|
FOLIC ACID 1 MG TABLET [3233]
|
Facility
|
OP
|
$0.21
|
|
|
Service Code
|
NDC 60687-681-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.18 |
| 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 |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.13
|
| Rate for Payer: Cash Price |
$0.11
|
| 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 |
$0.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA 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 |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.18
|
| 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 |
$0.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: Vantage Medical Group Senior |
$0.18
|
|
|
FOLIC ACID 1 MG TABLET [3233]
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 53746-361-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
|
FOLIC ACID 1 MG TABLET [3233]
|
Facility
|
IP
|
$0.21
|
|
|
Service Code
|
NDC 60687-681-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.18
|
|
|
FOLIC ACID 1 MG TABLET [3233]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 53746-361-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
|
|
FOLIC ACID 1 MG TABLET [3233]
|
Facility
|
OP
|
$0.21
|
|
|
Service Code
|
NDC 60687-681-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.18 |
| 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 |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.13
|
| Rate for Payer: Cash Price |
$0.11
|
| 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 |
$0.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA 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 |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.18
|
| 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 |
$0.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: Vantage Medical Group Senior |
$0.18
|
|
|
FOLIC ACID 1 MG TABLET [3233]
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
NDC 11534-165-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$0.05
|
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.06
|
|
|
FOLIC ACID 400 MCG TABLET [3234]
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
NDC 5026834611
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.17
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO |
$0.12
|
| Rate for Payer: United Healthcare HMO Rider |
$0.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
FOLIC ACID 400 MCG TABLET [3234]
|
Facility
|
IP
|
$0.24
|
|
|
Service Code
|
NDC 5026834611
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
|
|
FOLIC ACID 400 MCG TABLET [3234]
|
Facility
|
IP
|
$0.24
|
|
|
Service Code
|
NDC 5026834615
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
|
|
FOLIC ACID 400 MCG TABLET [3234]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 8770140733
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| 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 EPN |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$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 Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA 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
|
|
|
FOLIC ACID 400 MCG TABLET [3234]
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
NDC 5026834615
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO |
$0.12
|
| Rate for Payer: United Healthcare HMO Rider |
$0.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
FOLIC ACID 400 MCG TABLET [3234]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 8770140733
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Cash Price |
$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: 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 Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA 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 |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| 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
|
|
|
FOLIC ACID 5 MG/ML INJECTION SOLUTION [3232]
|
Facility
|
OP
|
$3.20
|
|
|
Service Code
|
HCPCS J1808
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: Adventist Health Commercial |
$0.64
|
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Adventist Health Commercial |
$1.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.27
|
| Rate for Payer: Cash Price |
$4.22
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cash Price |
$4.22
|
| Rate for Payer: Cigna of CA HMO |
$5.37
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA HMO |
$2.24
|
| Rate for Payer: Cigna of CA PPO |
$5.37
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$2.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: EPIC Health Plan Senior |
$3.07
|
| Rate for Payer: EPIC Health Plan Senior |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$1.28
|
| Rate for Payer: Galaxy Health WC |
$2.72
|
| Rate for Payer: Galaxy Health WC |
$6.52
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Global Benefits Group Commercial |
$1.92
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Global Benefits Group Commercial |
$4.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.94
|
| Rate for Payer: Multiplan Commercial |
$3.36
|
| Rate for Payer: Multiplan Commercial |
$6.14
|
| Rate for Payer: Multiplan Commercial |
$2.56
|
| Rate for Payer: Networks By Design Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$2.10
|
| Rate for Payer: Networks By Design Commercial |
$3.83
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
| Rate for Payer: Prime Health Services Commercial |
$6.52
|
| Rate for Payer: Prime Health Services Commercial |
$2.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.58
|
| Rate for Payer: United Healthcare All Other HMO |
$2.80
|
| Rate for Payer: United Healthcare All Other HMO |
$1.17
|
| Rate for Payer: United Healthcare All Other HMO |
$1.53
|
| Rate for Payer: United Healthcare HMO Rider |
$2.74
|
| Rate for Payer: United Healthcare HMO Rider |
$1.14
|
| Rate for Payer: United Healthcare HMO Rider |
$1.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.72
|
| Rate for Payer: Vantage Medical Group Senior |
$2.72
|
| Rate for Payer: Vantage Medical Group Senior |
$3.57
|
| Rate for Payer: Vantage Medical Group Senior |
$6.52
|
|
|
FOLIC ACID 5 MG/ML INJECTION SOLUTION [3232]
|
Facility
|
IP
|
$3.20
|
|
|
Service Code
|
HCPCS J1808
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: Adventist Health Commercial |
$0.64
|
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Adventist Health Commercial |
$1.53
|
| Rate for Payer: Blue Shield of California Commercial |
$3.10
|
| Rate for Payer: Blue Shield of California Commercial |
$5.66
|
| Rate for Payer: Blue Shield of California Commercial |
$2.36
|
| Rate for Payer: Blue Shield of California EPN |
$2.04
|
| Rate for Payer: Blue Shield of California EPN |
$1.56
|
| Rate for Payer: Blue Shield of California EPN |
$3.73
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cash Price |
$4.22
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA HMO |
$2.24
|
| Rate for Payer: Cigna of CA HMO |
$5.37
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$2.24
|
| Rate for Payer: Cigna of CA PPO |
$5.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.07
|
| Rate for Payer: EPIC Health Plan Senior |
$3.07
|
| Rate for Payer: EPIC Health Plan Senior |
$1.28
|
| Rate for Payer: EPIC Health Plan Senior |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Galaxy Health WC |
$2.72
|
| Rate for Payer: Galaxy Health WC |
$6.52
|
| Rate for Payer: Global Benefits Group Commercial |
$4.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1.92
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.84
|
| Rate for Payer: Multiplan Commercial |
$2.56
|
| Rate for Payer: Multiplan Commercial |
$3.36
|
| Rate for Payer: Multiplan Commercial |
$6.14
|
| Rate for Payer: Networks By Design Commercial |
$2.10
|
| Rate for Payer: Networks By Design Commercial |
$3.83
|
| Rate for Payer: Networks By Design Commercial |
$1.60
|
| Rate for Payer: Prime Health Services Commercial |
$2.72
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
| Rate for Payer: Prime Health Services Commercial |
$6.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.88
|
| Rate for Payer: United Healthcare All Other HMO |
$2.80
|
| Rate for Payer: United Healthcare All Other HMO |
$1.17
|
| Rate for Payer: United Healthcare All Other HMO |
$1.53
|
| Rate for Payer: United Healthcare HMO Rider |
$1.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2.74
|
| Rate for Payer: United Healthcare HMO Rider |
$1.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.38
|
|
|
FOLIC ACID ORAL SOLUTION COMPOUND 1 MG/ML [4080276]
|
Facility
|
IP
|
$0.51
|
|
|
Service Code
|
NDC 9994-0802-76
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.25
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Cigna of CA HMO |
$0.36
|
| Rate for Payer: Cigna of CA PPO |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.43
|
| Rate for Payer: Global Benefits Group Commercial |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Networks By Design Commercial |
$0.33
|
| Rate for Payer: Prime Health Services Commercial |
$0.43
|
|
|
FOLIC ACID ORAL SOLUTION COMPOUND 1 MG/ML [4080276]
|
Facility
|
OP
|
$0.51
|
|
|
Service Code
|
NDC 9994-0802-76
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: United Healthcare HMO Rider |
$0.26
|
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.31
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Cigna of CA HMO |
$0.36
|
| Rate for Payer: Cigna of CA PPO |
$0.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.43
|
| Rate for Payer: Global Benefits Group Commercial |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Networks By Design Commercial |
$0.33
|
| Rate for Payer: Prime Health Services Commercial |
$0.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.26
|
| Rate for Payer: United Healthcare All Other HMO |
$0.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: Vantage Medical Group Senior |
$0.43
|
|
|
FOMEPIZOLE 1 GRAM/ML INTRAVENOUS SOLUTION [22185]
|
Facility
|
IP
|
$788.00
|
|
|
Service Code
|
HCPCS J1451
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$157.60 |
| Max. Negotiated Rate |
$669.80 |
| Rate for Payer: Adventist Health Commercial |
$157.60
|
| Rate for Payer: Blue Shield of California Commercial |
$581.54
|
| Rate for Payer: Blue Shield of California EPN |
$382.97
|
| Rate for Payer: Cash Price |
$433.40
|
| Rate for Payer: Cigna of CA HMO |
$551.60
|
| Rate for Payer: Cigna of CA PPO |
$551.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$315.20
|
| Rate for Payer: EPIC Health Plan Senior |
$315.20
|
| Rate for Payer: Galaxy Health WC |
$669.80
|
| Rate for Payer: Global Benefits Group Commercial |
$472.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$525.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$300.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$487.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.12
|
| Rate for Payer: Multiplan Commercial |
$630.40
|
| Rate for Payer: Networks By Design Commercial |
$394.00
|
| Rate for Payer: Prime Health Services Commercial |
$669.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$295.74
|
| Rate for Payer: United Healthcare All Other HMO |
$287.86
|
| Rate for Payer: United Healthcare HMO Rider |
$281.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$258.07
|
|
|
FOMEPIZOLE 1 GRAM/ML INTRAVENOUS SOLUTION [22185]
|
Facility
|
OP
|
$788.00
|
|
|
Service Code
|
HCPCS J1451
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$669.80 |
| Rate for Payer: Adventist Health Commercial |
$157.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$516.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.32
|
| Rate for Payer: Blue Shield of California Commercial |
$15.16
|
| Rate for Payer: Blue Shield of California EPN |
$15.16
|
| Rate for Payer: Cash Price |
$433.40
|
| Rate for Payer: Cash Price |
$433.40
|
| Rate for Payer: Cigna of CA HMO |
$551.60
|
| Rate for Payer: Cigna of CA PPO |
$551.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.14
|
| Rate for Payer: EPIC Health Plan Senior |
$6.03
|
| Rate for Payer: Galaxy Health WC |
$669.80
|
| Rate for Payer: Global Benefits Group Commercial |
$472.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$525.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.08
|
| Rate for Payer: Multiplan Commercial |
$630.40
|
| Rate for Payer: Networks By Design Commercial |
$394.00
|
| Rate for Payer: Prime Health Services Commercial |
$669.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$472.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$472.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$295.74
|
| Rate for Payer: United Healthcare All Other HMO |
$287.86
|
| Rate for Payer: United Healthcare HMO Rider |
$281.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$258.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.63
|
| Rate for Payer: Vantage Medical Group Senior |
$6.63
|
|
|
FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE [108029]
|
Facility
|
OP
|
$87.15
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$74.08 |
| Rate for Payer: Adventist Health Commercial |
$17.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$57.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.04
|
| Rate for Payer: Blue Shield of California Commercial |
$5.76
|
| Rate for Payer: Blue Shield of California EPN |
$5.76
|
| Rate for Payer: Cash Price |
$47.93
|
| Rate for Payer: Cash Price |
$47.93
|
| Rate for Payer: Cigna of CA HMO |
$61.01
|
| Rate for Payer: Cigna of CA PPO |
$61.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$74.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.86
|
| Rate for Payer: EPIC Health Plan Senior |
$34.86
|
| Rate for Payer: Galaxy Health WC |
$74.08
|
| Rate for Payer: Global Benefits Group Commercial |
$52.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$61.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$61.01
|
| Rate for Payer: Multiplan Commercial |
$69.72
|
| Rate for Payer: Networks By Design Commercial |
$43.58
|
| Rate for Payer: Prime Health Services Commercial |
$74.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.71
|
| Rate for Payer: United Healthcare All Other HMO |
$31.84
|
| Rate for Payer: United Healthcare HMO Rider |
$31.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.08
|
| Rate for Payer: Vantage Medical Group Senior |
$74.08
|
|
|
FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE [108029]
|
Facility
|
IP
|
$87.15
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.43 |
| Max. Negotiated Rate |
$74.08 |
| Rate for Payer: Adventist Health Commercial |
$17.43
|
| Rate for Payer: Blue Shield of California Commercial |
$64.32
|
| Rate for Payer: Blue Shield of California EPN |
$42.35
|
| Rate for Payer: Cash Price |
$47.93
|
| Rate for Payer: Cigna of CA HMO |
$61.01
|
| Rate for Payer: Cigna of CA PPO |
$61.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.86
|
| Rate for Payer: EPIC Health Plan Senior |
$34.86
|
| Rate for Payer: Galaxy Health WC |
$74.08
|
| Rate for Payer: Global Benefits Group Commercial |
$52.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.92
|
| Rate for Payer: Multiplan Commercial |
$69.72
|
| Rate for Payer: Networks By Design Commercial |
$43.58
|
| Rate for Payer: Prime Health Services Commercial |
$74.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.71
|
| Rate for Payer: United Healthcare All Other HMO |
$31.84
|
| Rate for Payer: United Healthcare HMO Rider |
$31.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.54
|
|
|
FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE [32215]
|
Facility
|
IP
|
$59.66
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$50.71 |
| Rate for Payer: Adventist Health Commercial |
$11.93
|
| Rate for Payer: Blue Shield of California Commercial |
$44.03
|
| Rate for Payer: Blue Shield of California EPN |
$28.99
|
| Rate for Payer: Cash Price |
$32.81
|
| Rate for Payer: Cigna of CA HMO |
$41.76
|
| Rate for Payer: Cigna of CA PPO |
$41.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.86
|
| Rate for Payer: EPIC Health Plan Senior |
$23.86
|
| Rate for Payer: Galaxy Health WC |
$50.71
|
| Rate for Payer: Global Benefits Group Commercial |
$35.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.32
|
| Rate for Payer: Multiplan Commercial |
$47.73
|
| Rate for Payer: Networks By Design Commercial |
$29.83
|
| Rate for Payer: Prime Health Services Commercial |
$50.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.39
|
| Rate for Payer: United Healthcare All Other HMO |
$21.79
|
| Rate for Payer: United Healthcare HMO Rider |
$21.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.54
|
|
|
FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE [32215]
|
Facility
|
OP
|
$59.66
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$50.71 |
| Rate for Payer: Cash Price |
$32.81
|
| Rate for Payer: Cigna of CA HMO |
$41.76
|
| Rate for Payer: Cigna of CA PPO |
$41.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.86
|
| Rate for Payer: EPIC Health Plan Senior |
$23.86
|
| Rate for Payer: Galaxy Health WC |
$50.71
|
| Rate for Payer: Global Benefits Group Commercial |
$35.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.76
|
| Rate for Payer: Multiplan Commercial |
$47.73
|
| Rate for Payer: Networks By Design Commercial |
$29.83
|
| Rate for Payer: Prime Health Services Commercial |
$50.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.39
|
| Rate for Payer: United Healthcare All Other HMO |
$21.79
|
| Rate for Payer: United Healthcare HMO Rider |
$21.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.71
|
| Rate for Payer: Vantage Medical Group Senior |
$50.71
|
| Rate for Payer: Adventist Health Commercial |
$11.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.04
|
| Rate for Payer: Blue Shield of California Commercial |
$5.76
|
| Rate for Payer: Blue Shield of California EPN |
$5.76
|
| Rate for Payer: Cash Price |
$32.81
|
|
|
FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE [108028]
|
Facility
|
OP
|
$110.60
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$94.01 |
| Rate for Payer: Adventist Health Commercial |
$22.12
|
| Rate for Payer: Adventist Health Commercial |
$21.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$71.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$72.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$94.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$92.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$59.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$81.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.04
|
| Rate for Payer: Blue Shield of California Commercial |
$5.76
|
| Rate for Payer: Blue Shield of California Commercial |
$5.76
|
| Rate for Payer: Blue Shield of California EPN |
$5.76
|
| Rate for Payer: Blue Shield of California EPN |
$5.76
|
| Rate for Payer: Cash Price |
$60.83
|
| Rate for Payer: Cash Price |
$59.75
|
| Rate for Payer: Cash Price |
$60.83
|
| Rate for Payer: Cash Price |
$59.75
|
| Rate for Payer: Cigna of CA HMO |
$77.42
|
| Rate for Payer: Cigna of CA HMO |
$76.05
|
| Rate for Payer: Cigna of CA PPO |
$77.42
|
| Rate for Payer: Cigna of CA PPO |
$76.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$92.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$94.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$94.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$92.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$94.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.46
|
| Rate for Payer: EPIC Health Plan Senior |
$43.46
|
| Rate for Payer: EPIC Health Plan Senior |
$44.24
|
| Rate for Payer: Galaxy Health WC |
$94.01
|
| Rate for Payer: Galaxy Health WC |
$92.34
|
| Rate for Payer: Global Benefits Group Commercial |
$66.36
|
| Rate for Payer: Global Benefits Group Commercial |
$65.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$77.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$76.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$76.05
|
| Rate for Payer: Multiplan Commercial |
$88.48
|
| Rate for Payer: Multiplan Commercial |
$86.91
|
| Rate for Payer: Networks By Design Commercial |
$55.30
|
| Rate for Payer: Networks By Design Commercial |
$54.32
|
| Rate for Payer: Prime Health Services Commercial |
$92.34
|
| Rate for Payer: Prime Health Services Commercial |
$94.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$65.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.51
|
| Rate for Payer: United Healthcare All Other HMO |
$39.69
|
| Rate for Payer: United Healthcare All Other HMO |
$40.40
|
| Rate for Payer: United Healthcare HMO Rider |
$39.53
|
| Rate for Payer: United Healthcare HMO Rider |
$38.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$94.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$92.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$92.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$94.01
|
| Rate for Payer: Vantage Medical Group Senior |
$92.34
|
| Rate for Payer: Vantage Medical Group Senior |
$94.01
|
|
|
FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE [108028]
|
Facility
|
IP
|
$110.60
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.12 |
| Max. Negotiated Rate |
$94.01 |
| Rate for Payer: Adventist Health Commercial |
$22.12
|
| Rate for Payer: Adventist Health Commercial |
$21.73
|
| Rate for Payer: Blue Shield of California Commercial |
$81.62
|
| Rate for Payer: Blue Shield of California Commercial |
$80.18
|
| Rate for Payer: Blue Shield of California EPN |
$52.80
|
| Rate for Payer: Blue Shield of California EPN |
$53.75
|
| Rate for Payer: Cash Price |
$60.83
|
| Rate for Payer: Cash Price |
$59.75
|
| Rate for Payer: Cigna of CA HMO |
$77.42
|
| Rate for Payer: Cigna of CA HMO |
$76.05
|
| Rate for Payer: Cigna of CA PPO |
$76.05
|
| Rate for Payer: Cigna of CA PPO |
$77.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.24
|
| Rate for Payer: EPIC Health Plan Senior |
$43.46
|
| Rate for Payer: EPIC Health Plan Senior |
$44.24
|
| Rate for Payer: Galaxy Health WC |
$92.34
|
| Rate for Payer: Galaxy Health WC |
$94.01
|
| Rate for Payer: Global Benefits Group Commercial |
$65.18
|
| Rate for Payer: Global Benefits Group Commercial |
$66.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.54
|
| Rate for Payer: Multiplan Commercial |
$86.91
|
| Rate for Payer: Multiplan Commercial |
$88.48
|
| Rate for Payer: Networks By Design Commercial |
$55.30
|
| Rate for Payer: Networks By Design Commercial |
$54.32
|
| Rate for Payer: Prime Health Services Commercial |
$94.01
|
| Rate for Payer: Prime Health Services Commercial |
$92.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.51
|
| Rate for Payer: United Healthcare All Other HMO |
$40.40
|
| Rate for Payer: United Healthcare All Other HMO |
$39.69
|
| Rate for Payer: United Healthcare HMO Rider |
$38.83
|
| Rate for Payer: United Healthcare HMO Rider |
$39.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.22
|
|
|
FOOD SUPPLEMNT,LACTO-REDUCE 0.05 GRAM-1.2 KCAL/ML LIQUID FOR TUBE FEED [216461]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 4390018480
|
| 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: 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: 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 Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA 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 |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| 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
|
|
