|
TRASTUZUMAB 150 MG INTRAVENOUS SOLUTION [216113]
|
Facility
|
IP
|
$1,870.10
|
|
|
Service Code
|
HCPCS J9355
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$374.02 |
| Max. Negotiated Rate |
$1,589.59 |
| Rate for Payer: Adventist Health Commercial |
$374.02
|
| Rate for Payer: Blue Shield of California Commercial |
$1,438.11
|
| Rate for Payer: Blue Shield of California Commercial |
$948.14
|
| Rate for Payer: Cash Price |
$841.54
|
| Rate for Payer: Cigna of CA HMO |
$1,309.07
|
| Rate for Payer: Cigna of CA PPO |
$1,309.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,309.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$748.04
|
| Rate for Payer: EPIC Health Plan Senior |
$748.04
|
| Rate for Payer: Galaxy Health WC |
$1,589.59
|
| Rate for Payer: Global Benefits Group Commercial |
$1,122.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,187.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,103.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.82
|
| Rate for Payer: Multiplan Commercial |
$1,496.08
|
| Rate for Payer: Networks By Design Commercial |
$935.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,589.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$701.85
|
| Rate for Payer: United Healthcare All Other HMO |
$683.15
|
| Rate for Payer: United Healthcare HMO Rider |
$668.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$612.46
|
|
|
TRASTUZUMAB 600 MG-HYALURONIDASE-OYSK 10,000 UNIT/5 ML SUBCUT SOLUTION [224561]
|
Facility
|
IP
|
$1,122.06
|
|
|
Service Code
|
HCPCS J9356
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$224.41 |
| Max. Negotiated Rate |
$953.75 |
| Rate for Payer: Adventist Health Commercial |
$224.41
|
| Rate for Payer: Blue Shield of California Commercial |
$568.88
|
| Rate for Payer: Blue Shield of California Commercial |
$862.86
|
| Rate for Payer: Cash Price |
$504.93
|
| Rate for Payer: Cigna of CA HMO |
$785.44
|
| Rate for Payer: Cigna of CA PPO |
$785.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$785.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$448.82
|
| Rate for Payer: EPIC Health Plan Senior |
$448.82
|
| Rate for Payer: Galaxy Health WC |
$953.75
|
| Rate for Payer: Global Benefits Group Commercial |
$673.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$712.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$662.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.29
|
| Rate for Payer: Multiplan Commercial |
$897.65
|
| Rate for Payer: Networks By Design Commercial |
$561.03
|
| Rate for Payer: Prime Health Services Commercial |
$953.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$421.11
|
| Rate for Payer: United Healthcare All Other HMO |
$409.89
|
| Rate for Payer: United Healthcare HMO Rider |
$401.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$367.47
|
|
|
TRASTUZUMAB 600 MG-HYALURONIDASE-OYSK 10,000 UNIT/5 ML SUBCUT SOLUTION [224561]
|
Facility
|
OP
|
$1,122.06
|
|
|
Service Code
|
HCPCS J9356
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.34 |
| Max. Negotiated Rate |
$953.75 |
| Rate for Payer: Adventist Health Commercial |
$224.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$395.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$87.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$199.07
|
| Rate for Payer: Blue Shield of California Commercial |
$93.50
|
| Rate for Payer: Cash Price |
$504.93
|
| Rate for Payer: Cash Price |
$504.93
|
| Rate for Payer: Cigna of CA HMO |
$785.44
|
| Rate for Payer: Cigna of CA PPO |
$785.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$785.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.26
|
| Rate for Payer: EPIC Health Plan Senior |
$64.17
|
| Rate for Payer: Galaxy Health WC |
$953.75
|
| Rate for Payer: Global Benefits Group Commercial |
$673.24
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$95.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$58.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$712.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$124.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.18
|
| Rate for Payer: Multiplan Commercial |
$897.65
|
| Rate for Payer: Networks By Design Commercial |
$561.03
|
| Rate for Payer: Prime Health Services Commercial |
$953.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$673.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$673.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$421.11
|
| Rate for Payer: United Healthcare All Other HMO |
$409.89
|
| Rate for Payer: United Healthcare HMO Rider |
$401.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$367.47
|
| Rate for Payer: Upland Medical Group Pediatric |
$58.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.17
|
| Rate for Payer: Vantage Medical Group Senior |
$64.17
|
|
|
TRASTUZUMAB-ANNS 150 MG INTRAVENOUS SOLUTION [226189]
|
Facility
|
IP
|
$1,632.08
|
|
|
Service Code
|
HCPCS Q5117
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$326.42 |
| Max. Negotiated Rate |
$1,387.27 |
| Rate for Payer: Adventist Health Commercial |
$326.42
|
| Rate for Payer: Blue Shield of California Commercial |
$1,255.07
|
| Rate for Payer: Blue Shield of California Commercial |
$827.46
|
| Rate for Payer: Cash Price |
$734.44
|
| Rate for Payer: Cigna of CA HMO |
$1,142.46
|
| Rate for Payer: Cigna of CA PPO |
$1,142.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,142.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$652.83
|
| Rate for Payer: EPIC Health Plan Senior |
$652.83
|
| Rate for Payer: Galaxy Health WC |
$1,387.27
|
| Rate for Payer: Global Benefits Group Commercial |
$979.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,036.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$962.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$391.70
|
| Rate for Payer: Multiplan Commercial |
$1,305.66
|
| Rate for Payer: Networks By Design Commercial |
$816.04
|
| Rate for Payer: Prime Health Services Commercial |
$1,387.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$612.52
|
| Rate for Payer: United Healthcare All Other HMO |
$596.20
|
| Rate for Payer: United Healthcare HMO Rider |
$583.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$534.51
|
|
|
TRASTUZUMAB-ANNS 150 MG INTRAVENOUS SOLUTION [226189]
|
Facility
|
OP
|
$1,632.08
|
|
|
Service Code
|
HCPCS Q5117
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.52 |
| Max. Negotiated Rate |
$1,387.27 |
| Rate for Payer: Adventist Health Commercial |
$326.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$175.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$224.92
|
| Rate for Payer: Blue Shield of California Commercial |
$108.81
|
| Rate for Payer: Cash Price |
$734.44
|
| Rate for Payer: Cash Price |
$734.44
|
| Rate for Payer: Cigna of CA HMO |
$1,142.46
|
| Rate for Payer: Cigna of CA PPO |
$1,142.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$66.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,142.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.86
|
| Rate for Payer: EPIC Health Plan Senior |
$66.57
|
| Rate for Payer: Galaxy Health WC |
$1,387.27
|
| Rate for Payer: Global Benefits Group Commercial |
$979.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$99.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$60.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,036.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$97.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$391.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$76.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$81.10
|
| Rate for Payer: Multiplan Commercial |
$1,305.66
|
| Rate for Payer: Networks By Design Commercial |
$816.04
|
| Rate for Payer: Prime Health Services Commercial |
$1,387.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$979.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$979.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$612.52
|
| Rate for Payer: United Healthcare All Other HMO |
$596.20
|
| Rate for Payer: United Healthcare HMO Rider |
$583.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$534.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$60.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.57
|
| Rate for Payer: Vantage Medical Group Senior |
$66.57
|
|
|
TRASTUZUMAB-ANNS 420 MG INTRAVENOUS SOLUTION [225307]
|
Facility
|
IP
|
$4,569.82
|
|
|
Service Code
|
HCPCS Q5117
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$913.96 |
| Max. Negotiated Rate |
$3,884.35 |
| Rate for Payer: Adventist Health Commercial |
$913.96
|
| Rate for Payer: Blue Shield of California Commercial |
$2,316.90
|
| Rate for Payer: Blue Shield of California Commercial |
$3,514.19
|
| Rate for Payer: Cash Price |
$2,056.42
|
| Rate for Payer: Cigna of CA HMO |
$3,198.87
|
| Rate for Payer: Cigna of CA PPO |
$3,198.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,198.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,827.93
|
| Rate for Payer: EPIC Health Plan Senior |
$1,827.93
|
| Rate for Payer: Galaxy Health WC |
$3,884.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,741.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,901.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,696.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,096.76
|
| Rate for Payer: Multiplan Commercial |
$3,655.86
|
| Rate for Payer: Networks By Design Commercial |
$2,284.91
|
| Rate for Payer: Prime Health Services Commercial |
$3,884.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,715.05
|
| Rate for Payer: United Healthcare All Other HMO |
$1,669.36
|
| Rate for Payer: United Healthcare HMO Rider |
$1,633.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,496.62
|
|
|
TRASTUZUMAB-ANNS 420 MG INTRAVENOUS SOLUTION [225307]
|
Facility
|
OP
|
$4,569.82
|
|
|
Service Code
|
HCPCS Q5117
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.52 |
| Max. Negotiated Rate |
$3,884.35 |
| Rate for Payer: Adventist Health Commercial |
$913.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$175.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$224.92
|
| Rate for Payer: Blue Shield of California Commercial |
$108.81
|
| Rate for Payer: Cash Price |
$2,056.42
|
| Rate for Payer: Cash Price |
$2,056.42
|
| Rate for Payer: Cigna of CA HMO |
$3,198.87
|
| Rate for Payer: Cigna of CA PPO |
$3,198.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$66.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,198.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.86
|
| Rate for Payer: EPIC Health Plan Senior |
$66.57
|
| Rate for Payer: Galaxy Health WC |
$3,884.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,741.89
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$99.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$60.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,901.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$97.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,096.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$76.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$81.10
|
| Rate for Payer: Multiplan Commercial |
$3,655.86
|
| Rate for Payer: Networks By Design Commercial |
$2,284.91
|
| Rate for Payer: Prime Health Services Commercial |
$3,884.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,741.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,741.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,715.05
|
| Rate for Payer: United Healthcare All Other HMO |
$1,669.36
|
| Rate for Payer: United Healthcare HMO Rider |
$1,633.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,496.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$60.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.57
|
| Rate for Payer: Vantage Medical Group Senior |
$66.57
|
|
|
TRAUMATIC INJURY WITH MCC
|
Facility
|
IP
|
$108,255.30
|
|
|
Service Code
|
MSDRG 913
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$108,255.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49,554.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$108,255.30
|
| Rate for Payer: EPIC Health Plan Senior |
$72,170.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$65,609.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$91,852.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$87,916.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
TRAUMATIC INJURY WITHOUT MCC
|
Facility
|
IP
|
$94,962.65
|
|
|
Service Code
|
MSDRG 914
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$94,962.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$26,844.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$94,962.65
|
| Rate for Payer: EPIC Health Plan Senior |
$63,308.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$57,553.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80,574.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77,121.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC
|
Facility
|
IP
|
$102,365.79
|
|
|
Service Code
|
MSDRG 086
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$102,365.79 |
| Rate for Payer: Aetna of CA HMO/PPO |
$39,492.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$102,365.79
|
| Rate for Payer: EPIC Health Plan Senior |
$68,243.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62,039.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$86,855.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83,133.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC
|
Facility
|
IP
|
$104,017.86
|
|
|
Service Code
|
MSDRG 083
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$104,017.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$42,315.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$104,017.86
|
| Rate for Payer: EPIC Health Plan Senior |
$69,345.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$63,041.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88,257.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84,475.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC
|
Facility
|
IP
|
$119,564.08
|
|
|
Service Code
|
MSDRG 085
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$119,564.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$68,874.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$119,564.08
|
| Rate for Payer: EPIC Health Plan Senior |
$79,709.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$72,463.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$101,448.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$97,100.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC
|
Facility
|
IP
|
$119,807.19
|
|
|
Service Code
|
MSDRG 082
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$119,807.19 |
| Rate for Payer: EPIC Health Plan Senior |
$79,871.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$69,290.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$119,807.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$72,610.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$101,654.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$97,297.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC
|
Facility
|
IP
|
$95,480.81
|
|
|
Service Code
|
MSDRG 087
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$95,480.81 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,730.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$95,480.81
|
| Rate for Payer: EPIC Health Plan Senior |
$63,653.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$57,867.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81,014.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77,541.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC
|
Facility
|
IP
|
$96,210.13
|
|
|
Service Code
|
MSDRG 084
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$96,210.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$28,976.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$96,210.13
|
| Rate for Payer: EPIC Health Plan Senior |
$64,140.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58,309.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81,632.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78,134.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC
|
Facility
|
IP
|
$105,371.77
|
|
|
Service Code
|
MSDRG 604
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$105,371.77 |
| Rate for Payer: Aetna of CA HMO/PPO |
$44,628.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$105,371.77
|
| Rate for Payer: EPIC Health Plan Senior |
$70,247.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$63,861.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89,406.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$85,574.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC
|
Facility
|
IP
|
$95,503.90
|
|
|
Service Code
|
MSDRG 605
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$95,503.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,769.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$95,503.90
|
| Rate for Payer: EPIC Health Plan Senior |
$63,669.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$57,881.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81,033.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77,560.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
TRAVOPROST 0.004 % EYE DROPS [110762]
|
Facility
|
OP
|
$60.36
|
|
|
Service Code
|
NDC 6050505934
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.07 |
| Max. Negotiated Rate |
$51.31 |
| Rate for Payer: Adventist Health Commercial |
$12.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.73
|
| Rate for Payer: Cash Price |
$27.16
|
| Rate for Payer: Cigna of CA HMO |
$42.25
|
| Rate for Payer: Cigna of CA PPO |
$42.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.14
|
| Rate for Payer: EPIC Health Plan Senior |
$24.14
|
| Rate for Payer: Galaxy Health WC |
$51.31
|
| Rate for Payer: Global Benefits Group Commercial |
$36.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.25
|
| Rate for Payer: Multiplan Commercial |
$48.29
|
| Rate for Payer: Networks By Design Commercial |
$39.23
|
| Rate for Payer: Prime Health Services Commercial |
$51.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.18
|
| Rate for Payer: United Healthcare All Other HMO |
$30.18
|
| Rate for Payer: United Healthcare HMO Rider |
$30.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.31
|
| Rate for Payer: Vantage Medical Group Senior |
$51.31
|
|
|
TRAVOPROST 0.004 % EYE DROPS [110762]
|
Facility
|
OP
|
$76.17
|
|
|
Service Code
|
NDC 0378965132
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$15.23 |
| Max. Negotiated Rate |
$64.74 |
| Rate for Payer: Adventist Health Commercial |
$15.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.88
|
| Rate for Payer: Cash Price |
$34.28
|
| Rate for Payer: Cigna of CA HMO |
$53.32
|
| Rate for Payer: Cigna of CA PPO |
$53.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.47
|
| Rate for Payer: EPIC Health Plan Senior |
$30.47
|
| Rate for Payer: Galaxy Health WC |
$64.74
|
| Rate for Payer: Global Benefits Group Commercial |
$45.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.32
|
| Rate for Payer: Multiplan Commercial |
$60.94
|
| Rate for Payer: Networks By Design Commercial |
$49.51
|
| Rate for Payer: Prime Health Services Commercial |
$64.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.09
|
| Rate for Payer: United Healthcare All Other HMO |
$38.09
|
| Rate for Payer: United Healthcare HMO Rider |
$38.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.74
|
| Rate for Payer: Vantage Medical Group Senior |
$64.74
|
|
|
TRAVOPROST 0.004 % EYE DROPS [110762]
|
Facility
|
IP
|
$76.17
|
|
|
Service Code
|
NDC 0378965132
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$15.23 |
| Max. Negotiated Rate |
$64.74 |
| Rate for Payer: Adventist Health Commercial |
$15.23
|
| Rate for Payer: Blue Shield of California Commercial |
$38.62
|
| Rate for Payer: Blue Shield of California Commercial |
$58.57
|
| Rate for Payer: Cash Price |
$34.28
|
| Rate for Payer: Cigna of CA HMO |
$53.32
|
| Rate for Payer: Cigna of CA PPO |
$53.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.47
|
| Rate for Payer: EPIC Health Plan Senior |
$30.47
|
| Rate for Payer: Galaxy Health WC |
$64.74
|
| Rate for Payer: Global Benefits Group Commercial |
$45.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.28
|
| Rate for Payer: Multiplan Commercial |
$60.94
|
| Rate for Payer: Networks By Design Commercial |
$49.51
|
| Rate for Payer: Prime Health Services Commercial |
$64.74
|
|
|
TRAVOPROST 0.004 % EYE DROPS [110762]
|
Facility
|
IP
|
$60.36
|
|
|
Service Code
|
NDC 6050505934
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.07 |
| Max. Negotiated Rate |
$51.31 |
| Rate for Payer: Adventist Health Commercial |
$12.07
|
| Rate for Payer: Blue Shield of California Commercial |
$30.60
|
| Rate for Payer: Blue Shield of California Commercial |
$46.42
|
| Rate for Payer: Cash Price |
$27.16
|
| Rate for Payer: Cigna of CA HMO |
$42.25
|
| Rate for Payer: Cigna of CA PPO |
$42.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.14
|
| Rate for Payer: EPIC Health Plan Senior |
$24.14
|
| Rate for Payer: Galaxy Health WC |
$51.31
|
| Rate for Payer: Global Benefits Group Commercial |
$36.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.49
|
| Rate for Payer: Multiplan Commercial |
$48.29
|
| Rate for Payer: Networks By Design Commercial |
$39.23
|
| Rate for Payer: Prime Health Services Commercial |
$51.31
|
|
|
TRAZODONE 100 MG TABLET [8083]
|
Facility
|
IP
|
$0.11
|
|
|
Service Code
|
NDC 7001023201
|
| 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 |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.06
|
| 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
|
|
|
TRAZODONE 100 MG TABLET [8083]
|
Facility
|
IP
|
$0.15
|
|
|
Service Code
|
NDC 5011156101
|
| 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
|
|
|
TRAZODONE 100 MG TABLET [8083]
|
Facility
|
OP
|
$0.11
|
|
|
Service Code
|
NDC 7001023201
|
| 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 |
$0.05
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.06
|
| 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
|
|
|
TRAZODONE 100 MG TABLET [8083]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 6068745401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
|
