|
SACUBITRIL 97 MG-VALSARTAN 103 MG TABLET [210399]
|
Facility
|
OP
|
$1.99
|
|
|
Service Code
|
NDC 6923827331
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.69 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.28
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO |
$1.39
|
| Rate for Payer: Cigna of CA PPO |
$1.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Senior |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.69
|
| Rate for Payer: Global Benefits Group Commercial |
$1.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.39
|
| Rate for Payer: Multiplan Commercial |
$1.59
|
| Rate for Payer: Networks By Design Commercial |
$1.29
|
| Rate for Payer: Prime Health Services Commercial |
$1.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1.69
|
|
|
SACUBITRIL 97 MG-VALSARTAN 103 MG TABLET [210399]
|
Facility
|
OP
|
$1.64
|
|
|
Service Code
|
NDC 7037703313
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.39 |
| Rate for Payer: Adventist Health Commercial |
$0.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.05
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Cigna of CA HMO |
$1.15
|
| Rate for Payer: Cigna of CA PPO |
$1.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.66
|
| Rate for Payer: EPIC Health Plan Senior |
$0.66
|
| Rate for Payer: Galaxy Health WC |
$1.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.15
|
| Rate for Payer: Multiplan Commercial |
$1.31
|
| Rate for Payer: Networks By Design Commercial |
$1.07
|
| Rate for Payer: Prime Health Services Commercial |
$1.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.82
|
| Rate for Payer: United Healthcare All Other HMO |
$0.82
|
| Rate for Payer: United Healthcare HMO Rider |
$0.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1.39
|
|
|
SALICYLIC ACID 17 % TOPICAL LIQUID [11323]
|
Facility
|
IP
|
$0.62
|
|
|
Service Code
|
NDC 1101725220
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California Commercial |
$0.48
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: EPIC Health Plan Senior |
$0.25
|
| Rate for Payer: Galaxy Health WC |
$0.53
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.53
|
|
|
SALICYLIC ACID 17 % TOPICAL LIQUID [11323]
|
Facility
|
OP
|
$0.62
|
|
|
Service Code
|
NDC 1101725220
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.40
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: EPIC Health Plan Senior |
$0.25
|
| Rate for Payer: Galaxy Health WC |
$0.53
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO |
$0.31
|
| Rate for Payer: United Healthcare HMO Rider |
$0.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.53
|
| Rate for Payer: Vantage Medical Group Senior |
$0.53
|
|
|
SALIVARY GLAND PROCEDURES
|
Facility
|
IP
|
$101,176.91
|
|
|
Service Code
|
MSDRG 139
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$101,176.91 |
| Rate for Payer: Aetna of CA HMO/PPO |
$36,639.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$101,176.91
|
| Rate for Payer: EPIC Health Plan Senior |
$67,451.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$61,319.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$85,847.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$82,167.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY [120000]
|
Facility
|
OP
|
$0.15
|
|
|
Service Code
|
NDC 4858200155
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Vantage Medical Group Senior |
$0.13
|
|
|
SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY [120000]
|
Facility
|
IP
|
$0.15
|
|
|
Service Code
|
NDC 4858200155
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.13
|
|
|
SALIVA STIMULANT COMBINATION NO.7 ORAL MUCOSAL GEL [216603]
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
NDC 4858251201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
SALIVA STIMULANT COMBINATION NO.7 ORAL MUCOSAL GEL [216603]
|
Facility
|
IP
|
$0.16
|
|
|
Service Code
|
NDC 4858251201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
|
SARGRAMOSTIM 250 MCG SOLUTION FOR INJECTION [11338]
|
Facility
|
IP
|
$377.55
|
|
|
Service Code
|
HCPCS J2820
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$75.51 |
| Max. Negotiated Rate |
$320.92 |
| Rate for Payer: Adventist Health Commercial |
$75.51
|
| Rate for Payer: Blue Shield of California Commercial |
$191.42
|
| Rate for Payer: Blue Shield of California Commercial |
$290.34
|
| Rate for Payer: Cash Price |
$169.90
|
| Rate for Payer: Cigna of CA HMO |
$264.29
|
| Rate for Payer: Cigna of CA PPO |
$264.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$264.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.02
|
| Rate for Payer: EPIC Health Plan Senior |
$151.02
|
| Rate for Payer: Galaxy Health WC |
$320.92
|
| Rate for Payer: Global Benefits Group Commercial |
$226.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$239.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$222.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.61
|
| Rate for Payer: Multiplan Commercial |
$302.04
|
| Rate for Payer: Networks By Design Commercial |
$188.78
|
| Rate for Payer: Prime Health Services Commercial |
$320.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$141.69
|
| Rate for Payer: United Healthcare All Other HMO |
$137.92
|
| Rate for Payer: United Healthcare HMO Rider |
$134.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.65
|
|
|
SARGRAMOSTIM 250 MCG SOLUTION FOR INJECTION [11338]
|
Facility
|
OP
|
$377.55
|
|
|
Service Code
|
HCPCS J2820
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.47 |
| Max. Negotiated Rate |
$376.62 |
| Rate for Payer: Adventist Health Commercial |
$75.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$376.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$78.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$68.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$325.72
|
| Rate for Payer: Blue Shield of California Commercial |
$74.03
|
| Rate for Payer: Cash Price |
$169.90
|
| Rate for Payer: Cash Price |
$169.90
|
| Rate for Payer: Cigna of CA HMO |
$264.29
|
| Rate for Payer: Cigna of CA PPO |
$264.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$78.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$68.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$264.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.08
|
| Rate for Payer: EPIC Health Plan Senior |
$68.72
|
| Rate for Payer: Galaxy Health WC |
$320.92
|
| Rate for Payer: Global Benefits Group Commercial |
$226.53
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$102.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$62.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$239.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.71
|
| Rate for Payer: Multiplan Commercial |
$302.04
|
| Rate for Payer: Networks By Design Commercial |
$188.78
|
| Rate for Payer: Prime Health Services Commercial |
$320.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$226.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$226.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$141.69
|
| Rate for Payer: United Healthcare All Other HMO |
$137.92
|
| Rate for Payer: United Healthcare HMO Rider |
$134.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$62.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$78.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.72
|
| Rate for Payer: Vantage Medical Group Senior |
$68.72
|
|
|
SARILUMAB 200 MG/1.14 ML SUBCUTANEOUS SYRINGE [216968]
|
Facility
|
OP
|
$2,568.38
|
|
|
Service Code
|
HCPCS C9399
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$513.68 |
| Max. Negotiated Rate |
$2,183.12 |
| Rate for Payer: Adventist Health Commercial |
$513.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,684.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,183.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,412.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,926.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,648.13
|
| Rate for Payer: Cash Price |
$1,155.77
|
| Rate for Payer: Cigna of CA HMO |
$1,797.87
|
| Rate for Payer: Cigna of CA PPO |
$1,797.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,183.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,183.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,183.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,797.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,027.35
|
| Rate for Payer: EPIC Health Plan Senior |
$1,027.35
|
| Rate for Payer: Galaxy Health WC |
$2,183.12
|
| Rate for Payer: Global Benefits Group Commercial |
$1,541.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,630.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$932.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,515.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$616.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,797.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,797.87
|
| Rate for Payer: Multiplan Commercial |
$2,054.70
|
| Rate for Payer: Networks By Design Commercial |
$1,284.19
|
| Rate for Payer: Prime Health Services Commercial |
$2,183.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,541.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,541.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$963.91
|
| Rate for Payer: United Healthcare All Other HMO |
$938.23
|
| Rate for Payer: United Healthcare HMO Rider |
$917.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$841.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,183.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,183.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,183.12
|
|
|
SARILUMAB 200 MG/1.14 ML SUBCUTANEOUS SYRINGE [216968]
|
Facility
|
IP
|
$2,568.38
|
|
|
Service Code
|
HCPCS C9399
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$513.68 |
| Max. Negotiated Rate |
$2,183.12 |
| Rate for Payer: Adventist Health Commercial |
$513.68
|
| Rate for Payer: Blue Shield of California Commercial |
$1,302.17
|
| Rate for Payer: Blue Shield of California Commercial |
$1,975.08
|
| Rate for Payer: Cash Price |
$1,155.77
|
| Rate for Payer: Cigna of CA HMO |
$1,797.87
|
| Rate for Payer: Cigna of CA PPO |
$1,797.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,797.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,027.35
|
| Rate for Payer: EPIC Health Plan Senior |
$1,027.35
|
| Rate for Payer: Galaxy Health WC |
$2,183.12
|
| Rate for Payer: Global Benefits Group Commercial |
$1,541.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,630.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,515.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$616.41
|
| Rate for Payer: Multiplan Commercial |
$2,054.70
|
| Rate for Payer: Networks By Design Commercial |
$1,284.19
|
| Rate for Payer: Prime Health Services Commercial |
$2,183.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$963.91
|
| Rate for Payer: United Healthcare All Other HMO |
$938.23
|
| Rate for Payer: United Healthcare HMO Rider |
$917.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$841.14
|
|
|
SCHIZOAFFECTIVE DISORDERS
|
Facility
|
IP
|
$10,203.89
|
|
|
Service Code
|
APR-DRG 7612
|
| Min. Negotiated Rate |
$8,149.69 |
| Max. Negotiated Rate |
$10,203.89 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8,149.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,203.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,129.80
|
|
|
SCHIZOAFFECTIVE DISORDERS
|
Facility
|
IP
|
$36,809.33
|
|
|
Service Code
|
APR-DRG 7614
|
| Min. Negotiated Rate |
$29,399.03 |
| Max. Negotiated Rate |
$36,809.33 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29,399.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36,809.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32,934.66
|
|
|
SCHIZOAFFECTIVE DISORDERS
|
Facility
|
IP
|
$18,304.96
|
|
|
Service Code
|
APR-DRG 7613
|
| Min. Negotiated Rate |
$14,619.88 |
| Max. Negotiated Rate |
$18,304.96 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14,619.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18,304.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,378.12
|
|
|
SCHIZOAFFECTIVE DISORDERS
|
Facility
|
IP
|
$9,887.66
|
|
|
Service Code
|
APR-DRG 7611
|
| Min. Negotiated Rate |
$7,897.12 |
| Max. Negotiated Rate |
$9,887.66 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,897.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,887.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,846.85
|
|
|
SCHIZOPHRENIA AND OTHER SEVERE PSYCHOTIC DISORDERS
|
Facility
|
IP
|
$10,735.63
|
|
|
Service Code
|
APR-DRG 7502
|
| Min. Negotiated Rate |
$8,574.38 |
| Max. Negotiated Rate |
$10,735.63 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8,574.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,735.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,605.56
|
|
|
SCHIZOPHRENIA AND OTHER SEVERE PSYCHOTIC DISORDERS
|
Facility
|
IP
|
$33,775.96
|
|
|
Service Code
|
APR-DRG 7504
|
| Min. Negotiated Rate |
$26,976.32 |
| Max. Negotiated Rate |
$33,775.96 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26,976.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33,775.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,220.59
|
|
|
SCHIZOPHRENIA AND OTHER SEVERE PSYCHOTIC DISORDERS
|
Facility
|
IP
|
$16,043.03
|
|
|
Service Code
|
APR-DRG 7503
|
| Min. Negotiated Rate |
$12,813.31 |
| Max. Negotiated Rate |
$16,043.03 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12,813.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16,043.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,354.29
|
|
|
SCHIZOPHRENIA AND OTHER SEVERE PSYCHOTIC DISORDERS
|
Facility
|
IP
|
$8,276.31
|
|
|
Service Code
|
APR-DRG 7501
|
| Min. Negotiated Rate |
$6,610.15 |
| Max. Negotiated Rate |
$8,276.31 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,610.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,276.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,405.11
|
|
|
SCLEROTHERAPY OF A FLUID COLLECTION (EG, LYMPHOCELE, CYST, OR SEROMA), PERCUTANEOUS, INCLUDING CONTRAST INJECTION(S), SCLEROSANT INJECTION(S), DIAGNOSTIC STUDY, IMAGING GUIDANCE (EG, ULTRASOUND, FLUOROSCOPY) AND RADIOLOGICAL SUPERVISION AND INTERPRETATION WHEN PERFORMED
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 49185
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,546.78 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,546.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,749.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,973.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,676.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,846.47
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [27696]
|
Facility
|
OP
|
$11.40
|
|
|
Service Code
|
NDC 4580258084
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$9.69 |
| Rate for Payer: Adventist Health Commercial |
$2.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.32
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cigna of CA HMO |
$7.98
|
| Rate for Payer: Cigna of CA PPO |
$7.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.56
|
| Rate for Payer: EPIC Health Plan Senior |
$4.56
|
| Rate for Payer: Galaxy Health WC |
$9.69
|
| Rate for Payer: Global Benefits Group Commercial |
$6.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.98
|
| Rate for Payer: Multiplan Commercial |
$9.12
|
| Rate for Payer: Networks By Design Commercial |
$7.41
|
| Rate for Payer: Prime Health Services Commercial |
$9.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.70
|
| Rate for Payer: United Healthcare All Other HMO |
$5.70
|
| Rate for Payer: United Healthcare HMO Rider |
$5.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.69
|
| Rate for Payer: Vantage Medical Group Senior |
$9.69
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [27696]
|
Facility
|
OP
|
$11.40
|
|
|
Service Code
|
NDC 4285815014
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$9.69 |
| Rate for Payer: Adventist Health Commercial |
$2.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.32
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cigna of CA HMO |
$7.98
|
| Rate for Payer: Cigna of CA PPO |
$7.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.56
|
| Rate for Payer: EPIC Health Plan Senior |
$4.56
|
| Rate for Payer: Galaxy Health WC |
$9.69
|
| Rate for Payer: Global Benefits Group Commercial |
$6.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.98
|
| Rate for Payer: Multiplan Commercial |
$9.12
|
| Rate for Payer: Networks By Design Commercial |
$7.41
|
| Rate for Payer: Prime Health Services Commercial |
$9.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.70
|
| Rate for Payer: United Healthcare All Other HMO |
$5.70
|
| Rate for Payer: United Healthcare HMO Rider |
$5.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.69
|
| Rate for Payer: Vantage Medical Group Senior |
$9.69
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [27696]
|
Facility
|
OP
|
$22.06
|
|
|
Service Code
|
NDC 0378647016
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$4.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.16
|
| Rate for Payer: Cash Price |
$9.93
|
| Rate for Payer: Cigna of CA HMO |
$15.44
|
| Rate for Payer: Cigna of CA PPO |
$15.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.82
|
| Rate for Payer: EPIC Health Plan Senior |
$8.82
|
| Rate for Payer: Galaxy Health WC |
$18.75
|
| Rate for Payer: Global Benefits Group Commercial |
$13.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.44
|
| Rate for Payer: Multiplan Commercial |
$17.65
|
| Rate for Payer: Networks By Design Commercial |
$14.34
|
| Rate for Payer: Prime Health Services Commercial |
$18.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.03
|
| Rate for Payer: United Healthcare All Other HMO |
$11.03
|
| Rate for Payer: United Healthcare HMO Rider |
$11.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.75
|
| Rate for Payer: Vantage Medical Group Senior |
$18.75
|
|
