|
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) INTRAVENOUS SOLUTION [4985]
|
Facility
IP
|
$25.20
|
|
|
Service Code
|
CPT Q9968
|
| Hospital Charge Code |
1720296
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.04 |
| Max. Negotiated Rate |
$22.68 |
| Rate for Payer: Blue Shield of California Commercial |
$18.90
|
| Rate for Payer: Blue Shield of California EPN |
$13.46
|
| Rate for Payer: Cash Price |
$11.34
|
| 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 Transplant |
$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: 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
|
|
|
METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION [215473]
|
Facility
OP
|
$28.13
|
|
|
Service Code
|
CPT Q9968
|
| Hospital Charge Code |
NDG215473
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$107.62 |
| Rate for Payer: Adventist Health Medi-Cal |
$7.95
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.94
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.56
|
| Rate for Payer: BCBS Transplant Transplant |
$18.75
|
| Rate for Payer: BCBS Transplant Transplant |
$16.88
|
| Rate for Payer: Blue Shield of California Commercial |
$17.69
|
| Rate for Payer: Blue Shield of California Commercial |
$19.66
|
| Rate for Payer: Blue Shield of California EPN |
$15.28
|
| Rate for Payer: Blue Shield of California EPN |
$13.76
|
| Rate for Payer: Caremore Medicare Advantage |
$7.95
|
| Rate for Payer: Caremore Medicare Advantage |
$7.95
|
| Rate for Payer: Cash Price |
$14.06
|
| Rate for Payer: Cash Price |
$12.66
|
| Rate for Payer: Cash Price |
$14.06
|
| Rate for Payer: Cash Price |
$12.66
|
| Rate for Payer: Central Health Plan Commercial |
$25.00
|
| Rate for Payer: Central Health Plan Commercial |
$22.50
|
| Rate for Payer: Cigna of CA HMO |
$19.69
|
| Rate for Payer: Cigna of CA HMO |
$21.88
|
| Rate for Payer: Cigna of CA PPO |
$19.69
|
| Rate for Payer: Cigna of CA PPO |
$21.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.73
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7.95
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.95
|
| Rate for Payer: Galaxy Health WC |
$23.91
|
| Rate for Payer: Galaxy Health WC |
$26.56
|
| Rate for Payer: Global Benefits Group Commercial |
$18.75
|
| Rate for Payer: Global Benefits Group Commercial |
$16.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.12
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$21.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$23.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.04
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.04
|
| Rate for Payer: IEHP medi-cal |
$13.12
|
| Rate for Payer: IEHP medi-cal |
$13.12
|
| Rate for Payer: IEHP Medicare Advantage |
$7.95
|
| Rate for Payer: IEHP Medicare Advantage |
$7.95
|
| Rate for Payer: Innovage PACE Commercial |
$11.92
|
| Rate for Payer: Innovage PACE Commercial |
$11.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.65
|
| Rate for Payer: Multiplan Commercial |
$23.44
|
| Rate for Payer: Multiplan Commercial |
$21.10
|
| Rate for Payer: Networks By Design Commercial |
$15.62
|
| Rate for Payer: Networks By Design Commercial |
$14.06
|
| Rate for Payer: Prime Health Services Commercial |
$26.56
|
| Rate for Payer: Prime Health Services Commercial |
$23.91
|
| Rate for Payer: Prime Health Services Medicare |
$8.43
|
| Rate for Payer: Prime Health Services Medicare |
$8.43
|
| Rate for Payer: Riverside University Health MISP |
$8.74
|
| Rate for Payer: Riverside University Health MISP |
$8.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.62
|
| Rate for Payer: United Healthcare All Other HMO |
$14.06
|
| Rate for Payer: United Healthcare All Other HMO |
$15.62
|
| Rate for Payer: United Healthcare HMO Rider |
$14.06
|
| Rate for Payer: United Healthcare HMO Rider |
$15.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.74
|
| Rate for Payer: Vantage Medical Group Senior |
$7.95
|
| Rate for Payer: Vantage Medical Group Senior |
$7.95
|
|
|
METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION [215473]
|
Facility
IP
|
$28.13
|
|
|
Service Code
|
CPT Q9968
|
| Hospital Charge Code |
NDG215473
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.63 |
| Max. Negotiated Rate |
$25.32 |
| Rate for Payer: Blue Shield of California Commercial |
$21.10
|
| Rate for Payer: Blue Shield of California Commercial |
$23.44
|
| Rate for Payer: Blue Shield of California EPN |
$15.02
|
| Rate for Payer: Blue Shield of California EPN |
$16.69
|
| Rate for Payer: Cash Price |
$12.66
|
| Rate for Payer: Cash Price |
$14.06
|
| Rate for Payer: Central Health Plan Commercial |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$25.00
|
| Rate for Payer: Cigna of CA HMO |
$19.69
|
| Rate for Payer: Cigna of CA HMO |
$21.88
|
| Rate for Payer: Cigna of CA PPO |
$21.88
|
| Rate for Payer: Cigna of CA PPO |
$19.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.25
|
| Rate for Payer: Galaxy Health WC |
$23.91
|
| Rate for Payer: Galaxy Health WC |
$26.56
|
| Rate for Payer: Global Benefits Group Commercial |
$16.88
|
| Rate for Payer: Global Benefits Group Commercial |
$18.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.63
|
| Rate for Payer: Multiplan Commercial |
$23.44
|
| Rate for Payer: Multiplan Commercial |
$21.10
|
| Rate for Payer: Networks By Design Commercial |
$14.06
|
| Rate for Payer: Networks By Design Commercial |
$15.62
|
| Rate for Payer: Prime Health Services Commercial |
$26.56
|
| Rate for Payer: Prime Health Services Commercial |
$23.91
|
|
|
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION [10571]
|
Facility
IP
|
$23.71
|
|
|
Service Code
|
CPT J2210
|
| Hospital Charge Code |
1720284
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.74 |
| Max. Negotiated Rate |
$21.34 |
| Rate for Payer: Blue Shield of California Commercial |
$17.78
|
| Rate for Payer: Blue Shield of California Commercial |
$26.40
|
| Rate for Payer: Blue Shield of California EPN |
$12.66
|
| Rate for Payer: Blue Shield of California EPN |
$18.80
|
| Rate for Payer: Cash Price |
$15.84
|
| Rate for Payer: Cash Price |
$10.67
|
| Rate for Payer: Central Health Plan Commercial |
$28.16
|
| Rate for Payer: Central Health Plan Commercial |
$18.97
|
| Rate for Payer: Cigna of CA HMO |
$24.64
|
| Rate for Payer: Cigna of CA HMO |
$16.60
|
| Rate for Payer: Cigna of CA PPO |
$16.60
|
| Rate for Payer: Cigna of CA PPO |
$24.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.48
|
| Rate for Payer: Galaxy Health WC |
$20.15
|
| Rate for Payer: Galaxy Health WC |
$29.92
|
| Rate for Payer: Global Benefits Group Commercial |
$21.12
|
| 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 |
$31.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.04
|
| Rate for Payer: Multiplan Commercial |
$17.78
|
| Rate for Payer: Multiplan Commercial |
$26.40
|
| Rate for Payer: Networks By Design Commercial |
$17.60
|
| Rate for Payer: Networks By Design Commercial |
$11.86
|
| Rate for Payer: Prime Health Services Commercial |
$20.15
|
| Rate for Payer: Prime Health Services Commercial |
$29.92
|
|
|
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION [10571]
|
Facility
OP
|
$35.20
|
|
|
Service Code
|
CPT J2210
|
| Hospital Charge Code |
1720284
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$121.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$121.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$121.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$29.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.44
|
| Rate for Payer: BCBS Transplant Transplant |
$21.12
|
| Rate for Payer: BCBS Transplant Transplant |
$14.23
|
| 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 |
$10.67
|
| Rate for Payer: Cash Price |
$10.67
|
| Rate for Payer: Cash Price |
$15.84
|
| Rate for Payer: Cash Price |
$15.84
|
| Rate for Payer: Central Health Plan Commercial |
$18.97
|
| Rate for Payer: Central Health Plan Commercial |
$28.16
|
| Rate for Payer: Cigna of CA HMO |
$24.64
|
| Rate for Payer: Cigna of CA HMO |
$16.60
|
| Rate for Payer: Cigna of CA PPO |
$16.60
|
| Rate for Payer: Cigna of CA PPO |
$24.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.48
|
| Rate for Payer: Galaxy Health WC |
$29.92
|
| Rate for Payer: Galaxy Health WC |
$20.15
|
| Rate for Payer: Global Benefits Group Commercial |
$14.23
|
| Rate for Payer: Global Benefits Group Commercial |
$21.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.34
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$26.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$17.78
|
| Rate for Payer: IEHP medi-cal |
$20.79
|
| Rate for Payer: IEHP medi-cal |
$20.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.74
|
| Rate for Payer: Multiplan Commercial |
$17.78
|
| Rate for Payer: Multiplan Commercial |
$26.40
|
| Rate for Payer: Networks By Design Commercial |
$11.86
|
| Rate for Payer: Networks By Design Commercial |
$17.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.15
|
| Rate for Payer: Prime Health Services Commercial |
$29.92
|
| Rate for Payer: Riverside University Health MISP |
$9.48
|
| Rate for Payer: Riverside University Health MISP |
$14.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.60
|
| Rate for Payer: United Healthcare All Other HMO |
$11.86
|
| Rate for Payer: United Healthcare All Other HMO |
$17.60
|
| Rate for Payer: United Healthcare HMO Rider |
$11.86
|
| Rate for Payer: United Healthcare HMO Rider |
$17.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.92
|
| Rate for Payer: Vantage Medical Group Senior |
$20.15
|
| Rate for Payer: Vantage Medical Group Senior |
$29.92
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
IP
|
$23.83
|
|
|
Service Code
|
NDC 0093-3655-28
|
| Hospital Charge Code |
1710513
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.77 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Blue Shield of California Commercial |
$17.87
|
| Rate for Payer: Blue Shield of California EPN |
$12.73
|
| Rate for Payer: Cash Price |
$10.72
|
| 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: 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: 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
|
|
|
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 |
$14.93 |
| Max. Negotiated Rate |
$67.19 |
| Rate for Payer: Blue Shield of California Commercial |
$56.00
|
| Rate for Payer: Blue Shield of California EPN |
$39.87
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Central Health Plan Commercial |
$59.73
|
| 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: Health Management Network EPO/PPO |
$67.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.93
|
| Rate for Payer: Multiplan Commercial |
$56.00
|
| 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
IP
|
$19.80
|
|
|
Service Code
|
NDC 69238-1605-8
|
| Hospital Charge Code |
1710513
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$17.82 |
| Rate for Payer: Blue Shield of California Commercial |
$14.85
|
| Rate for Payer: Blue Shield of California EPN |
$10.57
|
| Rate for Payer: Cash Price |
$8.91
|
| 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: 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: 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
|
$74.66
|
|
|
Service Code
|
NDC 27437-050-56
|
| Hospital Charge Code |
1710513
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.93 |
| Max. Negotiated Rate |
$67.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$45.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$63.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$41.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$41.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.11
|
| Rate for Payer: BCBS Transplant Transplant |
$44.80
|
| Rate for Payer: Blue Shield of California Commercial |
$46.96
|
| Rate for Payer: Blue Shield of California EPN |
$36.51
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Central Health Plan Commercial |
$59.73
|
| Rate for Payer: Cigna of CA HMO |
$52.26
|
| Rate for Payer: Cigna of CA PPO |
$52.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$29.86
|
| Rate for Payer: Galaxy Health WC |
$63.46
|
| Rate for Payer: Global Benefits Group Commercial |
$44.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.19
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$56.00
|
| Rate for Payer: IEHP medi-cal |
$26.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.93
|
| Rate for Payer: Multiplan Commercial |
$56.00
|
| Rate for Payer: Networks By Design Commercial |
$48.53
|
| Rate for Payer: Prime Health Services Commercial |
$63.46
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$44.80
|
| Rate for Payer: Riverside University Health MISP |
$29.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.33
|
| Rate for Payer: United Healthcare All Other HMO |
$37.33
|
| Rate for Payer: United Healthcare HMO Rider |
$37.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.46
|
| Rate for Payer: Vantage Medical Group Senior |
$63.46
|
|
|
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 |
$12.90 |
| Max. Negotiated Rate |
$58.05 |
| Rate for Payer: Blue Shield of California Commercial |
$48.38
|
| Rate for Payer: Blue Shield of California EPN |
$34.44
|
| Rate for Payer: Cash Price |
$29.03
|
| Rate for Payer: Central Health Plan Commercial |
$51.60
|
| 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: Health Management Network EPO/PPO |
$58.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.90
|
| Rate for Payer: Multiplan Commercial |
$48.38
|
| Rate for Payer: Networks By Design Commercial |
$41.92
|
| Rate for Payer: Prime Health Services Commercial |
$54.82
|
|
|
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 |
$3.96 |
| Max. Negotiated Rate |
$17.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12.02
|
| 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 Exchange |
$9.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.70
|
| Rate for Payer: BCBS Transplant Transplant |
$11.88
|
| Rate for Payer: Blue Shield of California Commercial |
$12.45
|
| Rate for Payer: Blue Shield of California EPN |
$9.68
|
| Rate for Payer: Cash Price |
$8.91
|
| 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: 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 Management Network EPO/PPO |
$17.82
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14.85
|
| Rate for Payer: IEHP medi-cal |
$6.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.21
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$11.88
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$16.83
|
| Rate for Payer: Vantage Medical Group Senior |
$16.83
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
OP
|
$64.50
|
|
|
Service Code
|
NDC 43386-140-28
|
| Hospital Charge Code |
1710513
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$58.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$39.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$54.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$35.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$35.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.11
|
| Rate for Payer: BCBS Transplant Transplant |
$38.70
|
| Rate for Payer: Blue Shield of California Commercial |
$40.57
|
| Rate for Payer: Blue Shield of California EPN |
$31.54
|
| Rate for Payer: Cash Price |
$29.03
|
| Rate for Payer: Central Health Plan Commercial |
$51.60
|
| Rate for Payer: Cigna of CA HMO |
$45.15
|
| Rate for Payer: Cigna of CA PPO |
$45.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.80
|
| Rate for Payer: Galaxy Health WC |
$54.82
|
| Rate for Payer: Global Benefits Group Commercial |
$38.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.05
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$48.38
|
| Rate for Payer: IEHP medi-cal |
$22.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.90
|
| Rate for Payer: Multiplan Commercial |
$48.38
|
| Rate for Payer: Networks By Design Commercial |
$41.92
|
| Rate for Payer: Prime Health Services Commercial |
$54.82
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$38.70
|
| Rate for Payer: Riverside University Health MISP |
$25.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.25
|
| Rate for Payer: United Healthcare All Other HMO |
$32.25
|
| Rate for Payer: United Healthcare HMO Rider |
$32.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.82
|
| Rate for Payer: Vantage Medical Group Senior |
$54.82
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
IP
|
$19.80
|
|
|
Service Code
|
NDC 69238-1605-2
|
| Hospital Charge Code |
1710513
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$17.82 |
| Rate for Payer: Blue Shield of California Commercial |
$14.85
|
| Rate for Payer: Blue Shield of California EPN |
$10.57
|
| Rate for Payer: Cash Price |
$8.91
|
| 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: 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: 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 |
1710513
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.77 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.08
|
| Rate for Payer: BCBS Transplant Transplant |
$14.30
|
| Rate for Payer: Blue Shield of California Commercial |
$14.99
|
| Rate for Payer: Blue Shield of California EPN |
$11.65
|
| Rate for Payer: Cash Price |
$10.72
|
| 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: EPIC Health Plan Commercial |
$9.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$17.87
|
| Rate for Payer: IEHP medi-cal |
$8.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.89
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$14.30
|
| Rate for Payer: Riverside University Health 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 |
$11.92
|
| Rate for Payer: United Healthcare All Other HMO |
$11.92
|
| Rate for Payer: United Healthcare HMO Rider |
$11.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.92
|
| 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
OP
|
$19.80
|
|
|
Service Code
|
NDC 69238-1605-8
|
| Hospital Charge Code |
1710513
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$17.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12.02
|
| 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 Exchange |
$9.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.70
|
| Rate for Payer: BCBS Transplant Transplant |
$11.88
|
| Rate for Payer: Blue Shield of California Commercial |
$12.45
|
| Rate for Payer: Blue Shield of California EPN |
$9.68
|
| Rate for Payer: Cash Price |
$8.91
|
| 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: 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 Management Network EPO/PPO |
$17.82
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14.85
|
| Rate for Payer: IEHP medi-cal |
$6.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.21
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$11.88
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$16.83
|
| Rate for Payer: Vantage Medical Group Senior |
$16.83
|
|
|
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 |
$61.54 |
| Max. Negotiated Rate |
$276.93 |
| Rate for Payer: Blue Shield of California Commercial |
$230.78
|
| Rate for Payer: Blue Shield of California EPN |
$164.31
|
| Rate for Payer: Cash Price |
$138.47
|
| Rate for Payer: Central Health Plan Commercial |
$246.16
|
| 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: Health Management Network EPO/PPO |
$276.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$205.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.54
|
| Rate for Payer: Multiplan Commercial |
$230.78
|
| 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 SYRINGE [154475]
|
Facility
OP
|
$307.70
|
|
|
Service Code
|
CPT J2212
|
| Hospital Charge Code |
NDG154575
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$276.93 |
| Rate for Payer: Adventist Health Medi-Cal |
$1.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.85
|
| 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 Exchange |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.84
|
| Rate for Payer: BCBS Transplant Transplant |
$184.62
|
| Rate for Payer: Blue Shield of California Commercial |
$1.38
|
| Rate for Payer: Blue Shield of California EPN |
$1.25
|
| Rate for Payer: Caremore Medicare Advantage |
$1.20
|
| Rate for Payer: Cash Price |
$138.47
|
| Rate for Payer: Cash Price |
$138.47
|
| Rate for Payer: Central Health Plan Commercial |
$246.16
|
| 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: 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 Management Network EPO/PPO |
$276.93
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$230.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1.97
|
| Rate for Payer: IEHP medi-cal |
$1.98
|
| Rate for Payer: IEHP Medicare Advantage |
$1.20
|
| Rate for Payer: Innovage PACE Commercial |
$1.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$205.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.61
|
| Rate for Payer: Multiplan Commercial |
$230.78
|
| Rate for Payer: Networks By Design Commercial |
$153.85
|
| Rate for Payer: Prime Health Services Commercial |
$261.54
|
| Rate for Payer: Prime Health Services Medicare |
$1.27
|
| Rate for Payer: Riverside University Health MISP |
$1.32
|
| 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 |
$61.54 |
| Max. Negotiated Rate |
$276.93 |
| Rate for Payer: Blue Shield of California Commercial |
$230.78
|
| Rate for Payer: Blue Shield of California EPN |
$164.31
|
| Rate for Payer: Cash Price |
$138.47
|
| Rate for Payer: Central Health Plan Commercial |
$246.16
|
| 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: Health Management Network EPO/PPO |
$276.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$205.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.54
|
| Rate for Payer: Multiplan Commercial |
$230.78
|
| 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 |
$0.77 |
| Max. Negotiated Rate |
$276.93 |
| Rate for Payer: Adventist Health Medi-Cal |
$1.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.85
|
| 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 Exchange |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.84
|
| Rate for Payer: BCBS Transplant Transplant |
$184.62
|
| Rate for Payer: Blue Shield of California Commercial |
$1.38
|
| Rate for Payer: Blue Shield of California EPN |
$1.25
|
| Rate for Payer: Caremore Medicare Advantage |
$1.20
|
| Rate for Payer: Cash Price |
$138.47
|
| Rate for Payer: Cash Price |
$138.47
|
| Rate for Payer: Central Health Plan Commercial |
$246.16
|
| 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: 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 Management Network EPO/PPO |
$276.93
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$230.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1.97
|
| Rate for Payer: IEHP medi-cal |
$1.98
|
| Rate for Payer: IEHP Medicare Advantage |
$1.20
|
| Rate for Payer: Innovage PACE Commercial |
$1.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$205.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.61
|
| Rate for Payer: Multiplan Commercial |
$230.78
|
| Rate for Payer: Networks By Design Commercial |
$153.85
|
| Rate for Payer: Prime Health Services Commercial |
$261.54
|
| Rate for Payer: Prime Health Services Medicare |
$1.27
|
| Rate for Payer: Riverside University Health MISP |
$1.32
|
| 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
|
|
|
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 |
$0.03 |
| 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 Exchange |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
| Rate for Payer: BCBS Transplant Transplant |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Central Health Plan Commercial |
$0.13
|
| 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: 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 Management Network EPO/PPO |
$0.14
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.12
|
| Rate for Payer: IEHP medi-cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| 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: Riverside University Health MISP |
$0.06
|
| 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 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 |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Central Health Plan Commercial |
$0.13
|
| 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: Health Management Network EPO/PPO |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| 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 |
$0.37 |
| Max. Negotiated Rate |
$1.68 |
| Rate for Payer: Blue Shield of California Commercial |
$1.40
|
| Rate for Payer: Blue Shield of California EPN |
$1.00
|
| Rate for Payer: Cash Price |
$0.84
|
| Rate for Payer: Central Health Plan Commercial |
$1.50
|
| 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: Health Management Network EPO/PPO |
$1.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Multiplan Commercial |
$1.40
|
| 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 |
$0.37 |
| Max. Negotiated Rate |
$1.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.14
|
| 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 Exchange |
$0.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.10
|
| Rate for Payer: BCBS Transplant Transplant |
$1.12
|
| Rate for Payer: Blue Shield of California Commercial |
$1.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.91
|
| Rate for Payer: Cash Price |
$0.84
|
| Rate for Payer: Central Health Plan Commercial |
$1.50
|
| 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: 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 Management Network EPO/PPO |
$1.68
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.40
|
| Rate for Payer: IEHP medi-cal |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Multiplan Commercial |
$1.40
|
| 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: Riverside University Health MISP |
$0.75
|
| 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 Medi-Cal |
$1.59
|
| Rate for Payer: Vantage Medical Group Senior |
$1.59
|
|
|
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 |
$0.40 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Blue Shield of California Commercial |
$1.50
|
| Rate for Payer: Blue Shield of California EPN |
$1.07
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$1.60
|
| 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: Health Management Network EPO/PPO |
$1.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: Networks By Design Commercial |
$1.30
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
|
|
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 |
$0.02 |
| Max. Negotiated Rate |
$0.11 |
| 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: Central Health Plan Commercial |
$0.10
|
| 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: Health Management Network EPO/PPO |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
|
