|
TREPROSTINIL SODIUM 1 MG/ML INJECTION SOLUTION [32931]
|
Facility
|
OP
|
$68.76
|
|
|
Service Code
|
HCPCS J3285
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.75 |
| Max. Negotiated Rate |
$155.65 |
| Rate for Payer: Adventist Health Commercial |
$13.75
|
| Rate for Payer: Adventist Health Commercial |
$15.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$61.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$61.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.65
|
| Rate for Payer: Blue Shield of California Commercial |
$71.39
|
| Rate for Payer: Blue Shield of California Commercial |
$71.39
|
| Rate for Payer: Blue Shield of California EPN |
$71.39
|
| Rate for Payer: Blue Shield of California EPN |
$71.39
|
| Rate for Payer: Cash Price |
$42.02
|
| Rate for Payer: Cash Price |
$42.02
|
| Rate for Payer: Cash Price |
$37.82
|
| Rate for Payer: Cash Price |
$37.82
|
| Rate for Payer: Cigna of CA HMO |
$53.48
|
| Rate for Payer: Cigna of CA HMO |
$48.13
|
| Rate for Payer: Cigna of CA PPO |
$48.13
|
| Rate for Payer: Cigna of CA PPO |
$53.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$61.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$61.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$61.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$61.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.90
|
| Rate for Payer: EPIC Health Plan Senior |
$55.48
|
| Rate for Payer: EPIC Health Plan Senior |
$55.48
|
| Rate for Payer: Galaxy Health WC |
$58.45
|
| Rate for Payer: Galaxy Health WC |
$64.94
|
| Rate for Payer: Global Benefits Group Commercial |
$45.84
|
| Rate for Payer: Global Benefits Group Commercial |
$41.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$55.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$55.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$69.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$69.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74.34
|
| Rate for Payer: Multiplan Commercial |
$55.01
|
| Rate for Payer: Multiplan Commercial |
$61.12
|
| Rate for Payer: Networks By Design Commercial |
$38.20
|
| Rate for Payer: Networks By Design Commercial |
$34.38
|
| Rate for Payer: Prime Health Services Commercial |
$58.45
|
| Rate for Payer: Prime Health Services Commercial |
$64.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$41.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$41.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.81
|
| Rate for Payer: United Healthcare All Other HMO |
$25.12
|
| Rate for Payer: United Healthcare All Other HMO |
$27.91
|
| Rate for Payer: United Healthcare HMO Rider |
$24.57
|
| Rate for Payer: United Healthcare HMO Rider |
$27.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.52
|
| Rate for Payer: Upland Medical Group Pediatric |
$55.48
|
| Rate for Payer: Upland Medical Group Pediatric |
$55.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61.03
|
| Rate for Payer: Vantage Medical Group Senior |
$61.03
|
| Rate for Payer: Vantage Medical Group Senior |
$61.03
|
|
|
TREPROSTINIL SODIUM 2.5 MG/ML INJECTION SOLUTION [32932]
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
HCPCS J3285
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.20 |
| Max. Negotiated Rate |
$162.35 |
| Rate for Payer: Adventist Health Commercial |
$38.20
|
| Rate for Payer: Adventist Health Commercial |
$36.29
|
| Rate for Payer: Blue Shield of California Commercial |
$140.96
|
| Rate for Payer: Blue Shield of California Commercial |
$133.91
|
| Rate for Payer: Blue Shield of California EPN |
$88.18
|
| Rate for Payer: Blue Shield of California EPN |
$92.83
|
| Rate for Payer: Cash Price |
$105.05
|
| Rate for Payer: Cash Price |
$99.80
|
| Rate for Payer: Cigna of CA HMO |
$133.70
|
| Rate for Payer: Cigna of CA HMO |
$127.02
|
| Rate for Payer: Cigna of CA PPO |
$127.02
|
| Rate for Payer: Cigna of CA PPO |
$133.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.40
|
| Rate for Payer: EPIC Health Plan Senior |
$72.58
|
| Rate for Payer: EPIC Health Plan Senior |
$76.40
|
| Rate for Payer: Galaxy Health WC |
$154.23
|
| Rate for Payer: Galaxy Health WC |
$162.35
|
| Rate for Payer: Global Benefits Group Commercial |
$108.87
|
| Rate for Payer: Global Benefits Group Commercial |
$114.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$121.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$112.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$118.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.84
|
| Rate for Payer: Multiplan Commercial |
$145.16
|
| Rate for Payer: Multiplan Commercial |
$152.80
|
| Rate for Payer: Networks By Design Commercial |
$95.50
|
| Rate for Payer: Networks By Design Commercial |
$90.72
|
| Rate for Payer: Prime Health Services Commercial |
$162.35
|
| Rate for Payer: Prime Health Services Commercial |
$154.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$71.68
|
| Rate for Payer: United Healthcare All Other HMO |
$69.77
|
| Rate for Payer: United Healthcare All Other HMO |
$66.28
|
| Rate for Payer: United Healthcare HMO Rider |
$64.85
|
| Rate for Payer: United Healthcare HMO Rider |
$68.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.55
|
|
|
TREPROSTINIL SODIUM 2.5 MG/ML INJECTION SOLUTION [32932]
|
Facility
|
OP
|
$181.45
|
|
|
Service Code
|
HCPCS J3285
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.29 |
| Max. Negotiated Rate |
$155.65 |
| Rate for Payer: Adventist Health Commercial |
$36.29
|
| Rate for Payer: Adventist Health Commercial |
$38.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$125.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$61.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$61.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.65
|
| Rate for Payer: Blue Shield of California Commercial |
$71.39
|
| Rate for Payer: Blue Shield of California Commercial |
$71.39
|
| Rate for Payer: Blue Shield of California EPN |
$71.39
|
| Rate for Payer: Blue Shield of California EPN |
$71.39
|
| Rate for Payer: Cash Price |
$105.05
|
| Rate for Payer: Cash Price |
$105.05
|
| Rate for Payer: Cash Price |
$99.80
|
| Rate for Payer: Cash Price |
$99.80
|
| Rate for Payer: Cigna of CA HMO |
$133.70
|
| Rate for Payer: Cigna of CA HMO |
$127.02
|
| Rate for Payer: Cigna of CA PPO |
$127.02
|
| Rate for Payer: Cigna of CA PPO |
$133.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$61.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$61.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$61.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$61.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.90
|
| Rate for Payer: EPIC Health Plan Senior |
$55.48
|
| Rate for Payer: EPIC Health Plan Senior |
$55.48
|
| Rate for Payer: Galaxy Health WC |
$154.23
|
| Rate for Payer: Galaxy Health WC |
$162.35
|
| Rate for Payer: Global Benefits Group Commercial |
$114.60
|
| Rate for Payer: Global Benefits Group Commercial |
$108.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$55.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$55.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$121.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$69.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$69.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74.34
|
| Rate for Payer: Multiplan Commercial |
$145.16
|
| Rate for Payer: Multiplan Commercial |
$152.80
|
| Rate for Payer: Networks By Design Commercial |
$95.50
|
| Rate for Payer: Networks By Design Commercial |
$90.72
|
| Rate for Payer: Prime Health Services Commercial |
$154.23
|
| Rate for Payer: Prime Health Services Commercial |
$162.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$114.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$108.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$108.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$114.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$71.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.10
|
| Rate for Payer: United Healthcare All Other HMO |
$66.28
|
| Rate for Payer: United Healthcare All Other HMO |
$69.77
|
| Rate for Payer: United Healthcare HMO Rider |
$64.85
|
| Rate for Payer: United Healthcare HMO Rider |
$68.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$55.48
|
| Rate for Payer: Upland Medical Group Pediatric |
$55.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61.03
|
| Rate for Payer: Vantage Medical Group Senior |
$61.03
|
| Rate for Payer: Vantage Medical Group Senior |
$61.03
|
|
|
TREPROSTINIL SODIUM 5 MG/ML INJECTION SOLUTION [32933]
|
Facility
|
IP
|
$362.90
|
|
|
Service Code
|
HCPCS J3285
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$72.58 |
| Max. Negotiated Rate |
$308.46 |
| Rate for Payer: Adventist Health Commercial |
$72.58
|
| Rate for Payer: Adventist Health Commercial |
$68.76
|
| Rate for Payer: Blue Shield of California Commercial |
$267.82
|
| Rate for Payer: Blue Shield of California Commercial |
$253.72
|
| Rate for Payer: Blue Shield of California EPN |
$167.09
|
| Rate for Payer: Blue Shield of California EPN |
$176.37
|
| Rate for Payer: Cash Price |
$199.59
|
| Rate for Payer: Cash Price |
$189.09
|
| Rate for Payer: Cigna of CA HMO |
$254.03
|
| Rate for Payer: Cigna of CA HMO |
$240.66
|
| Rate for Payer: Cigna of CA PPO |
$240.66
|
| Rate for Payer: Cigna of CA PPO |
$254.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$137.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$145.16
|
| Rate for Payer: EPIC Health Plan Senior |
$137.52
|
| Rate for Payer: EPIC Health Plan Senior |
$145.16
|
| Rate for Payer: Galaxy Health WC |
$292.23
|
| Rate for Payer: Galaxy Health WC |
$308.46
|
| Rate for Payer: Global Benefits Group Commercial |
$206.28
|
| Rate for Payer: Global Benefits Group Commercial |
$217.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$242.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$229.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$138.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$212.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$224.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.10
|
| Rate for Payer: Multiplan Commercial |
$275.04
|
| Rate for Payer: Multiplan Commercial |
$290.32
|
| Rate for Payer: Networks By Design Commercial |
$181.45
|
| Rate for Payer: Networks By Design Commercial |
$171.90
|
| Rate for Payer: Prime Health Services Commercial |
$308.46
|
| Rate for Payer: Prime Health Services Commercial |
$292.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$129.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$136.20
|
| Rate for Payer: United Healthcare All Other HMO |
$132.57
|
| Rate for Payer: United Healthcare All Other HMO |
$125.59
|
| Rate for Payer: United Healthcare HMO Rider |
$122.87
|
| Rate for Payer: United Healthcare HMO Rider |
$129.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$118.85
|
|
|
TREPROSTINIL SODIUM 5 MG/ML INJECTION SOLUTION [32933]
|
Facility
|
OP
|
$343.80
|
|
|
Service Code
|
HCPCS J3285
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.48 |
| Max. Negotiated Rate |
$292.23 |
| Rate for Payer: Adventist Health Commercial |
$68.76
|
| Rate for Payer: Adventist Health Commercial |
$72.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$225.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$238.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$61.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$61.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.65
|
| Rate for Payer: Blue Shield of California Commercial |
$71.39
|
| Rate for Payer: Blue Shield of California Commercial |
$71.39
|
| Rate for Payer: Blue Shield of California EPN |
$71.39
|
| Rate for Payer: Blue Shield of California EPN |
$71.39
|
| Rate for Payer: Cash Price |
$199.59
|
| Rate for Payer: Cash Price |
$199.59
|
| Rate for Payer: Cash Price |
$189.09
|
| Rate for Payer: Cash Price |
$189.09
|
| Rate for Payer: Cigna of CA HMO |
$254.03
|
| Rate for Payer: Cigna of CA HMO |
$240.66
|
| Rate for Payer: Cigna of CA PPO |
$240.66
|
| Rate for Payer: Cigna of CA PPO |
$254.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$61.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$61.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$61.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$61.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.90
|
| Rate for Payer: EPIC Health Plan Senior |
$55.48
|
| Rate for Payer: EPIC Health Plan Senior |
$55.48
|
| Rate for Payer: Galaxy Health WC |
$292.23
|
| Rate for Payer: Galaxy Health WC |
$308.46
|
| Rate for Payer: Global Benefits Group Commercial |
$217.74
|
| Rate for Payer: Global Benefits Group Commercial |
$206.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$55.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$55.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$242.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$229.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$69.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$69.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74.34
|
| Rate for Payer: Multiplan Commercial |
$275.04
|
| Rate for Payer: Multiplan Commercial |
$290.32
|
| Rate for Payer: Networks By Design Commercial |
$181.45
|
| Rate for Payer: Networks By Design Commercial |
$171.90
|
| Rate for Payer: Prime Health Services Commercial |
$292.23
|
| Rate for Payer: Prime Health Services Commercial |
$308.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$217.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$206.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$206.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$217.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$136.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$129.03
|
| Rate for Payer: United Healthcare All Other HMO |
$125.59
|
| Rate for Payer: United Healthcare All Other HMO |
$132.57
|
| Rate for Payer: United Healthcare HMO Rider |
$122.87
|
| Rate for Payer: United Healthcare HMO Rider |
$129.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$118.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$55.48
|
| Rate for Payer: Upland Medical Group Pediatric |
$55.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61.03
|
| Rate for Payer: Vantage Medical Group Senior |
$61.03
|
| Rate for Payer: Vantage Medical Group Senior |
$61.03
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE [16005]
|
Facility
|
IP
|
$33.03
|
|
|
Service Code
|
NDC 68084-075-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.61 |
| Max. Negotiated Rate |
$28.08 |
| Rate for Payer: Adventist Health Commercial |
$6.61
|
| Rate for Payer: Blue Shield of California Commercial |
$24.38
|
| Rate for Payer: Blue Shield of California EPN |
$16.05
|
| Rate for Payer: Cash Price |
$18.17
|
| Rate for Payer: Cigna of CA HMO |
$23.12
|
| Rate for Payer: Cigna of CA PPO |
$23.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.21
|
| Rate for Payer: EPIC Health Plan Senior |
$13.21
|
| Rate for Payer: Galaxy Health WC |
$28.08
|
| Rate for Payer: Global Benefits Group Commercial |
$19.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.93
|
| Rate for Payer: Multiplan Commercial |
$26.42
|
| Rate for Payer: Networks By Design Commercial |
$21.47
|
| Rate for Payer: Prime Health Services Commercial |
$28.08
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE [16005]
|
Facility
|
IP
|
$35.34
|
|
|
Service Code
|
NDC 68462-792-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$30.04 |
| Rate for Payer: Adventist Health Commercial |
$7.07
|
| Rate for Payer: Blue Shield of California Commercial |
$26.08
|
| Rate for Payer: Blue Shield of California EPN |
$17.18
|
| Rate for Payer: Cash Price |
$19.44
|
| Rate for Payer: Cigna of CA HMO |
$24.74
|
| Rate for Payer: Cigna of CA PPO |
$24.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.14
|
| Rate for Payer: EPIC Health Plan Senior |
$14.14
|
| Rate for Payer: Galaxy Health WC |
$30.04
|
| Rate for Payer: Global Benefits Group Commercial |
$21.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.48
|
| Rate for Payer: Multiplan Commercial |
$28.27
|
| Rate for Payer: Networks By Design Commercial |
$22.97
|
| Rate for Payer: Prime Health Services Commercial |
$30.04
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE [16005]
|
Facility
|
OP
|
$33.03
|
|
|
Service Code
|
NDC 68084-075-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.61 |
| Max. Negotiated Rate |
$28.08 |
| Rate for Payer: Adventist Health Commercial |
$6.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.28
|
| Rate for Payer: Cash Price |
$18.17
|
| Rate for Payer: Cigna of CA HMO |
$23.12
|
| Rate for Payer: Cigna of CA PPO |
$23.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.21
|
| Rate for Payer: EPIC Health Plan Senior |
$13.21
|
| Rate for Payer: Galaxy Health WC |
$28.08
|
| Rate for Payer: Global Benefits Group Commercial |
$19.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.12
|
| Rate for Payer: Multiplan Commercial |
$26.42
|
| Rate for Payer: Networks By Design Commercial |
$21.47
|
| Rate for Payer: Prime Health Services Commercial |
$28.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.52
|
| Rate for Payer: United Healthcare All Other HMO |
$16.52
|
| Rate for Payer: United Healthcare HMO Rider |
$16.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.08
|
| Rate for Payer: Vantage Medical Group Senior |
$28.08
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE [16005]
|
Facility
|
IP
|
$33.03
|
|
|
Service Code
|
NDC 68084-075-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.61 |
| Max. Negotiated Rate |
$28.08 |
| Rate for Payer: Adventist Health Commercial |
$6.61
|
| Rate for Payer: Blue Shield of California Commercial |
$24.38
|
| Rate for Payer: Blue Shield of California EPN |
$16.05
|
| Rate for Payer: Cash Price |
$18.17
|
| Rate for Payer: Cigna of CA HMO |
$23.12
|
| Rate for Payer: Cigna of CA PPO |
$23.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.21
|
| Rate for Payer: EPIC Health Plan Senior |
$13.21
|
| Rate for Payer: Galaxy Health WC |
$28.08
|
| Rate for Payer: Global Benefits Group Commercial |
$19.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.93
|
| Rate for Payer: Multiplan Commercial |
$26.42
|
| Rate for Payer: Networks By Design Commercial |
$21.47
|
| Rate for Payer: Prime Health Services Commercial |
$28.08
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE [16005]
|
Facility
|
OP
|
$35.34
|
|
|
Service Code
|
NDC 68462-792-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$30.04 |
| Rate for Payer: Adventist Health Commercial |
$7.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.70
|
| Rate for Payer: Cash Price |
$19.44
|
| Rate for Payer: Cigna of CA HMO |
$24.74
|
| Rate for Payer: Cigna of CA PPO |
$24.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.14
|
| Rate for Payer: EPIC Health Plan Senior |
$14.14
|
| Rate for Payer: Galaxy Health WC |
$30.04
|
| Rate for Payer: Global Benefits Group Commercial |
$21.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.74
|
| Rate for Payer: Multiplan Commercial |
$28.27
|
| Rate for Payer: Networks By Design Commercial |
$22.97
|
| Rate for Payer: Prime Health Services Commercial |
$30.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.67
|
| Rate for Payer: United Healthcare All Other HMO |
$17.67
|
| Rate for Payer: United Healthcare HMO Rider |
$17.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.04
|
| Rate for Payer: Vantage Medical Group Senior |
$30.04
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE [16005]
|
Facility
|
OP
|
$33.03
|
|
|
Service Code
|
NDC 68084-075-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.61 |
| Max. Negotiated Rate |
$28.08 |
| Rate for Payer: Adventist Health Commercial |
$6.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.28
|
| Rate for Payer: Cash Price |
$18.17
|
| Rate for Payer: Cigna of CA HMO |
$23.12
|
| Rate for Payer: Cigna of CA PPO |
$23.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.21
|
| Rate for Payer: EPIC Health Plan Senior |
$13.21
|
| Rate for Payer: Galaxy Health WC |
$28.08
|
| Rate for Payer: Global Benefits Group Commercial |
$19.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.12
|
| Rate for Payer: Multiplan Commercial |
$26.42
|
| Rate for Payer: Networks By Design Commercial |
$21.47
|
| Rate for Payer: Prime Health Services Commercial |
$28.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.52
|
| Rate for Payer: United Healthcare All Other HMO |
$16.52
|
| Rate for Payer: United Healthcare HMO Rider |
$16.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.08
|
| Rate for Payer: Vantage Medical Group Senior |
$28.08
|
|
|
TRETINOIN MICROSPHERES 0.1 % TOPICAL GEL [19468]
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
NDC 0187-5140-45
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$17.85 |
| Rate for Payer: Cigna of CA HMO |
$14.70
|
| Rate for Payer: Adventist Health Commercial |
$4.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.90
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cigna of CA PPO |
$14.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.40
|
| Rate for Payer: EPIC Health Plan Senior |
$8.40
|
| Rate for Payer: Galaxy Health WC |
$17.85
|
| Rate for Payer: Global Benefits Group Commercial |
$12.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.70
|
| Rate for Payer: Multiplan Commercial |
$16.80
|
| Rate for Payer: Networks By Design Commercial |
$13.65
|
| Rate for Payer: Prime Health Services Commercial |
$17.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.50
|
| Rate for Payer: United Healthcare All Other HMO |
$10.50
|
| Rate for Payer: United Healthcare HMO Rider |
$10.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.85
|
| Rate for Payer: Vantage Medical Group Senior |
$17.85
|
|
|
TRETINOIN MICROSPHERES 0.1 % TOPICAL GEL [19468]
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
NDC 0187-5140-45
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$17.85 |
| Rate for Payer: Adventist Health Commercial |
$4.20
|
| Rate for Payer: Blue Shield of California Commercial |
$15.50
|
| Rate for Payer: Blue Shield of California EPN |
$10.21
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cigna of CA HMO |
$14.70
|
| Rate for Payer: Cigna of CA PPO |
$14.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.40
|
| Rate for Payer: EPIC Health Plan Senior |
$8.40
|
| Rate for Payer: Galaxy Health WC |
$17.85
|
| Rate for Payer: Global Benefits Group Commercial |
$12.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.04
|
| Rate for Payer: Multiplan Commercial |
$16.80
|
| Rate for Payer: Networks By Design Commercial |
$13.65
|
| Rate for Payer: Prime Health Services Commercial |
$17.85
|
|
|
TRETINOIN (VESANOID) ORAL SYRINGE [40820212]
|
Facility
|
OP
|
$33.03
|
|
|
Service Code
|
NDC 9940-8202-12
|
| Min. Negotiated Rate |
$6.61 |
| Max. Negotiated Rate |
$28.08 |
| Rate for Payer: Adventist Health Commercial |
$6.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.28
|
| Rate for Payer: Cash Price |
$18.17
|
| Rate for Payer: Cigna of CA HMO |
$21.14
|
| Rate for Payer: Cigna of CA PPO |
$24.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.21
|
| Rate for Payer: EPIC Health Plan Senior |
$13.21
|
| Rate for Payer: Galaxy Health WC |
$28.08
|
| Rate for Payer: Global Benefits Group Commercial |
$19.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.12
|
| Rate for Payer: Multiplan Commercial |
$26.42
|
| Rate for Payer: Networks By Design Commercial |
$21.47
|
| Rate for Payer: Prime Health Services Commercial |
$28.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.52
|
| Rate for Payer: United Healthcare All Other HMO |
$16.52
|
| Rate for Payer: United Healthcare HMO Rider |
$16.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.08
|
| Rate for Payer: Vantage Medical Group Senior |
$28.08
|
|
|
TRETINOIN (VESANOID) ORAL SYRINGE [40820212]
|
Facility
|
IP
|
$33.03
|
|
|
Service Code
|
NDC 9940-8202-12
|
| Min. Negotiated Rate |
$6.61 |
| Max. Negotiated Rate |
$28.08 |
| Rate for Payer: Adventist Health Commercial |
$6.61
|
| Rate for Payer: Cash Price |
$18.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.21
|
| Rate for Payer: EPIC Health Plan Senior |
$13.21
|
| Rate for Payer: Galaxy Health WC |
$28.08
|
| Rate for Payer: Global Benefits Group Commercial |
$19.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.93
|
| Rate for Payer: Multiplan Commercial |
$26.42
|
| Rate for Payer: Networks By Design Commercial |
$21.47
|
| Rate for Payer: Prime Health Services Commercial |
$28.08
|
|
|
TRIAMCINOLONE 9 MG-MOXIFLOX 0.6 MG/0.6 ML IN WATER(PF)INTRAOCULAR SUSP [221760]
|
Facility
|
OP
|
$30.60
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$26.01 |
| Rate for Payer: United Healthcare HMO Rider |
$10.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.01
|
| Rate for Payer: Vantage Medical Group Senior |
$26.01
|
| Rate for Payer: Adventist Health Commercial |
$6.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.79
|
| Rate for Payer: Cash Price |
$16.83
|
| Rate for Payer: Cigna of CA HMO |
$21.42
|
| Rate for Payer: Cigna of CA PPO |
$21.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.24
|
| Rate for Payer: EPIC Health Plan Senior |
$12.24
|
| Rate for Payer: Galaxy Health WC |
$26.01
|
| Rate for Payer: Global Benefits Group Commercial |
$18.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.42
|
| Rate for Payer: Multiplan Commercial |
$24.48
|
| Rate for Payer: Networks By Design Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Commercial |
$26.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.48
|
| Rate for Payer: United Healthcare All Other HMO |
$11.18
|
|
|
TRIAMCINOLONE 9 MG-MOXIFLOX 0.6 MG/0.6 ML IN WATER(PF)INTRAOCULAR SUSP [221760]
|
Facility
|
IP
|
$30.60
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$26.01 |
| Rate for Payer: Adventist Health Commercial |
$6.12
|
| Rate for Payer: Blue Shield of California Commercial |
$22.58
|
| Rate for Payer: Blue Shield of California EPN |
$14.87
|
| Rate for Payer: Cash Price |
$16.83
|
| Rate for Payer: Cigna of CA HMO |
$21.42
|
| Rate for Payer: Cigna of CA PPO |
$21.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.24
|
| Rate for Payer: EPIC Health Plan Senior |
$12.24
|
| Rate for Payer: Galaxy Health WC |
$26.01
|
| Rate for Payer: Global Benefits Group Commercial |
$18.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.34
|
| Rate for Payer: Multiplan Commercial |
$24.48
|
| Rate for Payer: Networks By Design Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Commercial |
$26.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.48
|
| Rate for Payer: United Healthcare All Other HMO |
$11.18
|
| Rate for Payer: United Healthcare HMO Rider |
$10.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.02
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL CREAM [8112]
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
NDC 33342-327-80
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL CREAM [8112]
|
Facility
|
IP
|
$0.12
|
|
|
Service Code
|
NDC 45802-063-36
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL CREAM [8112]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 33342-327-80
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL CREAM [8112]
|
Facility
|
OP
|
$0.12
|
|
|
Service Code
|
NDC 45802-063-36
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.07
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Vantage Medical Group Senior |
$0.10
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL CREAM [8112]
|
Facility
|
OP
|
$0.11
|
|
|
Service Code
|
NDC 0713-0226-80
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL CREAM [8112]
|
Facility
|
IP
|
$0.14
|
|
|
Service Code
|
NDC 0168-0003-80
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL CREAM [8112]
|
Facility
|
IP
|
$0.11
|
|
|
Service Code
|
NDC 0713-0226-80
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL CREAM [8112]
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
NDC 0168-0003-80
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.12
|
| 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 |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.12
|
|
