|
LETERMOVIR 480 MG TABLET [220339]
|
Facility
|
OP
|
$337.50
|
|
|
Service Code
|
NDC 0006307603
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$67.50 |
| Max. Negotiated Rate |
$286.88 |
| Rate for Payer: Adventist Health Commercial |
$67.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$221.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$286.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$185.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$253.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$216.57
|
| Rate for Payer: Cash Price |
$151.88
|
| Rate for Payer: Cigna of CA HMO |
$236.25
|
| Rate for Payer: Cigna of CA PPO |
$236.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$286.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$286.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$286.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$236.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.00
|
| Rate for Payer: EPIC Health Plan Senior |
$135.00
|
| Rate for Payer: Galaxy Health WC |
$286.88
|
| Rate for Payer: Global Benefits Group Commercial |
$202.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$214.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$122.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$199.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$236.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$236.25
|
| Rate for Payer: Multiplan Commercial |
$270.00
|
| Rate for Payer: Networks By Design Commercial |
$219.38
|
| Rate for Payer: Prime Health Services Commercial |
$286.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$202.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$202.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.75
|
| Rate for Payer: United Healthcare All Other HMO |
$168.75
|
| Rate for Payer: United Healthcare HMO Rider |
$168.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$286.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$286.88
|
| Rate for Payer: Vantage Medical Group Senior |
$286.88
|
|
|
LETERMOVIR 480 MG TABLET [220339]
|
Facility
|
IP
|
$337.50
|
|
|
Service Code
|
NDC 0006307603
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$67.50 |
| Max. Negotiated Rate |
$286.88 |
| Rate for Payer: Adventist Health Commercial |
$67.50
|
| Rate for Payer: Blue Shield of California Commercial |
$171.11
|
| Rate for Payer: Blue Shield of California Commercial |
$259.54
|
| Rate for Payer: Cash Price |
$151.88
|
| Rate for Payer: Cigna of CA HMO |
$236.25
|
| Rate for Payer: Cigna of CA PPO |
$236.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$236.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.00
|
| Rate for Payer: EPIC Health Plan Senior |
$135.00
|
| Rate for Payer: Galaxy Health WC |
$286.88
|
| Rate for Payer: Global Benefits Group Commercial |
$202.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$214.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$199.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.00
|
| Rate for Payer: Multiplan Commercial |
$270.00
|
| Rate for Payer: Networks By Design Commercial |
$219.38
|
| Rate for Payer: Prime Health Services Commercial |
$286.88
|
|
|
LETROZOLE 2.5 MG TABLET [21509]
|
Facility
|
IP
|
$0.30
|
|
|
Service Code
|
NDC 1672903410
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.24
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
|
|
LETROZOLE 2.5 MG TABLET [21509]
|
Facility
|
IP
|
$0.67
|
|
|
Service Code
|
NDC 5026847615
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$0.52
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna of CA HMO |
$0.47
|
| Rate for Payer: Cigna of CA PPO |
$0.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.27
|
| Rate for Payer: EPIC Health Plan Senior |
$0.27
|
| Rate for Payer: Galaxy Health WC |
$0.57
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
| Rate for Payer: Networks By Design Commercial |
$0.44
|
| Rate for Payer: Prime Health Services Commercial |
$0.57
|
|
|
LETROZOLE 2.5 MG TABLET [21509]
|
Facility
|
OP
|
$0.67
|
|
|
Service Code
|
NDC 5026847611
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.43
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna of CA HMO |
$0.47
|
| Rate for Payer: Cigna of CA PPO |
$0.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.27
|
| Rate for Payer: EPIC Health Plan Senior |
$0.27
|
| Rate for Payer: Galaxy Health WC |
$0.57
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.47
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
| Rate for Payer: Networks By Design Commercial |
$0.44
|
| Rate for Payer: Prime Health Services Commercial |
$0.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.34
|
| Rate for Payer: United Healthcare All Other HMO |
$0.34
|
| Rate for Payer: United Healthcare HMO Rider |
$0.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.57
|
| Rate for Payer: Vantage Medical Group Senior |
$0.57
|
|
|
LETROZOLE 2.5 MG TABLET [21509]
|
Facility
|
OP
|
$0.67
|
|
|
Service Code
|
NDC 5026847615
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.43
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna of CA HMO |
$0.47
|
| Rate for Payer: Cigna of CA PPO |
$0.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.27
|
| Rate for Payer: EPIC Health Plan Senior |
$0.27
|
| Rate for Payer: Galaxy Health WC |
$0.57
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.47
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
| Rate for Payer: Networks By Design Commercial |
$0.44
|
| Rate for Payer: Prime Health Services Commercial |
$0.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.34
|
| Rate for Payer: United Healthcare All Other HMO |
$0.34
|
| Rate for Payer: United Healthcare HMO Rider |
$0.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.57
|
| Rate for Payer: Vantage Medical Group Senior |
$0.57
|
|
|
LETROZOLE 2.5 MG TABLET [21509]
|
Facility
|
OP
|
$0.30
|
|
|
Service Code
|
NDC 1672903410
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.19
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.24
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.15
|
| Rate for Payer: United Healthcare All Other HMO |
$0.15
|
| Rate for Payer: United Healthcare HMO Rider |
$0.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
|
LETROZOLE 2.5 MG TABLET [21509]
|
Facility
|
IP
|
$0.67
|
|
|
Service Code
|
NDC 5026847611
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$0.52
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna of CA HMO |
$0.47
|
| Rate for Payer: Cigna of CA PPO |
$0.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.27
|
| Rate for Payer: EPIC Health Plan Senior |
$0.27
|
| Rate for Payer: Galaxy Health WC |
$0.57
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
| Rate for Payer: Networks By Design Commercial |
$0.44
|
| Rate for Payer: Prime Health Services Commercial |
$0.57
|
|
|
LEUCOVORIN CALCIUM 100 MG SOLUTION FOR INJECTION [4392]
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
HCPCS J0640
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Adventist Health Commercial |
$3.84
|
| Rate for Payer: Blue Shield of California Commercial |
$9.73
|
| Rate for Payer: Blue Shield of California Commercial |
$12.17
|
| Rate for Payer: Blue Shield of California Commercial |
$18.46
|
| Rate for Payer: Blue Shield of California Commercial |
$14.76
|
| Rate for Payer: Cash Price |
$8.64
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna of CA HMO |
$16.80
|
| Rate for Payer: Cigna of CA HMO |
$13.44
|
| Rate for Payer: Cigna of CA PPO |
$13.44
|
| Rate for Payer: Cigna of CA PPO |
$16.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$7.68
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$16.32
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Global Benefits Group Commercial |
$11.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Multiplan Commercial |
$15.36
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$9.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Prime Health Services Commercial |
$16.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.01
|
| Rate for Payer: United Healthcare All Other HMO |
$8.77
|
| Rate for Payer: United Healthcare All Other HMO |
$7.01
|
| Rate for Payer: United Healthcare HMO Rider |
$6.86
|
| Rate for Payer: United Healthcare HMO Rider |
$8.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.86
|
|
|
LEUCOVORIN CALCIUM 100 MG SOLUTION FOR INJECTION [4392]
|
Facility
|
OP
|
$19.20
|
|
|
Service Code
|
HCPCS J0640
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$51.33 |
| Rate for Payer: Adventist Health Commercial |
$3.84
|
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.33
|
| Rate for Payer: Blue Shield of California Commercial |
$9.90
|
| Rate for Payer: Blue Shield of California Commercial |
$9.90
|
| Rate for Payer: Cash Price |
$8.64
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$8.64
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna of CA HMO |
$16.80
|
| Rate for Payer: Cigna of CA HMO |
$13.44
|
| Rate for Payer: Cigna of CA PPO |
$16.80
|
| Rate for Payer: Cigna of CA PPO |
$13.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$7.68
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Galaxy Health WC |
$16.32
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Global Benefits Group Commercial |
$11.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Multiplan Commercial |
$15.36
|
| Rate for Payer: Networks By Design Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$9.60
|
| Rate for Payer: Prime Health Services Commercial |
$16.32
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.01
|
| Rate for Payer: United Healthcare All Other HMO |
$7.01
|
| Rate for Payer: United Healthcare All Other HMO |
$8.77
|
| Rate for Payer: United Healthcare HMO Rider |
$8.58
|
| Rate for Payer: United Healthcare HMO Rider |
$6.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$16.32
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
LEUCOVORIN CALCIUM 10 MG/ML INJECTION SOLUTION [15370]
|
Facility
|
IP
|
$2.84
|
|
|
Service Code
|
HCPCS J0640
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Adventist Health Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California Commercial |
$1.44
|
| Rate for Payer: Blue Shield of California Commercial |
$2.18
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: Cigna of CA HMO |
$1.99
|
| Rate for Payer: Cigna of CA PPO |
$1.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.14
|
| Rate for Payer: EPIC Health Plan Senior |
$1.14
|
| Rate for Payer: Galaxy Health WC |
$2.41
|
| Rate for Payer: Global Benefits Group Commercial |
$1.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: Multiplan Commercial |
$2.27
|
| Rate for Payer: Networks By Design Commercial |
$1.42
|
| Rate for Payer: Prime Health Services Commercial |
$2.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.07
|
| Rate for Payer: United Healthcare All Other HMO |
$1.04
|
| Rate for Payer: United Healthcare HMO Rider |
$1.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.93
|
|
|
LEUCOVORIN CALCIUM 10 MG/ML INJECTION SOLUTION [15370]
|
Facility
|
OP
|
$2.84
|
|
|
Service Code
|
HCPCS J0640
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$51.33 |
| Rate for Payer: Adventist Health Commercial |
$0.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.33
|
| Rate for Payer: Blue Shield of California Commercial |
$9.90
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: Cigna of CA HMO |
$1.99
|
| Rate for Payer: Cigna of CA PPO |
$1.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.14
|
| Rate for Payer: EPIC Health Plan Senior |
$1.14
|
| Rate for Payer: Galaxy Health WC |
$2.41
|
| Rate for Payer: Global Benefits Group Commercial |
$1.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.99
|
| Rate for Payer: Multiplan Commercial |
$2.27
|
| Rate for Payer: Networks By Design Commercial |
$1.42
|
| Rate for Payer: Prime Health Services Commercial |
$2.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.07
|
| Rate for Payer: United Healthcare All Other HMO |
$1.04
|
| Rate for Payer: United Healthcare HMO Rider |
$1.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.41
|
| Rate for Payer: Vantage Medical Group Senior |
$2.41
|
|
|
LEUCOVORIN CALCIUM 10 MG TABLET [4395]
|
Facility
|
IP
|
$7.48
|
|
|
Service Code
|
NDC 6931518512
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$6.36 |
| Rate for Payer: Adventist Health Commercial |
$1.50
|
| Rate for Payer: Blue Shield of California Commercial |
$3.79
|
| Rate for Payer: Blue Shield of California Commercial |
$5.75
|
| Rate for Payer: Cash Price |
$3.37
|
| Rate for Payer: Cigna of CA HMO |
$5.24
|
| Rate for Payer: Cigna of CA PPO |
$5.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.99
|
| Rate for Payer: EPIC Health Plan Senior |
$2.99
|
| Rate for Payer: Galaxy Health WC |
$6.36
|
| Rate for Payer: Global Benefits Group Commercial |
$4.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: Multiplan Commercial |
$5.98
|
| Rate for Payer: Networks By Design Commercial |
$4.86
|
| Rate for Payer: Prime Health Services Commercial |
$6.36
|
|
|
LEUCOVORIN CALCIUM 10 MG TABLET [4395]
|
Facility
|
OP
|
$7.48
|
|
|
Service Code
|
NDC 6931518512
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$6.36 |
| Rate for Payer: Adventist Health Commercial |
$1.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.80
|
| Rate for Payer: Cash Price |
$3.37
|
| Rate for Payer: Cigna of CA HMO |
$5.24
|
| Rate for Payer: Cigna of CA PPO |
$5.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.99
|
| Rate for Payer: EPIC Health Plan Senior |
$2.99
|
| Rate for Payer: Galaxy Health WC |
$6.36
|
| Rate for Payer: Global Benefits Group Commercial |
$4.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.24
|
| Rate for Payer: Multiplan Commercial |
$5.98
|
| Rate for Payer: Networks By Design Commercial |
$4.86
|
| Rate for Payer: Prime Health Services Commercial |
$6.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.74
|
| Rate for Payer: United Healthcare All Other HMO |
$3.74
|
| Rate for Payer: United Healthcare HMO Rider |
$3.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Vantage Medical Group Senior |
$6.36
|
|
|
LEUCOVORIN CALCIUM 10 MG TABLET [4395]
|
Facility
|
OP
|
$2.50
|
|
|
Service Code
|
NDC 5074218212
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Adventist Health Commercial |
$0.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.60
|
| Rate for Payer: Cash Price |
$1.12
|
| Rate for Payer: Cigna of CA HMO |
$1.75
|
| Rate for Payer: Cigna of CA PPO |
$1.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1.00
|
| Rate for Payer: Galaxy Health WC |
$2.12
|
| Rate for Payer: Global Benefits Group Commercial |
$1.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.75
|
| Rate for Payer: Multiplan Commercial |
$2.00
|
| Rate for Payer: Networks By Design Commercial |
$1.62
|
| Rate for Payer: Prime Health Services Commercial |
$2.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.25
|
| Rate for Payer: United Healthcare All Other HMO |
$1.25
|
| Rate for Payer: United Healthcare HMO Rider |
$1.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2.12
|
|
|
LEUCOVORIN CALCIUM 10 MG TABLET [4395]
|
Facility
|
IP
|
$7.48
|
|
|
Service Code
|
NDC 0054449705
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$6.36 |
| Rate for Payer: Adventist Health Commercial |
$1.50
|
| Rate for Payer: Blue Shield of California Commercial |
$3.79
|
| Rate for Payer: Blue Shield of California Commercial |
$5.75
|
| Rate for Payer: Cash Price |
$3.37
|
| Rate for Payer: Cigna of CA HMO |
$5.24
|
| Rate for Payer: Cigna of CA PPO |
$5.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.99
|
| Rate for Payer: EPIC Health Plan Senior |
$2.99
|
| Rate for Payer: Galaxy Health WC |
$6.36
|
| Rate for Payer: Global Benefits Group Commercial |
$4.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: Multiplan Commercial |
$5.98
|
| Rate for Payer: Networks By Design Commercial |
$4.86
|
| Rate for Payer: Prime Health Services Commercial |
$6.36
|
|
|
LEUCOVORIN CALCIUM 10 MG TABLET [4395]
|
Facility
|
IP
|
$2.50
|
|
|
Service Code
|
NDC 5074218224
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Adventist Health Commercial |
$0.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1.27
|
| Rate for Payer: Blue Shield of California Commercial |
$1.92
|
| Rate for Payer: Cash Price |
$1.12
|
| Rate for Payer: Cigna of CA HMO |
$1.75
|
| Rate for Payer: Cigna of CA PPO |
$1.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1.00
|
| Rate for Payer: Galaxy Health WC |
$2.12
|
| Rate for Payer: Global Benefits Group Commercial |
$1.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.60
|
| Rate for Payer: Multiplan Commercial |
$2.00
|
| Rate for Payer: Networks By Design Commercial |
$1.62
|
| Rate for Payer: Prime Health Services Commercial |
$2.12
|
|
|
LEUCOVORIN CALCIUM 10 MG TABLET [4395]
|
Facility
|
OP
|
$6.65
|
|
|
Service Code
|
NDC 6931518524
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$5.65 |
| Rate for Payer: Adventist Health Commercial |
$1.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.27
|
| Rate for Payer: Cash Price |
$2.99
|
| Rate for Payer: Cigna of CA HMO |
$4.66
|
| Rate for Payer: Cigna of CA PPO |
$4.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.66
|
| Rate for Payer: EPIC Health Plan Senior |
$2.66
|
| Rate for Payer: Galaxy Health WC |
$5.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.66
|
| Rate for Payer: Multiplan Commercial |
$5.32
|
| Rate for Payer: Networks By Design Commercial |
$4.32
|
| Rate for Payer: Prime Health Services Commercial |
$5.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.33
|
| Rate for Payer: United Healthcare All Other HMO |
$3.33
|
| Rate for Payer: United Healthcare HMO Rider |
$3.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.65
|
| Rate for Payer: Vantage Medical Group Senior |
$5.65
|
|
|
LEUCOVORIN CALCIUM 10 MG TABLET [4395]
|
Facility
|
OP
|
$2.50
|
|
|
Service Code
|
NDC 5074218224
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Adventist Health Commercial |
$0.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.60
|
| Rate for Payer: Cash Price |
$1.12
|
| Rate for Payer: Cigna of CA HMO |
$1.75
|
| Rate for Payer: Cigna of CA PPO |
$1.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1.00
|
| Rate for Payer: Galaxy Health WC |
$2.12
|
| Rate for Payer: Global Benefits Group Commercial |
$1.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.75
|
| Rate for Payer: Multiplan Commercial |
$2.00
|
| Rate for Payer: Networks By Design Commercial |
$1.62
|
| Rate for Payer: Prime Health Services Commercial |
$2.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.25
|
| Rate for Payer: United Healthcare All Other HMO |
$1.25
|
| Rate for Payer: United Healthcare HMO Rider |
$1.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2.12
|
|
|
LEUCOVORIN CALCIUM 10 MG TABLET [4395]
|
Facility
|
OP
|
$6.65
|
|
|
Service Code
|
NDC 0054449710
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$5.65 |
| Rate for Payer: Adventist Health Commercial |
$1.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.27
|
| Rate for Payer: Cash Price |
$2.99
|
| Rate for Payer: Cigna of CA HMO |
$4.66
|
| Rate for Payer: Cigna of CA PPO |
$4.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.66
|
| Rate for Payer: EPIC Health Plan Senior |
$2.66
|
| Rate for Payer: Galaxy Health WC |
$5.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.66
|
| Rate for Payer: Multiplan Commercial |
$5.32
|
| Rate for Payer: Networks By Design Commercial |
$4.32
|
| Rate for Payer: Prime Health Services Commercial |
$5.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.33
|
| Rate for Payer: United Healthcare All Other HMO |
$3.33
|
| Rate for Payer: United Healthcare HMO Rider |
$3.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.65
|
| Rate for Payer: Vantage Medical Group Senior |
$5.65
|
|
|
LEUCOVORIN CALCIUM 10 MG TABLET [4395]
|
Facility
|
IP
|
$6.65
|
|
|
Service Code
|
NDC 6931518524
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$5.65 |
| Rate for Payer: Adventist Health Commercial |
$1.33
|
| Rate for Payer: Blue Shield of California Commercial |
$3.37
|
| Rate for Payer: Blue Shield of California Commercial |
$5.11
|
| Rate for Payer: Cash Price |
$2.99
|
| Rate for Payer: Cigna of CA HMO |
$4.66
|
| Rate for Payer: Cigna of CA PPO |
$4.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.66
|
| Rate for Payer: EPIC Health Plan Senior |
$2.66
|
| Rate for Payer: Galaxy Health WC |
$5.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.60
|
| Rate for Payer: Multiplan Commercial |
$5.32
|
| Rate for Payer: Networks By Design Commercial |
$4.32
|
| Rate for Payer: Prime Health Services Commercial |
$5.65
|
|
|
LEUCOVORIN CALCIUM 10 MG TABLET [4395]
|
Facility
|
IP
|
$6.65
|
|
|
Service Code
|
NDC 0054449710
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$5.65 |
| Rate for Payer: Adventist Health Commercial |
$1.33
|
| Rate for Payer: Blue Shield of California Commercial |
$3.37
|
| Rate for Payer: Blue Shield of California Commercial |
$5.11
|
| Rate for Payer: Cash Price |
$2.99
|
| Rate for Payer: Cigna of CA HMO |
$4.66
|
| Rate for Payer: Cigna of CA PPO |
$4.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.66
|
| Rate for Payer: EPIC Health Plan Senior |
$2.66
|
| Rate for Payer: Galaxy Health WC |
$5.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.60
|
| Rate for Payer: Multiplan Commercial |
$5.32
|
| Rate for Payer: Networks By Design Commercial |
$4.32
|
| Rate for Payer: Prime Health Services Commercial |
$5.65
|
|
|
LEUCOVORIN CALCIUM 10 MG TABLET [4395]
|
Facility
|
OP
|
$7.48
|
|
|
Service Code
|
NDC 0054449705
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$6.36 |
| Rate for Payer: Adventist Health Commercial |
$1.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.80
|
| Rate for Payer: Cash Price |
$3.37
|
| Rate for Payer: Cigna of CA HMO |
$5.24
|
| Rate for Payer: Cigna of CA PPO |
$5.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.99
|
| Rate for Payer: EPIC Health Plan Senior |
$2.99
|
| Rate for Payer: Galaxy Health WC |
$6.36
|
| Rate for Payer: Global Benefits Group Commercial |
$4.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.24
|
| Rate for Payer: Multiplan Commercial |
$5.98
|
| Rate for Payer: Networks By Design Commercial |
$4.86
|
| Rate for Payer: Prime Health Services Commercial |
$6.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.74
|
| Rate for Payer: United Healthcare All Other HMO |
$3.74
|
| Rate for Payer: United Healthcare HMO Rider |
$3.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Vantage Medical Group Senior |
$6.36
|
|
|
LEUCOVORIN CALCIUM 10 MG TABLET [4395]
|
Facility
|
IP
|
$2.50
|
|
|
Service Code
|
NDC 5074218212
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Adventist Health Commercial |
$0.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1.27
|
| Rate for Payer: Blue Shield of California Commercial |
$1.92
|
| Rate for Payer: Cash Price |
$1.12
|
| Rate for Payer: Cigna of CA HMO |
$1.75
|
| Rate for Payer: Cigna of CA PPO |
$1.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1.00
|
| Rate for Payer: Galaxy Health WC |
$2.12
|
| Rate for Payer: Global Benefits Group Commercial |
$1.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.60
|
| Rate for Payer: Multiplan Commercial |
$2.00
|
| Rate for Payer: Networks By Design Commercial |
$1.62
|
| Rate for Payer: Prime Health Services Commercial |
$2.12
|
|
|
LEUCOVORIN CALCIUM 200 MG SOLUTION FOR INJECTION [15426]
|
Facility
|
OP
|
$28.80
|
|
|
Service Code
|
HCPCS J0640
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$51.33 |
| Rate for Payer: EPIC Health Plan Senior |
$11.52
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$11.07
|
| Rate for Payer: EPIC Health Plan Senior |
$19.20
|
| Rate for Payer: Galaxy Health WC |
$24.48
|
| Rate for Payer: Galaxy Health WC |
$23.52
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.52
|
| Rate for Payer: Vantage Medical Group Senior |
$40.80
|
| Rate for Payer: Vantage Medical Group Senior |
$23.52
|
| Rate for Payer: Vantage Medical Group Senior |
$24.48
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.52
|
| Rate for Payer: Adventist Health Commercial |
$5.76
|
| Rate for Payer: Adventist Health Commercial |
$5.53
|
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.33
|
| Rate for Payer: Blue Shield of California Commercial |
$9.90
|
| Rate for Payer: Blue Shield of California Commercial |
$9.90
|
| Rate for Payer: Blue Shield of California Commercial |
$9.90
|
| Rate for Payer: Blue Shield of California Commercial |
$9.90
|
| Rate for Payer: Cash Price |
$12.96
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$12.45
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$12.45
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$12.96
|
| Rate for Payer: Cigna of CA HMO |
$16.80
|
| Rate for Payer: Cigna of CA HMO |
$19.37
|
| Rate for Payer: Cigna of CA HMO |
$20.16
|
| Rate for Payer: Cigna of CA HMO |
$33.60
|
| Rate for Payer: Cigna of CA PPO |
$20.16
|
| Rate for Payer: Cigna of CA PPO |
$16.80
|
| Rate for Payer: Cigna of CA PPO |
$19.37
|
| Rate for Payer: Cigna of CA PPO |
$33.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: Global Benefits Group Commercial |
$16.60
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Global Benefits Group Commercial |
$17.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.37
|
| Rate for Payer: Multiplan Commercial |
$22.14
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Multiplan Commercial |
$23.04
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: Networks By Design Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$13.84
|
| Rate for Payer: Networks By Design Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$14.40
|
| Rate for Payer: Prime Health Services Commercial |
$23.52
|
| Rate for Payer: Prime Health Services Commercial |
$24.48
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.81
|
| Rate for Payer: United Healthcare All Other HMO |
$10.52
|
| Rate for Payer: United Healthcare All Other HMO |
$17.53
|
| Rate for Payer: United Healthcare All Other HMO |
$8.77
|
| Rate for Payer: United Healthcare All Other HMO |
$10.11
|
| Rate for Payer: United Healthcare HMO Rider |
$9.89
|
| Rate for Payer: United Healthcare HMO Rider |
$10.29
|
| Rate for Payer: United Healthcare HMO Rider |
$8.58
|
| Rate for Payer: United Healthcare HMO Rider |
$17.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.48
|
|
