|
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
OP
|
$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: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.07
|
| Rate for Payer: BCBS Transplant Transplant |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| 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: Dignity Health Commercial/Exchange |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.11
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.09
|
| Rate for Payer: IEHP medi-cal |
$0.04
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: Riverside University Health MISP |
$0.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Vantage Medical Group Senior |
$0.10
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR [28750]
|
Facility
IP
|
$9.34
|
|
|
Service Code
|
NDC 10147-0685-1
|
| Hospital Charge Code |
1731016
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$8.41 |
| Rate for Payer: Blue Shield of California Commercial |
$7.00
|
| Rate for Payer: Blue Shield of California EPN |
$4.99
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Central Health Plan Commercial |
$7.47
|
| Rate for Payer: Cigna of CA HMO |
$6.54
|
| Rate for Payer: Cigna of CA PPO |
$6.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.74
|
| Rate for Payer: Galaxy Health WC |
$7.94
|
| Rate for Payer: Global Benefits Group Commercial |
$5.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: Multiplan Commercial |
$7.00
|
| Rate for Payer: Networks By Design Commercial |
$6.07
|
| Rate for Payer: Prime Health Services Commercial |
$7.94
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR [28750]
|
Facility
OP
|
$6.22
|
|
|
Service Code
|
NDC 62175-310-37
|
| Hospital Charge Code |
1731016
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.29
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.42
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.67
|
| Rate for Payer: BCBS Transplant Transplant |
$3.73
|
| Rate for Payer: Blue Shield of California Commercial |
$3.91
|
| Rate for Payer: Blue Shield of California EPN |
$3.04
|
| Rate for Payer: Cash Price |
$2.80
|
| Rate for Payer: Central Health Plan Commercial |
$4.98
|
| Rate for Payer: Cigna of CA HMO |
$4.35
|
| Rate for Payer: Cigna of CA PPO |
$4.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.49
|
| Rate for Payer: Galaxy Health WC |
$5.29
|
| Rate for Payer: Global Benefits Group Commercial |
$3.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.66
|
| Rate for Payer: IEHP medi-cal |
$2.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.24
|
| Rate for Payer: Multiplan Commercial |
$4.66
|
| Rate for Payer: Networks By Design Commercial |
$4.04
|
| Rate for Payer: Prime Health Services Commercial |
$5.29
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.73
|
| Rate for Payer: Riverside University Health MISP |
$2.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.11
|
| Rate for Payer: United Healthcare All Other HMO |
$3.11
|
| Rate for Payer: United Healthcare HMO Rider |
$3.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.29
|
| Rate for Payer: Vantage Medical Group Senior |
$5.29
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR [28750]
|
Facility
OP
|
$9.34
|
|
|
Service Code
|
NDC 9999-7068-51
|
| Hospital Charge Code |
1731016
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$8.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.94
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.52
|
| Rate for Payer: BCBS Transplant Transplant |
$5.60
|
| Rate for Payer: Blue Shield of California Commercial |
$5.87
|
| Rate for Payer: Blue Shield of California EPN |
$4.57
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Central Health Plan Commercial |
$7.47
|
| Rate for Payer: Cigna of CA HMO |
$6.54
|
| Rate for Payer: Cigna of CA PPO |
$6.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.74
|
| Rate for Payer: Galaxy Health WC |
$7.94
|
| Rate for Payer: Global Benefits Group Commercial |
$5.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.41
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.00
|
| Rate for Payer: IEHP medi-cal |
$3.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: Multiplan Commercial |
$7.00
|
| Rate for Payer: Networks By Design Commercial |
$6.07
|
| Rate for Payer: Prime Health Services Commercial |
$7.94
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.60
|
| Rate for Payer: Riverside University Health MISP |
$3.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.67
|
| Rate for Payer: United Healthcare All Other HMO |
$4.67
|
| Rate for Payer: United Healthcare HMO Rider |
$4.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.94
|
| Rate for Payer: Vantage Medical Group Senior |
$7.94
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR [28750]
|
Facility
OP
|
$15.48
|
|
|
Service Code
|
NDC 50458-585-01
|
| Hospital Charge Code |
1731016
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$13.93 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.15
|
| Rate for Payer: BCBS Transplant Transplant |
$9.29
|
| Rate for Payer: Blue Shield of California Commercial |
$9.74
|
| Rate for Payer: Blue Shield of California EPN |
$7.57
|
| Rate for Payer: Cash Price |
$6.97
|
| Rate for Payer: Central Health Plan Commercial |
$12.38
|
| Rate for Payer: Cigna of CA HMO |
$10.84
|
| Rate for Payer: Cigna of CA PPO |
$10.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.19
|
| Rate for Payer: Galaxy Health WC |
$13.16
|
| Rate for Payer: Global Benefits Group Commercial |
$9.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.93
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.61
|
| Rate for Payer: IEHP medi-cal |
$5.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.10
|
| Rate for Payer: Multiplan Commercial |
$11.61
|
| Rate for Payer: Networks By Design Commercial |
$10.06
|
| Rate for Payer: Prime Health Services Commercial |
$13.16
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.29
|
| Rate for Payer: Riverside University Health MISP |
$6.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.74
|
| Rate for Payer: United Healthcare All Other HMO |
$7.74
|
| Rate for Payer: United Healthcare HMO Rider |
$7.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.16
|
| Rate for Payer: Vantage Medical Group Senior |
$13.16
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR [28750]
|
Facility
OP
|
$9.34
|
|
|
Service Code
|
NDC 10147-0685-1
|
| Hospital Charge Code |
1731016
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$8.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.94
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.52
|
| Rate for Payer: BCBS Transplant Transplant |
$5.60
|
| Rate for Payer: Blue Shield of California Commercial |
$5.87
|
| Rate for Payer: Blue Shield of California EPN |
$4.57
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Central Health Plan Commercial |
$7.47
|
| Rate for Payer: Cigna of CA HMO |
$6.54
|
| Rate for Payer: Cigna of CA PPO |
$6.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.74
|
| Rate for Payer: Galaxy Health WC |
$7.94
|
| Rate for Payer: Global Benefits Group Commercial |
$5.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.41
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.00
|
| Rate for Payer: IEHP medi-cal |
$3.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: Multiplan Commercial |
$7.00
|
| Rate for Payer: Networks By Design Commercial |
$6.07
|
| Rate for Payer: Prime Health Services Commercial |
$7.94
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.60
|
| Rate for Payer: Riverside University Health MISP |
$3.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.67
|
| Rate for Payer: United Healthcare All Other HMO |
$4.67
|
| Rate for Payer: United Healthcare HMO Rider |
$4.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.94
|
| Rate for Payer: Vantage Medical Group Senior |
$7.94
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR [28750]
|
Facility
IP
|
$6.22
|
|
|
Service Code
|
NDC 62175-310-37
|
| Hospital Charge Code |
1731016
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: Blue Shield of California Commercial |
$4.66
|
| Rate for Payer: Blue Shield of California EPN |
$3.32
|
| Rate for Payer: Cash Price |
$2.80
|
| Rate for Payer: Central Health Plan Commercial |
$4.98
|
| Rate for Payer: Cigna of CA HMO |
$4.35
|
| Rate for Payer: Cigna of CA PPO |
$4.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.49
|
| Rate for Payer: Galaxy Health WC |
$5.29
|
| Rate for Payer: Global Benefits Group Commercial |
$3.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.24
|
| Rate for Payer: Multiplan Commercial |
$4.66
|
| Rate for Payer: Networks By Design Commercial |
$4.04
|
| Rate for Payer: Prime Health Services Commercial |
$5.29
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR [28750]
|
Facility
IP
|
$9.34
|
|
|
Service Code
|
NDC 9999-7068-51
|
| Hospital Charge Code |
1731016
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$8.41 |
| Rate for Payer: Blue Shield of California Commercial |
$7.00
|
| Rate for Payer: Blue Shield of California EPN |
$4.99
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Central Health Plan Commercial |
$7.47
|
| Rate for Payer: Cigna of CA HMO |
$6.54
|
| Rate for Payer: Cigna of CA PPO |
$6.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.74
|
| Rate for Payer: Galaxy Health WC |
$7.94
|
| Rate for Payer: Global Benefits Group Commercial |
$5.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: Multiplan Commercial |
$7.00
|
| Rate for Payer: Networks By Design Commercial |
$6.07
|
| Rate for Payer: Prime Health Services Commercial |
$7.94
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR [28750]
|
Facility
IP
|
$15.48
|
|
|
Service Code
|
NDC 50458-585-01
|
| Hospital Charge Code |
1731016
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$13.93 |
| Rate for Payer: Blue Shield of California Commercial |
$11.61
|
| Rate for Payer: Blue Shield of California EPN |
$8.27
|
| Rate for Payer: Cash Price |
$6.97
|
| Rate for Payer: Central Health Plan Commercial |
$12.38
|
| Rate for Payer: Cigna of CA HMO |
$10.84
|
| Rate for Payer: Cigna of CA PPO |
$10.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.19
|
| Rate for Payer: Galaxy Health WC |
$13.16
|
| Rate for Payer: Global Benefits Group Commercial |
$9.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.10
|
| Rate for Payer: Multiplan Commercial |
$11.61
|
| Rate for Payer: Networks By Design Commercial |
$10.06
|
| Rate for Payer: Prime Health Services Commercial |
$13.16
|
|
|
METHYLPHENIDATE ER 20 MG TABLET,EXTENDED RELEASE [4989]
|
Facility
OP
|
$2.02
|
|
|
Service Code
|
NDC 10702-076-06
|
| Hospital Charge Code |
1734066
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.19
|
| Rate for Payer: BCBS Transplant Transplant |
$1.21
|
| Rate for Payer: Blue Shield of California Commercial |
$1.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.99
|
| Rate for Payer: Cash Price |
$0.91
|
| Rate for Payer: Central Health Plan Commercial |
$1.62
|
| Rate for Payer: Cigna of CA HMO |
$1.41
|
| Rate for Payer: Cigna of CA PPO |
$1.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.81
|
| Rate for Payer: Galaxy Health WC |
$1.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.82
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.52
|
| Rate for Payer: IEHP medi-cal |
$0.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.52
|
| Rate for Payer: Networks By Design Commercial |
$1.31
|
| Rate for Payer: Prime Health Services Commercial |
$1.72
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.21
|
| Rate for Payer: Riverside University Health MISP |
$0.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.01
|
| Rate for Payer: United Healthcare All Other HMO |
$1.01
|
| Rate for Payer: United Healthcare HMO Rider |
$1.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.72
|
| Rate for Payer: Vantage Medical Group Senior |
$1.72
|
|
|
METHYLPHENIDATE ER 20 MG TABLET,EXTENDED RELEASE [4989]
|
Facility
IP
|
$2.02
|
|
|
Service Code
|
NDC 10702-076-06
|
| Hospital Charge Code |
1734066
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: Blue Shield of California Commercial |
$1.52
|
| Rate for Payer: Blue Shield of California EPN |
$1.08
|
| Rate for Payer: Cash Price |
$0.91
|
| Rate for Payer: Central Health Plan Commercial |
$1.62
|
| Rate for Payer: Cigna of CA HMO |
$1.41
|
| Rate for Payer: Cigna of CA PPO |
$1.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.81
|
| Rate for Payer: Galaxy Health WC |
$1.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.52
|
| Rate for Payer: Networks By Design Commercial |
$1.31
|
| Rate for Payer: Prime Health Services Commercial |
$1.72
|
|
|
METHYLPHENIDATE ER 27 MG TABLET,EXTENDED RELEASE 24 HR [32654]
|
Facility
IP
|
$15.87
|
|
|
Service Code
|
NDC 50458-588-01
|
| Hospital Charge Code |
1731019
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$14.28 |
| Rate for Payer: Blue Shield of California Commercial |
$11.90
|
| Rate for Payer: Blue Shield of California EPN |
$8.47
|
| Rate for Payer: Cash Price |
$7.14
|
| Rate for Payer: Central Health Plan Commercial |
$12.70
|
| Rate for Payer: Cigna of CA HMO |
$11.11
|
| Rate for Payer: Cigna of CA PPO |
$11.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.35
|
| Rate for Payer: Galaxy Health WC |
$13.49
|
| Rate for Payer: Global Benefits Group Commercial |
$9.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Multiplan Commercial |
$11.90
|
| Rate for Payer: Networks By Design Commercial |
$10.32
|
| Rate for Payer: Prime Health Services Commercial |
$13.49
|
|
|
METHYLPHENIDATE ER 27 MG TABLET,EXTENDED RELEASE 24 HR [32654]
|
Facility
OP
|
$15.87
|
|
|
Service Code
|
NDC 50458-588-01
|
| Hospital Charge Code |
1731019
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$14.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.73
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.38
|
| Rate for Payer: BCBS Transplant Transplant |
$9.52
|
| Rate for Payer: Blue Shield of California Commercial |
$9.98
|
| Rate for Payer: Blue Shield of California EPN |
$7.76
|
| Rate for Payer: Cash Price |
$7.14
|
| Rate for Payer: Central Health Plan Commercial |
$12.70
|
| Rate for Payer: Cigna of CA HMO |
$11.11
|
| Rate for Payer: Cigna of CA PPO |
$11.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.35
|
| Rate for Payer: Galaxy Health WC |
$13.49
|
| Rate for Payer: Global Benefits Group Commercial |
$9.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.28
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.90
|
| Rate for Payer: IEHP medi-cal |
$5.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Multiplan Commercial |
$11.90
|
| Rate for Payer: Networks By Design Commercial |
$10.32
|
| Rate for Payer: Prime Health Services Commercial |
$13.49
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.52
|
| Rate for Payer: Riverside University Health MISP |
$6.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.94
|
| Rate for Payer: United Healthcare All Other HMO |
$7.94
|
| Rate for Payer: United Healthcare HMO Rider |
$7.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.49
|
| Rate for Payer: Vantage Medical Group Senior |
$13.49
|
|
|
METHYLPHENIDATE ER 36 MG TABLET,EXTENDED RELEASE 24 HR [28751]
|
Facility
OP
|
$12.42
|
|
|
Service Code
|
NDC 68084-829-95
|
| Hospital Charge Code |
1731018
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$11.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.34
|
| Rate for Payer: BCBS Transplant Transplant |
$7.45
|
| Rate for Payer: Blue Shield of California Commercial |
$7.81
|
| Rate for Payer: Blue Shield of California EPN |
$6.07
|
| Rate for Payer: Cash Price |
$5.59
|
| Rate for Payer: Central Health Plan Commercial |
$9.94
|
| Rate for Payer: Cigna of CA HMO |
$8.69
|
| Rate for Payer: Cigna of CA PPO |
$8.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.97
|
| Rate for Payer: Galaxy Health WC |
$10.56
|
| Rate for Payer: Global Benefits Group Commercial |
$7.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.18
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.32
|
| Rate for Payer: IEHP medi-cal |
$4.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.48
|
| Rate for Payer: Multiplan Commercial |
$9.32
|
| Rate for Payer: Networks By Design Commercial |
$8.07
|
| Rate for Payer: Prime Health Services Commercial |
$10.56
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7.45
|
| Rate for Payer: Riverside University Health MISP |
$4.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.21
|
| Rate for Payer: United Healthcare All Other HMO |
$6.21
|
| Rate for Payer: United Healthcare HMO Rider |
$6.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.56
|
| Rate for Payer: Vantage Medical Group Senior |
$10.56
|
|
|
METHYLPHENIDATE ER 36 MG TABLET,EXTENDED RELEASE 24 HR [28751]
|
Facility
IP
|
$12.42
|
|
|
Service Code
|
NDC 68084-829-95
|
| Hospital Charge Code |
1731018
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$11.18 |
| Rate for Payer: Blue Shield of California Commercial |
$9.32
|
| Rate for Payer: Blue Shield of California EPN |
$6.63
|
| Rate for Payer: Cash Price |
$5.59
|
| Rate for Payer: Central Health Plan Commercial |
$9.94
|
| Rate for Payer: Cigna of CA HMO |
$8.69
|
| Rate for Payer: Cigna of CA PPO |
$8.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.97
|
| Rate for Payer: Galaxy Health WC |
$10.56
|
| Rate for Payer: Global Benefits Group Commercial |
$7.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.48
|
| Rate for Payer: Multiplan Commercial |
$9.32
|
| Rate for Payer: Networks By Design Commercial |
$8.07
|
| Rate for Payer: Prime Health Services Commercial |
$10.56
|
|
|
METHYLPHENIDATE ER 36 MG TABLET,EXTENDED RELEASE 24 HR [28751]
|
Facility
OP
|
$16.37
|
|
|
Service Code
|
NDC 50458-586-01
|
| Hospital Charge Code |
1731018
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$14.73 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.91
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.67
|
| Rate for Payer: BCBS Transplant Transplant |
$9.82
|
| Rate for Payer: Blue Shield of California Commercial |
$10.30
|
| Rate for Payer: Blue Shield of California EPN |
$8.00
|
| Rate for Payer: Cash Price |
$7.37
|
| Rate for Payer: Central Health Plan Commercial |
$13.10
|
| Rate for Payer: Cigna of CA HMO |
$11.46
|
| Rate for Payer: Cigna of CA PPO |
$11.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.55
|
| Rate for Payer: Galaxy Health WC |
$13.91
|
| Rate for Payer: Global Benefits Group Commercial |
$9.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.73
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.28
|
| Rate for Payer: IEHP medi-cal |
$5.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.27
|
| Rate for Payer: Multiplan Commercial |
$12.28
|
| Rate for Payer: Networks By Design Commercial |
$10.64
|
| Rate for Payer: Prime Health Services Commercial |
$13.91
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.82
|
| Rate for Payer: Riverside University Health MISP |
$6.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.18
|
| Rate for Payer: United Healthcare All Other HMO |
$8.18
|
| Rate for Payer: United Healthcare HMO Rider |
$8.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.91
|
| Rate for Payer: Vantage Medical Group Senior |
$13.91
|
|
|
METHYLPHENIDATE ER 36 MG TABLET,EXTENDED RELEASE 24 HR [28751]
|
Facility
OP
|
$12.42
|
|
|
Service Code
|
NDC 68084-829-25
|
| Hospital Charge Code |
1731018
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$11.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.34
|
| Rate for Payer: BCBS Transplant Transplant |
$7.45
|
| Rate for Payer: Blue Shield of California Commercial |
$7.81
|
| Rate for Payer: Blue Shield of California EPN |
$6.07
|
| Rate for Payer: Cash Price |
$5.59
|
| Rate for Payer: Central Health Plan Commercial |
$9.94
|
| Rate for Payer: Cigna of CA HMO |
$8.69
|
| Rate for Payer: Cigna of CA PPO |
$8.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.97
|
| Rate for Payer: Galaxy Health WC |
$10.56
|
| Rate for Payer: Global Benefits Group Commercial |
$7.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.18
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.32
|
| Rate for Payer: IEHP medi-cal |
$4.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.48
|
| Rate for Payer: Multiplan Commercial |
$9.32
|
| Rate for Payer: Networks By Design Commercial |
$8.07
|
| Rate for Payer: Prime Health Services Commercial |
$10.56
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7.45
|
| Rate for Payer: Riverside University Health MISP |
$4.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.21
|
| Rate for Payer: United Healthcare All Other HMO |
$6.21
|
| Rate for Payer: United Healthcare HMO Rider |
$6.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.56
|
| Rate for Payer: Vantage Medical Group Senior |
$10.56
|
|
|
METHYLPHENIDATE ER 36 MG TABLET,EXTENDED RELEASE 24 HR [28751]
|
Facility
IP
|
$16.37
|
|
|
Service Code
|
NDC 50458-586-01
|
| Hospital Charge Code |
1731018
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$14.73 |
| Rate for Payer: Blue Shield of California Commercial |
$12.28
|
| Rate for Payer: Blue Shield of California EPN |
$8.74
|
| Rate for Payer: Cash Price |
$7.37
|
| Rate for Payer: Central Health Plan Commercial |
$13.10
|
| Rate for Payer: Cigna of CA HMO |
$11.46
|
| Rate for Payer: Cigna of CA PPO |
$11.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.55
|
| Rate for Payer: Galaxy Health WC |
$13.91
|
| Rate for Payer: Global Benefits Group Commercial |
$9.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.27
|
| Rate for Payer: Multiplan Commercial |
$12.28
|
| Rate for Payer: Networks By Design Commercial |
$10.64
|
| Rate for Payer: Prime Health Services Commercial |
$13.91
|
|
|
METHYLPHENIDATE ER 36 MG TABLET,EXTENDED RELEASE 24 HR [28751]
|
Facility
IP
|
$12.42
|
|
|
Service Code
|
NDC 68084-829-25
|
| Hospital Charge Code |
1731018
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$11.18 |
| Rate for Payer: Blue Shield of California Commercial |
$9.32
|
| Rate for Payer: Blue Shield of California EPN |
$6.63
|
| Rate for Payer: Cash Price |
$5.59
|
| Rate for Payer: Central Health Plan Commercial |
$9.94
|
| Rate for Payer: Cigna of CA HMO |
$8.69
|
| Rate for Payer: Cigna of CA PPO |
$8.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.97
|
| Rate for Payer: Galaxy Health WC |
$10.56
|
| Rate for Payer: Global Benefits Group Commercial |
$7.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.48
|
| Rate for Payer: Multiplan Commercial |
$9.32
|
| Rate for Payer: Networks By Design Commercial |
$8.07
|
| Rate for Payer: Prime Health Services Commercial |
$10.56
|
|
|
METHYLPHENIDATE LA 20 MG BIPHASIC 50-50 CAPSULE,EXTENDED RELEASE [33198]
|
Facility
OP
|
$13.78
|
|
|
Service Code
|
NDC 0078-0370-05
|
| Hospital Charge Code |
1730090
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$12.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.71
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.14
|
| Rate for Payer: BCBS Transplant Transplant |
$8.27
|
| Rate for Payer: Blue Shield of California Commercial |
$8.67
|
| Rate for Payer: Blue Shield of California EPN |
$6.74
|
| Rate for Payer: Cash Price |
$6.20
|
| Rate for Payer: Central Health Plan Commercial |
$11.02
|
| Rate for Payer: Cigna of CA HMO |
$9.65
|
| Rate for Payer: Cigna of CA PPO |
$9.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.51
|
| Rate for Payer: Galaxy Health WC |
$11.71
|
| Rate for Payer: Global Benefits Group Commercial |
$8.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10.34
|
| Rate for Payer: IEHP medi-cal |
$4.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.76
|
| Rate for Payer: Multiplan Commercial |
$10.34
|
| Rate for Payer: Networks By Design Commercial |
$8.96
|
| Rate for Payer: Prime Health Services Commercial |
$11.71
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8.27
|
| Rate for Payer: Riverside University Health MISP |
$5.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.89
|
| Rate for Payer: United Healthcare All Other HMO |
$6.89
|
| Rate for Payer: United Healthcare HMO Rider |
$6.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.71
|
| Rate for Payer: Vantage Medical Group Senior |
$11.71
|
|
|
METHYLPHENIDATE LA 20 MG BIPHASIC 50-50 CAPSULE,EXTENDED RELEASE [33198]
|
Facility
IP
|
$13.78
|
|
|
Service Code
|
NDC 0078-0370-05
|
| Hospital Charge Code |
1730090
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$12.40 |
| Rate for Payer: Blue Shield of California Commercial |
$10.34
|
| Rate for Payer: Blue Shield of California EPN |
$7.36
|
| Rate for Payer: Cash Price |
$6.20
|
| Rate for Payer: Central Health Plan Commercial |
$11.02
|
| Rate for Payer: Cigna of CA HMO |
$9.65
|
| Rate for Payer: Cigna of CA PPO |
$9.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.51
|
| Rate for Payer: Galaxy Health WC |
$11.71
|
| Rate for Payer: Global Benefits Group Commercial |
$8.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.76
|
| Rate for Payer: Multiplan Commercial |
$10.34
|
| Rate for Payer: Networks By Design Commercial |
$8.96
|
| Rate for Payer: Prime Health Services Commercial |
$11.71
|
|
|
METHYLPREDNISOLONE 125 MG INJ. [4081205]
|
Facility
OP
|
$11.68
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
1720347
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$36.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$36.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.42
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.67
|
| Rate for Payer: BCBS Transplant Transplant |
$8.39
|
| Rate for Payer: BCBS Transplant Transplant |
$7.01
|
| Rate for Payer: BCBS Transplant Transplant |
$5.47
|
| Rate for Payer: Blue Shield of California Commercial |
$9.36
|
| Rate for Payer: Blue Shield of California Commercial |
$9.36
|
| Rate for Payer: Blue Shield of California Commercial |
$9.36
|
| Rate for Payer: Blue Shield of California EPN |
$8.51
|
| Rate for Payer: Blue Shield of California EPN |
$8.51
|
| Rate for Payer: Blue Shield of California EPN |
$8.51
|
| Rate for Payer: Cash Price |
$6.29
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Cash Price |
$5.26
|
| Rate for Payer: Cash Price |
$5.26
|
| Rate for Payer: Cash Price |
$6.29
|
| Rate for Payer: Central Health Plan Commercial |
$11.18
|
| Rate for Payer: Central Health Plan Commercial |
$7.30
|
| Rate for Payer: Central Health Plan Commercial |
$9.34
|
| Rate for Payer: Cigna of CA HMO |
$9.79
|
| Rate for Payer: Cigna of CA HMO |
$6.38
|
| Rate for Payer: Cigna of CA HMO |
$8.18
|
| Rate for Payer: Cigna of CA PPO |
$9.79
|
| Rate for Payer: Cigna of CA PPO |
$8.18
|
| Rate for Payer: Cigna of CA PPO |
$6.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.59
|
| Rate for Payer: Galaxy Health WC |
$9.93
|
| Rate for Payer: Galaxy Health WC |
$11.88
|
| Rate for Payer: Galaxy Health WC |
$7.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5.47
|
| Rate for Payer: Global Benefits Group Commercial |
$7.01
|
| Rate for Payer: Global Benefits Group Commercial |
$8.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.21
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10.48
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.76
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.84
|
| Rate for Payer: IEHP medi-cal |
$4.09
|
| Rate for Payer: IEHP medi-cal |
$4.89
|
| Rate for Payer: IEHP medi-cal |
$3.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.80
|
| Rate for Payer: Multiplan Commercial |
$8.76
|
| Rate for Payer: Multiplan Commercial |
$10.48
|
| Rate for Payer: Multiplan Commercial |
$6.84
|
| Rate for Payer: Networks By Design Commercial |
$5.84
|
| Rate for Payer: Networks By Design Commercial |
$4.56
|
| Rate for Payer: Networks By Design Commercial |
$6.99
|
| Rate for Payer: Prime Health Services Commercial |
$9.93
|
| Rate for Payer: Prime Health Services Commercial |
$11.88
|
| Rate for Payer: Prime Health Services Commercial |
$7.75
|
| Rate for Payer: Riverside University Health MISP |
$5.59
|
| Rate for Payer: Riverside University Health MISP |
$4.67
|
| Rate for Payer: Riverside University Health MISP |
$3.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.99
|
| Rate for Payer: United Healthcare All Other HMO |
$5.84
|
| Rate for Payer: United Healthcare All Other HMO |
$4.56
|
| Rate for Payer: United Healthcare All Other HMO |
$6.99
|
| Rate for Payer: United Healthcare HMO Rider |
$4.56
|
| Rate for Payer: United Healthcare HMO Rider |
$6.99
|
| Rate for Payer: United Healthcare HMO Rider |
$5.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.75
|
| Rate for Payer: Vantage Medical Group Senior |
$11.88
|
| Rate for Payer: Vantage Medical Group Senior |
$9.93
|
| Rate for Payer: Vantage Medical Group Senior |
$7.75
|
|
|
METHYLPREDNISOLONE 125 MG INJ. [4081205]
|
Facility
IP
|
$11.68
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
1720347
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$10.51 |
| Rate for Payer: Blue Shield of California Commercial |
$8.76
|
| Rate for Payer: Blue Shield of California Commercial |
$10.48
|
| Rate for Payer: Blue Shield of California Commercial |
$6.84
|
| Rate for Payer: Blue Shield of California EPN |
$6.24
|
| Rate for Payer: Blue Shield of California EPN |
$4.87
|
| Rate for Payer: Blue Shield of California EPN |
$7.47
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Cash Price |
$5.26
|
| Rate for Payer: Cash Price |
$6.29
|
| Rate for Payer: Central Health Plan Commercial |
$9.34
|
| Rate for Payer: Central Health Plan Commercial |
$11.18
|
| Rate for Payer: Central Health Plan Commercial |
$7.30
|
| Rate for Payer: Cigna of CA HMO |
$9.79
|
| Rate for Payer: Cigna of CA HMO |
$6.38
|
| Rate for Payer: Cigna of CA HMO |
$8.18
|
| Rate for Payer: Cigna of CA PPO |
$8.18
|
| Rate for Payer: Cigna of CA PPO |
$9.79
|
| Rate for Payer: Cigna of CA PPO |
$6.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.59
|
| Rate for Payer: Galaxy Health WC |
$11.88
|
| Rate for Payer: Galaxy Health WC |
$7.75
|
| Rate for Payer: Galaxy Health WC |
$9.93
|
| Rate for Payer: Global Benefits Group Commercial |
$8.39
|
| Rate for Payer: Global Benefits Group Commercial |
$7.01
|
| Rate for Payer: Global Benefits Group Commercial |
$5.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.82
|
| Rate for Payer: Multiplan Commercial |
$10.48
|
| Rate for Payer: Multiplan Commercial |
$8.76
|
| Rate for Payer: Multiplan Commercial |
$6.84
|
| Rate for Payer: Networks By Design Commercial |
$6.99
|
| Rate for Payer: Networks By Design Commercial |
$4.56
|
| Rate for Payer: Networks By Design Commercial |
$5.84
|
| Rate for Payer: Prime Health Services Commercial |
$11.88
|
| Rate for Payer: Prime Health Services Commercial |
$9.93
|
| Rate for Payer: Prime Health Services Commercial |
$7.75
|
|
|
METHYLPREDNISOLONE 16 MG TABLET [4992]
|
Facility
IP
|
$2.98
|
|
|
Service Code
|
CPT J7509
|
| Hospital Charge Code |
1710277
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2.68 |
| Rate for Payer: Blue Shield of California Commercial |
$2.24
|
| Rate for Payer: Blue Shield of California EPN |
$1.59
|
| Rate for Payer: Cash Price |
$1.34
|
| Rate for Payer: Central Health Plan Commercial |
$2.38
|
| Rate for Payer: Cigna of CA HMO |
$2.09
|
| Rate for Payer: Cigna of CA PPO |
$2.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.19
|
| Rate for Payer: Galaxy Health WC |
$2.53
|
| Rate for Payer: Global Benefits Group Commercial |
$1.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.60
|
| Rate for Payer: Multiplan Commercial |
$2.24
|
| Rate for Payer: Networks By Design Commercial |
$1.49
|
| Rate for Payer: Prime Health Services Commercial |
$2.53
|
|
