|
METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SYRINGE [154475]
|
Facility
|
IP
|
$339.86
|
|
|
Service Code
|
HCPCS J2212
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.51 |
| Max. Negotiated Rate |
$254.90 |
| Rate for Payer: Adventist Health Commercial |
$67.97
|
| Rate for Payer: Cash Price |
$186.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$156.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$183.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.36
|
| Rate for Payer: Heritage Provider Network Senior |
$157.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.97
|
| Rate for Payer: Multiplan Commercial |
$254.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$122.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$112.53
|
|
|
METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SYRINGE [154475]
|
Facility
|
OP
|
$339.86
|
|
|
Service Code
|
HCPCS J2212
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$288.88 |
| Rate for Payer: Adventist Health Commercial |
$67.97
|
| Rate for Payer: Aetna of CA Gatekeeper |
$181.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$233.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$288.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$186.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$254.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.67
|
| Rate for Payer: Blue Shield of California Commercial |
$1.36
|
| Rate for Payer: Blue Shield of California EPN |
$1.36
|
| Rate for Payer: Cash Price |
$186.92
|
| Rate for Payer: Cash Price |
$186.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$156.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$288.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$288.88
|
| Rate for Payer: Dignity Health Senior |
$288.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$217.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.36
|
| Rate for Payer: Heritage Provider Network Senior |
$157.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$162.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$237.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$237.90
|
| Rate for Payer: Multiplan Commercial |
$254.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$135.94
|
| Rate for Payer: TriValley Medical Group Senior |
$135.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$122.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$112.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$288.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$288.88
|
| Rate for Payer: Vantage Medical Group Senior |
$288.88
|
|
|
METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS WRAP [40891651]
|
Facility
|
IP
|
$339.86
|
|
|
Service Code
|
HCPCS J2212
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.51 |
| Max. Negotiated Rate |
$254.90 |
| Rate for Payer: Adventist Health Commercial |
$67.97
|
| Rate for Payer: Cash Price |
$186.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$156.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$183.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.36
|
| Rate for Payer: Heritage Provider Network Senior |
$157.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.97
|
| Rate for Payer: Multiplan Commercial |
$254.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$122.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$112.53
|
|
|
METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS WRAP [40891651]
|
Facility
|
OP
|
$339.86
|
|
|
Service Code
|
HCPCS J2212
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$288.88 |
| Rate for Payer: Adventist Health Commercial |
$67.97
|
| Rate for Payer: Aetna of CA Gatekeeper |
$181.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$233.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$288.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$186.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$254.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.67
|
| Rate for Payer: Blue Shield of California Commercial |
$1.36
|
| Rate for Payer: Blue Shield of California EPN |
$1.36
|
| Rate for Payer: Cash Price |
$186.92
|
| Rate for Payer: Cash Price |
$186.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$156.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$288.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$288.88
|
| Rate for Payer: Dignity Health Senior |
$288.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$217.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.36
|
| Rate for Payer: Heritage Provider Network Senior |
$157.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$162.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$237.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$237.90
|
| Rate for Payer: Multiplan Commercial |
$254.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$135.94
|
| Rate for Payer: TriValley Medical Group Senior |
$135.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$122.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$112.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$288.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$288.88
|
| Rate for Payer: Vantage Medical Group Senior |
$288.88
|
|
|
METHYLPHENIDATE 5 MG TABLET [4988]
|
Facility
|
IP
|
$0.12
|
|
|
Service Code
|
NDC 0115-1800-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Senior |
$0.08
|
| 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 |
$0.09
|
|
|
METHYLPHENIDATE 5 MG TABLET [4988]
|
Facility
|
IP
|
$2.46
|
|
|
Service Code
|
NDC 68084-805-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Adventist Health Commercial |
$0.49
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.67
|
| Rate for Payer: Heritage Provider Network Senior |
$1.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Multiplan Commercial |
$1.84
|
|
|
METHYLPHENIDATE 5 MG TABLET [4988]
|
Facility
|
OP
|
$2.46
|
|
|
Service Code
|
NDC 68084-805-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.09 |
| Rate for Payer: Adventist Health Commercial |
$0.49
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1.50
|
| Rate for Payer: Blue Shield of California EPN |
$1.20
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.09
|
| Rate for Payer: Dignity Health Senior |
$2.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.52
|
| Rate for Payer: Heritage Provider Network Senior |
$1.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.72
|
| Rate for Payer: Multiplan Commercial |
$1.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.98
|
| Rate for Payer: TriValley Medical Group Senior |
$0.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2.09
|
|
|
METHYLPHENIDATE 5 MG TABLET [4988]
|
Facility
|
OP
|
$0.12
|
|
|
Service Code
|
NDC 0115-1800-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.10
|
| Rate for Payer: Dignity Health Senior |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$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: Molina Healthcare of CA Medi-Cal |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Vantage Medical Group Senior |
$0.10
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR [28750]
|
Facility
|
OP
|
$9.34
|
|
|
Service Code
|
NDC 9999-7068-51
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$7.94 |
| Rate for Payer: Adventist Health Commercial |
$1.87
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5.70
|
| Rate for Payer: Blue Shield of California EPN |
$4.56
|
| Rate for Payer: Cash Price |
$5.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.94
|
| Rate for Payer: Dignity Health Senior |
$7.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.78
|
| Rate for Payer: Heritage Provider Network Senior |
$5.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.54
|
| Rate for Payer: Multiplan Commercial |
$7.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.74
|
| Rate for Payer: TriValley Medical Group Senior |
$3.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.94
|
| Rate for Payer: Vantage Medical Group Senior |
$7.94
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR [28750]
|
Facility
|
IP
|
$9.34
|
|
|
Service Code
|
NDC 9999-7068-51
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: Adventist Health Commercial |
$1.87
|
| Rate for Payer: Cash Price |
$5.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.32
|
| Rate for Payer: Heritage Provider Network Senior |
$6.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.33
|
| Rate for Payer: Multiplan Commercial |
$7.00
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR [28750]
|
Facility
|
IP
|
$6.22
|
|
|
Service Code
|
NDC 62175-310-37
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$4.67 |
| Rate for Payer: Adventist Health Commercial |
$1.24
|
| Rate for Payer: Cash Price |
$3.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.21
|
| Rate for Payer: Heritage Provider Network Senior |
$4.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.55
|
| Rate for Payer: Multiplan Commercial |
$4.67
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR [28750]
|
Facility
|
OP
|
$15.48
|
|
|
Service Code
|
NDC 50458-585-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$13.16 |
| Rate for Payer: Adventist Health Commercial |
$3.10
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.61
|
| Rate for Payer: Blue Shield of California Commercial |
$9.44
|
| Rate for Payer: Blue Shield of California EPN |
$7.55
|
| Rate for Payer: Cash Price |
$8.51
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.16
|
| Rate for Payer: Dignity Health Senior |
$13.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.58
|
| Rate for Payer: Heritage Provider Network Senior |
$9.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.84
|
| Rate for Payer: Multiplan Commercial |
$11.61
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.19
|
| Rate for Payer: TriValley Medical Group Senior |
$6.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.16
|
| Rate for Payer: Vantage Medical Group Senior |
$13.16
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR [28750]
|
Facility
|
OP
|
$6.22
|
|
|
Service Code
|
NDC 62175-310-37
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$5.29 |
| Rate for Payer: Adventist Health Commercial |
$1.24
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.67
|
| Rate for Payer: Blue Shield of California Commercial |
$3.79
|
| Rate for Payer: Blue Shield of California EPN |
$3.04
|
| Rate for Payer: Cash Price |
$3.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.29
|
| Rate for Payer: Dignity Health Senior |
$5.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.85
|
| Rate for Payer: Heritage Provider Network Senior |
$3.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.13
|
| 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 Medicare |
$4.35
|
| Rate for Payer: Multiplan Commercial |
$4.67
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.49
|
| Rate for Payer: TriValley Medical Group Senior |
$2.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.29
|
| Rate for Payer: Vantage Medical Group Senior |
$5.29
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR [28750]
|
Facility
|
IP
|
$15.48
|
|
|
Service Code
|
NDC 50458-585-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$11.61 |
| Rate for Payer: Adventist Health Commercial |
$3.10
|
| Rate for Payer: Cash Price |
$8.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.48
|
| Rate for Payer: Heritage Provider Network Senior |
$10.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.87
|
| Rate for Payer: Multiplan Commercial |
$11.61
|
|
|
METHYLPHENIDATE ER 20 MG TABLET,EXTENDED RELEASE [4989]
|
Facility
|
IP
|
$2.02
|
|
|
Service Code
|
NDC 10702-076-06
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.51 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.37
|
| Rate for Payer: Heritage Provider Network Senior |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.51
|
| Rate for Payer: Multiplan Commercial |
$1.51
|
|
|
METHYLPHENIDATE ER 20 MG TABLET,EXTENDED RELEASE [4989]
|
Facility
|
OP
|
$2.02
|
|
|
Service Code
|
NDC 10702-076-06
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.72 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.51
|
| Rate for Payer: Blue Shield of California Commercial |
$1.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.99
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.72
|
| Rate for Payer: Dignity Health Senior |
$1.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.25
|
| Rate for Payer: Heritage Provider Network Senior |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.41
|
| Rate for Payer: Multiplan Commercial |
$1.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.81
|
| Rate for Payer: TriValley Medical Group Senior |
$0.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.72
|
| Rate for Payer: Vantage Medical Group Senior |
$1.72
|
|
|
METHYLPHENIDATE ER 27 MG TABLET,EXTENDED RELEASE 24 HR [32654]
|
Facility
|
IP
|
$15.87
|
|
|
Service Code
|
NDC 50458-588-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.87 |
| Max. Negotiated Rate |
$11.90 |
| Rate for Payer: Adventist Health Commercial |
$3.17
|
| Rate for Payer: Cash Price |
$8.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.74
|
| Rate for Payer: Heritage Provider Network Senior |
$10.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.97
|
| Rate for Payer: Multiplan Commercial |
$11.90
|
|
|
METHYLPHENIDATE ER 27 MG TABLET,EXTENDED RELEASE 24 HR [32654]
|
Facility
|
OP
|
$15.87
|
|
|
Service Code
|
NDC 50458-588-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.87 |
| Max. Negotiated Rate |
$13.49 |
| Rate for Payer: Adventist Health Commercial |
$3.17
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.90
|
| Rate for Payer: Blue Shield of California Commercial |
$9.68
|
| Rate for Payer: Blue Shield of California EPN |
$7.74
|
| Rate for Payer: Cash Price |
$8.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.49
|
| Rate for Payer: Dignity Health Senior |
$13.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.82
|
| Rate for Payer: Heritage Provider Network Senior |
$9.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.11
|
| Rate for Payer: Multiplan Commercial |
$11.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.35
|
| Rate for Payer: TriValley Medical Group Senior |
$6.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.49
|
| Rate for Payer: Vantage Medical Group Senior |
$13.49
|
|
|
METHYLPHENIDATE ER 36 MG TABLET,EXTENDED RELEASE 24 HR [28751]
|
Facility
|
IP
|
$16.37
|
|
|
Service Code
|
NDC 50458-586-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$12.28 |
| Rate for Payer: Adventist Health Commercial |
$3.27
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.08
|
| Rate for Payer: Heritage Provider Network Senior |
$11.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.09
|
| Rate for Payer: Multiplan Commercial |
$12.28
|
|
|
METHYLPHENIDATE ER 36 MG TABLET,EXTENDED RELEASE 24 HR [28751]
|
Facility
|
OP
|
$16.37
|
|
|
Service Code
|
NDC 50458-586-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$13.91 |
| Rate for Payer: Adventist Health Commercial |
$3.27
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.28
|
| Rate for Payer: Blue Shield of California Commercial |
$9.99
|
| Rate for Payer: Blue Shield of California EPN |
$7.99
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.91
|
| Rate for Payer: Dignity Health Senior |
$13.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.13
|
| Rate for Payer: Heritage Provider Network Senior |
$10.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.46
|
| Rate for Payer: Multiplan Commercial |
$12.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.55
|
| Rate for Payer: TriValley Medical Group Senior |
$6.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.91
|
| Rate for Payer: Vantage Medical Group Senior |
$13.91
|
|
|
METHYLPHENIDATE LA 20 MG BIPHASIC 50-50 CAPSULE,EXTENDED RELEASE [33198]
|
Facility
|
OP
|
$15.14
|
|
|
Service Code
|
NDC 0078-0370-05
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$12.87 |
| Rate for Payer: Adventist Health Commercial |
$3.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.36
|
| Rate for Payer: Blue Shield of California Commercial |
$9.24
|
| Rate for Payer: Blue Shield of California EPN |
$7.39
|
| Rate for Payer: Cash Price |
$8.33
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.87
|
| Rate for Payer: Dignity Health Senior |
$12.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.37
|
| Rate for Payer: Heritage Provider Network Senior |
$9.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.60
|
| Rate for Payer: Multiplan Commercial |
$11.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.06
|
| Rate for Payer: TriValley Medical Group Senior |
$6.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.87
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
|
METHYLPHENIDATE LA 20 MG BIPHASIC 50-50 CAPSULE,EXTENDED RELEASE [33198]
|
Facility
|
IP
|
$15.14
|
|
|
Service Code
|
NDC 0078-0370-05
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$11.36 |
| Rate for Payer: Adventist Health Commercial |
$3.03
|
| Rate for Payer: Cash Price |
$8.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.25
|
| Rate for Payer: Heritage Provider Network Senior |
$10.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.79
|
| Rate for Payer: Multiplan Commercial |
$11.36
|
|
|
METHYLPREDNISOLONE 125 MG INJ. [4081205]
|
Facility
|
OP
|
$9.12
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$6.84 |
| Rate for Payer: Adventist Health Commercial |
$1.82
|
| Rate for Payer: Adventist Health Commercial |
$1.55
|
| Rate for Payer: Adventist Health Commercial |
$2.80
|
| Rate for Payer: Adventist Health Commercial |
$2.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.87
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7.47
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.32
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Cash Price |
$5.02
|
| Rate for Payer: Cash Price |
$4.26
|
| Rate for Payer: Cash Price |
$7.69
|
| Rate for Payer: Cash Price |
$4.26
|
| Rate for Payer: Cash Price |
$6.88
|
| Rate for Payer: Cash Price |
$7.69
|
| Rate for Payer: Cash Price |
$5.02
|
| Rate for Payer: Cash Price |
$6.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.28
|
| Rate for Payer: Dignity Health Senior |
$0.28
|
| Rate for Payer: Dignity Health Senior |
$0.28
|
| Rate for Payer: Dignity Health Senior |
$0.28
|
| Rate for Payer: Dignity Health Senior |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$0.26
|
| Rate for Payer: EPIC Health Plan Medicare |
$0.26
|
| Rate for Payer: EPIC Health Plan Medicare |
$0.26
|
| Rate for Payer: EPIC Health Plan Medicare |
$0.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.79
|
| Rate for Payer: Heritage Provider Network Senior |
$4.22
|
| Rate for Payer: Heritage Provider Network Senior |
$6.47
|
| Rate for Payer: Heritage Provider Network Senior |
$5.79
|
| Rate for Payer: Heritage Provider Network Senior |
$3.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.33
|
| Rate for Payer: Multiplan Commercial |
$10.48
|
| Rate for Payer: Multiplan Commercial |
$9.38
|
| Rate for Payer: Multiplan Commercial |
$6.84
|
| Rate for Payer: Multiplan Commercial |
$5.81
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.59
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.10
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.65
|
| Rate for Payer: TriValley Medical Group Senior |
$5.00
|
| Rate for Payer: TriValley Medical Group Senior |
$5.59
|
| Rate for Payer: TriValley Medical Group Senior |
$3.65
|
| Rate for Payer: TriValley Medical Group Senior |
$3.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Vantage Medical Group Senior |
$0.28
|
| Rate for Payer: Vantage Medical Group Senior |
$0.28
|
| Rate for Payer: Vantage Medical Group Senior |
$0.28
|
| Rate for Payer: Vantage Medical Group Senior |
$0.28
|
|
|
METHYLPREDNISOLONE 125 MG INJ. [4081205]
|
Facility
|
IP
|
$7.75
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$5.81 |
| Rate for Payer: Adventist Health Commercial |
$1.55
|
| Rate for Payer: Adventist Health Commercial |
$1.82
|
| Rate for Payer: Adventist Health Commercial |
$2.50
|
| Rate for Payer: Adventist Health Commercial |
$2.80
|
| Rate for Payer: Cash Price |
$7.69
|
| Rate for Payer: Cash Price |
$4.26
|
| Rate for Payer: Cash Price |
$5.02
|
| Rate for Payer: Cash Price |
$6.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.79
|
| Rate for Payer: Heritage Provider Network Senior |
$4.22
|
| Rate for Payer: Heritage Provider Network Senior |
$5.79
|
| Rate for Payer: Heritage Provider Network Senior |
$6.47
|
| Rate for Payer: Heritage Provider Network Senior |
$3.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: Multiplan Commercial |
$9.38
|
| Rate for Payer: Multiplan Commercial |
$6.84
|
| Rate for Payer: Multiplan Commercial |
$5.81
|
| Rate for Payer: Multiplan Commercial |
$10.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.14
|
|
|
METHYLPREDNISOLONE 16 MG TABLET [4992]
|
Facility
|
IP
|
$2.98
|
|
|
Service Code
|
HCPCS J7509
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.23 |
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Adventist Health Commercial |
$0.68
|
| Rate for Payer: Cash Price |
$1.87
|
| Rate for Payer: Cash Price |
$1.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.38
|
| Rate for Payer: Heritage Provider Network Senior |
$1.38
|
| Rate for Payer: Heritage Provider Network Senior |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$2.55
|
| Rate for Payer: Multiplan Commercial |
$2.23
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.99
|
|
