|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION [152936]
|
Facility
|
IP
|
$0.15
|
|
|
Service Code
|
NDC 68094-193-59
|
| Hospital Charge Code |
1716069
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.11
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION [152936]
|
Facility
|
OP
|
$0.34
|
|
|
Service Code
|
NDC 0121-4675-40
|
| Hospital Charge Code |
1716069
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.26 |
| 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 |
$0.15
|
| 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 Beech St/Commercial/PHCS |
$0.26
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION [152936]
|
Facility
|
OP
|
$0.21
|
|
|
Service Code
|
NDC 0121-4675-05
|
| Hospital Charge Code |
1716069
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.16 |
| 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 |
$0.09
|
| 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 |
$0.16
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION [152936]
|
Facility
|
OP
|
$0.15
|
|
|
Service Code
|
NDC 68094-193-62
|
| Hospital Charge Code |
1716069
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.09
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.09
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.11
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION [152936]
|
Facility
|
IP
|
$0.21
|
|
|
Service Code
|
NDC 0121-4675-05
|
| Hospital Charge Code |
1716069
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.17
|
| 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 |
$0.16
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION [152936]
|
Facility
|
IP
|
$0.34
|
|
|
Service Code
|
NDC 0121-4675-40
|
| Hospital Charge Code |
1716069
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS |
$0.26
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION [152936]
|
Facility
|
IP
|
$0.15
|
|
|
Service Code
|
NDC 68094-193-62
|
| Hospital Charge Code |
1716069
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.11
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML ORAL SOLUTION [8428]
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 0121-0675-16
|
| Hospital Charge Code |
NDG8428
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.02
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML ORAL SOLUTION [8428]
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 60432-621-16
|
| Hospital Charge Code |
NDG8428
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.02
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML ORAL SOLUTION [8428]
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 60432-621-16
|
| Hospital Charge Code |
NDG8428
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.02
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.02
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML ORAL SOLUTION [8428]
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 0121-0675-16
|
| Hospital Charge Code |
NDG8428
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.02
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.02
|
|
|
VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION [188966]
|
Facility
|
IP
|
$0.15
|
|
|
Service Code
|
NDC 68094-701-61
|
| Hospital Charge Code |
NDG186966
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.11
|
|
|
VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION [188966]
|
Facility
|
IP
|
$0.19
|
|
|
Service Code
|
NDC 0121-1350-10
|
| Hospital Charge Code |
NDG186966
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.15
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.14
|
|
|
VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION [188966]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 60687-262-56
|
| Hospital Charge Code |
NDG186966
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.08
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.08
|
|
|
VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION [188966]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 60687-262-42
|
| Hospital Charge Code |
NDG186966
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.08
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.08
|
|
|
VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION [188966]
|
Facility
|
OP
|
$0.15
|
|
|
Service Code
|
NDC 68094-701-61
|
| Hospital Charge Code |
NDG186966
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.09
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.09
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.11
|
|
|
VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION [188966]
|
Facility
|
OP
|
$0.19
|
|
|
Service Code
|
NDC 0121-1350-10
|
| Hospital Charge Code |
NDG186966
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.11
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.11
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.14
|
|
|
VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION [188966]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
NDC 60687-262-56
|
| Hospital Charge Code |
NDG186966
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.06
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.08
|
|
|
VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION [188966]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
NDC 60687-262-42
|
| Hospital Charge Code |
NDG186966
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.06
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.08
|
|
|
VALRUBICIN 40 MG/ML INTRAVESICAL SOLUTION [24425]
|
Facility
|
OP
|
$508.13
|
|
|
Service Code
|
CPT J9357
|
| Hospital Charge Code |
NDG24425
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$279.47 |
| Max. Negotiated Rate |
$381.10 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$304.88
|
| Rate for Payer: Aetna of CA Government/Medicare |
$304.88
|
| Rate for Payer: Cash Price |
$228.66
|
| Rate for Payer: Health Smart Auto/Commercial |
$304.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$304.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$279.47
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$381.10
|
|
|
VALRUBICIN 40 MG/ML INTRAVESICAL SOLUTION [24425]
|
Facility
|
IP
|
$508.13
|
|
|
Service Code
|
CPT J9357
|
| Hospital Charge Code |
NDG24425
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$279.47 |
| Max. Negotiated Rate |
$406.50 |
| Rate for Payer: Cash Price |
$228.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$406.50
|
| Rate for Payer: Health Smart Auto/Commercial |
$304.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$279.47
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$381.10
|
|
|
VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION [8442]
|
Facility
|
OP
|
$19.08
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
1717199
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.49 |
| Max. Negotiated Rate |
$14.31 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$11.45
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$11.55
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$4.31
|
| Rate for Payer: Aetna of CA Government/Medicare |
$11.45
|
| Rate for Payer: Aetna of CA Government/Medicare |
$11.55
|
| Rate for Payer: Aetna of CA Government/Medicare |
$4.31
|
| Rate for Payer: Cash Price |
$8.66
|
| Rate for Payer: Cash Price |
$8.59
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Health Smart Auto/Commercial |
$11.55
|
| Rate for Payer: Health Smart Auto/Commercial |
$11.45
|
| Rate for Payer: Health Smart Auto/Commercial |
$4.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$11.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$11.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$4.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.59
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$5.39
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$14.44
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$14.31
|
|
|
VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION [8442]
|
Facility
|
IP
|
$19.25
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
1717199
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.59 |
| Max. Negotiated Rate |
$15.40 |
| Rate for Payer: Cash Price |
$8.66
|
| Rate for Payer: Cash Price |
$8.59
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.75
|
| Rate for Payer: Health Smart Auto/Commercial |
$11.55
|
| Rate for Payer: Health Smart Auto/Commercial |
$11.45
|
| Rate for Payer: Health Smart Auto/Commercial |
$4.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.49
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$14.44
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$5.39
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$14.31
|
|
|
VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION [11627]
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
ERX11627
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$76.80 |
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$117.31
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$76.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$204.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$208.54
|
| Rate for Payer: Health Smart Auto/Commercial |
$153.00
|
| Rate for Payer: Health Smart Auto/Commercial |
$57.60
|
| Rate for Payer: Health Smart Auto/Commercial |
$156.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.37
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$195.51
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$191.25
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$72.00
|
|
|
VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION [11627]
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
ERX11627
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$140.25 |
| Max. Negotiated Rate |
$191.25 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$153.00
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$156.41
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$57.60
|
| Rate for Payer: Aetna of CA Government/Medicare |
$156.41
|
| Rate for Payer: Aetna of CA Government/Medicare |
$153.00
|
| Rate for Payer: Aetna of CA Government/Medicare |
$57.60
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cash Price |
$117.31
|
| Rate for Payer: Health Smart Auto/Commercial |
$156.41
|
| Rate for Payer: Health Smart Auto/Commercial |
$153.00
|
| Rate for Payer: Health Smart Auto/Commercial |
$57.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$153.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$57.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$156.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.25
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$191.25
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$72.00
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$195.51
|
|
