|
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
|
|
|
METHOXSALEN 20 MCG/ML INJECTION SOLUTION [24933]
|
Facility
|
IP
|
$75.72
|
|
|
Service Code
|
NDC 64067-216-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.71 |
| Max. Negotiated Rate |
$56.79 |
| Rate for Payer: Adventist Health Commercial |
$15.14
|
| Rate for Payer: Cash Price |
$41.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$51.26
|
| Rate for Payer: Heritage Provider Network Senior |
$51.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.93
|
| Rate for Payer: Multiplan Commercial |
$56.79
|
|
|
METHOXSALEN 20 MCG/ML INJECTION SOLUTION [24933]
|
Facility
|
OP
|
$75.72
|
|
|
Service Code
|
NDC 64067-216-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.71 |
| Max. Negotiated Rate |
$64.36 |
| Rate for Payer: Adventist Health Commercial |
$15.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$40.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$56.79
|
| Rate for Payer: Blue Shield of California Commercial |
$46.19
|
| Rate for Payer: Blue Shield of California EPN |
$36.95
|
| Rate for Payer: Cash Price |
$41.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$49.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.36
|
| Rate for Payer: Dignity Health Senior |
$64.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$46.87
|
| Rate for Payer: Heritage Provider Network Senior |
$46.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$36.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.00
|
| Rate for Payer: Multiplan Commercial |
$56.79
|
| Rate for Payer: TriValley Medical Group Commercial |
$30.29
|
| Rate for Payer: TriValley Medical Group Senior |
$30.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.36
|
| Rate for Payer: Vantage Medical Group Senior |
$64.36
|
|
|
METHYLCELLULOSE (BULK) 1 % GEL [82599]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 5155207027
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Senior |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
|
|
METHYLCELLULOSE (BULK) 1 % GEL [82599]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 38779-30608
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Senior |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
|
|
METHYLCELLULOSE (BULK) 1 % GEL [82599]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 38779-30608
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Senior |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Senior |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
METHYLCELLULOSE (BULK) 1 % GEL [82599]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 5155207027
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Senior |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Senior |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
METHYLDOPA 250 MG TABLET [4982]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 51079-200-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Senior |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
|
|
METHYLDOPA 250 MG TABLET [4982]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 51079-200-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
| Rate for Payer: Dignity Health Senior |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Senior |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Senior |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
|
|
METHYLDOPA ORAL SUSPENSION COMPOUND 50 MG/ML [4080300]
|
Facility
|
OP
|
$1.54
|
|
|
Service Code
|
NDC 9994-0803-00
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.31 |
| Rate for Payer: Adventist Health Commercial |
$0.31
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.94
|
| Rate for Payer: Blue Shield of California EPN |
$0.75
|
| Rate for Payer: Cash Price |
$0.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.31
|
| Rate for Payer: Dignity Health Senior |
$1.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.95
|
| Rate for Payer: Heritage Provider Network Senior |
$0.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.08
|
| Rate for Payer: Multiplan Commercial |
$1.16
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.62
|
| Rate for Payer: TriValley Medical Group Senior |
$0.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.31
|
| Rate for Payer: Vantage Medical Group Senior |
$1.31
|
|
|
METHYLDOPA ORAL SUSPENSION COMPOUND 50 MG/ML [4080300]
|
Facility
|
IP
|
$1.54
|
|
|
Service Code
|
NDC 9994-0803-00
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Adventist Health Commercial |
$0.31
|
| Rate for Payer: Cash Price |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$1.16
|
|
|
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) INTRAVENOUS SOLUTION [4985]
|
Facility
|
IP
|
$25.20
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.56 |
| Max. Negotiated Rate |
$18.90 |
| Rate for Payer: Adventist Health Commercial |
$5.04
|
| Rate for Payer: Cash Price |
$13.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.67
|
| Rate for Payer: Heritage Provider Network Senior |
$11.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$18.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.34
|
|
|
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) INTRAVENOUS SOLUTION [4985]
|
Facility
|
OP
|
$25.20
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.56 |
| Max. Negotiated Rate |
$30.20 |
| Rate for Payer: Adventist Health Commercial |
$5.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.64
|
| Rate for Payer: Blue Shield of California Commercial |
$15.37
|
| Rate for Payer: Blue Shield of California EPN |
$12.30
|
| Rate for Payer: Cash Price |
$13.86
|
| Rate for Payer: Cash Price |
$13.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.64
|
| Rate for Payer: Dignity Health Senior |
$8.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.13
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.67
|
| Rate for Payer: Heritage Provider Network Senior |
$11.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.90
|
| Rate for Payer: Multiplan Commercial |
$18.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.08
|
| Rate for Payer: TriValley Medical Group Senior |
$10.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.64
|
| Rate for Payer: Vantage Medical Group Senior |
$8.64
|
|
|
METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION [215473]
|
Facility
|
OP
|
$16.20
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$30.20 |
| Rate for Payer: Adventist Health Commercial |
$3.24
|
| Rate for Payer: Adventist Health Commercial |
$5.63
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.66
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.64
|
| Rate for Payer: Blue Shield of California Commercial |
$9.88
|
| Rate for Payer: Blue Shield of California Commercial |
$17.16
|
| Rate for Payer: Blue Shield of California EPN |
$7.91
|
| Rate for Payer: Blue Shield of California EPN |
$13.73
|
| Rate for Payer: Cash Price |
$8.91
|
| Rate for Payer: Cash Price |
$15.47
|
| Rate for Payer: Cash Price |
$15.47
|
| Rate for Payer: Cash Price |
$8.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.64
|
| Rate for Payer: Dignity Health Senior |
$8.64
|
| Rate for Payer: Dignity Health Senior |
$8.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.86
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.50
|
| Rate for Payer: Heritage Provider Network Senior |
$13.02
|
| Rate for Payer: Heritage Provider Network Senior |
$7.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.90
|
| Rate for Payer: Multiplan Commercial |
$12.15
|
| Rate for Payer: Multiplan Commercial |
$21.10
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.48
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Senior |
$11.25
|
| Rate for Payer: TriValley Medical Group Senior |
$6.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.64
|
| Rate for Payer: Vantage Medical Group Senior |
$8.64
|
| Rate for Payer: Vantage Medical Group Senior |
$8.64
|
|
|
METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION [215473]
|
Facility
|
IP
|
$16.20
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$12.15 |
| Rate for Payer: Adventist Health Commercial |
$3.24
|
| Rate for Payer: Adventist Health Commercial |
$5.63
|
| Rate for Payer: Cash Price |
$8.91
|
| Rate for Payer: Cash Price |
$15.47
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.02
|
| Rate for Payer: Heritage Provider Network Senior |
$13.02
|
| Rate for Payer: Heritage Provider Network Senior |
$7.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.03
|
| Rate for Payer: Multiplan Commercial |
$12.15
|
| Rate for Payer: Multiplan Commercial |
$21.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.31
|
|
|
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION [10571]
|
Facility
|
IP
|
$23.71
|
|
|
Service Code
|
HCPCS J2210
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$17.78 |
| Rate for Payer: Adventist Health Commercial |
$4.74
|
| Rate for Payer: Adventist Health Commercial |
$7.51
|
| Rate for Payer: Cash Price |
$20.64
|
| Rate for Payer: Cash Price |
$13.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.98
|
| Rate for Payer: Heritage Provider Network Senior |
$10.98
|
| Rate for Payer: Heritage Provider Network Senior |
$17.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.93
|
| Rate for Payer: Multiplan Commercial |
$28.16
|
| Rate for Payer: Multiplan Commercial |
$17.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.85
|
|
|
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION [10571]
|
Facility
|
OP
|
$37.54
|
|
|
Service Code
|
HCPCS J2210
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$51.17 |
| Rate for Payer: Adventist Health Commercial |
$7.51
|
| Rate for Payer: Adventist Health Commercial |
$4.74
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.67
|
| Rate for Payer: Aetna of CA Gatekeeper |
$20.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.17
|
| Rate for Payer: Blue Shield of California Commercial |
$20.15
|
| Rate for Payer: Blue Shield of California Commercial |
$20.15
|
| Rate for Payer: Blue Shield of California EPN |
$20.15
|
| Rate for Payer: Blue Shield of California EPN |
$20.15
|
| Rate for Payer: Cash Price |
$20.64
|
| Rate for Payer: Cash Price |
$13.04
|
| Rate for Payer: Cash Price |
$13.04
|
| Rate for Payer: Cash Price |
$20.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.91
|
| Rate for Payer: Dignity Health Senior |
$20.15
|
| Rate for Payer: Dignity Health Senior |
$31.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.98
|
| Rate for Payer: Heritage Provider Network Senior |
$10.98
|
| Rate for Payer: Heritage Provider Network Senior |
$17.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.28
|
| Rate for Payer: Multiplan Commercial |
$28.16
|
| Rate for Payer: Multiplan Commercial |
$17.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.02
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.48
|
| Rate for Payer: TriValley Medical Group Senior |
$9.48
|
| Rate for Payer: TriValley Medical Group Senior |
$15.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.91
|
| Rate for Payer: Vantage Medical Group Senior |
$20.15
|
| Rate for Payer: Vantage Medical Group Senior |
$31.91
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
|
OP
|
$19.80
|
|
|
Service Code
|
NDC 69238-1605-8
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$16.83 |
| Rate for Payer: Adventist Health Commercial |
$3.96
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.85
|
| Rate for Payer: Blue Shield of California Commercial |
$12.08
|
| Rate for Payer: Blue Shield of California EPN |
$9.66
|
| Rate for Payer: Cash Price |
$10.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.83
|
| Rate for Payer: Dignity Health Senior |
$16.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.26
|
| Rate for Payer: Heritage Provider Network Senior |
$12.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.86
|
| Rate for Payer: Multiplan Commercial |
$14.85
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.92
|
| Rate for Payer: TriValley Medical Group Senior |
$7.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.83
|
| Rate for Payer: Vantage Medical Group Senior |
$16.83
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
|
IP
|
$19.80
|
|
|
Service Code
|
NDC 69238-1605-8
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$14.85 |
| Rate for Payer: Adventist Health Commercial |
$3.96
|
| Rate for Payer: Cash Price |
$10.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.40
|
| Rate for Payer: Heritage Provider Network Senior |
$13.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.95
|
| Rate for Payer: Multiplan Commercial |
$14.85
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
|
IP
|
$23.83
|
|
|
Service Code
|
NDC 0093-3655-28
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.31 |
| Max. Negotiated Rate |
$17.87 |
| Rate for Payer: Adventist Health Commercial |
$4.77
|
| Rate for Payer: Cash Price |
$13.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.13
|
| Rate for Payer: Heritage Provider Network Senior |
$16.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.96
|
| Rate for Payer: Multiplan Commercial |
$17.87
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
|
OP
|
$19.80
|
|
|
Service Code
|
NDC 69238-1605-2
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$16.83 |
| Rate for Payer: Adventist Health Commercial |
$3.96
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.85
|
| Rate for Payer: Blue Shield of California Commercial |
$12.08
|
| Rate for Payer: Blue Shield of California EPN |
$9.66
|
| Rate for Payer: Cash Price |
$10.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.83
|
| Rate for Payer: Dignity Health Senior |
$16.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.26
|
| Rate for Payer: Heritage Provider Network Senior |
$12.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.86
|
| Rate for Payer: Multiplan Commercial |
$14.85
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.92
|
| Rate for Payer: TriValley Medical Group Senior |
$7.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.83
|
| Rate for Payer: Vantage Medical Group Senior |
$16.83
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
|
IP
|
$16.83
|
|
|
Service Code
|
NDC 70010-786-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.05 |
| Max. Negotiated Rate |
$12.62 |
| Rate for Payer: Adventist Health Commercial |
$3.37
|
| Rate for Payer: Cash Price |
$9.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.39
|
| Rate for Payer: Heritage Provider Network Senior |
$11.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.21
|
| Rate for Payer: Multiplan Commercial |
$12.62
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
|
IP
|
$19.80
|
|
|
Service Code
|
NDC 69238-1605-2
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$14.85 |
| Rate for Payer: Adventist Health Commercial |
$3.96
|
| Rate for Payer: Cash Price |
$10.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.40
|
| Rate for Payer: Heritage Provider Network Senior |
$13.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.95
|
| Rate for Payer: Multiplan Commercial |
$14.85
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
|
OP
|
$16.83
|
|
|
Service Code
|
NDC 70010-786-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.05 |
| Max. Negotiated Rate |
$14.31 |
| Rate for Payer: Adventist Health Commercial |
$3.37
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.62
|
| Rate for Payer: Blue Shield of California Commercial |
$10.27
|
| Rate for Payer: Blue Shield of California EPN |
$8.21
|
| Rate for Payer: Cash Price |
$9.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.31
|
| Rate for Payer: Dignity Health Senior |
$14.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.42
|
| Rate for Payer: Heritage Provider Network Senior |
$10.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.78
|
| Rate for Payer: Multiplan Commercial |
$12.62
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.73
|
| Rate for Payer: TriValley Medical Group Senior |
$6.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Vantage Medical Group Senior |
$14.31
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
|
OP
|
$23.83
|
|
|
Service Code
|
NDC 0093-3655-28
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.31 |
| Max. Negotiated Rate |
$20.26 |
| Rate for Payer: Adventist Health Commercial |
$4.77
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.87
|
| Rate for Payer: Blue Shield of California Commercial |
$14.54
|
| Rate for Payer: Blue Shield of California EPN |
$11.63
|
| Rate for Payer: Cash Price |
$13.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.26
|
| Rate for Payer: Dignity Health Senior |
$20.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.75
|
| Rate for Payer: Heritage Provider Network Senior |
$14.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.68
|
| Rate for Payer: Multiplan Commercial |
$17.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.53
|
| Rate for Payer: TriValley Medical Group Senior |
$9.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.26
|
| Rate for Payer: Vantage Medical Group Senior |
$20.26
|
|
