|
METHOTREXATE SODIUM 25 MG/ML INJECTION SOLUTION [4974]
|
Facility
|
OP
|
$3.18
|
|
|
Service Code
|
HCPCS J9260
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$35.98 |
| Rate for Payer: Adventist Health Commercial |
$0.64
|
| Rate for Payer: Adventist Health Commercial |
$0.81
|
| Rate for Payer: Adventist Health Commercial |
$0.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.70
|
| 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 |
$1.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.98
|
| 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 |
$1.81
|
| Rate for Payer: Cash Price |
$1.43
|
| Rate for Payer: Cash Price |
$1.43
|
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Cash Price |
$1.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.70
|
| 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 |
$3.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.70
|
| 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 |
$2.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.02
|
| 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 Foundation Hospitals Commercial |
$2.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.82
|
| Rate for Payer: Multiplan Commercial |
$3.02
|
| Rate for Payer: Multiplan Commercial |
$3.27
|
| Rate for Payer: Multiplan Commercial |
$2.38
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.61
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.74
|
| Rate for Payer: TriValley Medical Group Senior |
$1.74
|
| Rate for Payer: TriValley Medical Group Senior |
$1.61
|
| Rate for Payer: TriValley Medical Group Senior |
$1.27
|
| 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 All Other HMO/non HMO |
$1.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.43
|
| Rate for Payer: Vantage Medical Group Senior |
$2.70
|
| 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 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: Aetna of CA Non-Gatekeeper |
$0.64
|
| Rate for Payer: Cash Price |
$0.45
|
| 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 Foundation Hospitals 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 |
$35.98 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.62
|
| 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 |
$35.98
|
| 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 |
$0.45
|
| Rate for Payer: Cash Price |
$0.45
|
| 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 Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$0.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
$0.24
|
|
|
Service Code
|
HCPCS J8610
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$6.76 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.82
|
| 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 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 |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.76
|
| 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 |
$0.30
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.53
|
| 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 |
$0.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.20
|
| 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 |
$0.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.54
|
| 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 Foundation Hospitals Commercial |
$1.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| 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: Molina Healthcare of CA Medi-Cal/Medicare |
$0.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.46
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$2.49
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.33
|
| Rate for Payer: TriValley Medical Group Senior |
$1.33
|
| Rate for Payer: TriValley Medical Group Senior |
$0.26
|
| Rate for Payer: TriValley Medical Group Senior |
$0.10
|
| 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 All Other HMO/non HMO |
$0.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.82
|
| 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 Medi-Cal |
$2.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.56
|
| 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
|
$3.32
|
|
|
Service Code
|
HCPCS J8610
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2.49 |
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.15
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cash Price |
$0.11
|
| 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: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| 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 Foundation Hospitals Medi-Cal |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals 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: 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
|
OP
|
$76.32
|
|
|
Service Code
|
HCPCS J9260
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$64.87 |
| Rate for Payer: Adventist Health Commercial |
$15.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$47.17
|
| 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 |
$35.98
|
| 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 |
$34.34
|
| Rate for Payer: Cash Price |
$34.34
|
| 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 Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$36.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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) 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: Aetna of CA Non-Gatekeeper |
$49.15
|
| Rate for Payer: Cash Price |
$34.34
|
| 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 Foundation Hospitals 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) 25 MG/ML INJECTION SOLUTION [96981]
|
Facility
|
OP
|
$1.16
|
|
|
Service Code
|
HCPCS J9260
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$35.98 |
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Adventist Health Commercial |
$1.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.98
|
| 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 |
$0.52
|
| Rate for Payer: Cash Price |
$2.79
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cash Price |
$2.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.54
|
| Rate for Payer: Heritage Provider Network Senior |
$2.88
|
| Rate for Payer: Heritage Provider Network Senior |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.81
|
| Rate for Payer: Multiplan Commercial |
$4.66
|
| Rate for Payer: Multiplan Commercial |
$0.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.46
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.48
|
| Rate for Payer: TriValley Medical Group Senior |
$0.46
|
| Rate for Payer: TriValley Medical Group Senior |
$2.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.28
|
| Rate for Payer: Vantage Medical Group Senior |
$5.28
|
| Rate for Payer: Vantage Medical Group Senior |
$0.99
|
|
|
METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION [96981]
|
Facility
|
IP
|
$1.16
|
|
|
Service Code
|
HCPCS J9260
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.87 |
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Adventist Health Commercial |
$1.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.00
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cash Price |
$2.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.88
|
| Rate for Payer: Heritage Provider Network Senior |
$2.88
|
| Rate for Payer: Heritage Provider Network Senior |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.55
|
| Rate for Payer: Multiplan Commercial |
$0.87
|
| Rate for Payer: Multiplan Commercial |
$4.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.38
|
|
|
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 Non-Gatekeeper |
$1.57
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$0.47
|
| 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 |
$1.14
|
| Rate for Payer: Cash Price |
$1.14
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$1.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
|
|
METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION [96981]
|
Facility
|
IP
|
$2.54
|
|
|
Service Code
|
HCPCS J9255
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Adventist Health Commercial |
$0.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.64
|
| Rate for Payer: Cash Price |
$1.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.18
|
| Rate for Payer: Heritage Provider Network Senior |
$1.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: Multiplan Commercial |
$1.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.84
|
|
|
METHOXSALEN 20 MCG/ML INJECTION SOLUTION [24933]
|
Facility
|
IP
|
$75.72
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.71 |
| Max. Negotiated Rate |
$56.79 |
| Rate for Payer: Adventist Health Commercial |
$15.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.76
|
| Rate for Payer: Cash Price |
$34.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.06
|
| Rate for Payer: Heritage Provider Network Senior |
$35.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.93
|
| Rate for Payer: Multiplan Commercial |
$56.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.07
|
|
|
METHOXSALEN 20 MCG/ML INJECTION SOLUTION [24933]
|
Facility
|
OP
|
$75.72
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.71 |
| Max. Negotiated Rate |
$64.36 |
| Rate for Payer: Adventist Health Commercial |
$15.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.79
|
| 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 |
$34.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.06
|
| Rate for Payer: Heritage Provider Network Senior |
$35.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$36.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 |
$27.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.07
|
| 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
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 3877930608
|
| 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 Non-Gatekeeper |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 Non-Gatekeeper |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
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: Aetna of CA Non-Gatekeeper |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Senior |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals 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 3877930608
|
| 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 Non-Gatekeeper |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Senior |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
|
|
METHYLDOPA 250 MG TABLET [4982]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 5107920001
|
| 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 Non-Gatekeeper |
$0.14
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$0.11
|
| 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 |
$0.10
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 250 MG TABLET [4982]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 5107920001
|
| 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: Aetna of CA Non-Gatekeeper |
$0.14
|
| Rate for Payer: Cash Price |
$0.10
|
| 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 Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
|
|
METHYLDOPA ORAL SUSPENSION COMPOUND 50 MG/ML [4080300]
|
Facility
|
OP
|
$1.54
|
|
|
Service Code
|
NDC 9994080300
|
| 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 Non-Gatekeeper |
$0.95
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$0.77
|
| 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 |
$0.69
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$0.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 9994080300
|
| 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: Aetna of CA Non-Gatekeeper |
$0.99
|
| Rate for Payer: Cash Price |
$0.69
|
| 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 Foundation Hospitals 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: Aetna of CA Non-Gatekeeper |
$16.23
|
| Rate for Payer: Cash Price |
$11.34
|
| 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 Foundation Hospitals 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 |
$0.63 |
| Max. Negotiated Rate |
$18.90 |
| Rate for Payer: Adventist Health Commercial |
$5.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.63
|
| 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 |
$11.34
|
| Rate for Payer: Cash Price |
$11.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.13
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.87
|
| 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) Medicare Advantage |
$10.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.57
|
| 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 |
$13.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.96
|
| Rate for Payer: Vantage Medical Group Senior |
$11.96
|
|
|
METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION [215473]
|
Facility
|
IP
|
$28.13
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.09 |
| Max. Negotiated Rate |
$21.10 |
| Rate for Payer: Adventist Health Commercial |
$5.63
|
| Rate for Payer: Adventist Health Commercial |
$2.88
|
| Rate for Payer: Adventist Health Commercial |
$3.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.27
|
| Rate for Payer: Cash Price |
$12.66
|
| Rate for Payer: Cash Price |
$7.29
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.78
|
| 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 |
$13.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.50
|
| Rate for Payer: Heritage Provider Network Senior |
$7.50
|
| Rate for Payer: Heritage Provider Network Senior |
$6.67
|
| Rate for Payer: Heritage Provider Network Senior |
$13.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.03
|
| Rate for Payer: Multiplan Commercial |
$21.10
|
| Rate for Payer: Multiplan Commercial |
$10.80
|
| Rate for Payer: Multiplan Commercial |
$12.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.36
|
|
|
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 |
$0.63 |
| Max. Negotiated Rate |
$16.30 |
| Rate for Payer: Adventist Health Commercial |
$3.24
|
| Rate for Payer: Adventist Health Commercial |
$5.63
|
| Rate for Payer: Adventist Health Commercial |
$2.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.63
|
| Rate for Payer: Blue Shield of California Commercial |
$8.78
|
| 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 |
$13.73
|
| Rate for Payer: Blue Shield of California EPN |
$7.03
|
| Rate for Payer: Blue Shield of California EPN |
$7.91
|
| Rate for Payer: Cash Price |
$12.66
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Cash Price |
$7.29
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Cash Price |
$7.29
|
| Rate for Payer: Cash Price |
$12.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.37
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.87
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.87
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.67
|
| Rate for Payer: Heritage Provider Network Senior |
$7.50
|
| Rate for Payer: Heritage Provider Network Senior |
$6.67
|
| Rate for Payer: Heritage Provider Network Senior |
$13.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.57
|
| Rate for Payer: Multiplan Commercial |
$12.15
|
| Rate for Payer: Multiplan Commercial |
$21.10
|
| Rate for Payer: Multiplan Commercial |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.76
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.48
|
| Rate for Payer: TriValley Medical Group Senior |
$11.25
|
| Rate for Payer: TriValley Medical Group Senior |
$5.76
|
| 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 All Other HMO/non HMO |
$5.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.96
|
| Rate for Payer: Vantage Medical Group Senior |
$11.96
|
| Rate for Payer: Vantage Medical Group Senior |
$11.96
|
| Rate for Payer: Vantage Medical Group Senior |
$11.96
|
|
