|
IFOSFAMIDE 1 GRAM/20 ML INTRAVENOUS SOLUTION [87925]
|
Facility
IP
|
$2.20
|
|
|
Service Code
|
CPT J9208
|
| Hospital Charge Code |
NDG87925
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$1.87 |
| Rate for Payer: Blue Shield of California Commercial |
$1.57
|
| Rate for Payer: Blue Shield of California EPN |
$1.13
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cigna of CA HMO |
$1.54
|
| Rate for Payer: Cigna of CA PPO |
$1.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.88
|
| Rate for Payer: Galaxy Health WC |
$1.87
|
| Rate for Payer: Global Benefits Group Commercial |
$1.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: Multiplan Commercial |
$1.76
|
| Rate for Payer: Networks By Design Commercial |
$1.10
|
| Rate for Payer: Prime Health Services Commercial |
$1.87
|
|
|
IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION [10248]
|
Facility
IP
|
$69.66
|
|
|
Service Code
|
CPT J9208
|
| Hospital Charge Code |
1755702
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.72 |
| Max. Negotiated Rate |
$59.21 |
| Rate for Payer: Blue Shield of California Commercial |
$49.60
|
| Rate for Payer: Blue Shield of California Commercial |
$31.39
|
| Rate for Payer: Blue Shield of California EPN |
$22.57
|
| Rate for Payer: Blue Shield of California EPN |
$35.67
|
| Rate for Payer: Cash Price |
$31.35
|
| Rate for Payer: Cash Price |
$19.84
|
| Rate for Payer: Cigna of CA HMO |
$30.86
|
| Rate for Payer: Cigna of CA HMO |
$48.76
|
| Rate for Payer: Cigna of CA PPO |
$48.76
|
| Rate for Payer: Cigna of CA PPO |
$30.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$27.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.64
|
| Rate for Payer: Galaxy Health WC |
$59.21
|
| Rate for Payer: Galaxy Health WC |
$37.48
|
| Rate for Payer: Global Benefits Group Commercial |
$41.80
|
| Rate for Payer: Global Benefits Group Commercial |
$26.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.58
|
| Rate for Payer: Multiplan Commercial |
$55.73
|
| Rate for Payer: Multiplan Commercial |
$35.27
|
| Rate for Payer: Networks By Design Commercial |
$22.04
|
| Rate for Payer: Networks By Design Commercial |
$34.83
|
| Rate for Payer: Prime Health Services Commercial |
$37.48
|
| Rate for Payer: Prime Health Services Commercial |
$59.21
|
|
|
IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION [10248]
|
Facility
OP
|
$44.09
|
|
|
Service Code
|
CPT J9208
|
| Hospital Charge Code |
1755702
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.58 |
| Max. Negotiated Rate |
$281.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$52.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$52.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$59.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$37.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$38.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$38.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$281.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$281.28
|
| Rate for Payer: BCBS Transplant Transplant |
$41.80
|
| Rate for Payer: BCBS Transplant Transplant |
$26.45
|
| Rate for Payer: Blue Shield of California Commercial |
$32.49
|
| Rate for Payer: Blue Shield of California Commercial |
$51.34
|
| Rate for Payer: Blue Shield of California EPN |
$44.09
|
| Rate for Payer: Blue Shield of California EPN |
$44.09
|
| Rate for Payer: Cash Price |
$31.35
|
| Rate for Payer: Cash Price |
$19.84
|
| Rate for Payer: Cash Price |
$31.35
|
| Rate for Payer: Cash Price |
$19.84
|
| Rate for Payer: Cigna of CA HMO |
$48.76
|
| Rate for Payer: Cigna of CA HMO |
$30.86
|
| Rate for Payer: Cigna of CA PPO |
$48.76
|
| Rate for Payer: Cigna of CA PPO |
$30.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.21
|
| Rate for Payer: Dignity Health Media |
$59.21
|
| Rate for Payer: Dignity Health Media |
$37.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$27.86
|
| Rate for Payer: Galaxy Health WC |
$59.21
|
| Rate for Payer: Galaxy Health WC |
$37.48
|
| Rate for Payer: Global Benefits Group Commercial |
$41.80
|
| Rate for Payer: Global Benefits Group Commercial |
$26.45
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$52.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$33.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.58
|
| Rate for Payer: Multiplan Commercial |
$55.73
|
| Rate for Payer: Multiplan Commercial |
$35.27
|
| Rate for Payer: Networks By Design Commercial |
$34.83
|
| Rate for Payer: Networks By Design Commercial |
$22.04
|
| Rate for Payer: Prime Health Services Commercial |
$37.48
|
| Rate for Payer: Prime Health Services Commercial |
$59.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$41.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$41.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.83
|
| Rate for Payer: United Healthcare All Other HMO |
$34.83
|
| Rate for Payer: United Healthcare All Other HMO |
$22.04
|
| Rate for Payer: United Healthcare HMO Rider |
$22.04
|
| Rate for Payer: United Healthcare HMO Rider |
$34.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.48
|
| Rate for Payer: Vantage Medical Group Senior |
$37.48
|
| Rate for Payer: Vantage Medical Group Senior |
$59.21
|
|
|
IFOSFAMIDE 3 GRAM/60 ML INTRAVENOUS SOLUTION [87926]
|
Facility
OP
|
$2.15
|
|
|
Service Code
|
CPT J9208
|
| Hospital Charge Code |
NDG87926
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$281.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$52.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$281.28
|
| Rate for Payer: BCBS Transplant Transplant |
$1.29
|
| Rate for Payer: Blue Shield of California Commercial |
$1.58
|
| Rate for Payer: Blue Shield of California EPN |
$44.09
|
| Rate for Payer: Cash Price |
$0.97
|
| Rate for Payer: Cash Price |
$0.97
|
| Rate for Payer: Cigna of CA HMO |
$1.50
|
| Rate for Payer: Cigna of CA PPO |
$1.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.83
|
| Rate for Payer: Dignity Health Media |
$1.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.86
|
| Rate for Payer: Galaxy Health WC |
$1.83
|
| Rate for Payer: Global Benefits Group Commercial |
$1.29
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Multiplan Commercial |
$1.72
|
| Rate for Payer: Networks By Design Commercial |
$1.08
|
| Rate for Payer: Prime Health Services Commercial |
$1.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.08
|
| Rate for Payer: United Healthcare All Other HMO |
$1.08
|
| Rate for Payer: United Healthcare HMO Rider |
$1.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.83
|
| Rate for Payer: Vantage Medical Group Senior |
$1.83
|
|
|
IFOSFAMIDE 3 GRAM/60 ML INTRAVENOUS SOLUTION [87926]
|
Facility
IP
|
$2.15
|
|
|
Service Code
|
CPT J9208
|
| Hospital Charge Code |
NDG87926
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$1.83 |
| Rate for Payer: Blue Shield of California Commercial |
$1.53
|
| Rate for Payer: Blue Shield of California EPN |
$1.10
|
| Rate for Payer: Cash Price |
$0.97
|
| Rate for Payer: Cigna of CA HMO |
$1.50
|
| Rate for Payer: Cigna of CA PPO |
$1.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.86
|
| Rate for Payer: Galaxy Health WC |
$1.83
|
| Rate for Payer: Global Benefits Group Commercial |
$1.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Multiplan Commercial |
$1.72
|
| Rate for Payer: Networks By Design Commercial |
$1.08
|
| Rate for Payer: Prime Health Services Commercial |
$1.83
|
|
|
IFOSFAMIDE 3 GRAM INTRAVENOUS SOLUTION [10249]
|
Facility
OP
|
$129.05
|
|
|
Service Code
|
CPT J9208
|
| Hospital Charge Code |
1755703
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.97 |
| Max. Negotiated Rate |
$281.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$52.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$109.69
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$70.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$70.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$281.28
|
| Rate for Payer: BCBS Transplant Transplant |
$77.43
|
| Rate for Payer: Blue Shield of California Commercial |
$95.11
|
| Rate for Payer: Blue Shield of California EPN |
$44.09
|
| Rate for Payer: Cash Price |
$58.07
|
| Rate for Payer: Cash Price |
$58.07
|
| Rate for Payer: Cigna of CA HMO |
$90.34
|
| Rate for Payer: Cigna of CA PPO |
$90.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$109.69
|
| Rate for Payer: Dignity Health Media |
$109.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$109.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$51.62
|
| Rate for Payer: Galaxy Health WC |
$109.69
|
| Rate for Payer: Global Benefits Group Commercial |
$77.43
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$96.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.97
|
| Rate for Payer: Multiplan Commercial |
$103.24
|
| Rate for Payer: Networks By Design Commercial |
$64.52
|
| Rate for Payer: Prime Health Services Commercial |
$109.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$77.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$77.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.52
|
| Rate for Payer: United Healthcare All Other HMO |
$64.52
|
| Rate for Payer: United Healthcare HMO Rider |
$64.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$109.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$109.69
|
| Rate for Payer: Vantage Medical Group Senior |
$109.69
|
|
|
IFOSFAMIDE 3 GRAM INTRAVENOUS SOLUTION [10249]
|
Facility
IP
|
$129.05
|
|
|
Service Code
|
CPT J9208
|
| Hospital Charge Code |
1755703
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.97 |
| Max. Negotiated Rate |
$109.69 |
| Rate for Payer: Blue Shield of California Commercial |
$91.88
|
| Rate for Payer: Blue Shield of California EPN |
$66.07
|
| Rate for Payer: Cash Price |
$58.07
|
| Rate for Payer: Cigna of CA HMO |
$90.34
|
| Rate for Payer: Cigna of CA PPO |
$90.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$51.62
|
| Rate for Payer: Galaxy Health WC |
$109.69
|
| Rate for Payer: Global Benefits Group Commercial |
$77.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.97
|
| Rate for Payer: Multiplan Commercial |
$103.24
|
| Rate for Payer: Networks By Design Commercial |
$64.52
|
| Rate for Payer: Prime Health Services Commercial |
$109.69
|
|
|
ILOPROST 10 MCG/ML SOLUTION FOR NEBULIZATION [40413]
|
Facility
IP
|
$161.64
|
|
|
Service Code
|
NDC 66215-302-00
|
| Hospital Charge Code |
1744129
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$38.79 |
| Max. Negotiated Rate |
$137.39 |
| Rate for Payer: Blue Shield of California Commercial |
$115.09
|
| Rate for Payer: Blue Shield of California EPN |
$82.76
|
| Rate for Payer: Cash Price |
$72.74
|
| Rate for Payer: Cigna of CA HMO |
$113.15
|
| Rate for Payer: Cigna of CA PPO |
$113.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.66
|
| Rate for Payer: Galaxy Health WC |
$137.39
|
| Rate for Payer: Global Benefits Group Commercial |
$96.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$107.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.79
|
| Rate for Payer: Multiplan Commercial |
$129.31
|
| Rate for Payer: Networks By Design Commercial |
$105.07
|
| Rate for Payer: Prime Health Services Commercial |
$137.39
|
|
|
ILOPROST 10 MCG/ML SOLUTION FOR NEBULIZATION [40413]
|
Facility
OP
|
$161.64
|
|
|
Service Code
|
NDC 66215-302-00
|
| Hospital Charge Code |
1744129
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$38.79 |
| Max. Negotiated Rate |
$137.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$106.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$137.39
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$88.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$88.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.31
|
| Rate for Payer: BCBS Transplant Transplant |
$96.98
|
| Rate for Payer: Blue Shield of California Commercial |
$119.13
|
| Rate for Payer: Blue Shield of California EPN |
$94.40
|
| Rate for Payer: Cash Price |
$72.74
|
| Rate for Payer: Cigna of CA HMO |
$113.15
|
| Rate for Payer: Cigna of CA PPO |
$113.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.39
|
| Rate for Payer: Dignity Health Media |
$137.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$137.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$64.66
|
| Rate for Payer: Galaxy Health WC |
$137.39
|
| Rate for Payer: Global Benefits Group Commercial |
$96.98
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$121.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$107.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.79
|
| Rate for Payer: Multiplan Commercial |
$129.31
|
| Rate for Payer: Networks By Design Commercial |
$105.07
|
| Rate for Payer: Prime Health Services Commercial |
$137.39
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$96.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$96.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$96.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$80.82
|
| Rate for Payer: United Healthcare All Other HMO |
$80.82
|
| Rate for Payer: United Healthcare HMO Rider |
$80.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$80.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$137.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$137.39
|
| Rate for Payer: Vantage Medical Group Senior |
$137.39
|
|
|
ILOPROST 10 MCG/ML SOLUTION FOR NEBULIZATION [40413]
|
Facility
OP
|
$161.64
|
|
|
Service Code
|
NDC 66215-302-30
|
| Hospital Charge Code |
1744129
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$38.79 |
| Max. Negotiated Rate |
$137.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$106.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$137.39
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$88.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$88.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.31
|
| Rate for Payer: BCBS Transplant Transplant |
$96.98
|
| Rate for Payer: Blue Shield of California Commercial |
$119.13
|
| Rate for Payer: Blue Shield of California EPN |
$94.40
|
| Rate for Payer: Cash Price |
$72.74
|
| Rate for Payer: Cigna of CA HMO |
$113.15
|
| Rate for Payer: Cigna of CA PPO |
$113.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.39
|
| Rate for Payer: Dignity Health Media |
$137.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$137.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$64.66
|
| Rate for Payer: Galaxy Health WC |
$137.39
|
| Rate for Payer: Global Benefits Group Commercial |
$96.98
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$121.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$107.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.79
|
| Rate for Payer: Multiplan Commercial |
$129.31
|
| Rate for Payer: Networks By Design Commercial |
$105.07
|
| Rate for Payer: Prime Health Services Commercial |
$137.39
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$96.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$96.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$96.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$80.82
|
| Rate for Payer: United Healthcare All Other HMO |
$80.82
|
| Rate for Payer: United Healthcare HMO Rider |
$80.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$80.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$137.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$137.39
|
| Rate for Payer: Vantage Medical Group Senior |
$137.39
|
|
|
ILOPROST 10 MCG/ML SOLUTION FOR NEBULIZATION [40413]
|
Facility
IP
|
$161.64
|
|
|
Service Code
|
NDC 66215-302-30
|
| Hospital Charge Code |
1744129
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$38.79 |
| Max. Negotiated Rate |
$137.39 |
| Rate for Payer: Blue Shield of California Commercial |
$115.09
|
| Rate for Payer: Blue Shield of California EPN |
$82.76
|
| Rate for Payer: Cash Price |
$72.74
|
| Rate for Payer: Cigna of CA HMO |
$113.15
|
| Rate for Payer: Cigna of CA PPO |
$113.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.66
|
| Rate for Payer: Galaxy Health WC |
$137.39
|
| Rate for Payer: Global Benefits Group Commercial |
$96.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$107.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.79
|
| Rate for Payer: Multiplan Commercial |
$129.31
|
| Rate for Payer: Networks By Design Commercial |
$105.07
|
| Rate for Payer: Prime Health Services Commercial |
$137.39
|
|
|
ILOPROST 20 MCG/ML SOLUTION FOR NEBULIZATION [99773]
|
Facility
OP
|
$161.64
|
|
|
Service Code
|
NDC 66215-303-30
|
| Hospital Charge Code |
1744134
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$38.79 |
| Max. Negotiated Rate |
$137.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$106.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$137.39
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$88.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$88.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.31
|
| Rate for Payer: BCBS Transplant Transplant |
$96.98
|
| Rate for Payer: Blue Shield of California Commercial |
$119.13
|
| Rate for Payer: Blue Shield of California EPN |
$94.40
|
| Rate for Payer: Cash Price |
$72.74
|
| Rate for Payer: Cigna of CA HMO |
$113.15
|
| Rate for Payer: Cigna of CA PPO |
$113.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.39
|
| Rate for Payer: Dignity Health Media |
$137.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$137.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$64.66
|
| Rate for Payer: Galaxy Health WC |
$137.39
|
| Rate for Payer: Global Benefits Group Commercial |
$96.98
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$121.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$107.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.79
|
| Rate for Payer: Multiplan Commercial |
$129.31
|
| Rate for Payer: Networks By Design Commercial |
$105.07
|
| Rate for Payer: Prime Health Services Commercial |
$137.39
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$96.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$96.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$96.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$80.82
|
| Rate for Payer: United Healthcare All Other HMO |
$80.82
|
| Rate for Payer: United Healthcare HMO Rider |
$80.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$80.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$137.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$137.39
|
| Rate for Payer: Vantage Medical Group Senior |
$137.39
|
|
|
ILOPROST 20 MCG/ML SOLUTION FOR NEBULIZATION [99773]
|
Facility
IP
|
$161.64
|
|
|
Service Code
|
NDC 66215-303-00
|
| Hospital Charge Code |
1744134
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$38.79 |
| Max. Negotiated Rate |
$137.39 |
| Rate for Payer: Blue Shield of California Commercial |
$115.09
|
| Rate for Payer: Blue Shield of California EPN |
$82.76
|
| Rate for Payer: Cash Price |
$72.74
|
| Rate for Payer: Cigna of CA HMO |
$113.15
|
| Rate for Payer: Cigna of CA PPO |
$113.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.66
|
| Rate for Payer: Galaxy Health WC |
$137.39
|
| Rate for Payer: Global Benefits Group Commercial |
$96.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$107.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.79
|
| Rate for Payer: Multiplan Commercial |
$129.31
|
| Rate for Payer: Networks By Design Commercial |
$105.07
|
| Rate for Payer: Prime Health Services Commercial |
$137.39
|
|
|
ILOPROST 20 MCG/ML SOLUTION FOR NEBULIZATION [99773]
|
Facility
OP
|
$161.64
|
|
|
Service Code
|
NDC 66215-303-00
|
| Hospital Charge Code |
1744134
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$38.79 |
| Max. Negotiated Rate |
$137.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$106.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$137.39
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$88.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$88.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.31
|
| Rate for Payer: BCBS Transplant Transplant |
$96.98
|
| Rate for Payer: Blue Shield of California Commercial |
$119.13
|
| Rate for Payer: Blue Shield of California EPN |
$94.40
|
| Rate for Payer: Cash Price |
$72.74
|
| Rate for Payer: Cigna of CA HMO |
$113.15
|
| Rate for Payer: Cigna of CA PPO |
$113.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.39
|
| Rate for Payer: Dignity Health Media |
$137.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$137.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$64.66
|
| Rate for Payer: Galaxy Health WC |
$137.39
|
| Rate for Payer: Global Benefits Group Commercial |
$96.98
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$121.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$107.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.79
|
| Rate for Payer: Multiplan Commercial |
$129.31
|
| Rate for Payer: Networks By Design Commercial |
$105.07
|
| Rate for Payer: Prime Health Services Commercial |
$137.39
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$96.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$96.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$96.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$80.82
|
| Rate for Payer: United Healthcare All Other HMO |
$80.82
|
| Rate for Payer: United Healthcare HMO Rider |
$80.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$80.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$137.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$137.39
|
| Rate for Payer: Vantage Medical Group Senior |
$137.39
|
|
|
ILOPROST 20 MCG/ML SOLUTION FOR NEBULIZATION [99773]
|
Facility
IP
|
$161.64
|
|
|
Service Code
|
NDC 66215-303-30
|
| Hospital Charge Code |
1744134
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$38.79 |
| Max. Negotiated Rate |
$137.39 |
| Rate for Payer: Blue Shield of California Commercial |
$115.09
|
| Rate for Payer: Blue Shield of California EPN |
$82.76
|
| Rate for Payer: Cash Price |
$72.74
|
| Rate for Payer: Cigna of CA HMO |
$113.15
|
| Rate for Payer: Cigna of CA PPO |
$113.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.66
|
| Rate for Payer: Galaxy Health WC |
$137.39
|
| Rate for Payer: Global Benefits Group Commercial |
$96.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$107.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.79
|
| Rate for Payer: Multiplan Commercial |
$129.31
|
| Rate for Payer: Networks By Design Commercial |
$105.07
|
| Rate for Payer: Prime Health Services Commercial |
$137.39
|
|
|
IMATINIB 100 MG TABLET [32979]
|
Facility
IP
|
$4.55
|
|
|
Service Code
|
CPT S0088
|
| Hospital Charge Code |
1711843
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$3.87 |
| Rate for Payer: Blue Shield of California Commercial |
$3.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1.05
|
| Rate for Payer: Blue Shield of California Commercial |
$38.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1.40
|
| Rate for Payer: Blue Shield of California EPN |
$1.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.75
|
| Rate for Payer: Blue Shield of California EPN |
$2.33
|
| Rate for Payer: Blue Shield of California EPN |
$27.44
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Cash Price |
$24.12
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cigna of CA HMO |
$3.18
|
| Rate for Payer: Cigna of CA HMO |
$1.03
|
| Rate for Payer: Cigna of CA HMO |
$37.52
|
| Rate for Payer: Cigna of CA HMO |
$1.38
|
| Rate for Payer: Cigna of CA PPO |
$37.52
|
| Rate for Payer: Cigna of CA PPO |
$3.18
|
| Rate for Payer: Cigna of CA PPO |
$1.38
|
| Rate for Payer: Cigna of CA PPO |
$1.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.59
|
| Rate for Payer: Galaxy Health WC |
$3.87
|
| Rate for Payer: Galaxy Health WC |
$1.25
|
| Rate for Payer: Galaxy Health WC |
$1.67
|
| Rate for Payer: Galaxy Health WC |
$45.56
|
| Rate for Payer: Global Benefits Group Commercial |
$0.88
|
| Rate for Payer: Global Benefits Group Commercial |
$1.18
|
| Rate for Payer: Global Benefits Group Commercial |
$2.73
|
| Rate for Payer: Global Benefits Group Commercial |
$32.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.09
|
| Rate for Payer: Multiplan Commercial |
$1.58
|
| Rate for Payer: Multiplan Commercial |
$42.88
|
| Rate for Payer: Multiplan Commercial |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$3.64
|
| Rate for Payer: Networks By Design Commercial |
$0.96
|
| Rate for Payer: Networks By Design Commercial |
$1.28
|
| Rate for Payer: Networks By Design Commercial |
$2.96
|
| Rate for Payer: Networks By Design Commercial |
$34.84
|
| Rate for Payer: Prime Health Services Commercial |
$45.56
|
| Rate for Payer: Prime Health Services Commercial |
$3.87
|
| Rate for Payer: Prime Health Services Commercial |
$1.25
|
| Rate for Payer: Prime Health Services Commercial |
$1.67
|
|
|
IMATINIB 100 MG TABLET [32979]
|
Facility
OP
|
$4.55
|
|
|
Service Code
|
CPT S0088
|
| Hospital Charge Code |
1711843
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$133.83 |
| Rate for Payer: BCBS Transplant Transplant |
$32.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$45.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.81
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$29.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$29.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.83
|
| Rate for Payer: BCBS Transplant Transplant |
$2.73
|
| Rate for Payer: BCBS Transplant Transplant |
$1.18
|
| Rate for Payer: BCBS Transplant Transplant |
$0.88
|
| Rate for Payer: Blue Shield of California Commercial |
$3.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1.08
|
| Rate for Payer: Blue Shield of California Commercial |
$39.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1.45
|
| Rate for Payer: Blue Shield of California EPN |
$2.66
|
| Rate for Payer: Blue Shield of California EPN |
$31.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.86
|
| Rate for Payer: Blue Shield of California EPN |
$1.15
|
| Rate for Payer: Cash Price |
$24.12
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Cash Price |
$24.12
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Cigna of CA HMO |
$1.38
|
| Rate for Payer: Cigna of CA HMO |
$37.52
|
| Rate for Payer: Cigna of CA HMO |
$1.03
|
| Rate for Payer: Cigna of CA HMO |
$3.18
|
| Rate for Payer: Cigna of CA PPO |
$3.18
|
| Rate for Payer: Cigna of CA PPO |
$1.03
|
| Rate for Payer: Cigna of CA PPO |
$1.38
|
| Rate for Payer: Cigna of CA PPO |
$37.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.87
|
| Rate for Payer: Dignity Health Media |
$45.56
|
| Rate for Payer: Dignity Health Media |
$1.67
|
| Rate for Payer: Dignity Health Media |
$3.87
|
| Rate for Payer: Dignity Health Media |
$1.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.59
|
| Rate for Payer: Galaxy Health WC |
$1.25
|
| Rate for Payer: Galaxy Health WC |
$3.87
|
| Rate for Payer: Galaxy Health WC |
$45.56
|
| Rate for Payer: Galaxy Health WC |
$1.67
|
| Rate for Payer: Global Benefits Group Commercial |
$2.73
|
| Rate for Payer: Global Benefits Group Commercial |
$0.88
|
| Rate for Payer: Global Benefits Group Commercial |
$1.18
|
| Rate for Payer: Global Benefits Group Commercial |
$32.16
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.48
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$40.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.47
|
| Rate for Payer: Multiplan Commercial |
$1.58
|
| Rate for Payer: Multiplan Commercial |
$3.64
|
| Rate for Payer: Multiplan Commercial |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$42.88
|
| Rate for Payer: Networks By Design Commercial |
$34.84
|
| Rate for Payer: Networks By Design Commercial |
$1.28
|
| Rate for Payer: Networks By Design Commercial |
$2.96
|
| Rate for Payer: Networks By Design Commercial |
$0.96
|
| Rate for Payer: Prime Health Services Commercial |
$1.25
|
| Rate for Payer: Prime Health Services Commercial |
$45.56
|
| Rate for Payer: Prime Health Services Commercial |
$3.87
|
| Rate for Payer: Prime Health Services Commercial |
$1.67
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$32.16
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.18
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.88
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.74
|
| Rate for Payer: United Healthcare All Other HMO |
$26.80
|
| Rate for Payer: United Healthcare All Other HMO |
$2.28
|
| Rate for Payer: United Healthcare All Other HMO |
$0.74
|
| Rate for Payer: United Healthcare All Other HMO |
$0.99
|
| Rate for Payer: United Healthcare HMO Rider |
$0.99
|
| Rate for Payer: United Healthcare HMO Rider |
$26.80
|
| Rate for Payer: United Healthcare HMO Rider |
$0.74
|
| Rate for Payer: United Healthcare HMO Rider |
$2.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.25
|
| Rate for Payer: Vantage Medical Group Senior |
$3.87
|
| Rate for Payer: Vantage Medical Group Senior |
$1.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1.67
|
| Rate for Payer: Vantage Medical Group Senior |
$45.56
|
|
|
IMATINIB 400 MG TABLET [36092]
|
Facility
OP
|
$16.38
|
|
|
Service Code
|
CPT S0088
|
| Hospital Charge Code |
1711842
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$133.83 |
| Rate for Payer: Vantage Medical Group Senior |
$13.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.83
|
| Rate for Payer: BCBS Transplant Transplant |
$9.83
|
| Rate for Payer: Blue Shield of California Commercial |
$12.07
|
| Rate for Payer: Blue Shield of California EPN |
$9.57
|
| Rate for Payer: Cash Price |
$7.37
|
| Rate for Payer: Cash Price |
$7.37
|
| Rate for Payer: Cigna of CA HMO |
$11.47
|
| Rate for Payer: Cigna of CA PPO |
$11.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.92
|
| Rate for Payer: Dignity Health Media |
$13.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.55
|
| Rate for Payer: Galaxy Health WC |
$13.92
|
| Rate for Payer: Global Benefits Group Commercial |
$9.83
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.93
|
| Rate for Payer: Multiplan Commercial |
$13.10
|
| Rate for Payer: Networks By Design Commercial |
$10.65
|
| Rate for Payer: Prime Health Services Commercial |
$13.92
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.19
|
| Rate for Payer: United Healthcare All Other HMO |
$8.19
|
| Rate for Payer: United Healthcare HMO Rider |
$8.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.92
|
|
|
IMATINIB 400 MG TABLET [36092]
|
Facility
IP
|
$16.38
|
|
|
Service Code
|
CPT S0088
|
| Hospital Charge Code |
1711842
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$13.92 |
| Rate for Payer: Blue Shield of California Commercial |
$11.66
|
| Rate for Payer: Blue Shield of California EPN |
$8.39
|
| Rate for Payer: Cash Price |
$7.37
|
| Rate for Payer: Cigna of CA HMO |
$11.47
|
| Rate for Payer: Cigna of CA PPO |
$11.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.55
|
| Rate for Payer: Galaxy Health WC |
$13.92
|
| Rate for Payer: Global Benefits Group Commercial |
$9.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.93
|
| Rate for Payer: Multiplan Commercial |
$13.10
|
| Rate for Payer: Networks By Design Commercial |
$10.65
|
| Rate for Payer: Prime Health Services Commercial |
$13.92
|
|
|
IMIPENEM-CILASTATIN 250 MG INTRAVENOUS SOLUTION [9602]
|
Facility
IP
|
$17.99
|
|
|
Service Code
|
CPT J0743
|
| Hospital Charge Code |
ERX9602
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.32 |
| Max. Negotiated Rate |
$15.29 |
| Rate for Payer: Blue Shield of California Commercial |
$12.81
|
| Rate for Payer: Blue Shield of California EPN |
$9.21
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna of CA HMO |
$12.59
|
| Rate for Payer: Cigna of CA PPO |
$12.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.20
|
| Rate for Payer: Galaxy Health WC |
$15.29
|
| Rate for Payer: Global Benefits Group Commercial |
$10.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: Multiplan Commercial |
$14.39
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Prime Health Services Commercial |
$15.29
|
|
|
IMIPENEM-CILASTATIN 250 MG INTRAVENOUS SOLUTION [9602]
|
Facility
OP
|
$17.99
|
|
|
Service Code
|
CPT J0743
|
| Hospital Charge Code |
ERX9602
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.32 |
| Max. Negotiated Rate |
$50.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$50.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15.29
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.26
|
| Rate for Payer: BCBS Transplant Transplant |
$10.79
|
| Rate for Payer: Blue Shield of California Commercial |
$13.26
|
| Rate for Payer: Blue Shield of California EPN |
$10.56
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna of CA HMO |
$12.59
|
| Rate for Payer: Cigna of CA PPO |
$12.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.29
|
| Rate for Payer: Dignity Health Media |
$15.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.20
|
| Rate for Payer: Galaxy Health WC |
$15.29
|
| Rate for Payer: Global Benefits Group Commercial |
$10.79
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: Multiplan Commercial |
$14.39
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Prime Health Services Commercial |
$15.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.00
|
| Rate for Payer: United Healthcare All Other HMO |
$9.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.29
|
| Rate for Payer: Vantage Medical Group Senior |
$15.29
|
|
|
IMIPENEM-CILASTATIN 500 MG INTRAVENOUS SOLUTION [9603]
|
Facility
IP
|
$35.98
|
|
|
Service Code
|
CPT J0743
|
| Hospital Charge Code |
1753116
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$30.58 |
| Rate for Payer: Blue Shield of California EPN |
$18.42
|
| Rate for Payer: Cash Price |
$14.77
|
| Rate for Payer: Cash Price |
$16.19
|
| Rate for Payer: Cigna of CA HMO |
$25.19
|
| Rate for Payer: Cigna of CA HMO |
$22.97
|
| Rate for Payer: Cigna of CA PPO |
$22.97
|
| Rate for Payer: Cigna of CA PPO |
$25.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.13
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.13
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.39
|
| Rate for Payer: Galaxy Health WC |
$27.90
|
| Rate for Payer: Galaxy Health WC |
$30.58
|
| Rate for Payer: Blue Shield of California EPN |
$16.80
|
| Rate for Payer: Blue Shield of California Commercial |
$25.62
|
| Rate for Payer: Blue Shield of California Commercial |
$23.37
|
| Rate for Payer: Global Benefits Group Commercial |
$21.59
|
| Rate for Payer: Global Benefits Group Commercial |
$19.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Multiplan Commercial |
$28.78
|
| Rate for Payer: Multiplan Commercial |
$26.26
|
| Rate for Payer: Networks By Design Commercial |
$16.41
|
| Rate for Payer: Networks By Design Commercial |
$17.99
|
| Rate for Payer: Prime Health Services Commercial |
$27.90
|
| Rate for Payer: Prime Health Services Commercial |
$30.58
|
|
|
IMIPENEM-CILASTATIN 500 MG INTRAVENOUS SOLUTION [9603]
|
Facility
OP
|
$32.82
|
|
|
Service Code
|
CPT J0743
|
| Hospital Charge Code |
1753116
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.88 |
| Max. Negotiated Rate |
$50.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$50.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$30.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.79
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.26
|
| Rate for Payer: BCBS Transplant Transplant |
$21.59
|
| Rate for Payer: BCBS Transplant Transplant |
$19.69
|
| Rate for Payer: Blue Shield of California Commercial |
$24.19
|
| Rate for Payer: Blue Shield of California Commercial |
$26.52
|
| Rate for Payer: Blue Shield of California EPN |
$10.56
|
| Rate for Payer: Blue Shield of California EPN |
$10.56
|
| Rate for Payer: Cash Price |
$14.77
|
| Rate for Payer: Cash Price |
$14.77
|
| Rate for Payer: Cash Price |
$16.19
|
| Rate for Payer: Cash Price |
$16.19
|
| Rate for Payer: Cigna of CA HMO |
$25.19
|
| Rate for Payer: Cigna of CA HMO |
$22.97
|
| Rate for Payer: Cigna of CA PPO |
$25.19
|
| Rate for Payer: Cigna of CA PPO |
$22.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.58
|
| Rate for Payer: Dignity Health Media |
$30.58
|
| Rate for Payer: Dignity Health Media |
$27.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.13
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.39
|
| Rate for Payer: Galaxy Health WC |
$30.58
|
| Rate for Payer: Galaxy Health WC |
$27.90
|
| Rate for Payer: Global Benefits Group Commercial |
$19.69
|
| Rate for Payer: Global Benefits Group Commercial |
$21.59
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$26.98
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$24.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.88
|
| Rate for Payer: Multiplan Commercial |
$26.26
|
| Rate for Payer: Multiplan Commercial |
$28.78
|
| Rate for Payer: Networks By Design Commercial |
$16.41
|
| Rate for Payer: Networks By Design Commercial |
$17.99
|
| Rate for Payer: Prime Health Services Commercial |
$30.58
|
| Rate for Payer: Prime Health Services Commercial |
$27.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.99
|
| Rate for Payer: United Healthcare All Other HMO |
$16.41
|
| Rate for Payer: United Healthcare All Other HMO |
$17.99
|
| Rate for Payer: United Healthcare HMO Rider |
$16.41
|
| Rate for Payer: United Healthcare HMO Rider |
$17.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.58
|
| Rate for Payer: Vantage Medical Group Senior |
$27.90
|
| Rate for Payer: Vantage Medical Group Senior |
$30.58
|
|
|
IMIPRAMINE 10 MG TABLET [3860]
|
Facility
OP
|
$0.22
|
|
|
Service Code
|
NDC 69315-133-01
|
| Hospital Charge Code |
1711106
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: BCBS Transplant Transplant |
$0.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
| Rate for Payer: Dignity Health Media |
$0.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
|
|
IMIPRAMINE 10 MG TABLET [3860]
|
Facility
IP
|
$0.22
|
|
|
Service Code
|
NDC 69315-133-01
|
| Hospital Charge Code |
1711106
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
|
