|
BRIVARACETAM 50 MG TABLET [214047]
|
Facility
|
IP
|
$0.38
|
|
|
Service Code
|
NDC 7220526901
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cigna of CA HMO |
$0.27
|
| Rate for Payer: Cigna of CA PPO |
$0.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: EPIC Health Plan Senior |
$0.15
|
| Rate for Payer: Galaxy Health WC |
$0.32
|
| Rate for Payer: Global Benefits Group Commercial |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.30
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.32
|
|
|
BRIVARACETAM 50 MG TABLET [214047]
|
Facility
|
OP
|
$0.38
|
|
|
Service Code
|
NDC 7220526906
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.24
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cigna of CA HMO |
$0.27
|
| Rate for Payer: Cigna of CA PPO |
$0.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: EPIC Health Plan Senior |
$0.15
|
| Rate for Payer: Galaxy Health WC |
$0.32
|
| Rate for Payer: Global Benefits Group Commercial |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.30
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.19
|
| Rate for Payer: United Healthcare All Other HMO |
$0.19
|
| Rate for Payer: United Healthcare HMO Rider |
$0.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Vantage Medical Group Senior |
$0.32
|
|
|
BRIVARACETAM 50 MG TABLET [214047]
|
Facility
|
OP
|
$0.38
|
|
|
Service Code
|
NDC 7220526901
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.24
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cigna of CA HMO |
$0.27
|
| Rate for Payer: Cigna of CA PPO |
$0.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: EPIC Health Plan Senior |
$0.15
|
| Rate for Payer: Galaxy Health WC |
$0.32
|
| Rate for Payer: Global Benefits Group Commercial |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.30
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.19
|
| Rate for Payer: United Healthcare All Other HMO |
$0.19
|
| Rate for Payer: United Healthcare HMO Rider |
$0.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Vantage Medical Group Senior |
$0.32
|
|
|
BRIVARACETAM 50 MG TABLET [214047]
|
Facility
|
OP
|
$30.23
|
|
|
Service Code
|
NDC 5047457009
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$25.70 |
| Rate for Payer: Adventist Health Commercial |
$6.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.40
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cigna of CA HMO |
$21.16
|
| Rate for Payer: Cigna of CA PPO |
$21.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.09
|
| Rate for Payer: EPIC Health Plan Senior |
$12.09
|
| Rate for Payer: Galaxy Health WC |
$25.70
|
| Rate for Payer: Global Benefits Group Commercial |
$18.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.16
|
| Rate for Payer: Multiplan Commercial |
$24.18
|
| Rate for Payer: Networks By Design Commercial |
$19.65
|
| Rate for Payer: Prime Health Services Commercial |
$25.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.12
|
| Rate for Payer: United Healthcare All Other HMO |
$15.12
|
| Rate for Payer: United Healthcare HMO Rider |
$15.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.70
|
| Rate for Payer: Vantage Medical Group Senior |
$25.70
|
|
|
BRIVARACETAM 50 MG TABLET [214047]
|
Facility
|
IP
|
$0.38
|
|
|
Service Code
|
NDC 7220526906
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cigna of CA HMO |
$0.27
|
| Rate for Payer: Cigna of CA PPO |
$0.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: EPIC Health Plan Senior |
$0.15
|
| Rate for Payer: Galaxy Health WC |
$0.32
|
| Rate for Payer: Global Benefits Group Commercial |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.30
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.32
|
|
|
BRIVARACETAM 50 MG TABLET [214047]
|
Facility
|
IP
|
$30.23
|
|
|
Service Code
|
NDC 5047457009
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$25.70 |
| Rate for Payer: Adventist Health Commercial |
$6.05
|
| Rate for Payer: Blue Shield of California Commercial |
$15.33
|
| Rate for Payer: Blue Shield of California Commercial |
$23.25
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cigna of CA HMO |
$21.16
|
| Rate for Payer: Cigna of CA PPO |
$21.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.09
|
| Rate for Payer: EPIC Health Plan Senior |
$12.09
|
| Rate for Payer: Galaxy Health WC |
$25.70
|
| Rate for Payer: Global Benefits Group Commercial |
$18.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.26
|
| Rate for Payer: Multiplan Commercial |
$24.18
|
| Rate for Payer: Networks By Design Commercial |
$19.65
|
| Rate for Payer: Prime Health Services Commercial |
$25.70
|
|
|
BRIVARACETAM 50 MG TABLET [214047]
|
Facility
|
IP
|
$30.22
|
|
|
Service Code
|
NDC 5047457066
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$25.69 |
| Rate for Payer: Adventist Health Commercial |
$6.04
|
| Rate for Payer: Blue Shield of California Commercial |
$15.32
|
| Rate for Payer: Blue Shield of California Commercial |
$23.24
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cigna of CA HMO |
$21.15
|
| Rate for Payer: Cigna of CA PPO |
$21.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.09
|
| Rate for Payer: EPIC Health Plan Senior |
$12.09
|
| Rate for Payer: Galaxy Health WC |
$25.69
|
| Rate for Payer: Global Benefits Group Commercial |
$18.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.25
|
| Rate for Payer: Multiplan Commercial |
$24.18
|
| Rate for Payer: Networks By Design Commercial |
$19.64
|
| Rate for Payer: Prime Health Services Commercial |
$25.69
|
|
|
BROMFENAC 0.09 % EYE DROPS [41146]
|
Facility
|
OP
|
$100.56
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.11 |
| Max. Negotiated Rate |
$85.48 |
| Rate for Payer: Adventist Health Commercial |
$20.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$65.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.42
|
| Rate for Payer: Cash Price |
$45.25
|
| Rate for Payer: Cigna of CA HMO |
$70.39
|
| Rate for Payer: Cigna of CA PPO |
$70.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.22
|
| Rate for Payer: EPIC Health Plan Senior |
$40.22
|
| Rate for Payer: Galaxy Health WC |
$85.48
|
| Rate for Payer: Global Benefits Group Commercial |
$60.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$70.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$70.39
|
| Rate for Payer: Multiplan Commercial |
$80.45
|
| Rate for Payer: Networks By Design Commercial |
$50.28
|
| Rate for Payer: Prime Health Services Commercial |
$85.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.74
|
| Rate for Payer: United Healthcare All Other HMO |
$36.73
|
| Rate for Payer: United Healthcare HMO Rider |
$35.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.48
|
| Rate for Payer: Vantage Medical Group Senior |
$85.48
|
|
|
BROMFENAC 0.09 % EYE DROPS [41146]
|
Facility
|
IP
|
$100.56
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.11 |
| Max. Negotiated Rate |
$85.48 |
| Rate for Payer: Adventist Health Commercial |
$20.11
|
| Rate for Payer: Blue Shield of California Commercial |
$50.98
|
| Rate for Payer: Blue Shield of California Commercial |
$77.33
|
| Rate for Payer: Cash Price |
$45.25
|
| Rate for Payer: Cigna of CA HMO |
$70.39
|
| Rate for Payer: Cigna of CA PPO |
$70.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.22
|
| Rate for Payer: EPIC Health Plan Senior |
$40.22
|
| Rate for Payer: Galaxy Health WC |
$85.48
|
| Rate for Payer: Global Benefits Group Commercial |
$60.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.13
|
| Rate for Payer: Multiplan Commercial |
$80.45
|
| Rate for Payer: Networks By Design Commercial |
$50.28
|
| Rate for Payer: Prime Health Services Commercial |
$85.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.74
|
| Rate for Payer: United Healthcare All Other HMO |
$36.73
|
| Rate for Payer: United Healthcare HMO Rider |
$35.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.93
|
|
|
BROMOCRIPTINE 2.5 MG TABLET [9297]
|
Facility
|
IP
|
$3.97
|
|
|
Service Code
|
NDC 6330496230
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Adventist Health Commercial |
$0.79
|
| Rate for Payer: Blue Shield of California Commercial |
$2.01
|
| Rate for Payer: Blue Shield of California Commercial |
$3.05
|
| Rate for Payer: Cash Price |
$1.79
|
| Rate for Payer: Cigna of CA HMO |
$2.78
|
| Rate for Payer: Cigna of CA PPO |
$2.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.59
|
| Rate for Payer: EPIC Health Plan Senior |
$1.59
|
| Rate for Payer: Galaxy Health WC |
$3.37
|
| Rate for Payer: Global Benefits Group Commercial |
$2.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Multiplan Commercial |
$3.18
|
| Rate for Payer: Networks By Design Commercial |
$2.58
|
| Rate for Payer: Prime Health Services Commercial |
$3.37
|
|
|
BROMOCRIPTINE 2.5 MG TABLET [9297]
|
Facility
|
IP
|
$3.97
|
|
|
Service Code
|
NDC 7095497810
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Adventist Health Commercial |
$0.79
|
| Rate for Payer: Blue Shield of California Commercial |
$2.01
|
| Rate for Payer: Blue Shield of California Commercial |
$3.05
|
| Rate for Payer: Cash Price |
$1.79
|
| Rate for Payer: Cigna of CA HMO |
$2.78
|
| Rate for Payer: Cigna of CA PPO |
$2.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.59
|
| Rate for Payer: EPIC Health Plan Senior |
$1.59
|
| Rate for Payer: Galaxy Health WC |
$3.37
|
| Rate for Payer: Global Benefits Group Commercial |
$2.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Multiplan Commercial |
$3.18
|
| Rate for Payer: Networks By Design Commercial |
$2.58
|
| Rate for Payer: Prime Health Services Commercial |
$3.37
|
|
|
BROMOCRIPTINE 2.5 MG TABLET [9297]
|
Facility
|
OP
|
$3.60
|
|
|
Service Code
|
NDC 7095497820
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.31
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.52
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Networks By Design Commercial |
$2.34
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other HMO |
$1.80
|
| Rate for Payer: United Healthcare HMO Rider |
$1.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
|
|
BROMOCRIPTINE 2.5 MG TABLET [9297]
|
Facility
|
OP
|
$3.97
|
|
|
Service Code
|
NDC 6330496230
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Adventist Health Commercial |
$0.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.55
|
| Rate for Payer: Cash Price |
$1.79
|
| Rate for Payer: Cigna of CA HMO |
$2.78
|
| Rate for Payer: Cigna of CA PPO |
$2.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.59
|
| Rate for Payer: EPIC Health Plan Senior |
$1.59
|
| Rate for Payer: Galaxy Health WC |
$3.37
|
| Rate for Payer: Global Benefits Group Commercial |
$2.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.78
|
| Rate for Payer: Multiplan Commercial |
$3.18
|
| Rate for Payer: Networks By Design Commercial |
$2.58
|
| Rate for Payer: Prime Health Services Commercial |
$3.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.99
|
| Rate for Payer: United Healthcare All Other HMO |
$1.99
|
| Rate for Payer: United Healthcare HMO Rider |
$1.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.37
|
| Rate for Payer: Vantage Medical Group Senior |
$3.37
|
|
|
BROMOCRIPTINE 2.5 MG TABLET [9297]
|
Facility
|
OP
|
$3.97
|
|
|
Service Code
|
NDC 7095497810
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Adventist Health Commercial |
$0.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.55
|
| Rate for Payer: Cash Price |
$1.79
|
| Rate for Payer: Cigna of CA HMO |
$2.78
|
| Rate for Payer: Cigna of CA PPO |
$2.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.59
|
| Rate for Payer: EPIC Health Plan Senior |
$1.59
|
| Rate for Payer: Galaxy Health WC |
$3.37
|
| Rate for Payer: Global Benefits Group Commercial |
$2.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.78
|
| Rate for Payer: Multiplan Commercial |
$3.18
|
| Rate for Payer: Networks By Design Commercial |
$2.58
|
| Rate for Payer: Prime Health Services Commercial |
$3.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.99
|
| Rate for Payer: United Healthcare All Other HMO |
$1.99
|
| Rate for Payer: United Healthcare HMO Rider |
$1.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.37
|
| Rate for Payer: Vantage Medical Group Senior |
$3.37
|
|
|
BROMOCRIPTINE 2.5 MG TABLET [9297]
|
Facility
|
OP
|
$3.97
|
|
|
Service Code
|
NDC 0574010603
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Adventist Health Commercial |
$0.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.55
|
| Rate for Payer: Cash Price |
$1.79
|
| Rate for Payer: Cigna of CA HMO |
$2.78
|
| Rate for Payer: Cigna of CA PPO |
$2.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.59
|
| Rate for Payer: EPIC Health Plan Senior |
$1.59
|
| Rate for Payer: Galaxy Health WC |
$3.37
|
| Rate for Payer: Global Benefits Group Commercial |
$2.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.78
|
| Rate for Payer: Multiplan Commercial |
$3.18
|
| Rate for Payer: Networks By Design Commercial |
$2.58
|
| Rate for Payer: Prime Health Services Commercial |
$3.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.99
|
| Rate for Payer: United Healthcare All Other HMO |
$1.99
|
| Rate for Payer: United Healthcare HMO Rider |
$1.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.37
|
| Rate for Payer: Vantage Medical Group Senior |
$3.37
|
|
|
BROMOCRIPTINE 2.5 MG TABLET [9297]
|
Facility
|
IP
|
$3.60
|
|
|
Service Code
|
NDC 7095497820
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Blue Shield of California Commercial |
$1.83
|
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Networks By Design Commercial |
$2.34
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
|
|
BROMOCRIPTINE 2.5 MG TABLET [9297]
|
Facility
|
IP
|
$3.97
|
|
|
Service Code
|
NDC 0574010603
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Adventist Health Commercial |
$0.79
|
| Rate for Payer: Blue Shield of California Commercial |
$2.01
|
| Rate for Payer: Blue Shield of California Commercial |
$3.05
|
| Rate for Payer: Cash Price |
$1.79
|
| Rate for Payer: Cigna of CA HMO |
$2.78
|
| Rate for Payer: Cigna of CA PPO |
$2.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.59
|
| Rate for Payer: EPIC Health Plan Senior |
$1.59
|
| Rate for Payer: Galaxy Health WC |
$3.37
|
| Rate for Payer: Global Benefits Group Commercial |
$2.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Multiplan Commercial |
$3.18
|
| Rate for Payer: Networks By Design Commercial |
$2.58
|
| Rate for Payer: Prime Health Services Commercial |
$3.37
|
|
|
BRONCHIOLITIS AND RSV PNEUMONIA
|
Facility
|
IP
|
$9,829.75
|
|
|
Service Code
|
APR-DRG 1382
|
| Min. Negotiated Rate |
$7,850.86 |
| Max. Negotiated Rate |
$9,829.75 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,850.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,829.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,795.03
|
|
|
BRONCHIOLITIS AND RSV PNEUMONIA
|
Facility
|
IP
|
$17,889.34
|
|
|
Service Code
|
APR-DRG 1383
|
| Min. Negotiated Rate |
$14,287.93 |
| Max. Negotiated Rate |
$17,889.34 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14,287.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17,889.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,006.25
|
|
|
BRONCHIOLITIS AND RSV PNEUMONIA
|
Facility
|
IP
|
$43,750.22
|
|
|
Service Code
|
APR-DRG 1384
|
| Min. Negotiated Rate |
$34,942.61 |
| Max. Negotiated Rate |
$43,750.22 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34,942.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43,750.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39,144.93
|
|
|
BRONCHIOLITIS AND RSV PNEUMONIA
|
Facility
|
IP
|
$6,194.25
|
|
|
Service Code
|
APR-DRG 1381
|
| Min. Negotiated Rate |
$4,947.25 |
| Max. Negotiated Rate |
$6,194.25 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,947.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,194.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,542.22
|
|
|
BRONCHITIS AND ASTHMA WITH CC/MCC
|
Facility
|
IP
|
$96,483.39
|
|
|
Service Code
|
MSDRG 202
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$96,483.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$29,442.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$96,483.39
|
| Rate for Payer: EPIC Health Plan Senior |
$64,322.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58,474.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81,864.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78,356.21
|
| 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
|
|
|
BRONCHITIS AND ASTHMA WITHOUT CC/MCC
|
Facility
|
IP
|
$91,138.64
|
|
|
Service Code
|
MSDRG 203
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$91,138.64 |
| Rate for Payer: Aetna of CA HMO/PPO |
$20,311.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$91,138.64
|
| Rate for Payer: EPIC Health Plan Senior |
$60,759.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$55,235.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77,329.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74,015.62
|
| 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
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; DIAGNOSTIC, WITH CELL WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 31622
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$277.08 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,289.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,518.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,289.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,777.26
|
| Rate for Payer: EPIC Health Plan Senior |
$2,518.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,754.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$277.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,289.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$313.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,204.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,884.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,067.59
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: Prime Health Services WC |
$3,455.53
|
| 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 |
$2,289.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Vantage Medical Group Senior |
$2,289.25
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH BRONCHIAL ALVEOLAR LAVAGE
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 31624
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$358.39 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,289.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,518.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,289.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,777.26
|
| Rate for Payer: EPIC Health Plan Senior |
$2,518.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,754.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$358.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,289.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$405.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,204.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,884.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,067.59
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: Prime Health Services WC |
$3,455.53
|
| 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 |
$2,289.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Vantage Medical Group Senior |
$2,289.25
|
|
