|
METHOCARBAMOL 750 MG TABLET [4972]
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
NDC 70010-770-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| 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 Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
|
|
METHOCARBAMOL 750 MG TABLET [4972]
|
Facility
|
OP
|
$0.40
|
|
|
Service Code
|
NDC 50268-521-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.30
|
| Rate for Payer: Blue Shield of California Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.34
|
| Rate for Payer: Dignity Health Senior |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.25
|
| Rate for Payer: Heritage Provider Network Senior |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$0.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Vantage Medical Group Senior |
$0.34
|
|
|
METHOCARBAMOL 750 MG TABLET [4972]
|
Facility
|
IP
|
$0.40
|
|
|
Service Code
|
NDC 50268-521-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.27
|
| Rate for Payer: Heritage Provider Network Senior |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.30
|
|
|
METHOCARBAMOL 750 MG TABLET [4972]
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
NDC 31722-534-05
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| 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 Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
|
|
METHOCARBAMOL 750 MG TABLET [4972]
|
Facility
|
OP
|
$0.07
|
|
|
Service Code
|
NDC 31722-534-05
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| 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 |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.06
|
| Rate for Payer: Dignity Health Senior |
$0.06
|
| 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 Commercial |
$0.03
|
| 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 |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| 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 |
$0.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Vantage Medical Group Senior |
$0.06
|
|
|
METHOCARBAMOL 750 MG TABLET [4972]
|
Facility
|
IP
|
$0.37
|
|
|
Service Code
|
NDC 60687-568-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.25
|
| Rate for Payer: Heritage Provider Network Senior |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.28
|
|
|
METHOCARBAMOL 750 MG TABLET [4972]
|
Facility
|
OP
|
$0.37
|
|
|
Service Code
|
NDC 60687-568-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.28
|
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
| Rate for Payer: Dignity Health Senior |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.23
|
| Rate for Payer: Heritage Provider Network Senior |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.15
|
| Rate for Payer: TriValley Medical Group Senior |
$0.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
|
METHOHEXITAL 100 MG/10 ML (10 MG/ML) IN STERILE WATER (PF) IV SYRINGE [153565]
|
Facility
|
IP
|
$7.48
|
|
|
Service Code
|
NDC 70092-1310-46
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$5.61 |
| Rate for Payer: Adventist Health Commercial |
$1.50
|
| Rate for Payer: Cash Price |
$4.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.06
|
| Rate for Payer: Heritage Provider Network Senior |
$5.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: Multiplan Commercial |
$5.61
|
|
|
METHOHEXITAL 100 MG/10 ML (10 MG/ML) IN STERILE WATER (PF) IV SYRINGE [153565]
|
Facility
|
OP
|
$7.48
|
|
|
Service Code
|
NDC 70092-1310-46
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$6.36 |
| Rate for Payer: Adventist Health Commercial |
$1.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.61
|
| Rate for Payer: Blue Shield of California Commercial |
$4.56
|
| Rate for Payer: Blue Shield of California EPN |
$3.65
|
| Rate for Payer: Cash Price |
$4.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.36
|
| Rate for Payer: Dignity Health Senior |
$6.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.63
|
| Rate for Payer: Heritage Provider Network Senior |
$4.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.24
|
| Rate for Payer: Multiplan Commercial |
$5.61
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.99
|
| Rate for Payer: TriValley Medical Group Senior |
$2.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Vantage Medical Group Senior |
$6.36
|
|
|
METHOHEXITAL 500 MG SOLUTION FOR INJECTION [70545]
|
Facility
|
IP
|
$133.84
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.23 |
| Max. Negotiated Rate |
$100.38 |
| Rate for Payer: Adventist Health Commercial |
$26.77
|
| Rate for Payer: Cash Price |
$73.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$61.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.97
|
| Rate for Payer: Heritage Provider Network Senior |
$61.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.46
|
| Rate for Payer: Multiplan Commercial |
$100.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$48.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$44.31
|
|
|
METHOHEXITAL 500 MG SOLUTION FOR INJECTION [70545]
|
Facility
|
OP
|
$133.84
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.23 |
| Max. Negotiated Rate |
$113.76 |
| Rate for Payer: Adventist Health Commercial |
$26.77
|
| Rate for Payer: Aetna of CA Gatekeeper |
$71.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$91.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$100.38
|
| Rate for Payer: Blue Shield of California Commercial |
$81.64
|
| Rate for Payer: Blue Shield of California EPN |
$65.31
|
| Rate for Payer: Cash Price |
$73.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$61.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$113.76
|
| Rate for Payer: Dignity Health Senior |
$113.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.97
|
| Rate for Payer: Heritage Provider Network Senior |
$61.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$63.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$93.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$93.69
|
| Rate for Payer: Multiplan Commercial |
$100.38
|
| Rate for Payer: TriValley Medical Group Commercial |
$53.54
|
| Rate for Payer: TriValley Medical Group Senior |
$53.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$48.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$44.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$113.76
|
| Rate for Payer: Vantage Medical Group Senior |
$113.76
|
|
|
METHOTREXATE ORAL SUSP IV FORM COMPOUND 2 MG/ML [4080299]
|
Facility
|
IP
|
$0.81
|
|
|
Service Code
|
NDC 9994-0802-99
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.55
|
| Rate for Payer: Heritage Provider Network Senior |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.61
|
|
|
METHOTREXATE ORAL SUSP IV FORM COMPOUND 2 MG/ML [4080299]
|
Facility
|
OP
|
$0.81
|
|
|
Service Code
|
NDC 9994-0802-99
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.69 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.61
|
| Rate for Payer: Blue Shield of California Commercial |
$0.49
|
| Rate for Payer: Blue Shield of California EPN |
$0.40
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.69
|
| Rate for Payer: Dignity Health Senior |
$0.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.50
|
| Rate for Payer: Heritage Provider Network Senior |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$0.61
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.32
|
| Rate for Payer: TriValley Medical Group Senior |
$0.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.69
|
| Rate for Payer: Vantage Medical Group Senior |
$0.69
|
|
|
METHOTREXATE SODIUM 1.25 MG 1/2 TABLET [4081484]
|
Facility
|
OP
|
$2.83
|
|
|
Service Code
|
HCPCS J8610
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Adventist Health Commercial |
$0.57
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.42
|
| Rate for Payer: Blue Shield of California Commercial |
$0.56
|
| Rate for Payer: Blue Shield of California EPN |
$0.56
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.41
|
| Rate for Payer: Dignity Health Senior |
$2.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.98
|
| Rate for Payer: Multiplan Commercial |
$2.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.13
|
| Rate for Payer: TriValley Medical Group Senior |
$1.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.41
|
| Rate for Payer: Vantage Medical Group Senior |
$2.41
|
|
|
METHOTREXATE SODIUM 1.25 MG 1/2 TABLET [4081484]
|
Facility
|
IP
|
$2.83
|
|
|
Service Code
|
HCPCS J8610
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Adventist Health Commercial |
$0.57
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.71
|
| Rate for Payer: Multiplan Commercial |
$2.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.94
|
|
|
METHOTREXATE SODIUM 25 MG/ML INJECTION SOLUTION [4974]
|
Facility
|
OP
|
$4.03
|
|
|
Service Code
|
HCPCS J9260
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$8.70 |
| Rate for Payer: Adventist Health Commercial |
$0.81
|
| Rate for Payer: Adventist Health Commercial |
$0.87
|
| Rate for Payer: Adventist Health Commercial |
$0.63
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.69
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.33
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.70
|
| Rate for Payer: Blue Shield of California Commercial |
$3.43
|
| Rate for Payer: Blue Shield of California Commercial |
$3.43
|
| Rate for Payer: Blue Shield of California Commercial |
$3.43
|
| Rate for Payer: Blue Shield of California EPN |
$3.43
|
| Rate for Payer: Blue Shield of California EPN |
$3.43
|
| Rate for Payer: Blue Shield of California EPN |
$3.43
|
| Rate for Payer: Cash Price |
$1.75
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cash Price |
$1.75
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.71
|
| Rate for Payer: Dignity Health Senior |
$3.71
|
| Rate for Payer: Dignity Health Senior |
$2.69
|
| Rate for Payer: Dignity Health Senior |
$3.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.87
|
| Rate for Payer: Heritage Provider Network Senior |
$2.02
|
| Rate for Payer: Heritage Provider Network Senior |
$1.47
|
| Rate for Payer: Heritage Provider Network Senior |
$1.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.22
|
| Rate for Payer: Multiplan Commercial |
$2.38
|
| Rate for Payer: Multiplan Commercial |
$3.02
|
| Rate for Payer: Multiplan Commercial |
$3.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.74
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.61
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.27
|
| Rate for Payer: TriValley Medical Group Senior |
$1.27
|
| Rate for Payer: TriValley Medical Group Senior |
$1.74
|
| Rate for Payer: TriValley Medical Group Senior |
$1.61
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.71
|
| Rate for Payer: Vantage Medical Group Senior |
$2.69
|
| Rate for Payer: Vantage Medical Group Senior |
$3.71
|
| Rate for Payer: Vantage Medical Group Senior |
$3.43
|
|
|
METHOTREXATE SODIUM 25 MG/ML INJECTION SOLUTION [4974]
|
Facility
|
IP
|
$4.03
|
|
|
Service Code
|
HCPCS J9260
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Adventist Health Commercial |
$0.81
|
| Rate for Payer: Adventist Health Commercial |
$0.63
|
| Rate for Payer: Adventist Health Commercial |
$0.87
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$1.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1.47
|
| Rate for Payer: Heritage Provider Network Senior |
$2.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.09
|
| Rate for Payer: Multiplan Commercial |
$3.27
|
| Rate for Payer: Multiplan Commercial |
$2.38
|
| Rate for Payer: Multiplan Commercial |
$3.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.33
|
|
|
METHOTREXATE SODIUM 25 MG/ML INJECTION SOLUTION WRAP. (FOR CNR ONLY) [4081565]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
HCPCS J9260
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.46
|
| Rate for Payer: Heritage Provider Network Senior |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.33
|
|
|
METHOTREXATE SODIUM 25 MG/ML INJECTION SOLUTION WRAP. (FOR CNR ONLY) [4081565]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
HCPCS J9260
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$8.70 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.70
|
| Rate for Payer: Blue Shield of California Commercial |
$3.43
|
| Rate for Payer: Blue Shield of California EPN |
$3.43
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: Dignity Health Senior |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.46
|
| Rate for Payer: Heritage Provider Network Senior |
$0.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.40
|
| Rate for Payer: TriValley Medical Group Senior |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
METHOTREXATE SODIUM 2.5 MG TABLET [4973]
|
Facility
|
OP
|
$0.66
|
|
|
Service Code
|
HCPCS J8610
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$1.42 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.13
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.77
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.42
|
| Rate for Payer: Blue Shield of California Commercial |
$0.56
|
| Rate for Payer: Blue Shield of California Commercial |
$0.56
|
| Rate for Payer: Blue Shield of California Commercial |
$0.56
|
| Rate for Payer: Blue Shield of California EPN |
$0.56
|
| Rate for Payer: Blue Shield of California EPN |
$0.56
|
| Rate for Payer: Blue Shield of California EPN |
$0.56
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cash Price |
$1.83
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cash Price |
$1.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.82
|
| Rate for Payer: Dignity Health Senior |
$2.82
|
| Rate for Payer: Dignity Health Senior |
$0.20
|
| Rate for Payer: Dignity Health Senior |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1.54
|
| Rate for Payer: Heritage Provider Network Senior |
$0.11
|
| Rate for Payer: Heritage Provider Network Senior |
$0.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$2.49
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.33
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Senior |
$0.10
|
| Rate for Payer: TriValley Medical Group Senior |
$1.33
|
| Rate for Payer: TriValley Medical Group Senior |
$0.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.82
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2.82
|
| Rate for Payer: Vantage Medical Group Senior |
$0.56
|
|
|
METHOTREXATE SODIUM 2.5 MG TABLET [4973]
|
Facility
|
IP
|
$0.66
|
|
|
Service Code
|
HCPCS J8610
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cash Price |
$1.83
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.31
|
| Rate for Payer: Heritage Provider Network Senior |
$0.31
|
| Rate for Payer: Heritage Provider Network Senior |
$0.11
|
| Rate for Payer: Heritage Provider Network Senior |
$1.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: Multiplan Commercial |
$2.49
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.22
|
|
|
METHOTREXATE SODIUM (PF) 1 GRAM SOLUTION FOR INJECTION [4975]
|
Facility
|
IP
|
$76.32
|
|
|
Service Code
|
HCPCS J9260
|
| Hospital Charge Code |
901700025
|
|
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: Cash Price |
$41.98
|
| 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 |
$35.34
|
| Rate for Payer: Heritage Provider Network Senior |
$35.34
|
| 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 |
$27.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.27
|
|
|
METHOTREXATE SODIUM (PF) 1 GRAM SOLUTION FOR INJECTION [4975]
|
Facility
|
OP
|
$76.32
|
|
|
Service Code
|
HCPCS J9260
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.58 |
| 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: Anthem Blue Cross of CA HMO/PPO |
$8.70
|
| Rate for Payer: Blue Shield of California Commercial |
$3.43
|
| Rate for Payer: Blue Shield of California EPN |
$3.43
|
| Rate for Payer: Cash Price |
$41.98
|
| Rate for Payer: Cash Price |
$41.98
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$36.40
|
| 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: Molina Healthcare of CA Medi-Cal |
$53.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.42
|
| 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 |
$27.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.87
|
| Rate for Payer: Vantage Medical Group Senior |
$64.87
|
|
|
METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION [96981]
|
Facility
|
OP
|
$6.21
|
|
|
Service Code
|
HCPCS J9260
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$8.70 |
| Rate for Payer: Adventist Health Commercial |
$1.24
|
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.59
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.70
|
| Rate for Payer: Blue Shield of California Commercial |
$3.43
|
| Rate for Payer: Blue Shield of California Commercial |
$3.43
|
| Rate for Payer: Blue Shield of California EPN |
$3.43
|
| Rate for Payer: Blue Shield of California EPN |
$3.43
|
| Rate for Payer: Cash Price |
$3.42
|
| Rate for Payer: Cash Price |
$0.61
|
| Rate for Payer: Cash Price |
$0.61
|
| Rate for Payer: Cash Price |
$3.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.51
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.28
|
| Rate for Payer: Dignity Health Senior |
$0.94
|
| Rate for Payer: Dignity Health Senior |
$5.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.51
|
| Rate for Payer: Heritage Provider Network Senior |
$0.51
|
| Rate for Payer: Heritage Provider Network Senior |
$2.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.35
|
| Rate for Payer: Multiplan Commercial |
$4.66
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.48
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.44
|
| Rate for Payer: TriValley Medical Group Senior |
$0.44
|
| Rate for Payer: TriValley Medical Group Senior |
$2.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.28
|
| Rate for Payer: Vantage Medical Group Senior |
$0.94
|
| Rate for Payer: Vantage Medical Group Senior |
$5.28
|
|
|
METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION [96981]
|
Facility
|
OP
|
$2.54
|
|
|
Service Code
|
HCPCS J9255
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$2.16 |
| Rate for Payer: Adventist Health Commercial |
$0.51
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.91
|
| Rate for Payer: Blue Shield of California Commercial |
$1.55
|
| Rate for Payer: Blue Shield of California EPN |
$1.24
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.16
|
| Rate for Payer: Dignity Health Senior |
$2.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.18
|
| Rate for Payer: Heritage Provider Network Senior |
$1.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.78
|
| Rate for Payer: Multiplan Commercial |
$1.91
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.02
|
| Rate for Payer: TriValley Medical Group Senior |
$1.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.16
|
| Rate for Payer: Vantage Medical Group Senior |
$2.16
|
|
