|
OXACILLIN 10 GRAM SOLUTION FOR INJECTION [5925]
|
Facility
OP
|
$133.20
|
|
|
Service Code
|
CPT J2700
|
| Hospital Charge Code |
ERX5925
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$113.22 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$113.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$113.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$119.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$77.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$73.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$77.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$73.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.08
|
| Rate for Payer: BCBS Transplant Transplant |
$79.92
|
| Rate for Payer: BCBS Transplant Transplant |
$84.10
|
| Rate for Payer: Blue Shield of California Commercial |
$103.30
|
| Rate for Payer: Blue Shield of California Commercial |
$98.17
|
| Rate for Payer: Blue Shield of California EPN |
$3.18
|
| Rate for Payer: Blue Shield of California EPN |
$3.18
|
| Rate for Payer: Cash Price |
$59.94
|
| Rate for Payer: Cash Price |
$59.94
|
| Rate for Payer: Cash Price |
$63.07
|
| Rate for Payer: Cash Price |
$63.07
|
| Rate for Payer: Cigna of CA HMO |
$93.24
|
| Rate for Payer: Cigna of CA HMO |
$98.11
|
| Rate for Payer: Cigna of CA PPO |
$93.24
|
| Rate for Payer: Cigna of CA PPO |
$98.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.14
|
| Rate for Payer: Dignity Health Media |
$119.14
|
| Rate for Payer: Dignity Health Media |
$113.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$113.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$56.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$53.28
|
| Rate for Payer: Galaxy Health WC |
$119.14
|
| Rate for Payer: Galaxy Health WC |
$113.22
|
| Rate for Payer: Global Benefits Group Commercial |
$79.92
|
| Rate for Payer: Global Benefits Group Commercial |
$84.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$99.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$105.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.64
|
| Rate for Payer: Multiplan Commercial |
$106.56
|
| Rate for Payer: Multiplan Commercial |
$112.13
|
| Rate for Payer: Networks By Design Commercial |
$66.60
|
| Rate for Payer: Networks By Design Commercial |
$70.08
|
| Rate for Payer: Prime Health Services Commercial |
$113.22
|
| Rate for Payer: Prime Health Services Commercial |
$119.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.08
|
| Rate for Payer: United Healthcare All Other HMO |
$66.60
|
| Rate for Payer: United Healthcare All Other HMO |
$70.08
|
| Rate for Payer: United Healthcare HMO Rider |
$70.08
|
| Rate for Payer: United Healthcare HMO Rider |
$66.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$70.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$119.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.14
|
| Rate for Payer: Vantage Medical Group Senior |
$119.14
|
| Rate for Payer: Vantage Medical Group Senior |
$113.22
|
|
|
OXACILLIN 10 GRAM SOLUTION FOR INJECTION [5925]
|
Facility
IP
|
$140.16
|
|
|
Service Code
|
CPT J2700
|
| Hospital Charge Code |
ERX5925
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.64 |
| Max. Negotiated Rate |
$119.14 |
| Rate for Payer: Blue Shield of California Commercial |
$99.79
|
| Rate for Payer: Blue Shield of California Commercial |
$94.84
|
| Rate for Payer: Blue Shield of California EPN |
$71.76
|
| Rate for Payer: Blue Shield of California EPN |
$68.20
|
| Rate for Payer: Cash Price |
$59.94
|
| Rate for Payer: Cash Price |
$63.07
|
| Rate for Payer: Cigna of CA HMO |
$98.11
|
| Rate for Payer: Cigna of CA HMO |
$93.24
|
| Rate for Payer: Cigna of CA PPO |
$93.24
|
| Rate for Payer: Cigna of CA PPO |
$98.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$53.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$56.06
|
| Rate for Payer: Galaxy Health WC |
$113.22
|
| Rate for Payer: Galaxy Health WC |
$119.14
|
| Rate for Payer: Global Benefits Group Commercial |
$79.92
|
| Rate for Payer: Global Benefits Group Commercial |
$84.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.97
|
| Rate for Payer: Multiplan Commercial |
$106.56
|
| Rate for Payer: Multiplan Commercial |
$112.13
|
| Rate for Payer: Networks By Design Commercial |
$66.60
|
| Rate for Payer: Networks By Design Commercial |
$70.08
|
| Rate for Payer: Prime Health Services Commercial |
$113.22
|
| Rate for Payer: Prime Health Services Commercial |
$119.14
|
|
|
OXACILLIN 1 GRAM SOLUTION FOR INJECTION [5924]
|
Facility
IP
|
$9.95
|
|
|
Service Code
|
CPT J2700
|
| Hospital Charge Code |
1753470
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$8.46 |
| Rate for Payer: Blue Shield of California Commercial |
$7.08
|
| Rate for Payer: Blue Shield of California Commercial |
$9.65
|
| Rate for Payer: Blue Shield of California Commercial |
$9.61
|
| Rate for Payer: Blue Shield of California Commercial |
$9.98
|
| Rate for Payer: Blue Shield of California EPN |
$7.17
|
| Rate for Payer: Blue Shield of California EPN |
$6.91
|
| Rate for Payer: Blue Shield of California EPN |
$6.94
|
| Rate for Payer: Blue Shield of California EPN |
$5.09
|
| Rate for Payer: Cash Price |
$6.10
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: Cash Price |
$6.08
|
| Rate for Payer: Cigna of CA HMO |
$6.96
|
| Rate for Payer: Cigna of CA HMO |
$9.81
|
| Rate for Payer: Cigna of CA HMO |
$9.45
|
| Rate for Payer: Cigna of CA HMO |
$9.49
|
| Rate for Payer: Cigna of CA PPO |
$9.49
|
| Rate for Payer: Cigna of CA PPO |
$9.81
|
| Rate for Payer: Cigna of CA PPO |
$6.96
|
| Rate for Payer: Cigna of CA PPO |
$9.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.40
|
| Rate for Payer: Galaxy Health WC |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$11.48
|
| Rate for Payer: Galaxy Health WC |
$8.46
|
| Rate for Payer: Galaxy Health WC |
$11.91
|
| Rate for Payer: Global Benefits Group Commercial |
$8.41
|
| Rate for Payer: Global Benefits Group Commercial |
$8.10
|
| Rate for Payer: Global Benefits Group Commercial |
$8.14
|
| Rate for Payer: Global Benefits Group Commercial |
$5.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.25
|
| Rate for Payer: Multiplan Commercial |
$10.80
|
| Rate for Payer: Multiplan Commercial |
$7.96
|
| Rate for Payer: Multiplan Commercial |
$10.85
|
| Rate for Payer: Multiplan Commercial |
$11.21
|
| Rate for Payer: Networks By Design Commercial |
$4.98
|
| Rate for Payer: Networks By Design Commercial |
$6.78
|
| Rate for Payer: Networks By Design Commercial |
$7.00
|
| Rate for Payer: Networks By Design Commercial |
$6.75
|
| Rate for Payer: Prime Health Services Commercial |
$8.46
|
| Rate for Payer: Prime Health Services Commercial |
$11.53
|
| Rate for Payer: Prime Health Services Commercial |
$11.91
|
| Rate for Payer: Prime Health Services Commercial |
$11.48
|
|
|
OXACILLIN 1 GRAM SOLUTION FOR INJECTION [5924]
|
Facility
OP
|
$13.56
|
|
|
Service Code
|
CPT J2700
|
| Hospital Charge Code |
1753470
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$11.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.91
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.71
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.42
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.46
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.42
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.08
|
| Rate for Payer: BCBS Transplant Transplant |
$5.97
|
| Rate for Payer: BCBS Transplant Transplant |
$8.41
|
| Rate for Payer: BCBS Transplant Transplant |
$8.14
|
| Rate for Payer: BCBS Transplant Transplant |
$8.10
|
| Rate for Payer: Blue Shield of California Commercial |
$10.33
|
| Rate for Payer: Blue Shield of California Commercial |
$7.33
|
| Rate for Payer: Blue Shield of California Commercial |
$9.99
|
| Rate for Payer: Blue Shield of California Commercial |
$9.95
|
| Rate for Payer: Blue Shield of California EPN |
$3.18
|
| Rate for Payer: Blue Shield of California EPN |
$3.18
|
| Rate for Payer: Blue Shield of California EPN |
$3.18
|
| Rate for Payer: Blue Shield of California EPN |
$3.18
|
| Rate for Payer: Cash Price |
$6.08
|
| Rate for Payer: Cash Price |
$6.08
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.10
|
| Rate for Payer: Cash Price |
$6.10
|
| Rate for Payer: Cigna of CA HMO |
$9.81
|
| Rate for Payer: Cigna of CA HMO |
$9.45
|
| Rate for Payer: Cigna of CA HMO |
$9.49
|
| Rate for Payer: Cigna of CA HMO |
$6.96
|
| Rate for Payer: Cigna of CA PPO |
$9.81
|
| Rate for Payer: Cigna of CA PPO |
$6.96
|
| Rate for Payer: Cigna of CA PPO |
$9.49
|
| Rate for Payer: Cigna of CA PPO |
$9.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.91
|
| Rate for Payer: Dignity Health Media |
$11.48
|
| Rate for Payer: Dignity Health Media |
$11.53
|
| Rate for Payer: Dignity Health Media |
$11.91
|
| Rate for Payer: Dignity Health Media |
$8.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.42
|
| Rate for Payer: Galaxy Health WC |
$11.91
|
| Rate for Payer: Galaxy Health WC |
$11.48
|
| Rate for Payer: Galaxy Health WC |
$8.46
|
| Rate for Payer: Galaxy Health WC |
$11.53
|
| Rate for Payer: Global Benefits Group Commercial |
$5.97
|
| Rate for Payer: Global Benefits Group Commercial |
$8.14
|
| Rate for Payer: Global Benefits Group Commercial |
$8.10
|
| Rate for Payer: Global Benefits Group Commercial |
$8.41
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10.12
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10.17
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10.51
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.36
|
| Rate for Payer: Multiplan Commercial |
$7.96
|
| Rate for Payer: Multiplan Commercial |
$10.85
|
| Rate for Payer: Multiplan Commercial |
$11.21
|
| Rate for Payer: Multiplan Commercial |
$10.80
|
| Rate for Payer: Networks By Design Commercial |
$4.98
|
| Rate for Payer: Networks By Design Commercial |
$6.78
|
| Rate for Payer: Networks By Design Commercial |
$6.75
|
| Rate for Payer: Networks By Design Commercial |
$7.00
|
| Rate for Payer: Prime Health Services Commercial |
$11.91
|
| Rate for Payer: Prime Health Services Commercial |
$11.48
|
| Rate for Payer: Prime Health Services Commercial |
$8.46
|
| Rate for Payer: Prime Health Services Commercial |
$11.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.78
|
| Rate for Payer: United Healthcare All Other HMO |
$6.75
|
| Rate for Payer: United Healthcare All Other HMO |
$7.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6.78
|
| Rate for Payer: United Healthcare All Other HMO |
$4.98
|
| Rate for Payer: United Healthcare HMO Rider |
$4.98
|
| Rate for Payer: United Healthcare HMO Rider |
$7.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6.78
|
| Rate for Payer: United Healthcare HMO Rider |
$6.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.46
|
| Rate for Payer: Vantage Medical Group Senior |
$11.48
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
| Rate for Payer: Vantage Medical Group Senior |
$8.46
|
| Rate for Payer: Vantage Medical Group Senior |
$11.91
|
|
|
OXACILLIN 2 GRAM SOLUTION FOR INJECTION [5926]
|
Facility
IP
|
$19.90
|
|
|
Service Code
|
CPT J2700
|
| Hospital Charge Code |
1753547
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.78 |
| Max. Negotiated Rate |
$16.92 |
| Rate for Payer: Blue Shield of California Commercial |
$14.17
|
| Rate for Payer: Blue Shield of California Commercial |
$19.31
|
| Rate for Payer: Blue Shield of California Commercial |
$19.96
|
| Rate for Payer: Blue Shield of California EPN |
$14.35
|
| Rate for Payer: Blue Shield of California EPN |
$10.19
|
| Rate for Payer: Blue Shield of California EPN |
$13.89
|
| Rate for Payer: Cash Price |
$8.96
|
| Rate for Payer: Cash Price |
$12.20
|
| Rate for Payer: Cash Price |
$12.61
|
| Rate for Payer: Cigna of CA HMO |
$13.93
|
| Rate for Payer: Cigna of CA HMO |
$18.98
|
| Rate for Payer: Cigna of CA HMO |
$19.62
|
| Rate for Payer: Cigna of CA PPO |
$13.93
|
| Rate for Payer: Cigna of CA PPO |
$19.62
|
| Rate for Payer: Cigna of CA PPO |
$18.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.85
|
| Rate for Payer: Galaxy Health WC |
$16.92
|
| Rate for Payer: Galaxy Health WC |
$23.05
|
| Rate for Payer: Galaxy Health WC |
$23.83
|
| Rate for Payer: Global Benefits Group Commercial |
$16.27
|
| Rate for Payer: Global Benefits Group Commercial |
$16.82
|
| Rate for Payer: Global Benefits Group Commercial |
$11.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.78
|
| Rate for Payer: Multiplan Commercial |
$15.92
|
| Rate for Payer: Multiplan Commercial |
$21.70
|
| Rate for Payer: Multiplan Commercial |
$22.42
|
| Rate for Payer: Networks By Design Commercial |
$13.56
|
| Rate for Payer: Networks By Design Commercial |
$9.95
|
| Rate for Payer: Networks By Design Commercial |
$14.02
|
| Rate for Payer: Prime Health Services Commercial |
$23.83
|
| Rate for Payer: Prime Health Services Commercial |
$16.92
|
| Rate for Payer: Prime Health Services Commercial |
$23.05
|
|
|
OXACILLIN 2 GRAM SOLUTION FOR INJECTION [5926]
|
Facility
OP
|
$28.03
|
|
|
Service Code
|
CPT J2700
|
| Hospital Charge Code |
1753547
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$23.83 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$23.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$23.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.94
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.42
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.42
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.08
|
| Rate for Payer: BCBS Transplant Transplant |
$16.82
|
| Rate for Payer: BCBS Transplant Transplant |
$11.94
|
| Rate for Payer: BCBS Transplant Transplant |
$16.27
|
| Rate for Payer: Blue Shield of California Commercial |
$19.99
|
| Rate for Payer: Blue Shield of California Commercial |
$14.67
|
| Rate for Payer: Blue Shield of California Commercial |
$20.66
|
| Rate for Payer: Blue Shield of California EPN |
$3.18
|
| Rate for Payer: Blue Shield of California EPN |
$3.18
|
| Rate for Payer: Blue Shield of California EPN |
$3.18
|
| Rate for Payer: Cash Price |
$12.61
|
| Rate for Payer: Cash Price |
$8.96
|
| Rate for Payer: Cash Price |
$12.61
|
| Rate for Payer: Cash Price |
$8.96
|
| Rate for Payer: Cash Price |
$12.20
|
| Rate for Payer: Cash Price |
$12.20
|
| Rate for Payer: Cigna of CA HMO |
$18.98
|
| Rate for Payer: Cigna of CA HMO |
$19.62
|
| Rate for Payer: Cigna of CA HMO |
$13.93
|
| Rate for Payer: Cigna of CA PPO |
$13.93
|
| Rate for Payer: Cigna of CA PPO |
$18.98
|
| Rate for Payer: Cigna of CA PPO |
$19.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.83
|
| Rate for Payer: Dignity Health Media |
$23.83
|
| Rate for Payer: Dignity Health Media |
$23.05
|
| Rate for Payer: Dignity Health Media |
$16.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.85
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.85
|
| Rate for Payer: Galaxy Health WC |
$23.83
|
| Rate for Payer: Galaxy Health WC |
$16.92
|
| Rate for Payer: Galaxy Health WC |
$23.05
|
| Rate for Payer: Global Benefits Group Commercial |
$11.94
|
| Rate for Payer: Global Benefits Group Commercial |
$16.27
|
| Rate for Payer: Global Benefits Group Commercial |
$16.82
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14.92
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$20.34
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$21.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.73
|
| Rate for Payer: Multiplan Commercial |
$21.70
|
| Rate for Payer: Multiplan Commercial |
$15.92
|
| Rate for Payer: Multiplan Commercial |
$22.42
|
| Rate for Payer: Networks By Design Commercial |
$9.95
|
| Rate for Payer: Networks By Design Commercial |
$14.02
|
| Rate for Payer: Networks By Design Commercial |
$13.56
|
| Rate for Payer: Prime Health Services Commercial |
$23.83
|
| Rate for Payer: Prime Health Services Commercial |
$23.05
|
| Rate for Payer: Prime Health Services Commercial |
$16.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.02
|
| Rate for Payer: United Healthcare All Other HMO |
$9.95
|
| Rate for Payer: United Healthcare All Other HMO |
$13.56
|
| Rate for Payer: United Healthcare All Other HMO |
$14.02
|
| Rate for Payer: United Healthcare HMO Rider |
$9.95
|
| Rate for Payer: United Healthcare HMO Rider |
$14.02
|
| Rate for Payer: United Healthcare HMO Rider |
$13.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.83
|
| Rate for Payer: Vantage Medical Group Senior |
$16.92
|
| Rate for Payer: Vantage Medical Group Senior |
$23.05
|
| Rate for Payer: Vantage Medical Group Senior |
$23.83
|
|
|
OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION [99612]
|
Facility
OP
|
$1.98
|
|
|
Service Code
|
CPT J9263
|
| Hospital Charge Code |
1755749
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$17.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.68
|
| Rate for Payer: BCBS Transplant Transplant |
$1.44
|
| Rate for Payer: BCBS Transplant Transplant |
$0.72
|
| Rate for Payer: BCBS Transplant Transplant |
$3.60
|
| Rate for Payer: BCBS Transplant Transplant |
$1.19
|
| Rate for Payer: Blue Shield of California Commercial |
$4.42
|
| Rate for Payer: Blue Shield of California Commercial |
$0.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.77
|
| Rate for Payer: Blue Shield of California Commercial |
$1.46
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA HMO |
$1.39
|
| Rate for Payer: Cigna of CA PPO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$1.39
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.10
|
| Rate for Payer: Dignity Health Media |
$1.02
|
| Rate for Payer: Dignity Health Media |
$1.68
|
| Rate for Payer: Dignity Health Media |
$2.04
|
| Rate for Payer: Dignity Health Media |
$5.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.79
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Galaxy Health WC |
$2.04
|
| Rate for Payer: Galaxy Health WC |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1.44
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.19
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.48
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.58
|
| Rate for Payer: Multiplan Commercial |
$1.92
|
| Rate for Payer: Multiplan Commercial |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Networks By Design Commercial |
$0.99
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: Networks By Design Commercial |
$3.00
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: Prime Health Services Commercial |
$2.04
|
| Rate for Payer: Prime Health Services Commercial |
$1.68
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.99
|
| Rate for Payer: United Healthcare All Other HMO |
$0.99
|
| Rate for Payer: United Healthcare All Other HMO |
$1.20
|
| Rate for Payer: United Healthcare All Other HMO |
$3.00
|
| Rate for Payer: United Healthcare All Other HMO |
$0.60
|
| Rate for Payer: United Healthcare HMO Rider |
$0.60
|
| Rate for Payer: United Healthcare HMO Rider |
$0.99
|
| Rate for Payer: United Healthcare HMO Rider |
$1.20
|
| Rate for Payer: United Healthcare HMO Rider |
$3.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1.68
|
| Rate for Payer: Vantage Medical Group Senior |
$1.02
|
| Rate for Payer: Vantage Medical Group Senior |
$2.04
|
| Rate for Payer: Vantage Medical Group Senior |
$5.10
|
|
|
OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION [99612]
|
Facility
IP
|
$2.40
|
|
|
Service Code
|
CPT J9263
|
| Hospital Charge Code |
1755749
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.04 |
| Rate for Payer: Blue Shield of California Commercial |
$1.71
|
| Rate for Payer: Blue Shield of California Commercial |
$4.27
|
| Rate for Payer: Blue Shield of California Commercial |
$1.41
|
| Rate for Payer: Blue Shield of California Commercial |
$0.85
|
| Rate for Payer: Blue Shield of California EPN |
$1.23
|
| Rate for Payer: Blue Shield of California EPN |
$3.07
|
| Rate for Payer: Blue Shield of California EPN |
$1.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.61
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA HMO |
$1.39
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.39
|
| Rate for Payer: Cigna of CA PPO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Galaxy Health WC |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$2.04
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1.44
|
| Rate for Payer: Global Benefits Group Commercial |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.92
|
| Rate for Payer: Multiplan Commercial |
$1.58
|
| Rate for Payer: Multiplan Commercial |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Networks By Design Commercial |
$0.99
|
| Rate for Payer: Networks By Design Commercial |
$3.00
|
| Rate for Payer: Prime Health Services Commercial |
$2.04
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
| Rate for Payer: Prime Health Services Commercial |
$1.68
|
|
|
OXALIPLATIN 100 MG INTRAVENOUS SOLUTION [23929]
|
Facility
OP
|
$636.00
|
|
|
Service Code
|
CPT J9263
|
| Hospital Charge Code |
ERX23929
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$540.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$540.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$349.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$349.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.68
|
| Rate for Payer: BCBS Transplant Transplant |
$381.60
|
| Rate for Payer: Blue Shield of California Commercial |
$468.73
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cigna of CA HMO |
$445.20
|
| Rate for Payer: Cigna of CA PPO |
$445.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$540.60
|
| Rate for Payer: Dignity Health Media |
$540.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$540.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$254.40
|
| Rate for Payer: Galaxy Health WC |
$540.60
|
| Rate for Payer: Global Benefits Group Commercial |
$381.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$477.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$424.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.64
|
| Rate for Payer: Multiplan Commercial |
$508.80
|
| Rate for Payer: Networks By Design Commercial |
$318.00
|
| Rate for Payer: Prime Health Services Commercial |
$540.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$381.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$381.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$318.00
|
| Rate for Payer: United Healthcare All Other HMO |
$318.00
|
| Rate for Payer: United Healthcare HMO Rider |
$318.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$318.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$540.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$540.60
|
| Rate for Payer: Vantage Medical Group Senior |
$540.60
|
|
|
OXALIPLATIN 100 MG INTRAVENOUS SOLUTION [23929]
|
Facility
IP
|
$636.00
|
|
|
Service Code
|
CPT J9263
|
| Hospital Charge Code |
ERX23929
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$152.64 |
| Max. Negotiated Rate |
$540.60 |
| Rate for Payer: Blue Shield of California Commercial |
$452.83
|
| Rate for Payer: Blue Shield of California EPN |
$325.63
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cigna of CA HMO |
$445.20
|
| Rate for Payer: Cigna of CA PPO |
$445.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$254.40
|
| Rate for Payer: Galaxy Health WC |
$540.60
|
| Rate for Payer: Global Benefits Group Commercial |
$381.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$424.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$242.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.64
|
| Rate for Payer: Multiplan Commercial |
$508.80
|
| Rate for Payer: Networks By Design Commercial |
$318.00
|
| Rate for Payer: Prime Health Services Commercial |
$540.60
|
|
|
OXALIPLATIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION [99610]
|
Facility
IP
|
$3.60
|
|
|
Service Code
|
CPT J9263
|
| Hospital Charge Code |
NDG99610
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Blue Shield of California Commercial |
$2.56
|
| Rate for Payer: Blue Shield of California Commercial |
$1.28
|
| Rate for Payer: Blue Shield of California Commercial |
$4.27
|
| Rate for Payer: Blue Shield of California EPN |
$3.07
|
| Rate for Payer: Blue Shield of California EPN |
$1.84
|
| Rate for Payer: Blue Shield of California EPN |
$0.92
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA HMO |
$1.26
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$1.26
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$1.53
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Networks By Design Commercial |
$3.00
|
| Rate for Payer: Networks By Design Commercial |
$0.90
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Prime Health Services Commercial |
$1.53
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
|
|
OXALIPLATIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION [99610]
|
Facility
OP
|
$3.60
|
|
|
Service Code
|
CPT J9263
|
| Hospital Charge Code |
NDG99610
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$17.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.99
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.68
|
| Rate for Payer: BCBS Transplant Transplant |
$2.16
|
| Rate for Payer: BCBS Transplant Transplant |
$1.08
|
| Rate for Payer: BCBS Transplant Transplant |
$3.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4.42
|
| Rate for Payer: Blue Shield of California Commercial |
$1.33
|
| Rate for Payer: Blue Shield of California Commercial |
$2.65
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA HMO |
$1.26
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$1.26
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.53
|
| Rate for Payer: Dignity Health Media |
$1.53
|
| Rate for Payer: Dignity Health Media |
$5.10
|
| Rate for Payer: Dignity Health Media |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$1.53
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Global Benefits Group Commercial |
$1.08
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.35
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Networks By Design Commercial |
$3.00
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$0.90
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Prime Health Services Commercial |
$1.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.90
|
| Rate for Payer: United Healthcare All Other HMO |
$1.80
|
| Rate for Payer: United Healthcare All Other HMO |
$3.00
|
| Rate for Payer: United Healthcare All Other HMO |
$0.90
|
| Rate for Payer: United Healthcare HMO Rider |
$1.80
|
| Rate for Payer: United Healthcare HMO Rider |
$0.90
|
| Rate for Payer: United Healthcare HMO Rider |
$3.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
| Rate for Payer: Vantage Medical Group Senior |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1.53
|
|
|
OXALIPLATIN 50 MG INTRAVENOUS SOLUTION [23928]
|
Facility
OP
|
$318.00
|
|
|
Service Code
|
CPT J9263
|
| Hospital Charge Code |
ERX23928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$270.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$270.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$174.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$174.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.68
|
| Rate for Payer: BCBS Transplant Transplant |
$190.80
|
| Rate for Payer: Blue Shield of California Commercial |
$234.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cigna of CA HMO |
$222.60
|
| Rate for Payer: Cigna of CA PPO |
$222.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$270.30
|
| Rate for Payer: Dignity Health Media |
$270.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$270.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$127.20
|
| Rate for Payer: Galaxy Health WC |
$270.30
|
| Rate for Payer: Global Benefits Group Commercial |
$190.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$238.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$212.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.32
|
| Rate for Payer: Multiplan Commercial |
$254.40
|
| Rate for Payer: Networks By Design Commercial |
$159.00
|
| Rate for Payer: Prime Health Services Commercial |
$270.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$190.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$190.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$159.00
|
| Rate for Payer: United Healthcare All Other HMO |
$159.00
|
| Rate for Payer: United Healthcare HMO Rider |
$159.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$270.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$270.30
|
| Rate for Payer: Vantage Medical Group Senior |
$270.30
|
|
|
OXALIPLATIN 50 MG INTRAVENOUS SOLUTION [23928]
|
Facility
IP
|
$318.00
|
|
|
Service Code
|
CPT J9263
|
| Hospital Charge Code |
ERX23928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$76.32 |
| Max. Negotiated Rate |
$270.30 |
| Rate for Payer: Blue Shield of California Commercial |
$226.42
|
| Rate for Payer: Blue Shield of California EPN |
$162.82
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cigna of CA HMO |
$222.60
|
| Rate for Payer: Cigna of CA PPO |
$222.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$127.20
|
| Rate for Payer: Galaxy Health WC |
$270.30
|
| Rate for Payer: Global Benefits Group Commercial |
$190.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$212.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.32
|
| Rate for Payer: Multiplan Commercial |
$254.40
|
| Rate for Payer: Networks By Design Commercial |
$159.00
|
| Rate for Payer: Prime Health Services Commercial |
$270.30
|
|
|
OXANDROLONE 10 MG TABLET [33826]
|
Facility
IP
|
$11.30
|
|
|
Service Code
|
NDC 0245-0272-06
|
| Hospital Charge Code |
1710982
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$9.60 |
| Rate for Payer: Blue Shield of California Commercial |
$8.05
|
| Rate for Payer: Blue Shield of California EPN |
$5.79
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Cigna of CA HMO |
$7.91
|
| Rate for Payer: Cigna of CA PPO |
$7.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.52
|
| Rate for Payer: Galaxy Health WC |
$9.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.71
|
| Rate for Payer: Multiplan Commercial |
$9.04
|
| Rate for Payer: Networks By Design Commercial |
$7.34
|
| Rate for Payer: Prime Health Services Commercial |
$9.60
|
|
|
OXANDROLONE 10 MG TABLET [33826]
|
Facility
OP
|
$11.30
|
|
|
Service Code
|
NDC 0245-0272-06
|
| Hospital Charge Code |
1710982
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$9.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.73
|
| Rate for Payer: BCBS Transplant Transplant |
$6.78
|
| Rate for Payer: Blue Shield of California Commercial |
$8.33
|
| Rate for Payer: Blue Shield of California EPN |
$6.60
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Cigna of CA HMO |
$7.91
|
| Rate for Payer: Cigna of CA PPO |
$7.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.60
|
| Rate for Payer: Dignity Health Media |
$9.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.52
|
| Rate for Payer: Galaxy Health WC |
$9.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6.78
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.71
|
| Rate for Payer: Multiplan Commercial |
$9.04
|
| Rate for Payer: Networks By Design Commercial |
$7.34
|
| Rate for Payer: Prime Health Services Commercial |
$9.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.65
|
| Rate for Payer: United Healthcare All Other HMO |
$5.65
|
| Rate for Payer: United Healthcare HMO Rider |
$5.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.60
|
| Rate for Payer: Vantage Medical Group Senior |
$9.60
|
|
|
OXANDROLONE 2.5 MG TABLET [10803]
|
Facility
IP
|
$5.19
|
|
|
Service Code
|
NDC 49884-301-01
|
| Hospital Charge Code |
1710935
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$4.41 |
| Rate for Payer: Blue Shield of California Commercial |
$3.70
|
| Rate for Payer: Blue Shield of California EPN |
$2.66
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cigna of CA HMO |
$3.63
|
| Rate for Payer: Cigna of CA PPO |
$3.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.08
|
| Rate for Payer: Galaxy Health WC |
$4.41
|
| Rate for Payer: Global Benefits Group Commercial |
$3.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.25
|
| Rate for Payer: Multiplan Commercial |
$4.15
|
| Rate for Payer: Networks By Design Commercial |
$3.37
|
| Rate for Payer: Prime Health Services Commercial |
$4.41
|
|
|
OXANDROLONE 2.5 MG TABLET [10803]
|
Facility
OP
|
$3.33
|
|
|
Service Code
|
NDC 0245-0271-11
|
| Hospital Charge Code |
1710935
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$2.83 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.98
|
| Rate for Payer: BCBS Transplant Transplant |
$2.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2.45
|
| Rate for Payer: Blue Shield of California EPN |
$1.94
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna of CA HMO |
$2.33
|
| Rate for Payer: Cigna of CA PPO |
$2.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.83
|
| Rate for Payer: Dignity Health Media |
$2.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.33
|
| Rate for Payer: Galaxy Health WC |
$2.83
|
| Rate for Payer: Global Benefits Group Commercial |
$2.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$2.66
|
| Rate for Payer: Networks By Design Commercial |
$2.16
|
| Rate for Payer: Prime Health Services Commercial |
$2.83
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.66
|
| Rate for Payer: United Healthcare All Other HMO |
$1.66
|
| Rate for Payer: United Healthcare HMO Rider |
$1.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.83
|
| Rate for Payer: Vantage Medical Group Senior |
$2.83
|
|
|
OXANDROLONE 2.5 MG TABLET [10803]
|
Facility
OP
|
$5.19
|
|
|
Service Code
|
NDC 49884-301-01
|
| Hospital Charge Code |
1710935
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$4.41 |
| Rate for Payer: Galaxy Health WC |
$4.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.09
|
| Rate for Payer: BCBS Transplant Transplant |
$3.11
|
| Rate for Payer: Blue Shield of California Commercial |
$3.83
|
| Rate for Payer: Blue Shield of California EPN |
$3.03
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cigna of CA HMO |
$3.63
|
| Rate for Payer: Cigna of CA PPO |
$3.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.41
|
| Rate for Payer: Dignity Health Media |
$4.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.08
|
| Rate for Payer: Global Benefits Group Commercial |
$3.11
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.25
|
| Rate for Payer: Multiplan Commercial |
$4.15
|
| Rate for Payer: Networks By Design Commercial |
$3.37
|
| Rate for Payer: Prime Health Services Commercial |
$4.41
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.60
|
| Rate for Payer: United Healthcare All Other HMO |
$2.60
|
| Rate for Payer: United Healthcare HMO Rider |
$2.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.41
|
| Rate for Payer: Vantage Medical Group Senior |
$4.41
|
|
|
OXANDROLONE 2.5 MG TABLET [10803]
|
Facility
IP
|
$3.33
|
|
|
Service Code
|
NDC 0245-0271-11
|
| Hospital Charge Code |
1710935
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$2.83 |
| Rate for Payer: Blue Shield of California Commercial |
$2.37
|
| Rate for Payer: Blue Shield of California EPN |
$1.70
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna of CA HMO |
$2.33
|
| Rate for Payer: Cigna of CA PPO |
$2.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.33
|
| Rate for Payer: Galaxy Health WC |
$2.83
|
| Rate for Payer: Global Benefits Group Commercial |
$2.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$2.66
|
| Rate for Payer: Networks By Design Commercial |
$2.16
|
| Rate for Payer: Prime Health Services Commercial |
$2.83
|
|
|
OXCARBAZEPINE 150 MG TABLET [27049]
|
Facility
IP
|
$0.65
|
|
|
Service Code
|
NDC 68084-845-01
|
| Hospital Charge Code |
1710905
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California EPN |
$0.33
|
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.46
|
| Rate for Payer: Cigna of CA PPO |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.55
|
| Rate for Payer: Global Benefits Group Commercial |
$0.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.52
|
| Rate for Payer: Networks By Design Commercial |
$0.42
|
| Rate for Payer: Prime Health Services Commercial |
$0.55
|
|
|
OXCARBAZEPINE 150 MG TABLET [27049]
|
Facility
IP
|
$0.65
|
|
|
Service Code
|
NDC 68084-845-11
|
| Hospital Charge Code |
1710905
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California EPN |
$0.33
|
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.46
|
| Rate for Payer: Cigna of CA PPO |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.55
|
| Rate for Payer: Global Benefits Group Commercial |
$0.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.52
|
| Rate for Payer: Networks By Design Commercial |
$0.42
|
| Rate for Payer: Prime Health Services Commercial |
$0.55
|
|
|
OXCARBAZEPINE 150 MG TABLET [27049]
|
Facility
OP
|
$0.36
|
|
|
Service Code
|
NDC 68462-137-01
|
| Hospital Charge Code |
1710905
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.21
|
| Rate for Payer: BCBS Transplant Transplant |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: Dignity Health Media |
$0.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
|
OXCARBAZEPINE 150 MG TABLET [27049]
|
Facility
OP
|
$0.65
|
|
|
Service Code
|
NDC 68084-845-01
|
| Hospital Charge Code |
1710905
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.39
|
| Rate for Payer: BCBS Transplant Transplant |
$0.39
|
| Rate for Payer: Blue Shield of California Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California EPN |
$0.38
|
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.46
|
| Rate for Payer: Cigna of CA PPO |
$0.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.55
|
| Rate for Payer: Dignity Health Media |
$0.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.55
|
| Rate for Payer: Global Benefits Group Commercial |
$0.39
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.52
|
| Rate for Payer: Networks By Design Commercial |
$0.42
|
| Rate for Payer: Prime Health Services Commercial |
$0.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.33
|
| Rate for Payer: United Healthcare All Other HMO |
$0.33
|
| Rate for Payer: United Healthcare HMO Rider |
$0.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: Vantage Medical Group Senior |
$0.55
|
|
|
OXCARBAZEPINE 150 MG TABLET [27049]
|
Facility
OP
|
$0.36
|
|
|
Service Code
|
NDC 62756-183-88
|
| Hospital Charge Code |
1710905
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.21
|
| Rate for Payer: BCBS Transplant Transplant |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: Dignity Health Media |
$0.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
