|
METHOTREXATE SODIUM (PF) 1 GRAM SOLUTION FOR INJECTION [4975]
|
Facility
|
OP
|
$76.32
|
|
|
Service Code
|
NDC 63323-122-50
|
| Hospital Charge Code |
1755718
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.81 |
| Max. Negotiated Rate |
$64.87 |
| Rate for Payer: Adventist Health Commercial |
$15.26
|
| Rate for Payer: Aetna of CA Gatekeeper |
$40.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.24
|
| Rate for Payer: Blue Shield of California Commercial |
$47.39
|
| Rate for Payer: Blue Shield of California EPN |
$44.80
|
| Rate for Payer: Cash Price |
$34.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.87
|
| Rate for Payer: Dignity Health Senior |
$64.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.34
|
| Rate for Payer: Heritage Provider Network Senior |
$35.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$36.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.08
|
| Rate for Payer: Multiplan Commercial |
$57.24
|
| Rate for Payer: TriValley Medical Group Commercial |
$30.53
|
| Rate for Payer: TriValley Medical Group Senior |
$30.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.87
|
| Rate for Payer: Vantage Medical Group Senior |
$64.87
|
|
|
METHOTREXATE SODIUM (PF) 1 GRAM SOLUTION FOR INJECTION [4975]
|
Facility
|
IP
|
$76.32
|
|
|
Service Code
|
NDC 0143-9830-01
|
| Hospital Charge Code |
1755718
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.81 |
| Max. Negotiated Rate |
$57.24 |
| Rate for Payer: Adventist Health Commercial |
$15.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.43
|
| Rate for Payer: Cash Price |
$34.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$51.67
|
| Rate for Payer: Heritage Provider Network Senior |
$51.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.08
|
| Rate for Payer: Multiplan Commercial |
$57.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.50
|
|
|
METHOTREXATE SODIUM (PF) 1 GRAM SOLUTION FOR INJECTION [4975]
|
Facility
|
OP
|
$76.32
|
|
|
Service Code
|
NDC 0143-9830-01
|
| Hospital Charge Code |
1755718
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.81 |
| Max. Negotiated Rate |
$64.87 |
| Rate for Payer: Adventist Health Commercial |
$15.26
|
| Rate for Payer: Aetna of CA Gatekeeper |
$40.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.24
|
| Rate for Payer: Blue Shield of California Commercial |
$47.39
|
| Rate for Payer: Blue Shield of California EPN |
$44.80
|
| Rate for Payer: Cash Price |
$34.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.87
|
| Rate for Payer: Dignity Health Senior |
$64.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.34
|
| Rate for Payer: Heritage Provider Network Senior |
$35.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$36.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.08
|
| Rate for Payer: Multiplan Commercial |
$57.24
|
| Rate for Payer: TriValley Medical Group Commercial |
$30.53
|
| Rate for Payer: TriValley Medical Group Senior |
$30.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.87
|
| Rate for Payer: Vantage Medical Group Senior |
$64.87
|
|
|
METHOTREXATE SODIUM (PF) 1 GRAM SOLUTION FOR INJECTION [4975]
|
Facility
|
IP
|
$76.32
|
|
|
Service Code
|
NDC 63323-122-50
|
| Hospital Charge Code |
1755718
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.81 |
| Max. Negotiated Rate |
$57.24 |
| Rate for Payer: Adventist Health Commercial |
$15.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.43
|
| Rate for Payer: Cash Price |
$34.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$51.67
|
| Rate for Payer: Heritage Provider Network Senior |
$51.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.08
|
| Rate for Payer: Multiplan Commercial |
$57.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.50
|
|
|
METHOXSALEN 20 MCG/ML INJECTION SOLUTION [24933]
|
Facility
|
OP
|
$69.74
|
|
|
Service Code
|
NDC 64067-216-01
|
| Hospital Charge Code |
NDG24933
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.62 |
| Max. Negotiated Rate |
$59.28 |
| Rate for Payer: Adventist Health Commercial |
$13.95
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$47.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.30
|
| Rate for Payer: Blue Shield of California Commercial |
$43.31
|
| Rate for Payer: Blue Shield of California EPN |
$40.94
|
| Rate for Payer: Cash Price |
$31.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$45.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.28
|
| Rate for Payer: Dignity Health Senior |
$59.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.17
|
| Rate for Payer: Heritage Provider Network Senior |
$43.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$33.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.44
|
| Rate for Payer: Multiplan Commercial |
$52.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$27.90
|
| Rate for Payer: TriValley Medical Group Senior |
$27.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.28
|
| Rate for Payer: Vantage Medical Group Senior |
$59.28
|
|
|
METHOXSALEN 20 MCG/ML INJECTION SOLUTION [24933]
|
Facility
|
IP
|
$69.74
|
|
|
Service Code
|
NDC 64067-216-01
|
| Hospital Charge Code |
NDG24933
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.62 |
| Max. Negotiated Rate |
$52.30 |
| Rate for Payer: Adventist Health Commercial |
$13.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$47.91
|
| Rate for Payer: Cash Price |
$31.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.21
|
| Rate for Payer: Heritage Provider Network Senior |
$47.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.44
|
| Rate for Payer: Multiplan Commercial |
$52.30
|
|
|
METHYLCELLULOSE (BULK) 1 % GEL [82599]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 38779-30608
|
| Hospital Charge Code |
NDG82259
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Senior |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
|
|
METHYLCELLULOSE (BULK) 1 % GEL [82599]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 5155207027
|
| Hospital Charge Code |
NDG82259
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Senior |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Senior |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Senior |
$0.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
METHYLCELLULOSE (BULK) 1 % GEL [82599]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 5155207027
|
| Hospital Charge Code |
NDG82259
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Senior |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
|
|
METHYLCELLULOSE (BULK) 1 % GEL [82599]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 38779-30608
|
| Hospital Charge Code |
NDG82259
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Senior |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Senior |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Senior |
$0.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
METHYLDOPA 250 MG TABLET [4982]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 51079-200-01
|
| Hospital Charge Code |
1710140
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.15
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Senior |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
|
|
METHYLDOPA 250 MG TABLET [4982]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 51079-200-01
|
| Hospital Charge Code |
1710140
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
| Rate for Payer: Dignity Health Senior |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Senior |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Senior |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
|
|
METHYLDOPA 500 MG TABLET [4983]
|
Facility
|
IP
|
$0.25
|
|
|
Service Code
|
NDC 16729-031-01
|
| Hospital Charge Code |
1710158
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.17
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Senior |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
|
|
METHYLDOPA 500 MG TABLET [4983]
|
Facility
|
OP
|
$0.25
|
|
|
Service Code
|
NDC 16729-031-01
|
| Hospital Charge Code |
1710158
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.21
|
| Rate for Payer: Dignity Health Senior |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Senior |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Senior |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Vantage Medical Group Senior |
$0.21
|
|
|
METHYLDOPA ORAL SUSPENSION COMPOUND 50 MG/ML [4080300]
|
Facility
|
OP
|
$1.54
|
|
|
Service Code
|
NDC 9994-0803-00
|
| Hospital Charge Code |
1715539
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.31 |
| Rate for Payer: Adventist Health Commercial |
$0.31
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.96
|
| Rate for Payer: Blue Shield of California EPN |
$0.90
|
| Rate for Payer: Cash Price |
$0.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.31
|
| Rate for Payer: Dignity Health Senior |
$1.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.95
|
| Rate for Payer: Heritage Provider Network Senior |
$0.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$1.16
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.62
|
| Rate for Payer: TriValley Medical Group Senior |
$0.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.31
|
| Rate for Payer: Vantage Medical Group Senior |
$1.31
|
|
|
METHYLDOPA ORAL SUSPENSION COMPOUND 50 MG/ML [4080300]
|
Facility
|
IP
|
$1.54
|
|
|
Service Code
|
NDC 9994-0803-00
|
| Hospital Charge Code |
1715539
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Adventist Health Commercial |
$0.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.06
|
| Rate for Payer: Cash Price |
$0.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$1.16
|
|
|
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 |
$4.56 |
| Max. Negotiated Rate |
$18.90 |
| Rate for Payer: Adventist Health Commercial |
$5.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.31
|
| Rate for Payer: Cash Price |
$11.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.06
|
| Rate for Payer: Heritage Provider Network Senior |
$17.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$18.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.42
|
|
|
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) INTRAVENOUS SOLUTION [4985]
|
Facility
|
OP
|
$25.20
|
|
|
Service Code
|
CPT Q9968
|
| Hospital Charge Code |
1720296
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$42.66 |
| Rate for Payer: Adventist Health Commercial |
$5.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$42.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.55
|
| Rate for Payer: Blue Shield of California Commercial |
$15.65
|
| Rate for Payer: Blue Shield of California EPN |
$14.79
|
| Rate for Payer: Cash Price |
$11.34
|
| Rate for Payer: Cash Price |
$11.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.74
|
| Rate for Payer: Dignity Health Senior |
$8.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.13
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.67
|
| Rate for Payer: Heritage Provider Network Senior |
$11.67
|
| Rate for Payer: Humana Medicare |
$7.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.02
|
| Rate for Payer: Multiplan Commercial |
$18.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.08
|
| Rate for Payer: TriValley Medical Group Senior |
$10.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.42
|
| 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 Senior |
$7.95
|
|
|
METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION [215473]
|
Facility
|
IP
|
$31.25
|
|
|
Service Code
|
CPT Q9968
|
| Hospital Charge Code |
NDG215473
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.66 |
| Max. Negotiated Rate |
$23.44 |
| Rate for Payer: Adventist Health Commercial |
$6.25
|
| Rate for Payer: Adventist Health Commercial |
$5.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.47
|
| Rate for Payer: Cash Price |
$12.66
|
| Rate for Payer: Cash Price |
$14.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.16
|
| Rate for Payer: Heritage Provider Network Senior |
$21.16
|
| Rate for Payer: Heritage Provider Network Senior |
$19.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.81
|
| Rate for Payer: Multiplan Commercial |
$21.10
|
| Rate for Payer: Multiplan Commercial |
$23.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.44
|
|
|
METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION [215473]
|
Facility
|
OP
|
$31.25
|
|
|
Service Code
|
CPT Q9968
|
| Hospital Charge Code |
NDG215473
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$42.66 |
| Rate for Payer: Adventist Health Commercial |
$6.25
|
| Rate for Payer: Adventist Health Commercial |
$5.63
|
| Rate for Payer: Aetna of CA Gatekeeper |
$42.66
|
| Rate for Payer: Aetna of CA Gatekeeper |
$42.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.55
|
| Rate for Payer: Blue Shield of California Commercial |
$17.47
|
| Rate for Payer: Blue Shield of California Commercial |
$19.41
|
| Rate for Payer: Blue Shield of California EPN |
$16.51
|
| Rate for Payer: Blue Shield of California EPN |
$18.34
|
| Rate for Payer: Cash Price |
$14.06
|
| Rate for Payer: Cash Price |
$12.66
|
| Rate for Payer: Cash Price |
$12.66
|
| Rate for Payer: Cash Price |
$14.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.74
|
| Rate for Payer: Dignity Health Senior |
$8.74
|
| Rate for Payer: Dignity Health Senior |
$8.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.47
|
| Rate for Payer: Heritage Provider Network Senior |
$13.02
|
| Rate for Payer: Heritage Provider Network Senior |
$14.47
|
| Rate for Payer: Humana Medicare |
$7.95
|
| Rate for Payer: Humana Medicare |
$7.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.02
|
| Rate for Payer: Multiplan Commercial |
$21.10
|
| Rate for Payer: Multiplan Commercial |
$23.44
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Senior |
$11.25
|
| Rate for Payer: TriValley Medical Group Senior |
$12.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.40
|
| 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
|
|
|
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 |
$6.37 |
| Max. Negotiated Rate |
$48.16 |
| Rate for Payer: Adventist Health Commercial |
$7.04
|
| Rate for Payer: Adventist Health Commercial |
$4.74
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.34
|
| Rate for Payer: Blue Shield of California Commercial |
$20.15
|
| Rate for Payer: Blue Shield of California Commercial |
$20.15
|
| Rate for Payer: Blue Shield of California EPN |
$20.15
|
| Rate for Payer: Blue Shield of California EPN |
$20.15
|
| 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: Cigna of CA HMO/PPO |
$10.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.92
|
| Rate for Payer: Dignity Health Senior |
$29.92
|
| Rate for Payer: Dignity Health Senior |
$20.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.98
|
| Rate for Payer: Heritage Provider Network Senior |
$10.98
|
| Rate for Payer: Heritage Provider Network Senior |
$16.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.93
|
| Rate for Payer: Multiplan Commercial |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$17.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.48
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.08
|
| Rate for Payer: TriValley Medical Group Senior |
$9.48
|
| Rate for Payer: TriValley Medical Group Senior |
$14.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.76
|
| 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 |
$29.92
|
| Rate for Payer: Vantage Medical Group Senior |
$20.15
|
|
|
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 |
$4.29 |
| Max. Negotiated Rate |
$17.78 |
| Rate for Payer: Adventist Health Commercial |
$4.74
|
| Rate for Payer: Adventist Health Commercial |
$7.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.18
|
| Rate for Payer: Cash Price |
$10.67
|
| Rate for Payer: Cash Price |
$15.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.83
|
| Rate for Payer: Heritage Provider Network Senior |
$23.83
|
| Rate for Payer: Heritage Provider Network Senior |
$16.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.80
|
| Rate for Payer: Multiplan Commercial |
$17.78
|
| Rate for Payer: Multiplan Commercial |
$26.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.83
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.92
|
|
|
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 |
$13.51 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Adventist Health Commercial |
$14.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$51.29
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.54
|
| Rate for Payer: Heritage Provider Network Senior |
$50.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.66
|
| Rate for Payer: Multiplan Commercial |
$56.00
|
|
|
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 |
$11.67 |
| Max. Negotiated Rate |
$54.82 |
| Rate for Payer: Adventist Health Commercial |
$12.90
|
| Rate for Payer: Aetna of CA Gatekeeper |
$34.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$44.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.38
|
| Rate for Payer: Blue Shield of California Commercial |
$40.05
|
| Rate for Payer: Blue Shield of California EPN |
$37.86
|
| Rate for Payer: Cash Price |
$29.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.82
|
| Rate for Payer: Dignity Health Senior |
$54.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.93
|
| Rate for Payer: Heritage Provider Network Senior |
$39.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$31.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.12
|
| Rate for Payer: Multiplan Commercial |
$48.38
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.80
|
| Rate for Payer: TriValley Medical Group Senior |
$25.80
|
| 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 69238-1605-8
|
| Hospital Charge Code |
1710513
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$14.85 |
| Rate for Payer: Adventist Health Commercial |
$3.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.60
|
| Rate for Payer: Cash Price |
$8.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.40
|
| Rate for Payer: Heritage Provider Network Senior |
$13.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.95
|
| Rate for Payer: Multiplan Commercial |
$14.85
|
|
