|
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION [10571]
|
Facility
|
OP
|
$23.71
|
|
|
Service Code
|
HCPCS J2210
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Adventist Health Commercial |
$4.74
|
| Rate for Payer: Adventist Health Commercial |
$7.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.33
|
| Rate for Payer: Blue Shield of California Commercial |
$20.15
|
| Rate for Payer: Blue Shield of California Commercial |
$20.15
|
| Rate for Payer: Blue Shield of California EPN |
$20.15
|
| Rate for Payer: Blue Shield of California EPN |
$20.15
|
| Rate for Payer: Cash Price |
$10.67
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: Cash Price |
$10.67
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.98
|
| Rate for Payer: Heritage Provider Network Senior |
$17.64
|
| Rate for Payer: Heritage Provider Network Senior |
$10.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$18.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.60
|
| Rate for Payer: Multiplan Commercial |
$28.58
|
| Rate for Payer: Multiplan Commercial |
$17.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.48
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.24
|
| Rate for Payer: TriValley Medical Group Senior |
$9.48
|
| Rate for Payer: TriValley Medical Group Senior |
$15.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.39
|
| Rate for Payer: Vantage Medical Group Senior |
$32.39
|
| Rate for Payer: Vantage Medical Group Senior |
$20.15
|
|
|
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION [10571]
|
Facility
|
IP
|
$23.71
|
|
|
Service Code
|
HCPCS J2210
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$17.78 |
| Rate for Payer: Adventist Health Commercial |
$4.74
|
| Rate for Payer: Adventist Health Commercial |
$7.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.54
|
| Rate for Payer: Cash Price |
$10.67
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.64
|
| Rate for Payer: Heritage Provider Network Senior |
$17.64
|
| Rate for Payer: Heritage Provider Network Senior |
$10.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.53
|
| Rate for Payer: Multiplan Commercial |
$17.78
|
| Rate for Payer: Multiplan Commercial |
$28.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.85
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
|
OP
|
$19.80
|
|
|
Service Code
|
NDC 6923816058
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$16.83 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.24
|
| Rate for Payer: Adventist Health Commercial |
$3.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.90
|
| Rate for Payer: Blue Shield of California Commercial |
$12.08
|
| Rate for Payer: Blue Shield of California EPN |
$9.66
|
| Rate for Payer: Cash Price |
$8.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.26
|
| Rate for Payer: Heritage Provider Network Senior |
$12.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.86
|
| Rate for Payer: Multiplan Commercial |
$14.85
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.92
|
| Rate for Payer: TriValley Medical Group Senior |
$7.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.83
|
| Rate for Payer: Vantage Medical Group Senior |
$16.83
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
|
OP
|
$23.83
|
|
|
Service Code
|
NDC 0093365528
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.31 |
| Max. Negotiated Rate |
$20.26 |
| Rate for Payer: Adventist Health Commercial |
$4.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.92
|
| Rate for Payer: Blue Shield of California Commercial |
$14.54
|
| Rate for Payer: Blue Shield of California EPN |
$11.63
|
| Rate for Payer: Cash Price |
$10.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.75
|
| Rate for Payer: Heritage Provider Network Senior |
$14.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.68
|
| Rate for Payer: Multiplan Commercial |
$17.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.53
|
| Rate for Payer: TriValley Medical Group Senior |
$9.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.26
|
| Rate for Payer: Vantage Medical Group Senior |
$20.26
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
|
IP
|
$19.80
|
|
|
Service Code
|
NDC 6923816058
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$14.85 |
| Rate for Payer: Adventist Health Commercial |
$3.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.75
|
| Rate for Payer: Cash Price |
$8.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.40
|
| Rate for Payer: Heritage Provider Network Senior |
$13.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.95
|
| Rate for Payer: Multiplan Commercial |
$14.85
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
|
IP
|
$19.80
|
|
|
Service Code
|
NDC 6923816052
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$14.85 |
| Rate for Payer: Adventist Health Commercial |
$3.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.75
|
| Rate for Payer: Cash Price |
$8.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.40
|
| Rate for Payer: Heritage Provider Network Senior |
$13.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.95
|
| Rate for Payer: Multiplan Commercial |
$14.85
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
|
IP
|
$23.83
|
|
|
Service Code
|
NDC 0093365528
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.31 |
| Max. Negotiated Rate |
$17.87 |
| Rate for Payer: Adventist Health Commercial |
$4.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.35
|
| Rate for Payer: Cash Price |
$10.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.13
|
| Rate for Payer: Heritage Provider Network Senior |
$16.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.96
|
| Rate for Payer: Multiplan Commercial |
$17.87
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
|
OP
|
$19.80
|
|
|
Service Code
|
NDC 6923816052
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$16.83 |
| Rate for Payer: Adventist Health Commercial |
$3.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.90
|
| Rate for Payer: Blue Shield of California Commercial |
$12.08
|
| Rate for Payer: Blue Shield of California EPN |
$9.66
|
| Rate for Payer: Cash Price |
$8.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.26
|
| Rate for Payer: Heritage Provider Network Senior |
$12.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.86
|
| Rate for Payer: Multiplan Commercial |
$14.85
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.92
|
| Rate for Payer: TriValley Medical Group Senior |
$7.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.83
|
| Rate for Payer: Vantage Medical Group Senior |
$16.83
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
|
OP
|
$16.83
|
|
|
Service Code
|
NDC 7001078612
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.05 |
| Max. Negotiated Rate |
$14.31 |
| Rate for Payer: Adventist Health Commercial |
$3.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.42
|
| Rate for Payer: Blue Shield of California Commercial |
$10.27
|
| Rate for Payer: Blue Shield of California EPN |
$8.21
|
| Rate for Payer: Cash Price |
$7.57
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.42
|
| Rate for Payer: Heritage Provider Network Senior |
$10.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.78
|
| Rate for Payer: Multiplan Commercial |
$12.62
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.73
|
| Rate for Payer: TriValley Medical Group Senior |
$6.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Vantage Medical Group Senior |
$14.31
|
|
|
METHYLERGONOVINE 0.2 MG TABLET [10572]
|
Facility
|
IP
|
$16.83
|
|
|
Service Code
|
NDC 7001078612
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.05 |
| Max. Negotiated Rate |
$12.62 |
| Rate for Payer: Adventist Health Commercial |
$3.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.84
|
| Rate for Payer: Cash Price |
$7.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.39
|
| Rate for Payer: Heritage Provider Network Senior |
$11.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.21
|
| Rate for Payer: Multiplan Commercial |
$12.62
|
|
|
METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SYRINGE [154475]
|
Facility
|
OP
|
$373.50
|
|
|
Service Code
|
HCPCS J2212
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$317.48 |
| Rate for Payer: Adventist Health Commercial |
$74.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$230.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$317.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$205.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$280.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.94
|
| 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 |
$168.08
|
| Rate for Payer: Cash Price |
$168.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$171.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$317.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$317.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$239.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$172.93
|
| Rate for Payer: Heritage Provider Network Senior |
$172.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$178.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$67.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$261.45
|
| Rate for Payer: Multiplan Commercial |
$280.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$149.40
|
| Rate for Payer: TriValley Medical Group Senior |
$149.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$134.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$123.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$317.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$317.48
|
| Rate for Payer: Vantage Medical Group Senior |
$317.48
|
|
|
METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SYRINGE [154475]
|
Facility
|
IP
|
$373.50
|
|
|
Service Code
|
HCPCS J2212
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.60 |
| Max. Negotiated Rate |
$280.12 |
| Rate for Payer: Adventist Health Commercial |
$74.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$240.53
|
| Rate for Payer: Cash Price |
$168.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$171.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$172.93
|
| Rate for Payer: Heritage Provider Network Senior |
$172.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$67.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.38
|
| Rate for Payer: Multiplan Commercial |
$280.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$134.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$123.67
|
|
|
METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS WRAP [40891651]
|
Facility
|
IP
|
$373.50
|
|
|
Service Code
|
HCPCS J2212
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.60 |
| Max. Negotiated Rate |
$280.12 |
| Rate for Payer: Adventist Health Commercial |
$74.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$240.53
|
| Rate for Payer: Cash Price |
$168.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$171.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$172.93
|
| Rate for Payer: Heritage Provider Network Senior |
$172.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$67.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.38
|
| Rate for Payer: Multiplan Commercial |
$280.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$134.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$123.67
|
|
|
METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS WRAP [40891651]
|
Facility
|
OP
|
$373.50
|
|
|
Service Code
|
HCPCS J2212
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$317.48 |
| Rate for Payer: Adventist Health Commercial |
$74.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$230.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$317.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$205.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$280.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.94
|
| 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 |
$168.08
|
| Rate for Payer: Cash Price |
$168.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$171.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$317.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$317.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$239.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$172.93
|
| Rate for Payer: Heritage Provider Network Senior |
$172.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$178.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$67.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$261.45
|
| Rate for Payer: Multiplan Commercial |
$280.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$149.40
|
| Rate for Payer: TriValley Medical Group Senior |
$149.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$134.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$123.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$317.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$317.48
|
| Rate for Payer: Vantage Medical Group Senior |
$317.48
|
|
|
METHYLPHENIDATE 5 MG TABLET [4988]
|
Facility
|
IP
|
$2.81
|
|
|
Service Code
|
NDC 6808480521
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$2.11 |
| Rate for Payer: Adventist Health Commercial |
$0.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.81
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.90
|
| Rate for Payer: Heritage Provider Network Senior |
$1.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$2.11
|
|
|
METHYLPHENIDATE 5 MG TABLET [4988]
|
Facility
|
OP
|
$2.81
|
|
|
Service Code
|
NDC 6808480521
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$2.39 |
| Rate for Payer: Adventist Health Commercial |
$0.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.41
|
| Rate for Payer: Blue Shield of California Commercial |
$1.71
|
| Rate for Payer: Blue Shield of California EPN |
$1.37
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.74
|
| Rate for Payer: Heritage Provider Network Senior |
$1.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.97
|
| Rate for Payer: Multiplan Commercial |
$2.11
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.12
|
| Rate for Payer: TriValley Medical Group Senior |
$1.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.39
|
| Rate for Payer: Vantage Medical Group Senior |
$2.39
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR [28750]
|
Facility
|
OP
|
$9.34
|
|
|
Service Code
|
NDC 9999706851
|
| 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 Non-Gatekeeper |
$5.77
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$4.67
|
| 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 |
$4.20
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$4.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
$6.22
|
|
|
Service Code
|
NDC 6217531037
|
| 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: Aetna of CA Non-Gatekeeper |
$4.01
|
| Rate for Payer: Cash Price |
$2.80
|
| 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 Foundation Hospitals 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
|
$6.22
|
|
|
Service Code
|
NDC 6217531037
|
| 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 Non-Gatekeeper |
$3.84
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$3.11
|
| 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 |
$2.80
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$2.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
$9.34
|
|
|
Service Code
|
NDC 9999706851
|
| 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: Aetna of CA Non-Gatekeeper |
$6.01
|
| Rate for Payer: Cash Price |
$4.20
|
| 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 Foundation Hospitals 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
|
$15.48
|
|
|
Service Code
|
NDC 5045858501
|
| 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: Aetna of CA Non-Gatekeeper |
$9.97
|
| Rate for Payer: Cash Price |
$6.97
|
| 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 Foundation Hospitals Medi-Cal |
$2.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.87
|
| Rate for Payer: Multiplan Commercial |
$11.61
|
|
|
METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR [28750]
|
Facility
|
OP
|
$15.48
|
|
|
Service Code
|
NDC 5045858501
|
| 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 Non-Gatekeeper |
$9.57
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$7.74
|
| 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 |
$6.97
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$7.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 20 MG TABLET,EXTENDED RELEASE [4989]
|
Facility
|
IP
|
$2.02
|
|
|
Service Code
|
NDC 1070207606
|
| 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: Aetna of CA Non-Gatekeeper |
$1.30
|
| Rate for Payer: Cash Price |
$0.91
|
| 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 Foundation Hospitals 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 1070207606
|
| 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 Non-Gatekeeper |
$1.25
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$1.01
|
| 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 |
$0.91
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$0.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
OP
|
$15.87
|
|
|
Service Code
|
NDC 5045858801
|
| 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 Non-Gatekeeper |
$9.81
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$7.94
|
| 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 |
$7.14
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$7.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
|
