for Payer: Central Health Plan Commercial |
$271.89
|
| Rate for Payer: Cigna of CA HMO |
$237.90
|
| Rate for Payer: Cigna of CA PPO |
$237.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.94
|
| Rate for Payer: EPIC Health Plan Senior |
$135.94
|
| Rate for Payer: Galaxy Health WC |
$288.88
|
| Rate for Payer: Global Benefits Group Commercial |
$203.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$305.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$210.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.97
|
| Rate for Payer: Multiplan Commercial |
$254.90
|
| Rate for Payer: Networks By Design Commercial |
$169.93
|
| Rate for Payer: Prime Health Services Commercial |
$288.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.55
|
| Rate for Payer: United Healthcare All Other HMO |
$124.15
|
| Rate for Payer: United Healthcare HMO Rider |
$121.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.30
|
|
