|
EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION [23123]
|
Facility
OP
|
$1.20
|
|
|
Service Code
|
CPT J1327
|
| Hospital Charge Code |
1722021
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$271.33 |
| Rate for Payer: Cigna of CA PPO |
$2.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$271.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$271.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$271.33
|
| Rate for Payer: BCBS Transplant Transplant |
$1.80
|
| Rate for Payer: BCBS Transplant Transplant |
$0.72
|
| Rate for Payer: BCBS Transplant Transplant |
$2.03
|
| Rate for Payer: Blue Shield of California Commercial |
$2.49
|
| Rate for Payer: Blue Shield of California Commercial |
$0.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2.21
|
| Rate for Payer: Blue Shield of California EPN |
$32.47
|
| Rate for Payer: Blue Shield of California EPN |
$32.47
|
| Rate for Payer: Blue Shield of California EPN |
$32.47
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA HMO |
$2.37
|
| Rate for Payer: Cigna of CA HMO |
$2.10
|
| Rate for Payer: Cigna of CA PPO |
$2.10
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.02
|
| Rate for Payer: Dignity Health Media |
$3.35
|
| Rate for Payer: Dignity Health Media |
$3.35
|
| Rate for Payer: Dignity Health Media |
$3.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.52
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.35
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.35
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.35
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Galaxy Health WC |
$2.87
|
| Rate for Payer: Galaxy Health WC |
$2.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1.80
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Global Benefits Group Commercial |
$2.03
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.54
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.49
|
| Rate for Payer: Heritage Provider Network Transplant |
$5.49
|
| Rate for Payer: Heritage Provider Network Transplant |
$5.49
|
| Rate for Payer: Heritage Provider Network Transplant |
$5.49
|
| Rate for Payer: IEHP Medi-Cal |
$5.42
|
| Rate for Payer: IEHP Medi-Cal |
$5.42
|
| Rate for Payer: IEHP Medi-Cal |
$5.42
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$5.42
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$5.42
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$5.42
|
| Rate for Payer: IEHP Medicare Advantage |
$3.35
|
| Rate for Payer: IEHP Medicare Advantage |
$3.35
|
| Rate for Payer: IEHP Medicare Advantage |
$3.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.48
|
| Rate for Payer: Multiplan Commercial |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Networks By Design Commercial |
$1.50
|
| Rate for Payer: Networks By Design Commercial |
$1.69
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
| Rate for Payer: Prime Health Services Commercial |
$2.55
|
| Rate for Payer: Prime Health Services Commercial |
$2.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.60
|
| Rate for Payer: United Healthcare All Other HMO |
$0.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1.69
|
| Rate for Payer: United Healthcare HMO Rider |
$1.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1.69
|
| Rate for Payer: United Healthcare HMO Rider |
$0.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.68
|
| Rate for Payer: Vantage Medical Group Senior |
$3.35
|
| Rate for Payer: Vantage Medical Group Senior |
$3.35
|
| Rate for Payer: Vantage Medical Group Senior |
$3.35
|
|
|
EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION [23123]
|
Facility
IP
|
$3.38
|
|
|
Service Code
|
CPT J1327
|
| Hospital Charge Code |
1722021
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Blue Shield of California Commercial |
$2.41
|
| Rate for Payer: Blue Shield of California Commercial |
$0.85
|
| Rate for Payer: Blue Shield of California Commercial |
$2.14
|
| Rate for Payer: Blue Shield of California EPN |
$1.73
|
| Rate for Payer: Blue Shield of California EPN |
$0.61
|
| Rate for Payer: Blue Shield of California EPN |
$1.54
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cigna of CA HMO |
$2.37
|
| Rate for Payer: Cigna of CA HMO |
$2.10
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$2.10
|
| Rate for Payer: Cigna of CA PPO |
$2.37
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Galaxy Health WC |
$2.87
|
| Rate for Payer: Galaxy Health WC |
$2.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2.03
|
| Rate for Payer: Global Benefits Group Commercial |
$1.80
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Networks By Design Commercial |
$1.69
|
| Rate for Payer: Networks By Design Commercial |
$1.50
|
| Rate for Payer: Prime Health Services Commercial |
$2.55
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
| Rate for Payer: Prime Health Services Commercial |
$2.87
|
|
|
EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION [23124]
|
Facility
IP
|
$6.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
NDG23124
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: Blue Shield of California Commercial |
$4.27
|
| Rate for Payer: Blue Shield of California EPN |
$3.07
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Networks By Design Commercial |
$3.00
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
|
|
EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION [23124]
|
Facility
OP
|
$5.40
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
1722020
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Vantage Medical Group Senior |
$4.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.97
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.97
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.20
|
| Rate for Payer: BCBS Transplant Transplant |
$3.24
|
| Rate for Payer: BCBS Transplant Transplant |
$6.77
|
| Rate for Payer: Blue Shield of California Commercial |
$8.31
|
| Rate for Payer: Blue Shield of California Commercial |
$3.98
|
| Rate for Payer: Blue Shield of California EPN |
$3.15
|
| Rate for Payer: Blue Shield of California EPN |
$6.59
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$5.08
|
| Rate for Payer: Cash Price |
$5.08
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cigna of CA HMO |
$7.90
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$7.90
|
| Rate for Payer: Cigna of CA PPO |
$3.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.59
|
| Rate for Payer: Dignity Health Media |
$9.59
|
| Rate for Payer: Dignity Health Media |
$4.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.16
|
| Rate for Payer: Galaxy Health WC |
$4.59
|
| Rate for Payer: Galaxy Health WC |
$9.59
|
| Rate for Payer: Global Benefits Group Commercial |
$6.77
|
| Rate for Payer: Global Benefits Group Commercial |
$3.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.05
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.71
|
| Rate for Payer: Multiplan Commercial |
$4.32
|
| Rate for Payer: Multiplan Commercial |
$9.02
|
| Rate for Payer: Networks By Design Commercial |
$5.64
|
| Rate for Payer: Networks By Design Commercial |
$2.70
|
| Rate for Payer: Prime Health Services Commercial |
$4.59
|
| Rate for Payer: Prime Health Services Commercial |
$9.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2.70
|
| Rate for Payer: United Healthcare All Other HMO |
$5.64
|
| Rate for Payer: United Healthcare HMO Rider |
$2.70
|
| Rate for Payer: United Healthcare HMO Rider |
$5.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.59
|
| Rate for Payer: Vantage Medical Group Senior |
$9.59
|
|
|
EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION [23124]
|
Facility
OP
|
$6.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
NDG23124
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.30
|
| Rate for Payer: BCBS Transplant Transplant |
$3.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4.42
|
| Rate for Payer: Blue Shield of California EPN |
$3.50
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.10
|
| Rate for Payer: Dignity Health Media |
$5.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Networks By Design Commercial |
$3.00
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$5.10
|
|
|
EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION [23124]
|
Facility
IP
|
$11.28
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
1722020
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$9.59 |
| Rate for Payer: Blue Shield of California Commercial |
$8.03
|
| Rate for Payer: Blue Shield of California Commercial |
$3.84
|
| Rate for Payer: Blue Shield of California EPN |
$2.76
|
| Rate for Payer: Blue Shield of California EPN |
$5.78
|
| Rate for Payer: Cash Price |
$5.08
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cigna of CA HMO |
$7.90
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$7.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.16
|
| Rate for Payer: Galaxy Health WC |
$9.59
|
| Rate for Payer: Galaxy Health WC |
$4.59
|
| Rate for Payer: Global Benefits Group Commercial |
$3.24
|
| Rate for Payer: Global Benefits Group Commercial |
$6.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.30
|
| Rate for Payer: Multiplan Commercial |
$9.02
|
| Rate for Payer: Multiplan Commercial |
$4.32
|
| Rate for Payer: Networks By Design Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$5.64
|
| Rate for Payer: Prime Health Services Commercial |
$9.59
|
| Rate for Payer: Prime Health Services Commercial |
$4.59
|
|
|
ERAVACYCLINE 50 MG INTRAVENOUS SOLUTION [222798]
|
Facility
OP
|
$68.40
|
|
|
Service Code
|
CPT J0122
|
| Hospital Charge Code |
ERX222798
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$58.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.09
|
| Rate for Payer: BCBS Transplant Transplant |
$41.04
|
| Rate for Payer: Blue Shield of California Commercial |
$50.41
|
| Rate for Payer: Blue Shield of California EPN |
$39.95
|
| Rate for Payer: Cash Price |
$30.78
|
| Rate for Payer: Cash Price |
$30.78
|
| Rate for Payer: Cigna of CA HMO |
$47.88
|
| Rate for Payer: Cigna of CA PPO |
$47.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.22
|
| Rate for Payer: Dignity Health Media |
$1.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.48
|
| Rate for Payer: Galaxy Health WC |
$58.14
|
| Rate for Payer: Global Benefits Group Commercial |
$41.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$51.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.43
|
| Rate for Payer: Heritage Provider Network Transplant |
$2.43
|
| Rate for Payer: IEHP Medi-Cal |
$2.40
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$2.40
|
| Rate for Payer: IEHP Medicare Advantage |
$1.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.98
|
| Rate for Payer: Multiplan Commercial |
$54.72
|
| Rate for Payer: Networks By Design Commercial |
$34.20
|
| Rate for Payer: Prime Health Services Commercial |
$58.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$41.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$41.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.20
|
| Rate for Payer: United Healthcare All Other HMO |
$34.20
|
| Rate for Payer: United Healthcare HMO Rider |
$34.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.63
|
| Rate for Payer: Vantage Medical Group Senior |
$1.48
|
|
|
ERAVACYCLINE 50 MG INTRAVENOUS SOLUTION [222798]
|
Facility
IP
|
$68.40
|
|
|
Service Code
|
CPT J0122
|
| Hospital Charge Code |
ERX222798
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.42 |
| Max. Negotiated Rate |
$58.14 |
| Rate for Payer: Blue Shield of California Commercial |
$48.70
|
| Rate for Payer: Blue Shield of California EPN |
$35.02
|
| Rate for Payer: Cash Price |
$30.78
|
| Rate for Payer: Cigna of CA HMO |
$47.88
|
| Rate for Payer: Cigna of CA PPO |
$47.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$27.36
|
| Rate for Payer: Galaxy Health WC |
$58.14
|
| Rate for Payer: Global Benefits Group Commercial |
$41.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.42
|
| Rate for Payer: Multiplan Commercial |
$54.72
|
| Rate for Payer: Networks By Design Commercial |
$34.20
|
| Rate for Payer: Prime Health Services Commercial |
$58.14
|
|
|
ERDAFITINIB 3 MG TABLET [224623]
|
Facility
IP
|
$403.73
|
|
|
Service Code
|
NDC 59676-030-56
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$96.90 |
| Max. Negotiated Rate |
$343.17 |
| Rate for Payer: Blue Shield of California Commercial |
$287.46
|
| Rate for Payer: Blue Shield of California EPN |
$206.71
|
| Rate for Payer: Cash Price |
$181.68
|
| Rate for Payer: Cigna of CA HMO |
$282.61
|
| Rate for Payer: Cigna of CA PPO |
$282.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$161.49
|
| Rate for Payer: Galaxy Health WC |
$343.17
|
| Rate for Payer: Global Benefits Group Commercial |
$242.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$269.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.90
|
| Rate for Payer: Multiplan Commercial |
$322.98
|
| Rate for Payer: Networks By Design Commercial |
$201.86
|
| Rate for Payer: Prime Health Services Commercial |
$343.17
|
|
|
ERDAFITINIB 3 MG TABLET [224623]
|
Facility
OP
|
$403.73
|
|
|
Service Code
|
NDC 59676-030-56
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$96.90 |
| Max. Negotiated Rate |
$343.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$264.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$343.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$222.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$222.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$240.54
|
| Rate for Payer: BCBS Transplant Transplant |
$242.24
|
| Rate for Payer: Blue Shield of California Commercial |
$297.55
|
| Rate for Payer: Blue Shield of California EPN |
$235.78
|
| Rate for Payer: Cash Price |
$181.68
|
| Rate for Payer: Cash Price |
$181.68
|
| Rate for Payer: Cigna of CA HMO |
$282.61
|
| Rate for Payer: Cigna of CA PPO |
$282.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$343.17
|
| Rate for Payer: Dignity Health Media |
$343.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$343.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$161.49
|
| Rate for Payer: Galaxy Health WC |
$343.17
|
| Rate for Payer: Global Benefits Group Commercial |
$242.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$302.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$269.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.90
|
| Rate for Payer: Multiplan Commercial |
$322.98
|
| Rate for Payer: Networks By Design Commercial |
$201.86
|
| Rate for Payer: Prime Health Services Commercial |
$343.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$242.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$242.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$201.86
|
| Rate for Payer: United Healthcare All Other HMO |
$201.86
|
| Rate for Payer: United Healthcare HMO Rider |
$201.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$201.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$343.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$343.17
|
| Rate for Payer: Vantage Medical Group Senior |
$343.17
|
|
|
ERDAFITINIB 4 MG TABLET [224624]
|
Facility
IP
|
$538.30
|
|
|
Service Code
|
NDC 59676-040-28
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$129.19 |
| Max. Negotiated Rate |
$457.56 |
| Rate for Payer: Blue Shield of California Commercial |
$383.27
|
| Rate for Payer: Blue Shield of California EPN |
$275.61
|
| Rate for Payer: Cash Price |
$242.24
|
| Rate for Payer: Cigna of CA HMO |
$376.81
|
| Rate for Payer: Cigna of CA PPO |
$376.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$215.32
|
| Rate for Payer: Galaxy Health WC |
$457.56
|
| Rate for Payer: Global Benefits Group Commercial |
$322.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$359.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.19
|
| Rate for Payer: Multiplan Commercial |
$430.64
|
| Rate for Payer: Networks By Design Commercial |
$269.15
|
| Rate for Payer: Prime Health Services Commercial |
$457.56
|
|
|
ERDAFITINIB 4 MG TABLET [224624]
|
Facility
OP
|
$538.30
|
|
|
Service Code
|
NDC 59676-040-28
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$129.19 |
| Max. Negotiated Rate |
$457.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$353.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$457.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$296.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$296.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$320.72
|
| Rate for Payer: BCBS Transplant Transplant |
$322.98
|
| Rate for Payer: Blue Shield of California Commercial |
$396.73
|
| Rate for Payer: Blue Shield of California EPN |
$314.37
|
| Rate for Payer: Cash Price |
$242.24
|
| Rate for Payer: Cash Price |
$242.24
|
| Rate for Payer: Cigna of CA HMO |
$376.81
|
| Rate for Payer: Cigna of CA PPO |
$376.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.56
|
| Rate for Payer: Dignity Health Media |
$457.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$457.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$215.32
|
| Rate for Payer: Galaxy Health WC |
$457.56
|
| Rate for Payer: Global Benefits Group Commercial |
$322.98
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$403.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$359.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.19
|
| Rate for Payer: Multiplan Commercial |
$430.64
|
| Rate for Payer: Networks By Design Commercial |
$269.15
|
| Rate for Payer: Prime Health Services Commercial |
$457.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$322.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$322.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$269.15
|
| Rate for Payer: United Healthcare All Other HMO |
$269.15
|
| Rate for Payer: United Healthcare HMO Rider |
$269.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$269.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$457.56
|
| Rate for Payer: Vantage Medical Group Senior |
$457.56
|
|
|
ERDAFITINIB 5 MG TABLET [224625]
|
Facility
OP
|
$672.88
|
|
|
Service Code
|
NDC 59676-050-28
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$161.49 |
| Max. Negotiated Rate |
$571.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$441.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$571.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$370.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$370.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$400.90
|
| Rate for Payer: BCBS Transplant Transplant |
$403.73
|
| Rate for Payer: Blue Shield of California Commercial |
$495.91
|
| Rate for Payer: Blue Shield of California EPN |
$392.96
|
| Rate for Payer: Cash Price |
$302.80
|
| Rate for Payer: Cash Price |
$302.80
|
| Rate for Payer: Cigna of CA HMO |
$471.02
|
| Rate for Payer: Cigna of CA PPO |
$471.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$571.95
|
| Rate for Payer: Dignity Health Media |
$571.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$571.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$269.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$269.15
|
| Rate for Payer: Galaxy Health WC |
$571.95
|
| Rate for Payer: Global Benefits Group Commercial |
$403.73
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$504.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$448.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$256.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.49
|
| Rate for Payer: Multiplan Commercial |
$538.30
|
| Rate for Payer: Networks By Design Commercial |
$336.44
|
| Rate for Payer: Prime Health Services Commercial |
$571.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$403.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$403.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$336.44
|
| Rate for Payer: United Healthcare All Other HMO |
$336.44
|
| Rate for Payer: United Healthcare HMO Rider |
$336.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$336.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$571.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$571.95
|
| Rate for Payer: Vantage Medical Group Senior |
$571.95
|
|
|
ERDAFITINIB 5 MG TABLET [224625]
|
Facility
IP
|
$672.88
|
|
|
Service Code
|
NDC 59676-050-28
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$161.49 |
| Max. Negotiated Rate |
$571.95 |
| Rate for Payer: Blue Shield of California Commercial |
$479.09
|
| Rate for Payer: Blue Shield of California EPN |
$344.51
|
| Rate for Payer: Cash Price |
$302.80
|
| Rate for Payer: Cigna of CA HMO |
$471.02
|
| Rate for Payer: Cigna of CA PPO |
$471.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$269.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$269.15
|
| Rate for Payer: Galaxy Health WC |
$571.95
|
| Rate for Payer: Global Benefits Group Commercial |
$403.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$448.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$256.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.49
|
| Rate for Payer: Multiplan Commercial |
$538.30
|
| Rate for Payer: Networks By Design Commercial |
$336.44
|
| Rate for Payer: Prime Health Services Commercial |
$571.95
|
|
|
ERENUMAB-AOOE 70 MG/ML SUBCUTANEOUS AUTO-INJECTOR [221765]
|
Facility
IP
|
$885.43
|
|
|
Service Code
|
CPT J3590
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$212.50 |
| Max. Negotiated Rate |
$752.62 |
| Rate for Payer: Blue Shield of California Commercial |
$630.43
|
| Rate for Payer: Blue Shield of California EPN |
$453.34
|
| Rate for Payer: Cash Price |
$398.44
|
| Rate for Payer: Cigna of CA HMO |
$619.80
|
| Rate for Payer: Cigna of CA PPO |
$619.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$354.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$354.17
|
| Rate for Payer: Galaxy Health WC |
$752.62
|
| Rate for Payer: Global Benefits Group Commercial |
$531.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$590.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$337.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.50
|
| Rate for Payer: Multiplan Commercial |
$708.34
|
| Rate for Payer: Networks By Design Commercial |
$442.72
|
| Rate for Payer: Prime Health Services Commercial |
$752.62
|
|
|
ERENUMAB-AOOE 70 MG/ML SUBCUTANEOUS AUTO-INJECTOR [221765]
|
Facility
OP
|
$885.43
|
|
|
Service Code
|
CPT J3590
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$212.50 |
| Max. Negotiated Rate |
$752.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$580.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$752.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$486.99
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$486.99
|
| Rate for Payer: BCBS Transplant Transplant |
$531.26
|
| Rate for Payer: Blue Shield of California Commercial |
$652.56
|
| Rate for Payer: Blue Shield of California EPN |
$517.09
|
| Rate for Payer: Cash Price |
$398.44
|
| Rate for Payer: Cash Price |
$398.44
|
| Rate for Payer: Cigna of CA HMO |
$619.80
|
| Rate for Payer: Cigna of CA PPO |
$619.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$752.62
|
| Rate for Payer: Dignity Health Media |
$752.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$752.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$354.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$354.17
|
| Rate for Payer: Galaxy Health WC |
$752.62
|
| Rate for Payer: Global Benefits Group Commercial |
$531.26
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$664.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$590.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.50
|
| Rate for Payer: Multiplan Commercial |
$708.34
|
| Rate for Payer: Networks By Design Commercial |
$442.72
|
| Rate for Payer: Prime Health Services Commercial |
$752.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$531.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$531.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$442.72
|
| Rate for Payer: United Healthcare All Other HMO |
$442.72
|
| Rate for Payer: United Healthcare HMO Rider |
$442.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$442.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$752.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$752.62
|
| Rate for Payer: Vantage Medical Group Senior |
$752.62
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE [2863]
|
Facility
OP
|
$0.44
|
|
|
Service Code
|
NDC 69452-151-20
|
| Hospital Charge Code |
1710033
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.26
|
| Rate for Payer: BCBS Transplant Transplant |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cigna of CA HMO |
$0.31
|
| Rate for Payer: Cigna of CA PPO |
$0.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.37
|
| Rate for Payer: Dignity Health Media |
$0.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO |
$0.22
|
| Rate for Payer: United Healthcare HMO Rider |
$0.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Vantage Medical Group Senior |
$0.37
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE [2863]
|
Facility
IP
|
$0.44
|
|
|
Service Code
|
NDC 69452-151-20
|
| Hospital Charge Code |
1710033
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Blue Shield of California Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cigna of CA HMO |
$0.31
|
| Rate for Payer: Cigna of CA PPO |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS [9943]
|
Facility
IP
|
$1.66
|
|
|
Service Code
|
NDC 3932835760
|
| Hospital Charge Code |
NDG9943
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.41 |
| Rate for Payer: Blue Shield of California Commercial |
$1.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.85
|
| Rate for Payer: Cash Price |
$0.75
|
| Rate for Payer: Cigna of CA HMO |
$1.16
|
| Rate for Payer: Cigna of CA PPO |
$1.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.66
|
| Rate for Payer: Galaxy Health WC |
$1.41
|
| Rate for Payer: Global Benefits Group Commercial |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.33
|
| Rate for Payer: Networks By Design Commercial |
$1.08
|
| Rate for Payer: Prime Health Services Commercial |
$1.41
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS [9943]
|
Facility
OP
|
$1.66
|
|
|
Service Code
|
NDC 3932835760
|
| Hospital Charge Code |
NDG9943
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.99
|
| Rate for Payer: BCBS Transplant Transplant |
$1.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.97
|
| Rate for Payer: Cash Price |
$0.75
|
| Rate for Payer: Cigna of CA HMO |
$1.16
|
| Rate for Payer: Cigna of CA PPO |
$1.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.41
|
| Rate for Payer: Dignity Health Media |
$1.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.66
|
| Rate for Payer: Galaxy Health WC |
$1.41
|
| Rate for Payer: Global Benefits Group Commercial |
$1.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.33
|
| Rate for Payer: Networks By Design Commercial |
$1.08
|
| Rate for Payer: Prime Health Services Commercial |
$1.41
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.83
|
| Rate for Payer: United Healthcare All Other HMO |
$0.83
|
| Rate for Payer: United Healthcare HMO Rider |
$0.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.41
|
| Rate for Payer: Vantage Medical Group Senior |
$1.41
|
|
|
ERGOTAMINE 1 MG-CAFFEINE 100 MG TABLET [9949]
|
Facility
OP
|
$14.82
|
|
|
Service Code
|
NDC 0781-5405-01
|
| Hospital Charge Code |
1712008
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$12.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.83
|
| Rate for Payer: BCBS Transplant Transplant |
$8.89
|
| Rate for Payer: Blue Shield of California Commercial |
$10.92
|
| Rate for Payer: Blue Shield of California EPN |
$8.65
|
| Rate for Payer: Cash Price |
$6.67
|
| Rate for Payer: Cigna of CA HMO |
$10.37
|
| Rate for Payer: Cigna of CA PPO |
$10.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.60
|
| Rate for Payer: Dignity Health Media |
$12.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.93
|
| Rate for Payer: Galaxy Health WC |
$12.60
|
| Rate for Payer: Global Benefits Group Commercial |
$8.89
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.56
|
| Rate for Payer: Multiplan Commercial |
$11.86
|
| Rate for Payer: Networks By Design Commercial |
$9.63
|
| Rate for Payer: Prime Health Services Commercial |
$12.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.41
|
| Rate for Payer: United Healthcare All Other HMO |
$7.41
|
| Rate for Payer: United Healthcare HMO Rider |
$7.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.60
|
| Rate for Payer: Vantage Medical Group Senior |
$12.60
|
|
|
ERGOTAMINE 1 MG-CAFFEINE 100 MG TABLET [9949]
|
Facility
IP
|
$14.82
|
|
|
Service Code
|
NDC 0781-5405-01
|
| Hospital Charge Code |
1712008
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$12.60 |
| Rate for Payer: Blue Shield of California Commercial |
$10.55
|
| Rate for Payer: Blue Shield of California EPN |
$7.59
|
| Rate for Payer: Cash Price |
$6.67
|
| Rate for Payer: Cigna of CA HMO |
$10.37
|
| Rate for Payer: Cigna of CA PPO |
$10.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.93
|
| Rate for Payer: Galaxy Health WC |
$12.60
|
| Rate for Payer: Global Benefits Group Commercial |
$8.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.56
|
| Rate for Payer: Multiplan Commercial |
$11.86
|
| Rate for Payer: Networks By Design Commercial |
$9.63
|
| Rate for Payer: Prime Health Services Commercial |
$12.60
|
|
|
ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION [106773]
|
Facility
OP
|
$820.80
|
|
|
Service Code
|
CPT J9179
|
| Hospital Charge Code |
1755763
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$134.02 |
| Max. Negotiated Rate |
$842.91 |
| Rate for Payer: Aetna of CA HMO/PPO |
$842.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$167.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$147.42
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$147.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$186.78
|
| Rate for Payer: BCBS Transplant Transplant |
$492.48
|
| Rate for Payer: Blue Shield of California Commercial |
$604.93
|
| Rate for Payer: Blue Shield of California EPN |
$141.60
|
| Rate for Payer: Cash Price |
$369.36
|
| Rate for Payer: Cash Price |
$369.36
|
| Rate for Payer: Cigna of CA HMO |
$574.56
|
| Rate for Payer: Cigna of CA PPO |
$574.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.03
|
| Rate for Payer: Dignity Health Media |
$134.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$134.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$134.02
|
| Rate for Payer: Galaxy Health WC |
$697.68
|
| Rate for Payer: Global Benefits Group Commercial |
$492.48
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$615.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$219.79
|
| Rate for Payer: Heritage Provider Network Transplant |
$219.79
|
| Rate for Payer: IEHP Medi-Cal |
$217.11
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$217.11
|
| Rate for Payer: IEHP Medicare Advantage |
$134.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$547.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$263.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$134.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$168.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$179.58
|
| Rate for Payer: Multiplan Commercial |
$656.64
|
| Rate for Payer: Networks By Design Commercial |
$410.40
|
| Rate for Payer: Prime Health Services Commercial |
$697.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$492.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$492.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$410.40
|
| Rate for Payer: United Healthcare All Other HMO |
$410.40
|
| Rate for Payer: United Healthcare HMO Rider |
$410.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$410.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.42
|
| Rate for Payer: Vantage Medical Group Senior |
$134.02
|
|
|
ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION [106773]
|
Facility
IP
|
$820.80
|
|
|
Service Code
|
CPT J9179
|
| Hospital Charge Code |
1755763
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$196.99 |
| Max. Negotiated Rate |
$697.68 |
| Rate for Payer: Blue Shield of California Commercial |
$584.41
|
| Rate for Payer: Blue Shield of California EPN |
$420.25
|
| Rate for Payer: Cash Price |
$369.36
|
| Rate for Payer: Cigna of CA HMO |
$574.56
|
| Rate for Payer: Cigna of CA PPO |
$574.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$328.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$328.32
|
| Rate for Payer: Galaxy Health WC |
$697.68
|
| Rate for Payer: Global Benefits Group Commercial |
$492.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$547.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$312.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.99
|
| Rate for Payer: Multiplan Commercial |
$656.64
|
| Rate for Payer: Networks By Design Commercial |
$410.40
|
| Rate for Payer: Prime Health Services Commercial |
$697.68
|
|
|
ERTAPENEM 1 GRAM INJECTION (IM) [4083192201]
|
Facility
IP
|
$120.00
|
|
|
Service Code
|
CPT J1335
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Blue Shield of California Commercial |
$85.44
|
| Rate for Payer: Blue Shield of California Commercial |
$40.58
|
| Rate for Payer: Blue Shield of California Commercial |
$109.93
|
| Rate for Payer: Blue Shield of California Commercial |
$118.59
|
| Rate for Payer: Blue Shield of California Commercial |
$100.02
|
| Rate for Payer: Blue Shield of California EPN |
$79.05
|
| Rate for Payer: Blue Shield of California EPN |
$71.93
|
| Rate for Payer: Blue Shield of California EPN |
$85.28
|
| Rate for Payer: Blue Shield of California EPN |
$29.18
|
| Rate for Payer: Blue Shield of California EPN |
$61.44
|
| Rate for Payer: Cash Price |
$69.48
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cash Price |
$74.95
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$63.22
|
| Rate for Payer: Cigna of CA HMO |
$116.59
|
| Rate for Payer: Cigna of CA HMO |
$39.90
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA HMO |
$98.34
|
| Rate for Payer: Cigna of CA HMO |
$108.07
|
| Rate for Payer: Cigna of CA PPO |
$39.90
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$98.34
|
| Rate for Payer: Cigna of CA PPO |
$108.07
|
| Rate for Payer: Cigna of CA PPO |
$116.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$61.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$22.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$66.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$56.19
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Galaxy Health WC |
$119.41
|
| Rate for Payer: Galaxy Health WC |
$131.23
|
| Rate for Payer: Galaxy Health WC |
$48.45
|
| Rate for Payer: Galaxy Health WC |
$141.58
|
| Rate for Payer: Global Benefits Group Commercial |
$34.20
|
| Rate for Payer: Global Benefits Group Commercial |
$84.29
|
| Rate for Payer: Global Benefits Group Commercial |
$92.63
|
| Rate for Payer: Global Benefits Group Commercial |
$99.94
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$111.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.97
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Multiplan Commercial |
$133.25
|
| Rate for Payer: Multiplan Commercial |
$45.60
|
| Rate for Payer: Multiplan Commercial |
$123.51
|
| Rate for Payer: Multiplan Commercial |
$112.38
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$28.50
|
| Rate for Payer: Networks By Design Commercial |
$83.28
|
| Rate for Payer: Networks By Design Commercial |
$70.24
|
| Rate for Payer: Networks By Design Commercial |
$77.20
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Prime Health Services Commercial |
$48.45
|
| Rate for Payer: Prime Health Services Commercial |
$141.58
|
| Rate for Payer: Prime Health Services Commercial |
$131.23
|
| Rate for Payer: Prime Health Services Commercial |
$119.41
|
|
