|
HYDROCORTISONE 100 MG SOLUTION FOR INJECTION. [408111163]
|
Facility
|
OP
|
$28.88
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.88 |
| Max. Negotiated Rate |
$23.10 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$17.33
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$13.79
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$17.01
|
| Rate for Payer: Aetna of CA Government/Medicare |
$13.79
|
| Rate for Payer: Aetna of CA Government/Medicare |
$17.33
|
| Rate for Payer: Aetna of CA Government/Medicare |
$17.01
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: Cash Price |
$15.89
|
| Rate for Payer: Cash Price |
$15.59
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$23.10
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$18.38
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$22.68
|
| Rate for Payer: Health Smart Auto/Commercial |
$13.79
|
| Rate for Payer: Health Smart Auto/Commercial |
$17.01
|
| Rate for Payer: Health Smart Auto/Commercial |
$17.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$17.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$13.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$17.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.88
|
| Rate for Payer: Multiplan Commercial |
$17.23
|
| Rate for Payer: Multiplan Commercial |
$21.26
|
| Rate for Payer: Multiplan Commercial |
$21.66
|
|
|
HYDROCORTISONE 100 MG SOLUTION FOR INJECTION. [408111163]
|
Facility
|
IP
|
$28.88
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.88 |
| Max. Negotiated Rate |
$23.10 |
| Rate for Payer: Cash Price |
$15.89
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: Cash Price |
$15.59
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$22.68
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$23.10
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$18.38
|
| Rate for Payer: Health Smart Auto/Commercial |
$13.79
|
| Rate for Payer: Health Smart Auto/Commercial |
$17.01
|
| Rate for Payer: Health Smart Auto/Commercial |
$17.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.59
|
| Rate for Payer: Multiplan Commercial |
$17.23
|
| Rate for Payer: Multiplan Commercial |
$21.26
|
| Rate for Payer: Multiplan Commercial |
$21.66
|
|
|
HYDROCORTISONE 10 MG TABLET [3733]
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 60687-582-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$1.60
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.10
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
|
|
HYDROCORTISONE 10 MG TABLET [3733]
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 60687-582-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$1.60
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.10
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
|
|
HYDROCORTISONE 10 MG TABLET [3733]
|
Facility
|
IP
|
$0.57
|
|
|
Service Code
|
NDC 0115-1697-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.46
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$0.43
|
|
|
HYDROCORTISONE 10 MG TABLET [3733]
|
Facility
|
OP
|
$0.57
|
|
|
Service Code
|
NDC 0115-1697-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.34
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.34
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.46
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$0.43
|
|
|
HYDROCORTISONE 10 MG TABLET [3733]
|
Facility
|
IP
|
$0.34
|
|
|
Service Code
|
NDC 59651-414-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.27
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
|
|
HYDROCORTISONE 10 MG TABLET [3733]
|
Facility
|
OP
|
$0.34
|
|
|
Service Code
|
NDC 59762-0074-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.20
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.20
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.27
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
|
|
HYDROCORTISONE 10 MG TABLET [3733]
|
Facility
|
OP
|
$1.03
|
|
|
Service Code
|
NDC 64380-971-06
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.62
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.62
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.82
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$0.77
|
|
|
HYDROCORTISONE 10 MG TABLET [3733]
|
Facility
|
IP
|
$1.03
|
|
|
Service Code
|
NDC 64380-971-06
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.82
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$0.77
|
|
|
HYDROCORTISONE 10 MG TABLET [3733]
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
NDC 60687-582-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.20
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.20
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$1.60
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.10
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
|
|
HYDROCORTISONE 10 MG TABLET [3733]
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
NDC 60687-582-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.20
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.20
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$1.60
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.10
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
|
|
HYDROCORTISONE 10 MG TABLET [3733]
|
Facility
|
OP
|
$0.34
|
|
|
Service Code
|
NDC 59651-414-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.20
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.20
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.27
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
|
|
HYDROCORTISONE 10 MG TABLET [3733]
|
Facility
|
IP
|
$0.34
|
|
|
Service Code
|
NDC 59762-0074-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.27
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
|
|
HYDROCORTISONE 1 % LOTION [3728]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 6373633942
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.05
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
|
|
HYDROCORTISONE 1 % LOTION [3728]
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 6373633942
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.04
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.05
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
|
|
HYDROCORTISONE 1 %-PRAMOXINE 1 % RECTAL FOAM [28849]
|
Facility
|
OP
|
$23.33
|
|
|
Service Code
|
NDC 0037-6822-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.83 |
| Max. Negotiated Rate |
$18.66 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$14.00
|
| Rate for Payer: Aetna of CA Government/Medicare |
$14.00
|
| Rate for Payer: Cash Price |
$12.83
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$18.66
|
| Rate for Payer: Health Smart Auto/Commercial |
$14.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$14.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.83
|
| Rate for Payer: Multiplan Commercial |
$17.50
|
|
|
HYDROCORTISONE 1 %-PRAMOXINE 1 % RECTAL FOAM [28849]
|
Facility
|
IP
|
$23.33
|
|
|
Service Code
|
NDC 0037-6822-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.83 |
| Max. Negotiated Rate |
$18.66 |
| Rate for Payer: Cash Price |
$12.83
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$18.66
|
| Rate for Payer: Health Smart Auto/Commercial |
$14.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.83
|
| Rate for Payer: Multiplan Commercial |
$17.50
|
|
|
HYDROCORTISONE 1 % TOPICAL CREAM [3726]
|
Facility
|
OP
|
$0.25
|
|
|
Service Code
|
NDC 0168-0015-31
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.15
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.15
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.20
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
|
|
HYDROCORTISONE 1 % TOPICAL CREAM [3726]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 45802-438-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.05
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.07
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
|
|
HYDROCORTISONE 1 % TOPICAL CREAM [3726]
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
NDC 45802-438-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.07
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
|
|
HYDROCORTISONE 1 % TOPICAL CREAM [3726]
|
Facility
|
IP
|
$0.25
|
|
|
Service Code
|
NDC 0168-0015-31
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.20
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
|
|
HYDROCORTISONE 1 % TOPICAL CREAM WRAP [4081930]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 68001-476-46
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.06
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
|
|
HYDROCORTISONE 1 % TOPICAL CREAM WRAP [4081930]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 68001-476-46
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.05
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.06
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
|
|
HYDROCORTISONE 1 % TOPICAL OINTMENT [3731]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 45802-276-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.05
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.07
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
|
