|
ADJUVANT AS01B (PF), COMPONENT VIAL 1 OF 2 INTRAMUSCULAR SUSPENSION [219987]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 5816082903
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.01
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
ADO-TRASTUZUMAB EMTANSINE 100 MG INTRAVENOUS SOLUTION [200177]
|
Facility
|
OP
|
$4,979.06
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.20 |
| Max. Negotiated Rate |
$3,983.25 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$2,987.44
|
| Rate for Payer: Aetna of CA Government/Medicare |
$2,987.44
|
| Rate for Payer: Cash Price |
$2,240.58
|
| Rate for Payer: Cash Price |
$2,240.58
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$3,983.25
|
| Rate for Payer: Health Smart Auto/Commercial |
$2,987.44
|
| Rate for Payer: Intervalley Health Plan Commercial |
$42.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Medi-Cal/Medicare Advantage |
$2,987.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,738.48
|
| Rate for Payer: Multiplan Commercial |
$3,734.30
|
|
|
ADO-TRASTUZUMAB EMTANSINE 100 MG INTRAVENOUS SOLUTION [200177]
|
Facility
|
IP
|
$4,979.06
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,738.48 |
| Max. Negotiated Rate |
$3,983.25 |
| Rate for Payer: Cash Price |
$2,240.58
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$3,983.25
|
| Rate for Payer: Health Smart Auto/Commercial |
$2,987.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,738.48
|
| Rate for Payer: Multiplan Commercial |
$3,734.30
|
|
|
ADO-TRASTUZUMAB EMTANSINE 160 MG INTRAVENOUS SOLUTION [200178]
|
Facility
|
OP
|
$7,966.49
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.20 |
| Max. Negotiated Rate |
$6,373.19 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$4,779.89
|
| Rate for Payer: Aetna of CA Government/Medicare |
$4,779.89
|
| Rate for Payer: Cash Price |
$3,584.92
|
| Rate for Payer: Cash Price |
$3,584.92
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$6,373.19
|
| Rate for Payer: Health Smart Auto/Commercial |
$4,779.89
|
| Rate for Payer: Intervalley Health Plan Commercial |
$42.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Medi-Cal/Medicare Advantage |
$4,779.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,381.57
|
| Rate for Payer: Multiplan Commercial |
$5,974.87
|
|
|
ADO-TRASTUZUMAB EMTANSINE 160 MG INTRAVENOUS SOLUTION [200178]
|
Facility
|
IP
|
$7,966.49
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,381.57 |
| Max. Negotiated Rate |
$6,373.19 |
| Rate for Payer: Cash Price |
$3,584.92
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$6,373.19
|
| Rate for Payer: Health Smart Auto/Commercial |
$4,779.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,381.57
|
| Rate for Payer: Multiplan Commercial |
$5,974.87
|
|
|
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLUTION FOR INJECTION [152966]
|
Facility
|
OP
|
$48,014.40
|
|
|
Service Code
|
HCPCS J0178
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$731.89 |
| Max. Negotiated Rate |
$38,411.52 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$28,808.64
|
| Rate for Payer: Aetna of CA Government/Medicare |
$28,808.64
|
| Rate for Payer: Cash Price |
$21,606.48
|
| Rate for Payer: Cash Price |
$21,606.48
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$38,411.52
|
| Rate for Payer: Health Smart Auto/Commercial |
$28,808.64
|
| Rate for Payer: Intervalley Health Plan Commercial |
$731.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Medi-Cal/Medicare Advantage |
$28,808.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26,407.92
|
| Rate for Payer: Multiplan Commercial |
$36,010.80
|
|
|
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLUTION FOR INJECTION [152966]
|
Facility
|
IP
|
$48,014.40
|
|
|
Service Code
|
HCPCS J0178
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26,407.92 |
| Max. Negotiated Rate |
$38,411.52 |
| Rate for Payer: Cash Price |
$21,606.48
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$38,411.52
|
| Rate for Payer: Health Smart Auto/Commercial |
$28,808.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26,407.92
|
| Rate for Payer: Multiplan Commercial |
$36,010.80
|
|
|
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SYRINGE [226632]
|
Facility
|
IP
|
$48,014.40
|
|
|
Service Code
|
HCPCS J0178
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26,407.92 |
| Max. Negotiated Rate |
$38,411.52 |
| Rate for Payer: Cash Price |
$21,606.48
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$38,411.52
|
| Rate for Payer: Health Smart Auto/Commercial |
$28,808.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26,407.92
|
| Rate for Payer: Multiplan Commercial |
$36,010.80
|
|
|
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SYRINGE [226632]
|
Facility
|
OP
|
$48,014.40
|
|
|
Service Code
|
HCPCS J0178
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$731.89 |
| Max. Negotiated Rate |
$38,411.52 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$28,808.64
|
| Rate for Payer: Aetna of CA Government/Medicare |
$28,808.64
|
| Rate for Payer: Cash Price |
$21,606.48
|
| Rate for Payer: Cash Price |
$21,606.48
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$38,411.52
|
| Rate for Payer: Health Smart Auto/Commercial |
$28,808.64
|
| Rate for Payer: Intervalley Health Plan Commercial |
$731.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Medi-Cal/Medicare Advantage |
$28,808.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26,407.92
|
| Rate for Payer: Multiplan Commercial |
$36,010.80
|
|
|
AFLIBERCEPT 8 MG/0.07 ML INTRAVITREAL SOLUTION FOR INJECTION [239224]
|
Facility
|
IP
|
$48,222.51
|
|
|
Service Code
|
HCPCS J0177
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26,522.38 |
| Max. Negotiated Rate |
$38,578.01 |
| Rate for Payer: Cash Price |
$21,700.13
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$38,578.01
|
| Rate for Payer: Health Smart Auto/Commercial |
$28,933.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26,522.38
|
| Rate for Payer: Multiplan Commercial |
$36,166.88
|
|
|
AFLIBERCEPT 8 MG/0.07 ML INTRAVITREAL SOLUTION FOR INJECTION [239224]
|
Facility
|
OP
|
$48,222.51
|
|
|
Service Code
|
HCPCS J0177
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$301.18 |
| Max. Negotiated Rate |
$38,578.01 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$28,933.51
|
| Rate for Payer: Aetna of CA Government/Medicare |
$28,933.51
|
| Rate for Payer: Cash Price |
$21,700.13
|
| Rate for Payer: Cash Price |
$21,700.13
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$38,578.01
|
| Rate for Payer: Health Smart Auto/Commercial |
$28,933.51
|
| Rate for Payer: Intervalley Health Plan Commercial |
$301.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Medi-Cal/Medicare Advantage |
$28,933.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26,522.38
|
| Rate for Payer: Multiplan Commercial |
$36,166.88
|
|
|
AGALSIDASE BETA 35 MG INTRAVENOUS SOLUTION [35775]
|
Facility
|
IP
|
$9,674.75
|
|
|
Service Code
|
HCPCS J0180
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,321.11 |
| Max. Negotiated Rate |
$7,739.80 |
| Rate for Payer: Cash Price |
$4,353.64
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$7,739.80
|
| Rate for Payer: Health Smart Auto/Commercial |
$5,804.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,321.11
|
| Rate for Payer: Multiplan Commercial |
$7,256.06
|
|
|
AGALSIDASE BETA 35 MG INTRAVENOUS SOLUTION [35775]
|
Facility
|
OP
|
$9,674.75
|
|
|
Service Code
|
HCPCS J0180
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$227.58 |
| Max. Negotiated Rate |
$7,739.80 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$5,804.85
|
| Rate for Payer: Aetna of CA Government/Medicare |
$5,804.85
|
| Rate for Payer: Cash Price |
$4,353.64
|
| Rate for Payer: Cash Price |
$4,353.64
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$7,739.80
|
| Rate for Payer: Health Smart Auto/Commercial |
$5,804.85
|
| Rate for Payer: Intervalley Health Plan Commercial |
$227.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Medi-Cal/Medicare Advantage |
$5,804.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,321.11
|
| Rate for Payer: Multiplan Commercial |
$7,256.06
|
|
|
AGALSIDASE BETA 5 MG INTRAVENOUS SOLUTION [38494]
|
Facility
|
OP
|
$1,381.87
|
|
|
Service Code
|
HCPCS J0180
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$227.58 |
| Max. Negotiated Rate |
$1,105.50 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$829.12
|
| Rate for Payer: Aetna of CA Government/Medicare |
$829.12
|
| Rate for Payer: Cash Price |
$621.84
|
| Rate for Payer: Cash Price |
$621.84
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$1,105.50
|
| Rate for Payer: Health Smart Auto/Commercial |
$829.12
|
| Rate for Payer: Intervalley Health Plan Commercial |
$227.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Medi-Cal/Medicare Advantage |
$829.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$760.03
|
| Rate for Payer: Multiplan Commercial |
$1,036.40
|
|
|
AGALSIDASE BETA 5 MG INTRAVENOUS SOLUTION [38494]
|
Facility
|
IP
|
$1,381.87
|
|
|
Service Code
|
HCPCS J0180
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$760.03 |
| Max. Negotiated Rate |
$1,105.50 |
| Rate for Payer: Cash Price |
$621.84
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$1,105.50
|
| Rate for Payer: Health Smart Auto/Commercial |
$829.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$760.03
|
| Rate for Payer: Multiplan Commercial |
$1,036.40
|
|
|
AGAR (BULK) 100 % POWDER [40822641]
|
Facility
|
OP
|
$0.17
|
|
|
Service Code
|
NDC 9999922641
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.10
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.10
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.14
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Medi-Cal/Medicare Advantage |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
|
|
AGAR (BULK) 100 % POWDER [40822641]
|
Facility
|
IP
|
$0.17
|
|
|
Service Code
|
NDC 9999922641
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.14
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
|
|
ALBENDAZOLE 200 MG TABLET [8979]
|
Facility
|
OP
|
$35.85
|
|
|
Service Code
|
NDC 7220505108
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.72 |
| Max. Negotiated Rate |
$28.68 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$21.51
|
| Rate for Payer: Aetna of CA Government/Medicare |
$21.51
|
| Rate for Payer: Cash Price |
$16.13
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$28.68
|
| Rate for Payer: Health Smart Auto/Commercial |
$21.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Medi-Cal/Medicare Advantage |
$21.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.72
|
| Rate for Payer: Multiplan Commercial |
$26.89
|
|
|
ALBENDAZOLE 200 MG TABLET [8979]
|
Facility
|
IP
|
$21.49
|
|
|
Service Code
|
NDC 4359845202
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.82 |
| Max. Negotiated Rate |
$17.19 |
| Rate for Payer: Cash Price |
$9.67
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$17.19
|
| Rate for Payer: Health Smart Auto/Commercial |
$12.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.82
|
| Rate for Payer: Multiplan Commercial |
$16.12
|
|
|
ALBENDAZOLE 200 MG TABLET [8979]
|
Facility
|
IP
|
$35.85
|
|
|
Service Code
|
NDC 7220505108
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.72 |
| Max. Negotiated Rate |
$28.68 |
| Rate for Payer: Cash Price |
$16.13
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$28.68
|
| Rate for Payer: Health Smart Auto/Commercial |
$21.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.72
|
| Rate for Payer: Multiplan Commercial |
$26.89
|
|
|
ALBENDAZOLE 200 MG TABLET [8979]
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
NDC 3172293502
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.80 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$28.80
|
| Rate for Payer: Health Smart Auto/Commercial |
$21.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.80
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
|
|
ALBENDAZOLE 200 MG TABLET [8979]
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
NDC 3172293502
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.80 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$21.60
|
| Rate for Payer: Aetna of CA Government/Medicare |
$21.60
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$28.80
|
| Rate for Payer: Health Smart Auto/Commercial |
$21.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Medi-Cal/Medicare Advantage |
$21.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.80
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
|
|
ALBENDAZOLE 200 MG TABLET [8979]
|
Facility
|
OP
|
$21.49
|
|
|
Service Code
|
NDC 4359845202
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.82 |
| Max. Negotiated Rate |
$17.19 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$12.89
|
| Rate for Payer: Aetna of CA Government/Medicare |
$12.89
|
| Rate for Payer: Cash Price |
$9.67
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$17.19
|
| Rate for Payer: Health Smart Auto/Commercial |
$12.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Medi-Cal/Medicare Advantage |
$12.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.82
|
| Rate for Payer: Multiplan Commercial |
$16.12
|
|
|
ALBUMIN, HUMAN 25% CONTINUOUS INTRAVENOUS SOLUTION [4088981]
|
Facility
|
IP
|
$1.39
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$1.11 |
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.90
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$1.11
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.67
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$1.04
|
| Rate for Payer: Multiplan Commercial |
$0.84
|
|
|
ALBUMIN, HUMAN 25% CONTINUOUS INTRAVENOUS SOLUTION [4088981]
|
Facility
|
OP
|
$1.39
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$53.08 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.83
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.67
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.83
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.67
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$1.11
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.90
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.83
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.67
|
| Rate for Payer: Intervalley Health Plan Commercial |
$53.08
|
| Rate for Payer: Intervalley Health Plan Commercial |
$53.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Medi-Cal/Medicare Advantage |
$0.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Medi-Cal/Medicare Advantage |
$0.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$1.04
|
| Rate for Payer: Multiplan Commercial |
$0.84
|
|
