|
ILOPROST 10 MCG/ML SOLUTION FOR NEBULIZATION [40413]
|
Facility
|
OP
|
$161.64
|
|
|
Service Code
|
NDC 66215-302-00
|
| Hospital Charge Code |
1744129
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$88.90 |
| Max. Negotiated Rate |
$121.23 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$96.98
|
| Rate for Payer: Aetna of CA Government/Medicare |
$96.98
|
| Rate for Payer: Cash Price |
$72.74
|
| Rate for Payer: Health Smart Auto/Commercial |
$96.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$96.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.90
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$121.23
|
|
|
ILOPROST 10 MCG/ML SOLUTION FOR NEBULIZATION [40413]
|
Facility
|
IP
|
$161.64
|
|
|
Service Code
|
NDC 66215-302-30
|
| Hospital Charge Code |
1744129
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$88.90 |
| Max. Negotiated Rate |
$129.31 |
| Rate for Payer: Cash Price |
$72.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$129.31
|
| Rate for Payer: Health Smart Auto/Commercial |
$96.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.90
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$121.23
|
|
|
ILOPROST 20 MCG/ML SOLUTION FOR NEBULIZATION [99773]
|
Facility
|
OP
|
$161.64
|
|
|
Service Code
|
NDC 66215-303-30
|
| Hospital Charge Code |
1744134
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$88.90 |
| Max. Negotiated Rate |
$121.23 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$96.98
|
| Rate for Payer: Aetna of CA Government/Medicare |
$96.98
|
| Rate for Payer: Cash Price |
$72.74
|
| Rate for Payer: Health Smart Auto/Commercial |
$96.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$96.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.90
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$121.23
|
|
|
ILOPROST 20 MCG/ML SOLUTION FOR NEBULIZATION [99773]
|
Facility
|
IP
|
$161.64
|
|
|
Service Code
|
NDC 66215-303-30
|
| Hospital Charge Code |
1744134
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$88.90 |
| Max. Negotiated Rate |
$129.31 |
| Rate for Payer: Cash Price |
$72.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$129.31
|
| Rate for Payer: Health Smart Auto/Commercial |
$96.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.90
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$121.23
|
|
|
ILOPROST 20 MCG/ML SOLUTION FOR NEBULIZATION [99773]
|
Facility
|
IP
|
$161.64
|
|
|
Service Code
|
NDC 66215-303-00
|
| Hospital Charge Code |
1744134
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$88.90 |
| Max. Negotiated Rate |
$129.31 |
| Rate for Payer: Cash Price |
$72.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$129.31
|
| Rate for Payer: Health Smart Auto/Commercial |
$96.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.90
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$121.23
|
|
|
ILOPROST 20 MCG/ML SOLUTION FOR NEBULIZATION [99773]
|
Facility
|
OP
|
$161.64
|
|
|
Service Code
|
NDC 66215-303-00
|
| Hospital Charge Code |
1744134
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$88.90 |
| Max. Negotiated Rate |
$121.23 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$96.98
|
| Rate for Payer: Aetna of CA Government/Medicare |
$96.98
|
| Rate for Payer: Cash Price |
$72.74
|
| Rate for Payer: Health Smart Auto/Commercial |
$96.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$96.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.90
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$121.23
|
|
|
IMATINIB 100 MG TABLET [32979]
|
Facility
|
OP
|
$1.97
|
|
|
Service Code
|
CPT S0088
|
| Hospital Charge Code |
1711843
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.18
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$32.16
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$2.73
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.88
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.88
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.18
|
| Rate for Payer: Aetna of CA Government/Medicare |
$32.16
|
| Rate for Payer: Aetna of CA Government/Medicare |
$2.73
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Cash Price |
$24.12
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.88
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.18
|
| Rate for Payer: Health Smart Auto/Commercial |
$32.16
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$32.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$2.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.48
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$3.41
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.48
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.10
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$40.20
|
|
|
IMATINIB 100 MG TABLET [32979]
|
Facility
|
IP
|
$1.97
|
|
|
Service Code
|
CPT S0088
|
| Hospital Charge Code |
1711843
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$1.58 |
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cash Price |
$24.12
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$42.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.58
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.18
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.18
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.73
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.88
|
| Rate for Payer: Health Smart Auto/Commercial |
$32.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$40.20
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.10
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$3.41
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.48
|
|
|
IMATINIB 400 MG TABLET [36092]
|
Facility
|
OP
|
$16.38
|
|
|
Service Code
|
CPT S0088
|
| Hospital Charge Code |
1711842
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$12.28 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$9.83
|
| Rate for Payer: Aetna of CA Government/Medicare |
$9.83
|
| Rate for Payer: Cash Price |
$7.37
|
| Rate for Payer: Health Smart Auto/Commercial |
$9.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$9.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.01
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$12.28
|
|
|
IMATINIB 400 MG TABLET [36092]
|
Facility
|
IP
|
$16.38
|
|
|
Service Code
|
CPT S0088
|
| Hospital Charge Code |
1711842
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$13.10 |
| Rate for Payer: Cash Price |
$7.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.10
|
| Rate for Payer: Health Smart Auto/Commercial |
$9.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.01
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$12.28
|
|
|
IMIPENEM-CILASTATIN 250 MG INTRAVENOUS SOLUTION [9602]
|
Facility
|
IP
|
$17.99
|
|
|
Service Code
|
CPT J0743
|
| Hospital Charge Code |
ERX9602
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.89 |
| Max. Negotiated Rate |
$14.39 |
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.39
|
| Rate for Payer: Health Smart Auto/Commercial |
$10.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.89
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$13.49
|
|
|
IMIPENEM-CILASTATIN 250 MG INTRAVENOUS SOLUTION [9602]
|
Facility
|
OP
|
$17.99
|
|
|
Service Code
|
CPT J0743
|
| Hospital Charge Code |
ERX9602
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.89 |
| Max. Negotiated Rate |
$13.49 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$10.79
|
| Rate for Payer: Aetna of CA Government/Medicare |
$10.79
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Health Smart Auto/Commercial |
$10.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$10.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.89
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$13.49
|
|
|
IMIPENEM-CILASTATIN 500 MG INTRAVENOUS SOLUTION [9603]
|
Facility
|
IP
|
$32.82
|
|
|
Service Code
|
CPT J0743
|
| Hospital Charge Code |
1753116
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.05 |
| Max. Negotiated Rate |
$26.26 |
| Rate for Payer: Cash Price |
$14.77
|
| Rate for Payer: Cash Price |
$16.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.26
|
| Rate for Payer: Health Smart Auto/Commercial |
$19.69
|
| Rate for Payer: Health Smart Auto/Commercial |
$21.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.05
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$24.62
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$26.98
|
|
|
IMIPENEM-CILASTATIN 500 MG INTRAVENOUS SOLUTION [9603]
|
Facility
|
OP
|
$32.82
|
|
|
Service Code
|
CPT J0743
|
| Hospital Charge Code |
1753116
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.05 |
| Max. Negotiated Rate |
$24.62 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$19.69
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$21.59
|
| Rate for Payer: Aetna of CA Government/Medicare |
$21.59
|
| Rate for Payer: Aetna of CA Government/Medicare |
$19.69
|
| Rate for Payer: Cash Price |
$16.19
|
| Rate for Payer: Cash Price |
$14.77
|
| Rate for Payer: Health Smart Auto/Commercial |
$19.69
|
| Rate for Payer: Health Smart Auto/Commercial |
$21.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$21.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$19.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.05
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$26.98
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$24.62
|
|
|
IMIPRAMINE 10 MG TABLET [3860]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 69315-133-01
|
| Hospital Charge Code |
1711106
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.17
|
|
|
IMIPRAMINE 10 MG TABLET [3860]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 69315-133-01
|
| Hospital Charge Code |
1711106
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.13
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.13
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.17
|
|
|
IMIPRAMINE 25 MG TABLET [3861]
|
Facility
|
OP
|
$0.29
|
|
|
Service Code
|
NDC 49884-055-01
|
| Hospital Charge Code |
1711197
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.17
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.17
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.22
|
|
|
IMIPRAMINE 25 MG TABLET [3861]
|
Facility
|
IP
|
$0.29
|
|
|
Service Code
|
NDC 69315-134-01
|
| Hospital Charge Code |
1711197
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.23
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.22
|
|
|
IMIPRAMINE 25 MG TABLET [3861]
|
Facility
|
OP
|
$0.29
|
|
|
Service Code
|
NDC 69315-134-01
|
| Hospital Charge Code |
1711197
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.17
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.17
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.22
|
|
|
IMIPRAMINE 25 MG TABLET [3861]
|
Facility
|
IP
|
$0.29
|
|
|
Service Code
|
NDC 49884-055-01
|
| Hospital Charge Code |
1711197
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.23
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.22
|
|
|
IMIPRAMINE 25 MG TABLET [3861]
|
Facility
|
IP
|
$0.41
|
|
|
Service Code
|
NDC 0781-1764-01
|
| Hospital Charge Code |
1711197
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.33 |
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.33
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.31
|
|
|
IMIPRAMINE 25 MG TABLET [3861]
|
Facility
|
OP
|
$0.41
|
|
|
Service Code
|
NDC 0781-1764-01
|
| Hospital Charge Code |
1711197
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.25
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.25
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.31
|
|
|
IMIQUIMOD 5 % TOPICAL CREAM PACKET [20718]
|
Facility
|
IP
|
$8.50
|
|
|
Service Code
|
NDC 99207-260-12
|
| Hospital Charge Code |
1743682
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$6.80 |
| Rate for Payer: Cash Price |
$3.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.80
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.68
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$6.38
|
|
|
IMIQUIMOD 5 % TOPICAL CREAM PACKET [20718]
|
Facility
|
OP
|
$2.50
|
|
|
Service Code
|
NDC 45802-368-62
|
| Hospital Charge Code |
1743682
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.50
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.50
|
| Rate for Payer: Cash Price |
$1.13
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.38
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.88
|
|
|
IMIQUIMOD 5 % TOPICAL CREAM PACKET [20718]
|
Facility
|
OP
|
$2.50
|
|
|
Service Code
|
NDC 45802-368-00
|
| Hospital Charge Code |
1743682
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.50
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.50
|
| Rate for Payer: Cash Price |
$1.13
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.38
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.88
|
|
