|
METHYLPREDNISOLONE SOD SUCC (PF) 1,000 MG/8 ML INTRAVENOUS SOLUTION [120963]
|
Facility
|
IP
|
$77.29
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
ERX120963
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$57.97 |
| Rate for Payer: Adventist Health Commercial |
$15.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53.10
|
| Rate for Payer: Cash Price |
$34.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.33
|
| Rate for Payer: Heritage Provider Network Senior |
$52.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.32
|
| Rate for Payer: Multiplan Commercial |
$57.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$28.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.82
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 1,000 MG/8 ML INTRAVENOUS SOLUTION [120963]
|
Facility
|
OP
|
$77.29
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
ERX120963
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.01 |
| Max. Negotiated Rate |
$65.70 |
| Rate for Payer: Adventist Health Commercial |
$15.46
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$65.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.53
|
| Rate for Payer: Blue Shield of California Commercial |
$7.01
|
| Rate for Payer: Blue Shield of California EPN |
$7.01
|
| Rate for Payer: Cash Price |
$34.78
|
| Rate for Payer: Cash Price |
$34.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$65.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.70
|
| Rate for Payer: Dignity Health Senior |
$65.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.79
|
| Rate for Payer: Heritage Provider Network Senior |
$35.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$37.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.32
|
| Rate for Payer: Multiplan Commercial |
$57.97
|
| Rate for Payer: TriValley Medical Group Commercial |
$30.92
|
| Rate for Payer: TriValley Medical Group Senior |
$30.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$28.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.70
|
| Rate for Payer: Vantage Medical Group Senior |
$65.70
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION [120961]
|
Facility
|
OP
|
$11.68
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
ERX120961
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$14.45 |
| Rate for Payer: Adventist Health Commercial |
$2.34
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.53
|
| Rate for Payer: Blue Shield of California Commercial |
$7.01
|
| Rate for Payer: Blue Shield of California EPN |
$7.01
|
| Rate for Payer: Cash Price |
$5.26
|
| Rate for Payer: Cash Price |
$5.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.93
|
| Rate for Payer: Dignity Health Senior |
$9.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.41
|
| Rate for Payer: Heritage Provider Network Senior |
$5.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.92
|
| Rate for Payer: Multiplan Commercial |
$8.76
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.67
|
| Rate for Payer: TriValley Medical Group Senior |
$4.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.93
|
| Rate for Payer: Vantage Medical Group Senior |
$9.93
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION [120961]
|
Facility
|
IP
|
$11.68
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
ERX120961
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$8.76 |
| Rate for Payer: Adventist Health Commercial |
$2.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.02
|
| Rate for Payer: Cash Price |
$5.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.91
|
| Rate for Payer: Heritage Provider Network Senior |
$7.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.92
|
| Rate for Payer: Multiplan Commercial |
$8.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.90
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 40 MG/ML SOLUTION FOR INJECTION [120960]
|
Facility
|
OP
|
$7.26
|
|
|
Service Code
|
CPT J2920
|
| Hospital Charge Code |
ERX120960
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$10.29 |
| Rate for Payer: Adventist Health Commercial |
$1.45
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.02
|
| Rate for Payer: Blue Shield of California Commercial |
$5.12
|
| Rate for Payer: Blue Shield of California EPN |
$5.12
|
| Rate for Payer: Cash Price |
$3.27
|
| Rate for Payer: Cash Price |
$3.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.17
|
| Rate for Payer: Dignity Health Senior |
$6.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.36
|
| Rate for Payer: Heritage Provider Network Senior |
$3.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.82
|
| Rate for Payer: Multiplan Commercial |
$5.44
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.90
|
| Rate for Payer: TriValley Medical Group Senior |
$2.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.17
|
| Rate for Payer: Vantage Medical Group Senior |
$6.17
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 40 MG/ML SOLUTION FOR INJECTION [120960]
|
Facility
|
IP
|
$7.26
|
|
|
Service Code
|
CPT J2920
|
| Hospital Charge Code |
ERX120960
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$5.44 |
| Rate for Payer: Adventist Health Commercial |
$1.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.99
|
| Rate for Payer: Cash Price |
$3.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.92
|
| Rate for Payer: Heritage Provider Network Senior |
$4.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.82
|
| Rate for Payer: Multiplan Commercial |
$5.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.43
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 500 MG/4 ML INTRAVENOUS SOLUTION [120962]
|
Facility
|
IP
|
$53.14
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
ERX120962
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$39.86 |
| Rate for Payer: Adventist Health Commercial |
$10.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.51
|
| Rate for Payer: Cash Price |
$23.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.98
|
| Rate for Payer: Heritage Provider Network Senior |
$35.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.28
|
| Rate for Payer: Multiplan Commercial |
$39.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.75
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 500 MG/4 ML INTRAVENOUS SOLUTION [120962]
|
Facility
|
OP
|
$53.14
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
ERX120962
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.01 |
| Max. Negotiated Rate |
$45.17 |
| Rate for Payer: Adventist Health Commercial |
$10.63
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.53
|
| Rate for Payer: Blue Shield of California Commercial |
$7.01
|
| Rate for Payer: Blue Shield of California EPN |
$7.01
|
| Rate for Payer: Cash Price |
$23.91
|
| Rate for Payer: Cash Price |
$23.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.17
|
| Rate for Payer: Dignity Health Senior |
$45.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.60
|
| Rate for Payer: Heritage Provider Network Senior |
$24.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.28
|
| Rate for Payer: Multiplan Commercial |
$39.86
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.26
|
| Rate for Payer: TriValley Medical Group Senior |
$21.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.17
|
| Rate for Payer: Vantage Medical Group Senior |
$45.17
|
|
|
METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM [118363]
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 41167-0600-3
|
| Hospital Charge Code |
NDG118363A
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| 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 Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
|
|
METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM [118363]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 45802-174-53
|
| Hospital Charge Code |
NDG118363A
|
|
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
|
|
|
METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM [118363]
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 4116706003
|
| Hospital Charge Code |
NDG118363A
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| 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 Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
|
|
METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM [118363]
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 4116706003
|
| Hospital Charge Code |
NDG118363A
|
|
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 |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.02
|
| 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 |
$0.02
|
| 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 |
$0.01
|
| 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 |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Senior |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM [118363]
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 41167-0600-3
|
| Hospital Charge Code |
NDG118363A
|
|
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 |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.02
|
| 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 |
$0.02
|
| 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 |
$0.01
|
| 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 |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Senior |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM [118363]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 45802-174-53
|
| Hospital Charge Code |
NDG118363A
|
|
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
|
|
|
METOCLOPRAMIDE 10 MG/10 ML ORAL SOLUTION [40877725]
|
Facility
|
IP
|
$0.42
|
|
|
Service Code
|
NDC 0121-1576-10
|
| Hospital Charge Code |
1716072
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.29
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.28
|
| Rate for Payer: Heritage Provider Network Senior |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.32
|
|
|
METOCLOPRAMIDE 10 MG/10 ML ORAL SOLUTION [40877725]
|
Facility
|
OP
|
$0.65
|
|
|
Service Code
|
NDC 66689-031-50
|
| Hospital Charge Code |
1716072
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.49
|
| Rate for Payer: Blue Shield of California Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California EPN |
$0.38
|
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.55
|
| Rate for Payer: Dignity Health Senior |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.40
|
| Rate for Payer: Heritage Provider Network Senior |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.49
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.26
|
| Rate for Payer: TriValley Medical Group Senior |
$0.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: Vantage Medical Group Senior |
$0.55
|
|
|
METOCLOPRAMIDE 10 MG/10 ML ORAL SOLUTION [40877725]
|
Facility
|
IP
|
$0.65
|
|
|
Service Code
|
NDC 66689-031-50
|
| Hospital Charge Code |
1716072
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.45
|
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.44
|
| Rate for Payer: Heritage Provider Network Senior |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.49
|
|
|
METOCLOPRAMIDE 10 MG/10 ML ORAL SOLUTION [40877725]
|
Facility
|
OP
|
$0.65
|
|
|
Service Code
|
NDC 66689-031-01
|
| Hospital Charge Code |
1716072
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.49
|
| Rate for Payer: Blue Shield of California Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California EPN |
$0.38
|
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.55
|
| Rate for Payer: Dignity Health Senior |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.40
|
| Rate for Payer: Heritage Provider Network Senior |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.49
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.26
|
| Rate for Payer: TriValley Medical Group Senior |
$0.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: Vantage Medical Group Senior |
$0.55
|
|
|
METOCLOPRAMIDE 10 MG/10 ML ORAL SOLUTION [40877725]
|
Facility
|
IP
|
$0.65
|
|
|
Service Code
|
NDC 66689-031-01
|
| Hospital Charge Code |
1716072
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.45
|
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.44
|
| Rate for Payer: Heritage Provider Network Senior |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.49
|
|
|
METOCLOPRAMIDE 10 MG/10 ML ORAL SOLUTION [40877725]
|
Facility
|
OP
|
$0.42
|
|
|
Service Code
|
NDC 0121-1576-10
|
| Hospital Charge Code |
1716072
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.32
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.25
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.36
|
| Rate for Payer: Dignity Health Senior |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.26
|
| Rate for Payer: Heritage Provider Network Senior |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.32
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Senior |
$0.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: Vantage Medical Group Senior |
$0.36
|
|
|
METOCLOPRAMIDE 10 MG TABLET [5005]
|
Facility
|
OP
|
$0.72
|
|
|
Service Code
|
NDC 68084-676-11
|
| Hospital Charge Code |
1710529
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.54
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.42
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.61
|
| Rate for Payer: Dignity Health Senior |
$0.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.45
|
| Rate for Payer: Heritage Provider Network Senior |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Senior |
$0.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.61
|
| Rate for Payer: Vantage Medical Group Senior |
$0.61
|
|
|
METOCLOPRAMIDE 10 MG TABLET [5005]
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
NDC 0093-2203-01
|
| Hospital Charge Code |
1710529
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.06
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Senior |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
|
|
METOCLOPRAMIDE 10 MG TABLET [5005]
|
Facility
|
OP
|
$0.72
|
|
|
Service Code
|
NDC 68084-676-01
|
| Hospital Charge Code |
1710529
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.54
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.42
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.61
|
| Rate for Payer: Dignity Health Senior |
$0.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.45
|
| Rate for Payer: Heritage Provider Network Senior |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Senior |
$0.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.61
|
| Rate for Payer: Vantage Medical Group Senior |
$0.61
|
|
|
METOCLOPRAMIDE 10 MG TABLET [5005]
|
Facility
|
IP
|
$0.96
|
|
|
Service Code
|
NDC 51079-888-01
|
| Hospital Charge Code |
1710529
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.72 |
| Rate for Payer: Adventist Health Commercial |
$0.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.66
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.65
|
| Rate for Payer: Heritage Provider Network Senior |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.72
|
|
|
METOCLOPRAMIDE 10 MG TABLET [5005]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 0093-2203-05
|
| Hospital Charge Code |
1710529
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: Dignity Health Senior |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Senior |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Senior |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
