|
METAXALONE 800 MG TABLET [33963]
|
Facility
IP
|
$12.75
|
|
|
Service Code
|
NDC 60793-136-01
|
| Hospital Charge Code |
1712374
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.31 |
| Max. Negotiated Rate |
$9.56 |
| Rate for Payer: Adventist Health Commercial |
$2.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.76
|
| Rate for Payer: Cash Price |
$5.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.63
|
| Rate for Payer: Heritage Provider Network Senior |
$8.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.19
|
| Rate for Payer: Multiplan Commercial |
$9.56
|
|
|
METAXALONE 800 MG TABLET [33963]
|
Facility
OP
|
$0.72
|
|
|
Service Code
|
NDC 0527-1435-01
|
| Hospital Charge Code |
1712374
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.61
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.54
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.42
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.61
|
| Rate for Payer: Dignity Health Senior |
$0.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.45
|
| Rate for Payer: Heritage Provider Network Senior |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.61
|
| Rate for Payer: Vantage Medical Group Senior |
$0.61
|
|
|
METFORMIN 500 MG/5 ML ORAL SOLUTION [37125]
|
Facility
OP
|
$1.69
|
|
|
Service Code
|
NDC 10631-206-01
|
| Hospital Charge Code |
NDG37125
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.44 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.93
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.27
|
| Rate for Payer: Blue Shield of California Commercial |
$1.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.99
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.44
|
| Rate for Payer: Dignity Health Senior |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.05
|
| Rate for Payer: Heritage Provider Network Senior |
$1.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$1.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.44
|
| Rate for Payer: Vantage Medical Group Senior |
$1.44
|
|
|
METFORMIN 500 MG/5 ML ORAL SOLUTION [37125]
|
Facility
IP
|
$1.69
|
|
|
Service Code
|
NDC 10631-206-01
|
| Hospital Charge Code |
NDG37125
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.27 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.16
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.14
|
| Rate for Payer: Heritage Provider Network Senior |
$1.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$1.27
|
|
|
METFORMIN 500 MG TABLET [10544]
|
Facility
OP
|
$0.08
|
|
|
Service Code
|
NDC 0904-6689-61
|
| Hospital Charge Code |
1712181
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: Dignity Health Senior |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Senior |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
METFORMIN 500 MG TABLET [10544]
|
Facility
IP
|
$0.08
|
|
|
Service Code
|
NDC 0904-6689-61
|
| Hospital Charge Code |
1712181
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Senior |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
|
|
METFORMIN 500 MG TABLET [10544]
|
Facility
IP
|
$0.03
|
|
|
Service Code
|
NDC 70010-063-01
|
| Hospital Charge Code |
1712181
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Senior |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
|
|
METFORMIN 500 MG TABLET [10544]
|
Facility
IP
|
$0.05
|
|
|
Service Code
|
NDC 23155-102-01
|
| Hospital Charge Code |
1712181
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| 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 |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Senior |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
|
|
METFORMIN 500 MG TABLET [10544]
|
Facility
OP
|
$0.05
|
|
|
Service Code
|
NDC 23155-102-01
|
| Hospital Charge Code |
1712181
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.04
|
| Rate for Payer: Dignity Health Senior |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Senior |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.04
|
|
|
METFORMIN 500 MG TABLET [10544]
|
Facility
OP
|
$0.03
|
|
|
Service Code
|
NDC 70010-063-01
|
| Hospital Charge Code |
1712181
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$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 |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Senior |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Senior |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
METFORMIN 850 MG TABLET [14719]
|
Facility
IP
|
$0.26
|
|
|
Service Code
|
NDC 60687-143-11
|
| Hospital Charge Code |
1712182
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.18
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Senior |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
|
|
METFORMIN 850 MG TABLET [14719]
|
Facility
OP
|
$0.26
|
|
|
Service Code
|
NDC 60687-143-11
|
| Hospital Charge Code |
1712182
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.22
|
| Rate for Payer: Dignity Health Senior |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Senior |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Vantage Medical Group Senior |
$0.22
|
|
|
METFORMIN 850 MG TABLET [14719]
|
Facility
IP
|
$0.26
|
|
|
Service Code
|
NDC 60687-143-01
|
| Hospital Charge Code |
1712182
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.18
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Senior |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
|
|
METFORMIN 850 MG TABLET [14719]
|
Facility
OP
|
$0.26
|
|
|
Service Code
|
NDC 60687-143-01
|
| Hospital Charge Code |
1712182
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.22
|
| Rate for Payer: Dignity Health Senior |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Senior |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Vantage Medical Group Senior |
$0.22
|
|
|
METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR [28995]
|
Facility
IP
|
$0.06
|
|
|
Service Code
|
NDC 70010-491-01
|
| Hospital Charge Code |
1712246
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Senior |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
|
|
METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR [28995]
|
Facility
OP
|
$0.06
|
|
|
Service Code
|
NDC 70010-491-01
|
| Hospital Charge Code |
1712246
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.05
|
| Rate for Payer: Dignity Health Senior |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Senior |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
|
METFORMIN ER 750 MG TABLET,EXTENDED RELEASE 24 HR [35771]
|
Facility
OP
|
$0.26
|
|
|
Service Code
|
NDC 76385-129-01
|
| Hospital Charge Code |
ERX35771
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.22
|
| Rate for Payer: Dignity Health Senior |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Senior |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Vantage Medical Group Senior |
$0.22
|
|
|
METFORMIN ER 750 MG TABLET,EXTENDED RELEASE 24 HR [35771]
|
Facility
IP
|
$0.26
|
|
|
Service Code
|
NDC 76385-129-01
|
| Hospital Charge Code |
ERX35771
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.18
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Senior |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
|
|
METHACHOLINE CHLORIDE 100 MG SOLUTION FOR INHALATION [27032]
|
Facility
IP
|
$99.60
|
|
|
Service Code
|
CPT J7674
|
| Hospital Charge Code |
ERX27032
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$18.03 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Adventist Health Commercial |
$19.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.43
|
| Rate for Payer: Cash Price |
$44.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.43
|
| Rate for Payer: Heritage Provider Network Senior |
$67.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.90
|
| Rate for Payer: Multiplan Commercial |
$74.70
|
|
|
METHACHOLINE CHLORIDE 100 MG SOLUTION FOR INHALATION [27032]
|
Facility
OP
|
$99.60
|
|
|
Service Code
|
CPT J7674
|
| Hospital Charge Code |
ERX27032
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$84.66 |
| Rate for Payer: Adventist Health Commercial |
$19.92
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$84.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$54.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$74.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.97
|
| Rate for Payer: Blue Shield of California Commercial |
$61.85
|
| Rate for Payer: Blue Shield of California EPN |
$58.47
|
| Rate for Payer: Cash Price |
$44.82
|
| Rate for Payer: Cash Price |
$44.82
|
| Rate for Payer: Cigna of CA HMO/PPO |
$64.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$84.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.66
|
| Rate for Payer: Dignity Health Senior |
$84.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.65
|
| Rate for Payer: Heritage Provider Network Senior |
$61.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$48.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.90
|
| Rate for Payer: Multiplan Commercial |
$74.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.66
|
| Rate for Payer: Vantage Medical Group Senior |
$84.66
|
|
|
METHADONE 10 MG/ML INJECTION. [4081195]
|
Facility
IP
|
$21.60
|
|
|
Service Code
|
CPT J1230
|
| Hospital Charge Code |
NDG10546
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.91 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Adventist Health Commercial |
$4.32
|
| Rate for Payer: Adventist Health Commercial |
$4.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.84
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.62
|
| Rate for Payer: Heritage Provider Network Senior |
$14.62
|
| Rate for Payer: Heritage Provider Network Senior |
$15.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.40
|
| Rate for Payer: Multiplan Commercial |
$16.20
|
| Rate for Payer: Multiplan Commercial |
$17.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.80
|
|
|
METHADONE 10 MG/ML INJECTION. [4081195]
|
Facility
OP
|
$21.60
|
|
|
Service Code
|
CPT J1230
|
| Hospital Charge Code |
1730057
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$48.33 |
| Rate for Payer: Adventist Health Commercial |
$4.32
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.88
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.11
|
| Rate for Payer: Blue Shield of California Commercial |
$17.85
|
| Rate for Payer: Blue Shield of California EPN |
$17.85
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.36
|
| Rate for Payer: Dignity Health Senior |
$18.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.00
|
| Rate for Payer: Heritage Provider Network Senior |
$10.00
|
| Rate for Payer: IEHP Medi-Cal |
$37.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.40
|
| Rate for Payer: Multiplan Commercial |
$16.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.36
|
| Rate for Payer: Vantage Medical Group Senior |
$18.36
|
|
|
METHADONE 10 MG/ML INJECTION. [4081195]
|
Facility
IP
|
$21.60
|
|
|
Service Code
|
CPT J1230
|
| Hospital Charge Code |
1730057
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.91 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Adventist Health Commercial |
$4.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.84
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.62
|
| Rate for Payer: Heritage Provider Network Senior |
$14.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.40
|
| Rate for Payer: Multiplan Commercial |
$16.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.22
|
|
|
METHADONE 10 MG/ML INJECTION. [4081195]
|
Facility
OP
|
$23.34
|
|
|
Service Code
|
CPT J1230
|
| Hospital Charge Code |
NDG10546
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$48.33 |
| Rate for Payer: Adventist Health Commercial |
$4.67
|
| Rate for Payer: Adventist Health Commercial |
$4.32
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.33
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.84
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.11
|
| Rate for Payer: Blue Shield of California Commercial |
$17.85
|
| Rate for Payer: Blue Shield of California Commercial |
$17.85
|
| Rate for Payer: Blue Shield of California EPN |
$17.85
|
| Rate for Payer: Blue Shield of California EPN |
$17.85
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.36
|
| Rate for Payer: Dignity Health Senior |
$19.84
|
| Rate for Payer: Dignity Health Senior |
$18.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.81
|
| Rate for Payer: Heritage Provider Network Senior |
$10.00
|
| Rate for Payer: Heritage Provider Network Senior |
$10.81
|
| Rate for Payer: IEHP Medi-Cal |
$37.64
|
| Rate for Payer: IEHP Medi-Cal |
$37.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.84
|
| Rate for Payer: Multiplan Commercial |
$16.20
|
| Rate for Payer: Multiplan Commercial |
$17.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.84
|
| Rate for Payer: Vantage Medical Group Senior |
$18.36
|
| Rate for Payer: Vantage Medical Group Senior |
$19.84
|
|
|
METHADONE 10 MG/ML INJECTION SOLUTION [10546]
|
Facility
IP
|
$21.60
|
|
|
Service Code
|
NDC 17478-380-20
|
| Hospital Charge Code |
NDG10546
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.91 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Adventist Health Commercial |
$4.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.84
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.62
|
| Rate for Payer: Heritage Provider Network Senior |
$14.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.40
|
| Rate for Payer: Multiplan Commercial |
$16.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.22
|
|
