|
BICALUTAMIDE 50 MG TABLET [15746]
|
Facility
|
IP
|
$0.60
|
|
|
Service Code
|
NDC 4733548583
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
|
|
BICALUTAMIDE 50 MG TABLET [15746]
|
Facility
|
OP
|
$0.60
|
|
|
Service Code
|
NDC 4733548583
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.39
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
|
BICARB HEMODIALYSIS SOLN WITHOUT CALCIUM NO 16 POT 4 MEQ-MAG 1.5 MEQ/L [121436]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.00
|
| Rate for Payer: United Healthcare All Other HMO |
$0.00
|
| Rate for Payer: United Healthcare HMO Rider |
$0.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
BICARB HEMODIALYSIS SOLN WITHOUT CALCIUM NO 16 POT 4 MEQ-MAG 1.5 MEQ/L [121436]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.00
|
| Rate for Payer: United Healthcare All Other HMO |
$0.00
|
| Rate for Payer: United Healthcare HMO Rider |
$0.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.00
|
|
|
BICARBONATE DIALYSIS SOLN WITHOUT CALCIUM NO15 POT 4 MEQ-MAG 1.2 MEQ/L [121260]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.00
|
| Rate for Payer: United Healthcare All Other HMO |
$0.00
|
| Rate for Payer: United Healthcare HMO Rider |
$0.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
BICARBONATE DIALYSIS SOLN WITHOUT CALCIUM NO15 POT 4 MEQ-MAG 1.2 MEQ/L [121260]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.00
|
| Rate for Payer: United Healthcare All Other HMO |
$0.00
|
| Rate for Payer: United Healthcare HMO Rider |
$0.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.00
|
|
|
BICARBONATE HEMODIALYSIS SOLUTION NO.2 K 2 MEQ-CA 3.5 MEQ-MG 1 MEQ/L [120070]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS A4706
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$41.71 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.00
|
| Rate for Payer: United Healthcare All Other HMO |
$0.00
|
| Rate for Payer: United Healthcare HMO Rider |
$0.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
BICARBONATE HEMODIALYSIS SOLUTION NO.2 K 2 MEQ-CA 3.5 MEQ-MG 1 MEQ/L [120070]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS A4706
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.00
|
| Rate for Payer: United Healthcare All Other HMO |
$0.00
|
| Rate for Payer: United Healthcare HMO Rider |
$0.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.00
|
|
|
BICARBONATE HEMODIALYSIS SOLUTION NO.9 K 4 MEQ-CA 2.5 MEQ-MG 1.5 MEQ/L [100176]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.00
|
| Rate for Payer: United Healthcare All Other HMO |
$0.00
|
| Rate for Payer: United Healthcare HMO Rider |
$0.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
|
|
BICARBONATE HEMODIALYSIS SOLUTION NO.9 K 4 MEQ-CA 2.5 MEQ-MG 1.5 MEQ/L [100176]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.00
|
| Rate for Payer: United Healthcare All Other HMO |
$0.00
|
| Rate for Payer: United Healthcare HMO Rider |
$0.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.00
|
|
|
BICTEGRAVIR 50 MG-EMTRICITABINE 200 MG-TENOFOVIR ALAFENAM 25 MG TABLET [221141]
|
Facility
|
IP
|
$168.64
|
|
|
Service Code
|
NDC 6195825013
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$33.73 |
| Max. Negotiated Rate |
$143.34 |
| Rate for Payer: Adventist Health Commercial |
$33.73
|
| Rate for Payer: Blue Shield of California Commercial |
$129.68
|
| Rate for Payer: Blue Shield of California Commercial |
$85.50
|
| Rate for Payer: Cash Price |
$75.89
|
| Rate for Payer: Cigna of CA HMO |
$118.05
|
| Rate for Payer: Cigna of CA PPO |
$118.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$118.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.46
|
| Rate for Payer: EPIC Health Plan Senior |
$67.46
|
| Rate for Payer: Galaxy Health WC |
$143.34
|
| Rate for Payer: Global Benefits Group Commercial |
$101.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$99.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.47
|
| Rate for Payer: Multiplan Commercial |
$134.91
|
| Rate for Payer: Networks By Design Commercial |
$109.62
|
| Rate for Payer: Prime Health Services Commercial |
$143.34
|
|
|
BICTEGRAVIR 50 MG-EMTRICITABINE 200 MG-TENOFOVIR ALAFENAM 25 MG TABLET [221141]
|
Facility
|
OP
|
$168.64
|
|
|
Service Code
|
NDC 6195825013
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$33.73 |
| Max. Negotiated Rate |
$143.34 |
| Rate for Payer: Adventist Health Commercial |
$33.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$143.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$92.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$126.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.22
|
| Rate for Payer: Cash Price |
$75.89
|
| Rate for Payer: Cigna of CA HMO |
$118.05
|
| Rate for Payer: Cigna of CA PPO |
$118.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$143.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$143.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$143.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$118.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.46
|
| Rate for Payer: EPIC Health Plan Senior |
$67.46
|
| Rate for Payer: Galaxy Health WC |
$143.34
|
| Rate for Payer: Global Benefits Group Commercial |
$101.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$61.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$99.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$118.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$118.05
|
| Rate for Payer: Multiplan Commercial |
$134.91
|
| Rate for Payer: Networks By Design Commercial |
$109.62
|
| Rate for Payer: Prime Health Services Commercial |
$143.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$101.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$101.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$84.32
|
| Rate for Payer: United Healthcare All Other HMO |
$84.32
|
| Rate for Payer: United Healthcare HMO Rider |
$84.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$84.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$143.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$143.34
|
| Rate for Payer: Vantage Medical Group Senior |
$143.34
|
|
|
BICTEGRAVIR 50 MG-EMTRICITABINE 200 MG-TENOFOVIR ALAFENAM 25 MG TABLET [221141]
|
Facility
|
IP
|
$168.64
|
|
|
Service Code
|
NDC 6195825011
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$33.73 |
| Max. Negotiated Rate |
$143.34 |
| Rate for Payer: Adventist Health Commercial |
$33.73
|
| Rate for Payer: Blue Shield of California Commercial |
$129.68
|
| Rate for Payer: Blue Shield of California Commercial |
$85.50
|
| Rate for Payer: Cash Price |
$75.89
|
| Rate for Payer: Cigna of CA HMO |
$118.05
|
| Rate for Payer: Cigna of CA PPO |
$118.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$118.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.46
|
| Rate for Payer: EPIC Health Plan Senior |
$67.46
|
| Rate for Payer: Galaxy Health WC |
$143.34
|
| Rate for Payer: Global Benefits Group Commercial |
$101.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$99.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.47
|
| Rate for Payer: Multiplan Commercial |
$134.91
|
| Rate for Payer: Networks By Design Commercial |
$109.62
|
| Rate for Payer: Prime Health Services Commercial |
$143.34
|
|
|
BICTEGRAVIR 50 MG-EMTRICITABINE 200 MG-TENOFOVIR ALAFENAM 25 MG TABLET [221141]
|
Facility
|
OP
|
$168.64
|
|
|
Service Code
|
NDC 6195825011
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$33.73 |
| Max. Negotiated Rate |
$143.34 |
| Rate for Payer: Adventist Health Commercial |
$33.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$143.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$92.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$126.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.22
|
| Rate for Payer: Cash Price |
$75.89
|
| Rate for Payer: Cigna of CA HMO |
$118.05
|
| Rate for Payer: Cigna of CA PPO |
$118.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$143.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$143.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$143.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$118.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.46
|
| Rate for Payer: EPIC Health Plan Senior |
$67.46
|
| Rate for Payer: Galaxy Health WC |
$143.34
|
| Rate for Payer: Global Benefits Group Commercial |
$101.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$61.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$99.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$118.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$118.05
|
| Rate for Payer: Multiplan Commercial |
$134.91
|
| Rate for Payer: Networks By Design Commercial |
$109.62
|
| Rate for Payer: Prime Health Services Commercial |
$143.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$101.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$101.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$84.32
|
| Rate for Payer: United Healthcare All Other HMO |
$84.32
|
| Rate for Payer: United Healthcare HMO Rider |
$84.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$84.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$143.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$143.34
|
| Rate for Payer: Vantage Medical Group Senior |
$143.34
|
|
|
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC
|
Facility
|
IP
|
$177,254.30
|
|
|
Service Code
|
MSDRG 461
|
| Min. Negotiated Rate |
$45,279.00 |
| Max. Negotiated Rate |
$177,254.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$162,511.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$177,254.30
|
| Rate for Payer: EPIC Health Plan Senior |
$118,169.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$107,426.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$150,397.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$143,951.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$64,494.00
|
| Rate for Payer: United Healthcare All Other HMO |
$64,494.00
|
| Rate for Payer: United Healthcare HMO Rider |
$49,424.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45,279.00
|
|
|
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC
|
Facility
|
IP
|
$126,450.85
|
|
|
Service Code
|
MSDRG 462
|
| Min. Negotiated Rate |
$36,596.00 |
| Max. Negotiated Rate |
$126,450.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$80,640.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$126,450.85
|
| Rate for Payer: EPIC Health Plan Senior |
$84,300.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76,636.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$107,291.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102,693.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$52,127.00
|
| Rate for Payer: United Healthcare All Other HMO |
$52,127.00
|
| Rate for Payer: United Healthcare HMO Rider |
$39,944.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36,596.00
|
|
|
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC
|
Facility
|
IP
|
$117,885.40
|
|
|
Service Code
|
MSDRG 409
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$117,885.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$66,007.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$117,885.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78,590.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$71,445.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100,023.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$95,737.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC
|
Facility
|
IP
|
$142,520.57
|
|
|
Service Code
|
MSDRG 408
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$142,520.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$108,094.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$142,520.57
|
| Rate for Payer: EPIC Health Plan Senior |
$95,013.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$86,376.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$120,926.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$115,743.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC
|
Facility
|
IP
|
$107,423.09
|
|
|
Service Code
|
MSDRG 410
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$107,423.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$48,132.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$107,423.09
|
| Rate for Payer: EPIC Health Plan Senior |
$71,615.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$65,104.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$91,146.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$87,240.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
BIMATOPROST 0.01 % EYE DROPS [105410]
|
Facility
|
OP
|
$129.36
|
|
|
Service Code
|
NDC 0023320503
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.87 |
| Max. Negotiated Rate |
$109.96 |
| Rate for Payer: Adventist Health Commercial |
$25.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$84.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$109.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$71.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$97.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.01
|
| Rate for Payer: Cash Price |
$58.21
|
| Rate for Payer: Cigna of CA HMO |
$90.55
|
| Rate for Payer: Cigna of CA PPO |
$90.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$109.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$109.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$109.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$90.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.74
|
| Rate for Payer: EPIC Health Plan Senior |
$51.74
|
| Rate for Payer: Galaxy Health WC |
$109.96
|
| Rate for Payer: Global Benefits Group Commercial |
$77.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$82.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$90.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.55
|
| Rate for Payer: Multiplan Commercial |
$103.49
|
| Rate for Payer: Networks By Design Commercial |
$84.08
|
| Rate for Payer: Prime Health Services Commercial |
$109.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$77.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$77.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.68
|
| Rate for Payer: United Healthcare All Other HMO |
$64.68
|
| Rate for Payer: United Healthcare HMO Rider |
$64.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$109.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$109.96
|
| Rate for Payer: Vantage Medical Group Senior |
$109.96
|
|
|
BIMATOPROST 0.01 % EYE DROPS [105410]
|
Facility
|
IP
|
$129.36
|
|
|
Service Code
|
NDC 0023320503
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.87 |
| Max. Negotiated Rate |
$109.96 |
| Rate for Payer: Adventist Health Commercial |
$25.87
|
| Rate for Payer: Blue Shield of California Commercial |
$65.59
|
| Rate for Payer: Blue Shield of California Commercial |
$99.48
|
| Rate for Payer: Cash Price |
$58.21
|
| Rate for Payer: Cigna of CA HMO |
$90.55
|
| Rate for Payer: Cigna of CA PPO |
$90.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$90.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.74
|
| Rate for Payer: EPIC Health Plan Senior |
$51.74
|
| Rate for Payer: Galaxy Health WC |
$109.96
|
| Rate for Payer: Global Benefits Group Commercial |
$77.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$82.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.05
|
| Rate for Payer: Multiplan Commercial |
$103.49
|
| Rate for Payer: Networks By Design Commercial |
$84.08
|
| Rate for Payer: Prime Health Services Commercial |
$109.96
|
|
|
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC
|
Facility
|
IP
|
$122,887.68
|
|
|
Service Code
|
MSDRG 478
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$122,887.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$74,553.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$122,887.68
|
| Rate for Payer: EPIC Health Plan Senior |
$81,925.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$74,477.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$104,268.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$99,799.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC
|
Facility
|
IP
|
$140,550.89
|
|
|
Service Code
|
MSDRG 477
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$140,550.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$104,729.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$140,550.89
|
| Rate for Payer: EPIC Health Plan Senior |
$93,700.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$85,182.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$119,255.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$114,144.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC
|
Facility
|
IP
|
$112,235.48
|
|
|
Service Code
|
MSDRG 479
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$112,235.48 |
| Rate for Payer: Aetna of CA HMO/PPO |
$56,354.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$112,235.48
|
| Rate for Payer: EPIC Health Plan Senior |
$74,823.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$68,021.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95,230.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$91,148.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
BIOPSY OF ANORECTAL WALL, ANAL APPROACH (EG, CONGENITAL MEGACOLON)
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 45100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$283.33 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,926.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,569.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,926.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,569.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,890.43
|
| Rate for Payer: EPIC Health Plan Senior |
$3,926.96
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,854.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$283.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,569.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$320.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,997.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,498.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,783.75
|
| Rate for Payer: Multiplan WC |
$5,551.91
|
| Rate for Payer: Prime Health Services WC |
$5,495.25
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,569.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,926.96
|
| Rate for Payer: Vantage Medical Group Senior |
$3,569.96
|
|
