|
METHADONE 10 MG/5 ML ORAL SOLUTION [4951]
|
Facility
|
IP
|
$0.13
|
|
|
Service Code
|
HCPCS S0109
|
| Hospital Charge Code |
901700032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| 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 |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.04
|
|
|
METHADONE 10 MG/ML INJECTION. [4081195]
|
Facility
|
IP
|
$21.60
|
|
|
Service Code
|
HCPCS J1230
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.91 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Adventist Health Commercial |
$4.32
|
| Rate for Payer: Adventist Health Commercial |
$5.64
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Cash Price |
$11.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.00
|
| Rate for Payer: Heritage Provider Network Senior |
$10.00
|
| Rate for Payer: Heritage Provider Network Senior |
$13.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.40
|
| Rate for Payer: Multiplan Commercial |
$21.14
|
| Rate for Payer: Multiplan Commercial |
$16.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.15
|
|
|
METHADONE 10 MG/ML INJECTION. [4081195]
|
Facility
|
OP
|
$28.19
|
|
|
Service Code
|
HCPCS J1230
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$55.36 |
| Rate for Payer: Adventist Health Commercial |
$5.64
|
| Rate for Payer: Adventist Health Commercial |
$4.32
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.55
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.36
|
| Rate for Payer: Blue Shield of California Commercial |
$21.80
|
| Rate for Payer: Blue Shield of California Commercial |
$21.80
|
| Rate for Payer: Blue Shield of California EPN |
$21.80
|
| Rate for Payer: Blue Shield of California EPN |
$21.80
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Cash Price |
$11.88
|
| Rate for Payer: Cash Price |
$11.88
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.96
|
| Rate for Payer: Dignity Health Senior |
$18.36
|
| Rate for Payer: Dignity Health Senior |
$23.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.00
|
| Rate for Payer: Heritage Provider Network Senior |
$10.00
|
| Rate for Payer: Heritage Provider Network Senior |
$13.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.73
|
| Rate for Payer: Multiplan Commercial |
$21.14
|
| Rate for Payer: Multiplan Commercial |
$16.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.64
|
| Rate for Payer: TriValley Medical Group Senior |
$8.64
|
| Rate for Payer: TriValley Medical Group Senior |
$11.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.96
|
| Rate for Payer: Vantage Medical Group Senior |
$18.36
|
| Rate for Payer: Vantage Medical Group Senior |
$23.96
|
|
|
METHADONE 10 MG/ML INJECTION SOLUTION [10546]
|
Facility
|
IP
|
$25.65
|
|
|
Service Code
|
HCPCS J1230
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$19.24 |
| Rate for Payer: Adventist Health Commercial |
$5.13
|
| Rate for Payer: Adventist Health Commercial |
$4.92
|
| Rate for Payer: Adventist Health Commercial |
$5.64
|
| Rate for Payer: Cash Price |
$14.11
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Cash Price |
$13.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.88
|
| Rate for Payer: Heritage Provider Network Senior |
$11.88
|
| Rate for Payer: Heritage Provider Network Senior |
$11.39
|
| Rate for Payer: Heritage Provider Network Senior |
$13.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.05
|
| Rate for Payer: Multiplan Commercial |
$21.14
|
| Rate for Payer: Multiplan Commercial |
$18.45
|
| Rate for Payer: Multiplan Commercial |
$19.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.49
|
|
|
METHADONE 10 MG/ML INJECTION SOLUTION [10546]
|
Facility
|
OP
|
$25.65
|
|
|
Service Code
|
HCPCS J1230
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$55.36 |
| Rate for Payer: Adventist Health Commercial |
$5.13
|
| Rate for Payer: Adventist Health Commercial |
$5.64
|
| Rate for Payer: Adventist Health Commercial |
$4.92
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.15
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.36
|
| Rate for Payer: Blue Shield of California Commercial |
$21.80
|
| Rate for Payer: Blue Shield of California Commercial |
$21.80
|
| Rate for Payer: Blue Shield of California Commercial |
$21.80
|
| Rate for Payer: Blue Shield of California EPN |
$21.80
|
| Rate for Payer: Blue Shield of California EPN |
$21.80
|
| Rate for Payer: Blue Shield of California EPN |
$21.80
|
| Rate for Payer: Cash Price |
$13.53
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Cash Price |
$14.11
|
| Rate for Payer: Cash Price |
$14.11
|
| Rate for Payer: Cash Price |
$13.53
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.96
|
| Rate for Payer: Dignity Health Senior |
$23.96
|
| Rate for Payer: Dignity Health Senior |
$20.91
|
| Rate for Payer: Dignity Health Senior |
$21.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.88
|
| Rate for Payer: Heritage Provider Network Senior |
$13.05
|
| Rate for Payer: Heritage Provider Network Senior |
$11.39
|
| Rate for Payer: Heritage Provider Network Senior |
$11.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.22
|
| Rate for Payer: Multiplan Commercial |
$18.45
|
| Rate for Payer: Multiplan Commercial |
$19.24
|
| Rate for Payer: Multiplan Commercial |
$21.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.84
|
| Rate for Payer: TriValley Medical Group Senior |
$9.84
|
| Rate for Payer: TriValley Medical Group Senior |
$11.28
|
| Rate for Payer: TriValley Medical Group Senior |
$10.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.96
|
| Rate for Payer: Vantage Medical Group Senior |
$20.91
|
| Rate for Payer: Vantage Medical Group Senior |
$23.96
|
| Rate for Payer: Vantage Medical Group Senior |
$21.80
|
|
|
METHADONE 10 MG/ML INTRAVENOUS SYRINGE [153564]
|
Facility
|
IP
|
$21.60
|
|
|
Service Code
|
HCPCS J1230
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.91 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Adventist Health Commercial |
$4.32
|
| Rate for Payer: Cash Price |
$11.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.00
|
| Rate for Payer: Heritage Provider Network Senior |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.40
|
| Rate for Payer: Multiplan Commercial |
$16.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.15
|
|
|
METHADONE 10 MG/ML INTRAVENOUS SYRINGE [153564]
|
Facility
|
OP
|
$21.60
|
|
|
Service Code
|
HCPCS J1230
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.91 |
| Max. Negotiated Rate |
$55.36 |
| Rate for Payer: Adventist Health Commercial |
$4.32
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.36
|
| Rate for Payer: Blue Shield of California Commercial |
$21.80
|
| Rate for Payer: Blue Shield of California EPN |
$21.80
|
| Rate for Payer: Cash Price |
$11.88
|
| Rate for Payer: Cash Price |
$11.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.36
|
| Rate for Payer: Dignity Health Senior |
$18.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.00
|
| Rate for Payer: Heritage Provider Network Senior |
$10.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.12
|
| Rate for Payer: Multiplan Commercial |
$16.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.64
|
| Rate for Payer: TriValley Medical Group Senior |
$8.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.36
|
| Rate for Payer: Vantage Medical Group Senior |
$18.36
|
|
|
METHADONE 10 MG/ML ORAL CONCENTRATE [15996]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
HCPCS S0109
|
| Hospital Charge Code |
901700032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.80
|
| Rate for Payer: Blue Shield of California Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.08
|
| Rate for Payer: Dignity Health Senior |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Senior |
$0.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.04
|
| 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: Molina Healthcare of CA Medi-Cal |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
|
METHADONE 10 MG/ML ORAL CONCENTRATE [15996]
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
HCPCS S0109
|
| Hospital Charge Code |
901700032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Senior |
$0.04
|
| 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
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.03
|
|
|
METHADONE 10 MG TABLET [4953]
|
Facility
|
IP
|
$0.30
|
|
|
Service Code
|
HCPCS S0109
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.37
|
| Rate for Payer: Heritage Provider Network Senior |
$0.37
|
| Rate for Payer: Heritage Provider Network Senior |
$0.37
|
| Rate for Payer: Heritage Provider Network Senior |
$0.28
|
| Rate for Payer: Heritage Provider Network Senior |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
|
|
METHADONE 10 MG TABLET [4953]
|
Facility
|
OP
|
$0.42
|
|
|
Service Code
|
HCPCS S0109
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.29
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.38
|
| 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 Commercial/Exchange |
$0.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.80
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.33
|
| Rate for Payer: Blue Shield of California Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.46
|
| Rate for Payer: Dignity Health Senior |
$0.46
|
| Rate for Payer: Dignity Health Senior |
$0.47
|
| Rate for Payer: Dignity Health Senior |
$0.36
|
| Rate for Payer: Dignity Health Senior |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.33
|
| Rate for Payer: Heritage Provider Network Senior |
$0.33
|
| Rate for Payer: Heritage Provider Network Senior |
$0.19
|
| Rate for Payer: Heritage Provider Network Senior |
$0.26
|
| Rate for Payer: Heritage Provider Network Senior |
$0.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.22
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.22
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Senior |
$0.22
|
| Rate for Payer: TriValley Medical Group Senior |
$0.17
|
| Rate for Payer: TriValley Medical Group Senior |
$0.12
|
| Rate for Payer: TriValley Medical Group Senior |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.47
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.36
|
| Rate for Payer: Vantage Medical Group Senior |
$0.46
|
| Rate for Payer: Vantage Medical Group Senior |
$0.47
|
|
|
METHADONE 1 MG/ML ORAL SOLN UD [4080790]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
HCPCS S0109
|
| Hospital Charge Code |
901700032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.80 |
| 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: Anthem Blue Cross of CA HMO/PPO |
$0.80
|
| Rate for Payer: Blue Shield of California Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.04
|
| 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 |
$0.04
|
| Rate for Payer: Heritage Provider Network Senior |
$0.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.18
|
| 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: Molina Healthcare of CA Medi-Cal |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.06
|
| 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: United Healthcare All Other HMO/non HMO |
$0.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
METHADONE 1 MG/ML ORAL SOLN UD [4080790]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
HCPCS S0109
|
| Hospital Charge Code |
901700032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Senior |
$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: United Healthcare All Other HMO/non HMO |
$0.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.03
|
|
|
METHADONE 5 MG/5 ML ORAL SOLUTION [4952]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
HCPCS S0109
|
| Hospital Charge Code |
901700032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Senior |
$0.04
|
| Rate for Payer: Heritage Provider Network Senior |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.03
|
|
|
METHADONE 5 MG/5 ML ORAL SOLUTION [4952]
|
Facility
|
OP
|
$0.59
|
|
|
Service Code
|
HCPCS S0109
|
| Hospital Charge Code |
901700032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.80
|
| Rate for Payer: Blue Shield of California Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.50
|
| Rate for Payer: Dignity Health Senior |
$0.07
|
| Rate for Payer: Dignity Health Senior |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Senior |
$0.04
|
| Rate for Payer: Heritage Provider Network Senior |
$0.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| 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: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.24
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Senior |
$0.03
|
| Rate for Payer: TriValley Medical Group Senior |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.50
|
|
|
METHADONE 5 MG TABLET [4954]
|
Facility
|
IP
|
$0.35
|
|
|
Service Code
|
HCPCS S0109
|
| Hospital Charge Code |
901700032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Senior |
$0.16
|
| Rate for Payer: Heritage Provider Network Senior |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.12
|
|
|
METHADONE 5 MG TABLET [4954]
|
Facility
|
OP
|
$0.48
|
|
|
Service Code
|
HCPCS S0109
|
| Hospital Charge Code |
901700032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.19
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.80
|
| Rate for Payer: Blue Shield of California Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.41
|
| Rate for Payer: Dignity Health Senior |
$0.30
|
| Rate for Payer: Dignity Health Senior |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Senior |
$0.16
|
| Rate for Payer: Heritage Provider Network Senior |
$0.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Senior |
$0.14
|
| Rate for Payer: TriValley Medical Group Senior |
$0.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Vantage Medical Group Senior |
$0.30
|
| Rate for Payer: Vantage Medical Group Senior |
$0.41
|
|
|
METHAZOLAMIDE 50 MG TABLET [4962]
|
Facility
|
IP
|
$3.74
|
|
|
Service Code
|
NDC 62559-241-01
|
| Hospital Charge Code |
901700030
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.53
|
| Rate for Payer: Heritage Provider Network Senior |
$2.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.94
|
| Rate for Payer: Multiplan Commercial |
$2.81
|
|
|
METHAZOLAMIDE 50 MG TABLET [4962]
|
Facility
|
OP
|
$3.74
|
|
|
Service Code
|
NDC 62559-241-01
|
| Hospital Charge Code |
901700030
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$3.18 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.81
|
| Rate for Payer: Blue Shield of California Commercial |
$2.28
|
| Rate for Payer: Blue Shield of California EPN |
$1.83
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.18
|
| Rate for Payer: Dignity Health Senior |
$3.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.32
|
| Rate for Payer: Heritage Provider Network Senior |
$2.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.62
|
| Rate for Payer: Multiplan Commercial |
$2.81
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.50
|
| Rate for Payer: TriValley Medical Group Senior |
$1.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.18
|
| Rate for Payer: Vantage Medical Group Senior |
$3.18
|
|
|
METHENAMINE HIPPURATE 1 GRAM TABLET [10549]
|
Facility
|
IP
|
$0.96
|
|
|
Service Code
|
NDC 65862-782-01
|
| Hospital Charge Code |
901700029
|
|
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: Cash Price |
$0.53
|
| 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
|
|
|
METHENAMINE HIPPURATE 1 GRAM TABLET [10549]
|
Facility
|
OP
|
$0.96
|
|
|
Service Code
|
NDC 65862-782-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: Adventist Health Commercial |
$0.19
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.72
|
| Rate for Payer: Blue Shield of California Commercial |
$0.59
|
| Rate for Payer: Blue Shield of California EPN |
$0.47
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.82
|
| Rate for Payer: Dignity Health Senior |
$0.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.59
|
| Rate for Payer: Heritage Provider Network Senior |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.46
|
| 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: Molina Healthcare of CA Medi-Cal |
$0.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.67
|
| Rate for Payer: Multiplan Commercial |
$0.72
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.38
|
| Rate for Payer: TriValley Medical Group Senior |
$0.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.82
|
| Rate for Payer: Vantage Medical Group Senior |
$0.82
|
|
|
METHENAMINE HIPPURATE 1 GRAM TABLET [10549]
|
Facility
|
IP
|
$2.96
|
|
|
Service Code
|
NDC 60687-694-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: Adventist Health Commercial |
$0.59
|
| Rate for Payer: Cash Price |
$1.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$2.22
|
|
|
METHENAMINE HIPPURATE 1 GRAM TABLET [10549]
|
Facility
|
IP
|
$2.96
|
|
|
Service Code
|
NDC 60687-694-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: Adventist Health Commercial |
$0.59
|
| Rate for Payer: Cash Price |
$1.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$2.22
|
|
|
METHENAMINE HIPPURATE 1 GRAM TABLET [10549]
|
Facility
|
OP
|
$2.96
|
|
|
Service Code
|
NDC 60687-694-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.52 |
| Rate for Payer: Adventist Health Commercial |
$0.59
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1.81
|
| Rate for Payer: Blue Shield of California EPN |
$1.44
|
| Rate for Payer: Cash Price |
$1.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.52
|
| Rate for Payer: Dignity Health Senior |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.83
|
| Rate for Payer: Heritage Provider Network Senior |
$1.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.07
|
| Rate for Payer: Multiplan Commercial |
$2.22
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.18
|
| Rate for Payer: TriValley Medical Group Senior |
$1.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.52
|
| Rate for Payer: Vantage Medical Group Senior |
$2.52
|
|
|
METHENAMINE HIPPURATE 1 GRAM TABLET [10549]
|
Facility
|
OP
|
$2.96
|
|
|
Service Code
|
NDC 60687-694-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.52 |
| Rate for Payer: Adventist Health Commercial |
$0.59
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1.81
|
| Rate for Payer: Blue Shield of California EPN |
$1.44
|
| Rate for Payer: Cash Price |
$1.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.52
|
| Rate for Payer: Dignity Health Senior |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.83
|
| Rate for Payer: Heritage Provider Network Senior |
$1.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.07
|
| Rate for Payer: Multiplan Commercial |
$2.22
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.18
|
| Rate for Payer: TriValley Medical Group Senior |
$1.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.52
|
| Rate for Payer: Vantage Medical Group Senior |
$2.52
|
|
