|
MISOPROSTOL 100 MCG TABLET [10628]
|
Facility
|
IP
|
$0.79
|
|
|
Service Code
|
CPT S0191
|
| Hospital Charge Code |
1711502
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: Blue Shield of California Commercial |
$0.56
|
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California EPN |
$0.40
|
| Rate for Payer: Blue Shield of California EPN |
$0.41
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cigna of CA HMO |
$0.55
|
| Rate for Payer: Cigna of CA HMO |
$0.56
|
| Rate for Payer: Cigna of CA PPO |
$0.56
|
| Rate for Payer: Cigna of CA PPO |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$0.68
|
| Rate for Payer: Global Benefits Group Commercial |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.63
|
| Rate for Payer: Multiplan Commercial |
$0.64
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.67
|
| Rate for Payer: Prime Health Services Commercial |
$0.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.29
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.29
|
| Rate for Payer: United Healthcare HMO Rider |
$0.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.26
|
|
|
MISOPROSTOL 100 MCG TABLET [10628]
|
Facility
|
OP
|
$0.79
|
|
|
Service Code
|
CPT S0191
|
| Hospital Charge Code |
1711502
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$6.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.85
|
| Rate for Payer: Blue Distinction Transplant |
$0.47
|
| Rate for Payer: Blue Distinction Transplant |
$0.48
|
| Rate for Payer: Blue Shield of California Commercial |
$0.58
|
| Rate for Payer: Blue Shield of California Commercial |
$0.59
|
| Rate for Payer: Blue Shield of California EPN |
$1.16
|
| Rate for Payer: Blue Shield of California EPN |
$1.16
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cigna of CA HMO |
$0.55
|
| Rate for Payer: Cigna of CA HMO |
$0.56
|
| Rate for Payer: Cigna of CA PPO |
$0.55
|
| Rate for Payer: Cigna of CA PPO |
$0.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.67
|
| Rate for Payer: Dignity Health Media |
$0.68
|
| Rate for Payer: Dignity Health Media |
$0.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$0.68
|
| Rate for Payer: Global Benefits Group Commercial |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.64
|
| Rate for Payer: Multiplan Commercial |
$0.63
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.68
|
| Rate for Payer: Prime Health Services Commercial |
$0.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO |
$0.40
|
| Rate for Payer: United Healthcare HMO Rider |
$0.40
|
| Rate for Payer: United Healthcare HMO Rider |
$0.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.68
|
| Rate for Payer: Vantage Medical Group Senior |
$0.68
|
| Rate for Payer: Vantage Medical Group Senior |
$0.67
|
|
|
MISOPROSTOL 100MCGX10TABLET KIT [4081172]
|
Facility
|
IP
|
$9.88
|
|
|
Service Code
|
CPT S0191
|
| Hospital Charge Code |
NDG10628
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$8.40 |
| Rate for Payer: Blue Shield of California Commercial |
$7.03
|
| Rate for Payer: Blue Shield of California EPN |
$5.06
|
| Rate for Payer: Cash Price |
$4.45
|
| Rate for Payer: Cigna of CA HMO |
$6.92
|
| Rate for Payer: Cigna of CA PPO |
$6.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.95
|
| Rate for Payer: Galaxy Health WC |
$8.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.37
|
| Rate for Payer: Multiplan Commercial |
$7.90
|
| Rate for Payer: Networks By Design Commercial |
$4.94
|
| Rate for Payer: Prime Health Services Commercial |
$8.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.73
|
| Rate for Payer: United Healthcare All Other HMO |
$3.64
|
| Rate for Payer: United Healthcare HMO Rider |
$3.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.26
|
|
|
MISOPROSTOL 100MCGX10TABLET KIT [4081172]
|
Facility
|
OP
|
$9.88
|
|
|
Service Code
|
CPT S0191
|
| Hospital Charge Code |
NDG10628
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$8.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.85
|
| Rate for Payer: Blue Distinction Transplant |
$5.93
|
| Rate for Payer: Blue Shield of California Commercial |
$7.28
|
| Rate for Payer: Blue Shield of California EPN |
$1.16
|
| Rate for Payer: Cash Price |
$4.45
|
| Rate for Payer: Cash Price |
$4.45
|
| Rate for Payer: Cigna of CA HMO |
$6.92
|
| Rate for Payer: Cigna of CA PPO |
$6.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.40
|
| Rate for Payer: Dignity Health Media |
$8.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.95
|
| Rate for Payer: Galaxy Health WC |
$8.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5.93
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.37
|
| Rate for Payer: Multiplan Commercial |
$7.90
|
| Rate for Payer: Networks By Design Commercial |
$4.94
|
| Rate for Payer: Prime Health Services Commercial |
$8.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.94
|
| Rate for Payer: United Healthcare All Other HMO |
$4.94
|
| Rate for Payer: United Healthcare HMO Rider |
$4.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.40
|
| Rate for Payer: Vantage Medical Group Senior |
$8.40
|
|
|
MISOPROSTOL 200 MCG TABLET [10629]
|
Facility
|
IP
|
$1.16
|
|
|
Service Code
|
CPT S0191
|
| Hospital Charge Code |
1711307
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Blue Shield of California Commercial |
$0.83
|
| Rate for Payer: Blue Shield of California EPN |
$0.59
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cigna of CA HMO |
$0.81
|
| Rate for Payer: Cigna of CA PPO |
$0.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.46
|
| Rate for Payer: Galaxy Health WC |
$0.99
|
| Rate for Payer: Global Benefits Group Commercial |
$0.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: Networks By Design Commercial |
$0.58
|
| Rate for Payer: Prime Health Services Commercial |
$0.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.44
|
| Rate for Payer: United Healthcare All Other HMO |
$0.43
|
| Rate for Payer: United Healthcare HMO Rider |
$0.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.38
|
|
|
MISOPROSTOL 200 MCG TABLET [10629]
|
Facility
|
OP
|
$1.16
|
|
|
Service Code
|
CPT S0191
|
| Hospital Charge Code |
1711307
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$6.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.85
|
| Rate for Payer: Blue Distinction Transplant |
$0.70
|
| Rate for Payer: Blue Shield of California Commercial |
$0.85
|
| Rate for Payer: Blue Shield of California EPN |
$1.16
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cigna of CA HMO |
$0.81
|
| Rate for Payer: Cigna of CA PPO |
$0.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.99
|
| Rate for Payer: Dignity Health Media |
$0.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.46
|
| Rate for Payer: Galaxy Health WC |
$0.99
|
| Rate for Payer: Global Benefits Group Commercial |
$0.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: Networks By Design Commercial |
$0.58
|
| Rate for Payer: Prime Health Services Commercial |
$0.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.58
|
| Rate for Payer: United Healthcare All Other HMO |
$0.58
|
| Rate for Payer: United Healthcare HMO Rider |
$0.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: Vantage Medical Group Senior |
$0.99
|
|
|
MISOPROSTOL 200MCGX5TABLET KIT [4081585]
|
Facility
|
OP
|
$0.25
|
|
|
Service Code
|
CPT S0191
|
| Hospital Charge Code |
ERX4081585
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$6.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.85
|
| Rate for Payer: Blue Distinction Transplant |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$1.16
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.21
|
| Rate for Payer: Dignity Health Media |
$0.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.13
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Vantage Medical Group Senior |
$0.21
|
|
|
MISOPROSTOL 200MCGX5TABLET KIT [4081585]
|
Facility
|
IP
|
$0.25
|
|
|
Service Code
|
CPT S0191
|
| Hospital Charge Code |
ERX4081585
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.13
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
|
|
MISOPROSTOL 25 MCG 1/4 TAB [4080523]
|
Facility
|
IP
|
$0.62
|
|
|
Service Code
|
CPT S0191
|
| Hospital Charge Code |
1712404
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.32
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.25
|
| Rate for Payer: Galaxy Health WC |
$0.53
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Networks By Design Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.23
|
| Rate for Payer: United Healthcare All Other HMO |
$0.23
|
| Rate for Payer: United Healthcare HMO Rider |
$0.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.20
|
|
|
MISOPROSTOL 25 MCG 1/4 TAB [4080523]
|
Facility
|
OP
|
$0.62
|
|
|
Service Code
|
CPT S0191
|
| Hospital Charge Code |
1712404
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$6.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.85
|
| Rate for Payer: Blue Distinction Transplant |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California EPN |
$1.16
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.53
|
| Rate for Payer: Dignity Health Media |
$0.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.25
|
| Rate for Payer: Galaxy Health WC |
$0.53
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Networks By Design Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO |
$0.31
|
| Rate for Payer: United Healthcare HMO Rider |
$0.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.53
|
| Rate for Payer: Vantage Medical Group Senior |
$0.53
|
|
|
MITOMYCIN 0.2 MG OPHTHALMIC KIT [196340]
|
Facility
|
IP
|
$430.80
|
|
|
Service Code
|
CPT J7315
|
| Hospital Charge Code |
ERX196257
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.39 |
| Max. Negotiated Rate |
$366.18 |
| Rate for Payer: Blue Shield of California Commercial |
$306.73
|
| Rate for Payer: Blue Shield of California EPN |
$220.57
|
| Rate for Payer: Cash Price |
$193.86
|
| Rate for Payer: Cigna of CA HMO |
$301.56
|
| Rate for Payer: Cigna of CA PPO |
$301.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$172.32
|
| Rate for Payer: Galaxy Health WC |
$366.18
|
| Rate for Payer: Global Benefits Group Commercial |
$258.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$287.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.39
|
| Rate for Payer: Multiplan Commercial |
$344.64
|
| Rate for Payer: Networks By Design Commercial |
$215.40
|
| Rate for Payer: Prime Health Services Commercial |
$366.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$162.67
|
| Rate for Payer: United Healthcare All Other HMO |
$158.88
|
| Rate for Payer: United Healthcare HMO Rider |
$155.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142.16
|
|
|
MITOMYCIN 0.2 MG OPHTHALMIC KIT [196340]
|
Facility
|
OP
|
$430.80
|
|
|
Service Code
|
CPT J7315
|
| Hospital Charge Code |
ERX196257
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.39 |
| Max. Negotiated Rate |
$2,666.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,666.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$366.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$236.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$236.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$260.97
|
| Rate for Payer: Blue Distinction Transplant |
$258.48
|
| Rate for Payer: Blue Shield of California Commercial |
$317.50
|
| Rate for Payer: Blue Shield of California EPN |
$464.40
|
| Rate for Payer: Cash Price |
$193.86
|
| Rate for Payer: Cash Price |
$193.86
|
| Rate for Payer: Cigna of CA HMO |
$301.56
|
| Rate for Payer: Cigna of CA PPO |
$301.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$366.18
|
| Rate for Payer: Dignity Health Media |
$366.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$366.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$172.32
|
| Rate for Payer: Galaxy Health WC |
$366.18
|
| Rate for Payer: Global Benefits Group Commercial |
$258.48
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$323.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$287.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$817.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.39
|
| Rate for Payer: Multiplan Commercial |
$344.64
|
| Rate for Payer: Networks By Design Commercial |
$215.40
|
| Rate for Payer: Prime Health Services Commercial |
$366.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$258.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$258.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$215.40
|
| Rate for Payer: United Healthcare All Other HMO |
$215.40
|
| Rate for Payer: United Healthcare HMO Rider |
$215.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$215.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$366.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$366.18
|
| Rate for Payer: Vantage Medical Group Senior |
$366.18
|
|
|
MITOMYCIN 20 MG INTRAVENOUS SOLUTION [10630]
|
Facility
|
IP
|
$758.38
|
|
|
Service Code
|
CPT J9280
|
| Hospital Charge Code |
1755047
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$182.01 |
| Max. Negotiated Rate |
$644.62 |
| Rate for Payer: Blue Shield of California Commercial |
$539.97
|
| Rate for Payer: Blue Shield of California Commercial |
$539.98
|
| Rate for Payer: Blue Shield of California EPN |
$388.29
|
| Rate for Payer: Blue Shield of California EPN |
$388.30
|
| Rate for Payer: Cash Price |
$341.27
|
| Rate for Payer: Cash Price |
$341.28
|
| Rate for Payer: Cigna of CA HMO |
$530.87
|
| Rate for Payer: Cigna of CA HMO |
$530.88
|
| Rate for Payer: Cigna of CA PPO |
$530.88
|
| Rate for Payer: Cigna of CA PPO |
$530.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$303.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$303.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$303.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$303.36
|
| Rate for Payer: Galaxy Health WC |
$644.62
|
| Rate for Payer: Galaxy Health WC |
$644.64
|
| Rate for Payer: Global Benefits Group Commercial |
$455.04
|
| Rate for Payer: Global Benefits Group Commercial |
$455.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$505.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$505.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.02
|
| Rate for Payer: Multiplan Commercial |
$606.70
|
| Rate for Payer: Multiplan Commercial |
$606.72
|
| Rate for Payer: Networks By Design Commercial |
$379.19
|
| Rate for Payer: Networks By Design Commercial |
$379.20
|
| Rate for Payer: Prime Health Services Commercial |
$644.62
|
| Rate for Payer: Prime Health Services Commercial |
$644.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$286.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$286.37
|
| Rate for Payer: United Healthcare All Other HMO |
$279.69
|
| Rate for Payer: United Healthcare All Other HMO |
$279.70
|
| Rate for Payer: United Healthcare HMO Rider |
$273.62
|
| Rate for Payer: United Healthcare HMO Rider |
$273.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$250.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$250.27
|
|
|
MITOMYCIN 20 MG INTRAVENOUS SOLUTION [10630]
|
Facility
|
OP
|
$758.38
|
|
|
Service Code
|
CPT J9280
|
| Hospital Charge Code |
1755047
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.35 |
| Max. Negotiated Rate |
$644.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$124.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$124.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$69.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$69.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$69.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$69.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$254.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$254.61
|
| Rate for Payer: Blue Distinction Transplant |
$455.04
|
| Rate for Payer: Blue Distinction Transplant |
$455.03
|
| Rate for Payer: Blue Shield of California Commercial |
$558.94
|
| Rate for Payer: Blue Shield of California Commercial |
$558.93
|
| Rate for Payer: Blue Shield of California EPN |
$221.13
|
| Rate for Payer: Blue Shield of California EPN |
$221.13
|
| Rate for Payer: Cash Price |
$341.28
|
| Rate for Payer: Cash Price |
$341.27
|
| Rate for Payer: Cash Price |
$341.28
|
| Rate for Payer: Cash Price |
$341.27
|
| Rate for Payer: Cigna of CA HMO |
$530.88
|
| Rate for Payer: Cigna of CA HMO |
$530.87
|
| Rate for Payer: Cigna of CA PPO |
$530.87
|
| Rate for Payer: Cigna of CA PPO |
$530.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$95.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$95.02
|
| Rate for Payer: Dignity Health Media |
$63.35
|
| Rate for Payer: Dignity Health Media |
$63.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.52
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$63.35
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$63.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$63.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$63.35
|
| Rate for Payer: Galaxy Health WC |
$644.62
|
| Rate for Payer: Galaxy Health WC |
$644.64
|
| Rate for Payer: Global Benefits Group Commercial |
$455.03
|
| Rate for Payer: Global Benefits Group Commercial |
$455.04
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$568.78
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$568.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$103.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$103.89
|
| Rate for Payer: Heritage Provider Network Transplant |
$103.89
|
| Rate for Payer: Heritage Provider Network Transplant |
$103.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$102.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$102.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$102.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$102.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$63.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$63.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$505.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$505.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$63.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$63.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84.89
|
| Rate for Payer: Multiplan Commercial |
$606.70
|
| Rate for Payer: Multiplan Commercial |
$606.72
|
| Rate for Payer: Networks By Design Commercial |
$379.20
|
| Rate for Payer: Networks By Design Commercial |
$379.19
|
| Rate for Payer: Prime Health Services Commercial |
$644.62
|
| Rate for Payer: Prime Health Services Commercial |
$644.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$455.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$455.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$455.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$455.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$379.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$379.19
|
| Rate for Payer: United Healthcare All Other HMO |
$379.19
|
| Rate for Payer: United Healthcare All Other HMO |
$379.20
|
| Rate for Payer: United Healthcare HMO Rider |
$379.19
|
| Rate for Payer: United Healthcare HMO Rider |
$379.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$379.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$379.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$95.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$95.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.68
|
| Rate for Payer: Vantage Medical Group Senior |
$63.35
|
| Rate for Payer: Vantage Medical Group Senior |
$63.35
|
|
|
MITOMYCIN 40 MG INTRAVENOUS SOLUTION [10631]
|
Facility
|
IP
|
$1,516.75
|
|
|
Service Code
|
CPT J9280
|
| Hospital Charge Code |
ERX10631
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$364.02 |
| Max. Negotiated Rate |
$1,289.24 |
| Rate for Payer: Blue Shield of California Commercial |
$1,079.93
|
| Rate for Payer: Blue Shield of California Commercial |
$1,079.96
|
| Rate for Payer: Blue Shield of California EPN |
$776.58
|
| Rate for Payer: Blue Shield of California EPN |
$776.60
|
| Rate for Payer: Cash Price |
$682.54
|
| Rate for Payer: Cash Price |
$682.56
|
| Rate for Payer: Cigna of CA HMO |
$1,061.72
|
| Rate for Payer: Cigna of CA HMO |
$1,061.76
|
| Rate for Payer: Cigna of CA PPO |
$1,061.76
|
| Rate for Payer: Cigna of CA PPO |
$1,061.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$606.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$606.72
|
| Rate for Payer: Galaxy Health WC |
$1,289.24
|
| Rate for Payer: Galaxy Health WC |
$1,289.28
|
| Rate for Payer: Global Benefits Group Commercial |
$910.08
|
| Rate for Payer: Global Benefits Group Commercial |
$910.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,011.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,011.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$577.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$577.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$364.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$364.03
|
| Rate for Payer: Multiplan Commercial |
$1,213.40
|
| Rate for Payer: Multiplan Commercial |
$1,213.44
|
| Rate for Payer: Networks By Design Commercial |
$758.38
|
| Rate for Payer: Networks By Design Commercial |
$758.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,289.24
|
| Rate for Payer: Prime Health Services Commercial |
$1,289.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$572.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$572.74
|
| Rate for Payer: United Healthcare All Other HMO |
$559.38
|
| Rate for Payer: United Healthcare All Other HMO |
$559.40
|
| Rate for Payer: United Healthcare HMO Rider |
$547.24
|
| Rate for Payer: United Healthcare HMO Rider |
$547.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$500.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$500.54
|
|
|
MITOMYCIN 40 MG INTRAVENOUS SOLUTION [10631]
|
Facility
|
OP
|
$1,516.75
|
|
|
Service Code
|
CPT J9280
|
| Hospital Charge Code |
ERX10631
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.35 |
| Max. Negotiated Rate |
$1,289.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$124.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$124.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$69.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$69.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$69.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$69.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$254.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$254.61
|
| Rate for Payer: Blue Distinction Transplant |
$910.08
|
| Rate for Payer: Blue Distinction Transplant |
$910.05
|
| Rate for Payer: Blue Shield of California Commercial |
$1,117.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1,117.84
|
| Rate for Payer: Blue Shield of California EPN |
$221.13
|
| Rate for Payer: Blue Shield of California EPN |
$221.13
|
| Rate for Payer: Cash Price |
$682.56
|
| Rate for Payer: Cash Price |
$682.54
|
| Rate for Payer: Cash Price |
$682.56
|
| Rate for Payer: Cash Price |
$682.54
|
| Rate for Payer: Cigna of CA HMO |
$1,061.76
|
| Rate for Payer: Cigna of CA HMO |
$1,061.72
|
| Rate for Payer: Cigna of CA PPO |
$1,061.72
|
| Rate for Payer: Cigna of CA PPO |
$1,061.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$95.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$95.02
|
| Rate for Payer: Dignity Health Media |
$63.35
|
| Rate for Payer: Dignity Health Media |
$63.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.52
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$63.35
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$63.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$63.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$63.35
|
| Rate for Payer: Galaxy Health WC |
$1,289.24
|
| Rate for Payer: Galaxy Health WC |
$1,289.28
|
| Rate for Payer: Global Benefits Group Commercial |
$910.05
|
| Rate for Payer: Global Benefits Group Commercial |
$910.08
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,137.56
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,137.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$103.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$103.89
|
| Rate for Payer: Heritage Provider Network Transplant |
$103.89
|
| Rate for Payer: Heritage Provider Network Transplant |
$103.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$102.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$102.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$102.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$102.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$63.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$63.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,011.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,011.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$63.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$63.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$364.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$364.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84.89
|
| Rate for Payer: Multiplan Commercial |
$1,213.40
|
| Rate for Payer: Multiplan Commercial |
$1,213.44
|
| Rate for Payer: Networks By Design Commercial |
$758.40
|
| Rate for Payer: Networks By Design Commercial |
$758.38
|
| Rate for Payer: Prime Health Services Commercial |
$1,289.24
|
| Rate for Payer: Prime Health Services Commercial |
$1,289.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$910.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$910.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$910.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$910.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$758.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$758.38
|
| Rate for Payer: United Healthcare All Other HMO |
$758.38
|
| Rate for Payer: United Healthcare All Other HMO |
$758.40
|
| Rate for Payer: United Healthcare HMO Rider |
$758.38
|
| Rate for Payer: United Healthcare HMO Rider |
$758.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$758.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$758.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$95.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$95.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.68
|
| Rate for Payer: Vantage Medical Group Senior |
$63.35
|
| Rate for Payer: Vantage Medical Group Senior |
$63.35
|
|
|
MITOMYCIN 40 MG X 2 INTRA-PYELOCALYCEAL KIT [227769]
|
Facility
|
OP
|
$27,872.40
|
|
|
Service Code
|
CPT J9281
|
| Hospital Charge Code |
ERX227769
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$300.75 |
| Max. Negotiated Rate |
$23,691.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$592.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$330.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$330.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$569.60
|
| Rate for Payer: Blue Distinction Transplant |
$16,723.44
|
| Rate for Payer: Blue Shield of California Commercial |
$20,541.96
|
| Rate for Payer: Blue Shield of California EPN |
$16,277.48
|
| Rate for Payer: Cash Price |
$12,542.58
|
| Rate for Payer: Cash Price |
$12,542.58
|
| Rate for Payer: Cigna of CA HMO |
$19,510.68
|
| Rate for Payer: Cigna of CA PPO |
$19,510.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.93
|
| Rate for Payer: Dignity Health Media |
$330.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$330.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$300.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$300.75
|
| Rate for Payer: Galaxy Health WC |
$23,691.54
|
| Rate for Payer: Global Benefits Group Commercial |
$16,723.44
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$20,904.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$493.23
|
| Rate for Payer: Heritage Provider Network Transplant |
$493.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$487.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$487.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$300.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,590.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$571.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$300.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,689.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$378.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$403.00
|
| Rate for Payer: Multiplan Commercial |
$22,297.92
|
| Rate for Payer: Networks By Design Commercial |
$13,936.20
|
| Rate for Payer: Prime Health Services Commercial |
$23,691.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,723.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16,723.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,936.20
|
| Rate for Payer: United Healthcare All Other HMO |
$13,936.20
|
| Rate for Payer: United Healthcare HMO Rider |
$13,936.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13,936.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$330.82
|
| Rate for Payer: Vantage Medical Group Senior |
$330.82
|
|
|
MITOMYCIN 40 MG X 2 INTRA-PYELOCALYCEAL KIT [227769]
|
Facility
|
IP
|
$27,872.40
|
|
|
Service Code
|
CPT J9281
|
| Hospital Charge Code |
ERX227769
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,689.38 |
| Max. Negotiated Rate |
$23,691.54 |
| Rate for Payer: Blue Shield of California Commercial |
$19,845.15
|
| Rate for Payer: Blue Shield of California EPN |
$14,270.67
|
| Rate for Payer: Cash Price |
$12,542.58
|
| Rate for Payer: Cigna of CA HMO |
$19,510.68
|
| Rate for Payer: Cigna of CA PPO |
$19,510.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,148.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$11,148.96
|
| Rate for Payer: Galaxy Health WC |
$23,691.54
|
| Rate for Payer: Global Benefits Group Commercial |
$16,723.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,590.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,619.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,689.38
|
| Rate for Payer: Multiplan Commercial |
$22,297.92
|
| Rate for Payer: Networks By Design Commercial |
$13,936.20
|
| Rate for Payer: Prime Health Services Commercial |
$23,691.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,524.62
|
| Rate for Payer: United Healthcare All Other HMO |
$10,279.34
|
| Rate for Payer: United Healthcare HMO Rider |
$10,056.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,197.89
|
|
|
MITOMYCIN (BULK) POWDER [24011]
|
Facility
|
OP
|
$56,293.48
|
|
|
Service Code
|
NDC 38779-0553-6
|
| Hospital Charge Code |
NDG24011
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13,510.44 |
| Max. Negotiated Rate |
$47,849.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$36,922.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$47,849.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30,961.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30,961.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33,539.66
|
| Rate for Payer: Blue Distinction Transplant |
$33,776.09
|
| Rate for Payer: Blue Shield of California Commercial |
$41,488.29
|
| Rate for Payer: Blue Shield of California EPN |
$32,875.39
|
| Rate for Payer: Cash Price |
$25,332.07
|
| Rate for Payer: Cigna of CA HMO |
$39,405.44
|
| Rate for Payer: Cigna of CA PPO |
$39,405.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$47,849.46
|
| Rate for Payer: Dignity Health Media |
$47,849.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$47,849.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,517.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$22,517.39
|
| Rate for Payer: Galaxy Health WC |
$47,849.46
|
| Rate for Payer: Global Benefits Group Commercial |
$33,776.09
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$42,220.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37,547.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21,447.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,510.44
|
| Rate for Payer: Multiplan Commercial |
$45,034.78
|
| Rate for Payer: Networks By Design Commercial |
$36,590.76
|
| Rate for Payer: Prime Health Services Commercial |
$47,849.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33,776.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33,776.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$28,146.74
|
| Rate for Payer: United Healthcare All Other HMO |
$28,146.74
|
| Rate for Payer: United Healthcare HMO Rider |
$28,146.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,146.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$47,849.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47,849.46
|
| Rate for Payer: Vantage Medical Group Senior |
$47,849.46
|
|
|
MITOMYCIN (BULK) POWDER [24011]
|
Facility
|
IP
|
$56,293.48
|
|
|
Service Code
|
NDC 38779-0553-6
|
| Hospital Charge Code |
NDG24011
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13,510.44 |
| Max. Negotiated Rate |
$47,849.46 |
| Rate for Payer: Blue Shield of California Commercial |
$40,080.96
|
| Rate for Payer: Blue Shield of California EPN |
$28,822.26
|
| Rate for Payer: Cash Price |
$25,332.07
|
| Rate for Payer: Cigna of CA HMO |
$39,405.44
|
| Rate for Payer: Cigna of CA PPO |
$39,405.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,517.39
|
| Rate for Payer: Galaxy Health WC |
$47,849.46
|
| Rate for Payer: Global Benefits Group Commercial |
$33,776.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37,547.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21,447.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,510.44
|
| Rate for Payer: Multiplan Commercial |
$45,034.78
|
| Rate for Payer: Networks By Design Commercial |
$36,590.76
|
| Rate for Payer: Prime Health Services Commercial |
$47,849.46
|
|
|
MITOMYCIN IN NS 0.04 % (0.4 MG/ML) TOPICAL [4080715]
|
Facility
|
OP
|
$13.25
|
|
|
Service Code
|
NDC 9994-0807-15
|
| Hospital Charge Code |
NDC4080715
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$11.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.89
|
| Rate for Payer: Blue Distinction Transplant |
$7.95
|
| Rate for Payer: Blue Shield of California Commercial |
$9.77
|
| Rate for Payer: Blue Shield of California EPN |
$7.74
|
| Rate for Payer: Cash Price |
$5.96
|
| Rate for Payer: Cigna of CA HMO |
$9.28
|
| Rate for Payer: Cigna of CA PPO |
$9.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.26
|
| Rate for Payer: Dignity Health Media |
$11.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.30
|
| Rate for Payer: Galaxy Health WC |
$11.26
|
| Rate for Payer: Global Benefits Group Commercial |
$7.95
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.18
|
| Rate for Payer: Multiplan Commercial |
$10.60
|
| Rate for Payer: Networks By Design Commercial |
$8.61
|
| Rate for Payer: Prime Health Services Commercial |
$11.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.62
|
| Rate for Payer: United Healthcare All Other HMO |
$6.62
|
| Rate for Payer: United Healthcare HMO Rider |
$6.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.26
|
| Rate for Payer: Vantage Medical Group Senior |
$11.26
|
|
|
MITOMYCIN IN NS 0.04 % (0.4 MG/ML) TOPICAL [4080715]
|
Facility
|
OP
|
$13.25
|
|
|
Service Code
|
NDC 9994-0807-17
|
| Hospital Charge Code |
ERX4080715
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$11.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.89
|
| Rate for Payer: Blue Distinction Transplant |
$7.95
|
| Rate for Payer: Blue Shield of California Commercial |
$9.77
|
| Rate for Payer: Blue Shield of California EPN |
$7.74
|
| Rate for Payer: Cash Price |
$5.96
|
| Rate for Payer: Cigna of CA HMO |
$9.28
|
| Rate for Payer: Cigna of CA PPO |
$9.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.26
|
| Rate for Payer: Dignity Health Media |
$11.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.30
|
| Rate for Payer: Galaxy Health WC |
$11.26
|
| Rate for Payer: Global Benefits Group Commercial |
$7.95
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.18
|
| Rate for Payer: Multiplan Commercial |
$10.60
|
| Rate for Payer: Networks By Design Commercial |
$8.61
|
| Rate for Payer: Prime Health Services Commercial |
$11.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.62
|
| Rate for Payer: United Healthcare All Other HMO |
$6.62
|
| Rate for Payer: United Healthcare HMO Rider |
$6.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.26
|
| Rate for Payer: Vantage Medical Group Senior |
$11.26
|
|
|
MITOMYCIN IN NS 0.04 % (0.4 MG/ML) TOPICAL [4080715]
|
Facility
|
IP
|
$13.25
|
|
|
Service Code
|
NDC 9994-0807-17
|
| Hospital Charge Code |
ERX4080715
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$11.26 |
| Rate for Payer: Blue Shield of California Commercial |
$9.43
|
| Rate for Payer: Blue Shield of California EPN |
$6.78
|
| Rate for Payer: Cash Price |
$5.96
|
| Rate for Payer: Cigna of CA HMO |
$9.28
|
| Rate for Payer: Cigna of CA PPO |
$9.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.30
|
| Rate for Payer: Galaxy Health WC |
$11.26
|
| Rate for Payer: Global Benefits Group Commercial |
$7.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.18
|
| Rate for Payer: Multiplan Commercial |
$10.60
|
| Rate for Payer: Networks By Design Commercial |
$8.61
|
| Rate for Payer: Prime Health Services Commercial |
$11.26
|
|
|
MITOMYCIN IN NS 0.04 % (0.4 MG/ML) TOPICAL [4080715]
|
Facility
|
IP
|
$13.25
|
|
|
Service Code
|
NDC 9994-0807-15
|
| Hospital Charge Code |
NDC4080715
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$11.26 |
| Rate for Payer: Blue Shield of California Commercial |
$9.43
|
| Rate for Payer: Blue Shield of California EPN |
$6.78
|
| Rate for Payer: Cash Price |
$5.96
|
| Rate for Payer: Cigna of CA HMO |
$9.28
|
| Rate for Payer: Cigna of CA PPO |
$9.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.30
|
| Rate for Payer: Galaxy Health WC |
$11.26
|
| Rate for Payer: Global Benefits Group Commercial |
$7.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.18
|
| Rate for Payer: Multiplan Commercial |
$10.60
|
| Rate for Payer: Networks By Design Commercial |
$8.61
|
| Rate for Payer: Prime Health Services Commercial |
$11.26
|
|
|
MITOMYCIN IN STERILE WATER 0.01 % (0.1 MG/ML) TOPICAL [4080716]
|
Facility
|
IP
|
$142.55
|
|
|
Service Code
|
NDC 9994-0807-16
|
| Hospital Charge Code |
ERX4080716
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$34.21 |
| Max. Negotiated Rate |
$121.17 |
| Rate for Payer: Blue Shield of California Commercial |
$101.50
|
| Rate for Payer: Blue Shield of California EPN |
$72.99
|
| Rate for Payer: Cash Price |
$64.15
|
| Rate for Payer: Cigna of CA HMO |
$99.78
|
| Rate for Payer: Cigna of CA PPO |
$99.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.02
|
| Rate for Payer: Galaxy Health WC |
$121.17
|
| Rate for Payer: Global Benefits Group Commercial |
$85.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$95.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.21
|
| Rate for Payer: Multiplan Commercial |
$114.04
|
| Rate for Payer: Networks By Design Commercial |
$92.66
|
| Rate for Payer: Prime Health Services Commercial |
$121.17
|
|
