|
BORIC ACID (BULK) POWDER [1131]
|
Facility
|
IP
|
$0.94
|
|
|
Service Code
|
NDC 3877900649
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Adventist Health Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.73
|
| Rate for Payer: Blue Shield of California EPN |
$0.47
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Central Health Plan Commercial |
$0.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: EPIC Health Plan Senior |
$0.38
|
| Rate for Payer: Galaxy Health WC |
$0.80
|
| Rate for Payer: Global Benefits Group Commercial |
$0.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.71
|
| Rate for Payer: Networks By Design Commercial |
$0.61
|
| Rate for Payer: Prime Health Services Commercial |
$0.80
|
|
|
BORTEZOMIB 3.5 MG INJECTION POWDER FOR SOLUTION [35839]
|
Facility
|
IP
|
$50.40
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.08 |
| Max. Negotiated Rate |
$45.36 |
| Rate for Payer: Adventist Health Commercial |
$10.08
|
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Adventist Health Commercial |
$48.00
|
| Rate for Payer: Blue Shield of California Commercial |
$38.96
|
| Rate for Payer: Blue Shield of California Commercial |
$231.90
|
| Rate for Payer: Blue Shield of California Commercial |
$185.52
|
| Rate for Payer: Blue Shield of California EPN |
$120.96
|
| Rate for Payer: Blue Shield of California EPN |
$25.40
|
| Rate for Payer: Blue Shield of California EPN |
$151.20
|
| Rate for Payer: Cash Price |
$27.72
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Central Health Plan Commercial |
$240.00
|
| Rate for Payer: Central Health Plan Commercial |
$192.00
|
| Rate for Payer: Central Health Plan Commercial |
$40.32
|
| Rate for Payer: Cigna of CA HMO |
$35.28
|
| Rate for Payer: Cigna of CA HMO |
$168.00
|
| Rate for Payer: Cigna of CA HMO |
$210.00
|
| Rate for Payer: Cigna of CA PPO |
$35.28
|
| Rate for Payer: Cigna of CA PPO |
$210.00
|
| Rate for Payer: Cigna of CA PPO |
$168.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$96.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.16
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Galaxy Health WC |
$204.00
|
| Rate for Payer: Galaxy Health WC |
$42.84
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Global Benefits Group Commercial |
$144.00
|
| Rate for Payer: Global Benefits Group Commercial |
$30.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$216.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$160.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$148.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$37.80
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: Networks By Design Commercial |
$25.20
|
| Rate for Payer: Networks By Design Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$150.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: Prime Health Services Commercial |
$42.84
|
| Rate for Payer: Prime Health Services Commercial |
$204.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$90.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.59
|
| Rate for Payer: United Healthcare All Other HMO |
$109.59
|
| Rate for Payer: United Healthcare All Other HMO |
$87.67
|
| Rate for Payer: United Healthcare All Other HMO |
$18.41
|
| Rate for Payer: United Healthcare HMO Rider |
$85.78
|
| Rate for Payer: United Healthcare HMO Rider |
$107.22
|
| Rate for Payer: United Healthcare HMO Rider |
$18.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$78.60
|
|
|
BORTEZOMIB 3.5 MG INJECTION POWDER FOR SOLUTION [35839]
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Adventist Health Commercial |
$10.08
|
| Rate for Payer: Adventist Health Commercial |
$48.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$145.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$182.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$204.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$132.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$180.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4.84
|
| Rate for Payer: Blue Shield of California Commercial |
$4.84
|
| Rate for Payer: Blue Shield of California Commercial |
$4.84
|
| Rate for Payer: Blue Shield of California EPN |
$4.40
|
| Rate for Payer: Blue Shield of California EPN |
$4.40
|
| Rate for Payer: Blue Shield of California EPN |
$4.40
|
| Rate for Payer: Cash Price |
$27.72
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$27.72
|
| Rate for Payer: Central Health Plan Commercial |
$40.32
|
| Rate for Payer: Central Health Plan Commercial |
$240.00
|
| Rate for Payer: Central Health Plan Commercial |
$192.00
|
| Rate for Payer: Cigna of CA HMO |
$35.28
|
| Rate for Payer: Cigna of CA HMO |
$210.00
|
| Rate for Payer: Cigna of CA HMO |
$168.00
|
| Rate for Payer: Cigna of CA PPO |
$168.00
|
| Rate for Payer: Cigna of CA PPO |
$35.28
|
| Rate for Payer: Cigna of CA PPO |
$210.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$204.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$204.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$204.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.16
|
| Rate for Payer: EPIC Health Plan Senior |
$96.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.16
|
| Rate for Payer: Galaxy Health WC |
$42.84
|
| Rate for Payer: Galaxy Health WC |
$204.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$144.00
|
| Rate for Payer: Global Benefits Group Commercial |
$30.24
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$216.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.50
|
| Rate for Payer: InnovAge PACE Commercial |
$25.20
|
| Rate for Payer: InnovAge PACE Commercial |
$150.00
|
| Rate for Payer: InnovAge PACE Commercial |
$120.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$160.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$148.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$210.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$168.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$168.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$210.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.28
|
| Rate for Payer: Multiplan Commercial |
$37.80
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: Networks By Design Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$25.20
|
| Rate for Payer: Networks By Design Commercial |
$150.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: Prime Health Services Commercial |
$42.84
|
| Rate for Payer: Prime Health Services Commercial |
$204.00
|
| Rate for Payer: Riverside University Health System MISP |
$20.16
|
| Rate for Payer: Riverside University Health System MISP |
$120.00
|
| Rate for Payer: Riverside University Health System MISP |
$96.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$180.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$144.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$180.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$144.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$90.07
|
| Rate for Payer: United Healthcare All Other HMO |
$87.67
|
| Rate for Payer: United Healthcare All Other HMO |
$109.59
|
| Rate for Payer: United Healthcare All Other HMO |
$18.41
|
| Rate for Payer: United Healthcare HMO Rider |
$107.22
|
| Rate for Payer: United Healthcare HMO Rider |
$85.78
|
| Rate for Payer: United Healthcare HMO Rider |
$18.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$78.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$204.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$204.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.00
|
| Rate for Payer: Vantage Medical Group Senior |
$255.00
|
| Rate for Payer: Vantage Medical Group Senior |
$204.00
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
BOSENTAN 125 MG TABLET [31876]
|
Facility
|
OP
|
$17.45
|
|
|
Service Code
|
NDC 68382-447-14
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$15.71 |
| Rate for Payer: Adventist Health Commercial |
$3.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.25
|
| Rate for Payer: Blue Shield of California Commercial |
$10.66
|
| Rate for Payer: Blue Shield of California EPN |
$6.96
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Central Health Plan Commercial |
$13.96
|
| Rate for Payer: Cigna of CA HMO |
$12.21
|
| Rate for Payer: Cigna of CA PPO |
$12.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.98
|
| Rate for Payer: EPIC Health Plan Senior |
$6.98
|
| Rate for Payer: Galaxy Health WC |
$14.83
|
| Rate for Payer: Global Benefits Group Commercial |
$10.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.71
|
| Rate for Payer: InnovAge PACE Commercial |
$8.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.21
|
| Rate for Payer: Multiplan Commercial |
$13.09
|
| Rate for Payer: Networks By Design Commercial |
$11.34
|
| Rate for Payer: Prime Health Services Commercial |
$14.83
|
| Rate for Payer: Riverside University Health System MISP |
$6.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.72
|
| Rate for Payer: United Healthcare All Other HMO |
$8.72
|
| Rate for Payer: United Healthcare HMO Rider |
$8.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.83
|
| Rate for Payer: Vantage Medical Group Senior |
$14.83
|
|
|
BOSENTAN 125 MG TABLET [31876]
|
Facility
|
IP
|
$17.45
|
|
|
Service Code
|
NDC 68382-447-14
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$15.71 |
| Rate for Payer: Adventist Health Commercial |
$3.49
|
| Rate for Payer: Blue Shield of California Commercial |
$13.49
|
| Rate for Payer: Blue Shield of California EPN |
$8.79
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Central Health Plan Commercial |
$13.96
|
| Rate for Payer: Cigna of CA HMO |
$12.21
|
| Rate for Payer: Cigna of CA PPO |
$12.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.98
|
| Rate for Payer: EPIC Health Plan Senior |
$6.98
|
| Rate for Payer: Galaxy Health WC |
$14.83
|
| Rate for Payer: Global Benefits Group Commercial |
$10.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.49
|
| Rate for Payer: Multiplan Commercial |
$13.09
|
| Rate for Payer: Networks By Design Commercial |
$11.34
|
| Rate for Payer: Prime Health Services Commercial |
$14.83
|
|
|
BOSENTAN 31.25 MG 1/2 TABLET [4081538]
|
Facility
|
IP
|
$17.45
|
|
|
Service Code
|
NDC 68382-446-14
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$15.71 |
| Rate for Payer: Adventist Health Commercial |
$3.49
|
| Rate for Payer: Blue Shield of California Commercial |
$13.49
|
| Rate for Payer: Blue Shield of California EPN |
$8.79
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Central Health Plan Commercial |
$13.96
|
| Rate for Payer: Cigna of CA HMO |
$12.21
|
| Rate for Payer: Cigna of CA PPO |
$12.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.98
|
| Rate for Payer: EPIC Health Plan Senior |
$6.98
|
| Rate for Payer: Galaxy Health WC |
$14.83
|
| Rate for Payer: Global Benefits Group Commercial |
$10.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.49
|
| Rate for Payer: Multiplan Commercial |
$13.09
|
| Rate for Payer: Networks By Design Commercial |
$11.34
|
| Rate for Payer: Prime Health Services Commercial |
$14.83
|
|
|
BOSENTAN 31.25 MG 1/2 TABLET [4081538]
|
Facility
|
OP
|
$17.45
|
|
|
Service Code
|
NDC 68382-446-14
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$15.71 |
| Rate for Payer: Adventist Health Commercial |
$3.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.25
|
| Rate for Payer: Blue Shield of California Commercial |
$10.66
|
| Rate for Payer: Blue Shield of California EPN |
$6.96
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Central Health Plan Commercial |
$13.96
|
| Rate for Payer: Cigna of CA HMO |
$12.21
|
| Rate for Payer: Cigna of CA PPO |
$12.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.98
|
| Rate for Payer: EPIC Health Plan Senior |
$6.98
|
| Rate for Payer: Galaxy Health WC |
$14.83
|
| Rate for Payer: Global Benefits Group Commercial |
$10.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.71
|
| Rate for Payer: InnovAge PACE Commercial |
$8.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.21
|
| Rate for Payer: Multiplan Commercial |
$13.09
|
| Rate for Payer: Networks By Design Commercial |
$11.34
|
| Rate for Payer: Prime Health Services Commercial |
$14.83
|
| Rate for Payer: Riverside University Health System MISP |
$6.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.72
|
| Rate for Payer: United Healthcare All Other HMO |
$8.72
|
| Rate for Payer: United Healthcare HMO Rider |
$8.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.83
|
| Rate for Payer: Vantage Medical Group Senior |
$14.83
|
|
|
BOSENTAN 62.5 MG TABLET [31875]
|
Facility
|
OP
|
$17.45
|
|
|
Service Code
|
NDC 68382-446-14
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$15.71 |
| Rate for Payer: Adventist Health Commercial |
$3.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.25
|
| Rate for Payer: Blue Shield of California Commercial |
$10.66
|
| Rate for Payer: Blue Shield of California EPN |
$6.96
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Central Health Plan Commercial |
$13.96
|
| Rate for Payer: Cigna of CA HMO |
$12.21
|
| Rate for Payer: Cigna of CA PPO |
$12.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.98
|
| Rate for Payer: EPIC Health Plan Senior |
$6.98
|
| Rate for Payer: Galaxy Health WC |
$14.83
|
| Rate for Payer: Global Benefits Group Commercial |
$10.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.71
|
| Rate for Payer: InnovAge PACE Commercial |
$8.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.21
|
| Rate for Payer: Multiplan Commercial |
$13.09
|
| Rate for Payer: Networks By Design Commercial |
$11.34
|
| Rate for Payer: Prime Health Services Commercial |
$14.83
|
| Rate for Payer: Riverside University Health System MISP |
$6.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.72
|
| Rate for Payer: United Healthcare All Other HMO |
$8.72
|
| Rate for Payer: United Healthcare HMO Rider |
$8.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.83
|
| Rate for Payer: Vantage Medical Group Senior |
$14.83
|
|
|
BOSENTAN 62.5 MG TABLET [31875]
|
Facility
|
OP
|
$268.28
|
|
|
Service Code
|
NDC 66215-101-06
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$53.66 |
| Max. Negotiated Rate |
$241.45 |
| Rate for Payer: Adventist Health Commercial |
$53.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$162.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$228.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$201.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$129.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.56
|
| Rate for Payer: Blue Shield of California Commercial |
$163.92
|
| Rate for Payer: Blue Shield of California EPN |
$107.04
|
| Rate for Payer: Cash Price |
$147.55
|
| Rate for Payer: Central Health Plan Commercial |
$214.62
|
| Rate for Payer: Cigna of CA HMO |
$187.80
|
| Rate for Payer: Cigna of CA PPO |
$187.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$228.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$228.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$228.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.31
|
| Rate for Payer: EPIC Health Plan Senior |
$107.31
|
| Rate for Payer: Galaxy Health WC |
$228.04
|
| Rate for Payer: Global Benefits Group Commercial |
$160.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$241.45
|
| Rate for Payer: InnovAge PACE Commercial |
$134.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$166.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$187.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$187.80
|
| Rate for Payer: Multiplan Commercial |
$201.21
|
| Rate for Payer: Networks By Design Commercial |
$174.38
|
| Rate for Payer: Prime Health Services Commercial |
$228.04
|
| Rate for Payer: Riverside University Health System MISP |
$107.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$134.14
|
| Rate for Payer: United Healthcare All Other HMO |
$134.14
|
| Rate for Payer: United Healthcare HMO Rider |
$134.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$228.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$228.04
|
| Rate for Payer: Vantage Medical Group Senior |
$228.04
|
|
|
BOSENTAN 62.5 MG TABLET [31875]
|
Facility
|
IP
|
$17.45
|
|
|
Service Code
|
NDC 68382-446-14
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$15.71 |
| Rate for Payer: Adventist Health Commercial |
$3.49
|
| Rate for Payer: Blue Shield of California Commercial |
$13.49
|
| Rate for Payer: Blue Shield of California EPN |
$8.79
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Central Health Plan Commercial |
$13.96
|
| Rate for Payer: Cigna of CA HMO |
$12.21
|
| Rate for Payer: Cigna of CA PPO |
$12.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.98
|
| Rate for Payer: EPIC Health Plan Senior |
$6.98
|
| Rate for Payer: Galaxy Health WC |
$14.83
|
| Rate for Payer: Global Benefits Group Commercial |
$10.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.49
|
| Rate for Payer: Multiplan Commercial |
$13.09
|
| Rate for Payer: Networks By Design Commercial |
$11.34
|
| Rate for Payer: Prime Health Services Commercial |
$14.83
|
|
|
BOSENTAN 62.5 MG TABLET [31875]
|
Facility
|
IP
|
$268.28
|
|
|
Service Code
|
NDC 66215-101-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$53.66 |
| Max. Negotiated Rate |
$241.45 |
| Rate for Payer: Adventist Health Commercial |
$53.66
|
| Rate for Payer: Blue Shield of California Commercial |
$207.38
|
| Rate for Payer: Blue Shield of California EPN |
$135.21
|
| Rate for Payer: Cash Price |
$147.55
|
| Rate for Payer: Central Health Plan Commercial |
$214.62
|
| Rate for Payer: Cigna of CA HMO |
$187.80
|
| Rate for Payer: Cigna of CA PPO |
$187.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.31
|
| Rate for Payer: EPIC Health Plan Senior |
$107.31
|
| Rate for Payer: Galaxy Health WC |
$228.04
|
| Rate for Payer: Global Benefits Group Commercial |
$160.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$241.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$166.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.66
|
| Rate for Payer: Multiplan Commercial |
$201.21
|
| Rate for Payer: Networks By Design Commercial |
$174.38
|
| Rate for Payer: Prime Health Services Commercial |
$228.04
|
|
|
BOSENTAN 62.5 MG TABLET [31875]
|
Facility
|
OP
|
$268.28
|
|
|
Service Code
|
NDC 66215-101-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$53.66 |
| Max. Negotiated Rate |
$241.45 |
| Rate for Payer: Adventist Health Commercial |
$53.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$162.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$228.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$201.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$129.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.56
|
| Rate for Payer: Blue Shield of California Commercial |
$163.92
|
| Rate for Payer: Blue Shield of California EPN |
$107.04
|
| Rate for Payer: Cash Price |
$147.55
|
| Rate for Payer: Central Health Plan Commercial |
$214.62
|
| Rate for Payer: Cigna of CA HMO |
$187.80
|
| Rate for Payer: Cigna of CA PPO |
$187.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$228.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$228.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$228.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.31
|
| Rate for Payer: EPIC Health Plan Senior |
$107.31
|
| Rate for Payer: Galaxy Health WC |
$228.04
|
| Rate for Payer: Global Benefits Group Commercial |
$160.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$241.45
|
| Rate for Payer: InnovAge PACE Commercial |
$134.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$166.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$187.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$187.80
|
| Rate for Payer: Multiplan Commercial |
$201.21
|
| Rate for Payer: Networks By Design Commercial |
$174.38
|
| Rate for Payer: Prime Health Services Commercial |
$228.04
|
| Rate for Payer: Riverside University Health System MISP |
$107.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$134.14
|
| Rate for Payer: United Healthcare All Other HMO |
$134.14
|
| Rate for Payer: United Healthcare HMO Rider |
$134.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$228.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$228.04
|
| Rate for Payer: Vantage Medical Group Senior |
$228.04
|
|
|
BOSENTAN 62.5 MG TABLET [31875]
|
Facility
|
IP
|
$268.28
|
|
|
Service Code
|
NDC 66215-101-06
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$53.66 |
| Max. Negotiated Rate |
$241.45 |
| Rate for Payer: Adventist Health Commercial |
$53.66
|
| Rate for Payer: Blue Shield of California Commercial |
$207.38
|
| Rate for Payer: Blue Shield of California EPN |
$135.21
|
| Rate for Payer: Cash Price |
$147.55
|
| Rate for Payer: Central Health Plan Commercial |
$214.62
|
| Rate for Payer: Cigna of CA HMO |
$187.80
|
| Rate for Payer: Cigna of CA PPO |
$187.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.31
|
| Rate for Payer: EPIC Health Plan Senior |
$107.31
|
| Rate for Payer: Galaxy Health WC |
$228.04
|
| Rate for Payer: Global Benefits Group Commercial |
$160.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$241.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$166.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.66
|
| Rate for Payer: Multiplan Commercial |
$201.21
|
| Rate for Payer: Networks By Design Commercial |
$174.38
|
| Rate for Payer: Prime Health Services Commercial |
$228.04
|
|
|
BOSENTAN CRUSHED TABLET IN WATER [40831875]
|
Facility
|
IP
|
$268.28
|
|
|
Service Code
|
NDC 66215-101-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$53.66 |
| Max. Negotiated Rate |
$241.45 |
| Rate for Payer: Adventist Health Commercial |
$53.66
|
| Rate for Payer: Blue Shield of California Commercial |
$207.38
|
| Rate for Payer: Blue Shield of California EPN |
$135.21
|
| Rate for Payer: Cash Price |
$147.55
|
| Rate for Payer: Central Health Plan Commercial |
$214.62
|
| Rate for Payer: Cigna of CA HMO |
$187.80
|
| Rate for Payer: Cigna of CA PPO |
$187.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.31
|
| Rate for Payer: EPIC Health Plan Senior |
$107.31
|
| Rate for Payer: Galaxy Health WC |
$228.04
|
| Rate for Payer: Global Benefits Group Commercial |
$160.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$241.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$166.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.66
|
| Rate for Payer: Multiplan Commercial |
$201.21
|
| Rate for Payer: Networks By Design Commercial |
$174.38
|
| Rate for Payer: Prime Health Services Commercial |
$228.04
|
|
|
BOSENTAN CRUSHED TABLET IN WATER [40831875]
|
Facility
|
IP
|
$268.28
|
|
|
Service Code
|
NDC 66215-101-06
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$53.66 |
| Max. Negotiated Rate |
$241.45 |
| Rate for Payer: Adventist Health Commercial |
$53.66
|
| Rate for Payer: Blue Shield of California Commercial |
$207.38
|
| Rate for Payer: Blue Shield of California EPN |
$135.21
|
| Rate for Payer: Cash Price |
$147.55
|
| Rate for Payer: Central Health Plan Commercial |
$214.62
|
| Rate for Payer: Cigna of CA HMO |
$187.80
|
| Rate for Payer: Cigna of CA PPO |
$187.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.31
|
| Rate for Payer: EPIC Health Plan Senior |
$107.31
|
| Rate for Payer: Galaxy Health WC |
$228.04
|
| Rate for Payer: Global Benefits Group Commercial |
$160.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$241.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$166.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.66
|
| Rate for Payer: Multiplan Commercial |
$201.21
|
| Rate for Payer: Networks By Design Commercial |
$174.38
|
| Rate for Payer: Prime Health Services Commercial |
$228.04
|
|
|
BOSENTAN CRUSHED TABLET IN WATER [40831875]
|
Facility
|
OP
|
$268.28
|
|
|
Service Code
|
NDC 66215-101-06
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$53.66 |
| Max. Negotiated Rate |
$241.45 |
| Rate for Payer: Adventist Health Commercial |
$53.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$162.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$228.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$201.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$129.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.56
|
| Rate for Payer: Blue Shield of California Commercial |
$163.92
|
| Rate for Payer: Blue Shield of California EPN |
$107.04
|
| Rate for Payer: Cash Price |
$147.55
|
| Rate for Payer: Central Health Plan Commercial |
$214.62
|
| Rate for Payer: Cigna of CA HMO |
$187.80
|
| Rate for Payer: Cigna of CA PPO |
$187.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$228.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$228.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$228.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.31
|
| Rate for Payer: EPIC Health Plan Senior |
$107.31
|
| Rate for Payer: Galaxy Health WC |
$228.04
|
| Rate for Payer: Global Benefits Group Commercial |
$160.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$241.45
|
| Rate for Payer: InnovAge PACE Commercial |
$134.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$166.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$187.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$187.80
|
| Rate for Payer: Multiplan Commercial |
$201.21
|
| Rate for Payer: Networks By Design Commercial |
$174.38
|
| Rate for Payer: Prime Health Services Commercial |
$228.04
|
| Rate for Payer: Riverside University Health System MISP |
$107.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$134.14
|
| Rate for Payer: United Healthcare All Other HMO |
$134.14
|
| Rate for Payer: United Healthcare HMO Rider |
$134.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$228.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$228.04
|
| Rate for Payer: Vantage Medical Group Senior |
$228.04
|
|
|
BOSENTAN CRUSHED TABLET IN WATER [40831875]
|
Facility
|
OP
|
$268.28
|
|
|
Service Code
|
NDC 66215-101-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$53.66 |
| Max. Negotiated Rate |
$241.45 |
| Rate for Payer: Adventist Health Commercial |
$53.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$162.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$228.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$201.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$129.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.56
|
| Rate for Payer: Blue Shield of California Commercial |
$163.92
|
| Rate for Payer: Blue Shield of California EPN |
$107.04
|
| Rate for Payer: Cash Price |
$147.55
|
| Rate for Payer: Central Health Plan Commercial |
$214.62
|
| Rate for Payer: Cigna of CA HMO |
$187.80
|
| Rate for Payer: Cigna of CA PPO |
$187.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$228.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$228.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$228.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.31
|
| Rate for Payer: EPIC Health Plan Senior |
$107.31
|
| Rate for Payer: Galaxy Health WC |
$228.04
|
| Rate for Payer: Global Benefits Group Commercial |
$160.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$241.45
|
| Rate for Payer: InnovAge PACE Commercial |
$134.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$166.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$187.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$187.80
|
| Rate for Payer: Multiplan Commercial |
$201.21
|
| Rate for Payer: Networks By Design Commercial |
$174.38
|
| Rate for Payer: Prime Health Services Commercial |
$228.04
|
| Rate for Payer: Riverside University Health System MISP |
$107.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$134.14
|
| Rate for Payer: United Healthcare All Other HMO |
$134.14
|
| Rate for Payer: United Healthcare HMO Rider |
$134.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$228.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$228.04
|
| Rate for Payer: Vantage Medical Group Senior |
$228.04
|
|
|
BOSENTAN ORAL SUSPENSION COMPOUND 6.25MG/ML [40831876]
|
Facility
|
IP
|
$16.44
|
|
|
Service Code
|
NDC 9940-8318-76
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.29 |
| Max. Negotiated Rate |
$14.80 |
| Rate for Payer: Adventist Health Commercial |
$3.29
|
| Rate for Payer: Blue Shield of California Commercial |
$12.71
|
| Rate for Payer: Blue Shield of California EPN |
$8.29
|
| Rate for Payer: Cash Price |
$9.04
|
| Rate for Payer: Central Health Plan Commercial |
$13.15
|
| Rate for Payer: Cigna of CA HMO |
$11.51
|
| Rate for Payer: Cigna of CA PPO |
$11.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.58
|
| Rate for Payer: EPIC Health Plan Senior |
$6.58
|
| Rate for Payer: Galaxy Health WC |
$13.97
|
| Rate for Payer: Global Benefits Group Commercial |
$9.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.29
|
| Rate for Payer: Multiplan Commercial |
$12.33
|
| Rate for Payer: Networks By Design Commercial |
$10.69
|
| Rate for Payer: Prime Health Services Commercial |
$13.97
|
|
|
BOSENTAN ORAL SUSPENSION COMPOUND 6.25MG/ML [40831876]
|
Facility
|
OP
|
$16.44
|
|
|
Service Code
|
NDC 9940-8318-76
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.29 |
| Max. Negotiated Rate |
$14.80 |
| Rate for Payer: Adventist Health Commercial |
$3.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.66
|
| Rate for Payer: Blue Shield of California Commercial |
$10.04
|
| Rate for Payer: Blue Shield of California EPN |
$6.56
|
| Rate for Payer: Cash Price |
$9.04
|
| Rate for Payer: Central Health Plan Commercial |
$13.15
|
| Rate for Payer: Cigna of CA HMO |
$11.51
|
| Rate for Payer: Cigna of CA PPO |
$11.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.58
|
| Rate for Payer: EPIC Health Plan Senior |
$6.58
|
| Rate for Payer: Galaxy Health WC |
$13.97
|
| Rate for Payer: Global Benefits Group Commercial |
$9.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.80
|
| Rate for Payer: InnovAge PACE Commercial |
$8.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.51
|
| Rate for Payer: Multiplan Commercial |
$12.33
|
| Rate for Payer: Networks By Design Commercial |
$10.69
|
| Rate for Payer: Prime Health Services Commercial |
$13.97
|
| Rate for Payer: Riverside University Health System MISP |
$6.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.22
|
| Rate for Payer: United Healthcare All Other HMO |
$8.22
|
| Rate for Payer: United Healthcare HMO Rider |
$8.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.97
|
| Rate for Payer: Vantage Medical Group Senior |
$13.97
|
|
|
BOSUTINIB 100 MG TABLET [197246]
|
Facility
|
IP
|
$214.96
|
|
|
Service Code
|
NDC 0069-0135-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$42.99 |
| Max. Negotiated Rate |
$193.46 |
| Rate for Payer: Adventist Health Commercial |
$42.99
|
| Rate for Payer: Blue Shield of California Commercial |
$166.16
|
| Rate for Payer: Blue Shield of California EPN |
$108.34
|
| Rate for Payer: Cash Price |
$118.23
|
| Rate for Payer: Central Health Plan Commercial |
$171.97
|
| Rate for Payer: Cigna of CA HMO |
$150.47
|
| Rate for Payer: Cigna of CA PPO |
$150.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.98
|
| Rate for Payer: EPIC Health Plan Senior |
$85.98
|
| Rate for Payer: Galaxy Health WC |
$182.72
|
| Rate for Payer: Global Benefits Group Commercial |
$128.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$193.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$143.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.99
|
| Rate for Payer: Multiplan Commercial |
$161.22
|
| Rate for Payer: Networks By Design Commercial |
$139.72
|
| Rate for Payer: Prime Health Services Commercial |
$182.72
|
|
|
BOSUTINIB 100 MG TABLET [197246]
|
Facility
|
OP
|
$214.96
|
|
|
Service Code
|
NDC 0069-0135-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$42.99 |
| Max. Negotiated Rate |
$193.46 |
| Rate for Payer: Adventist Health Commercial |
$42.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$130.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$182.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$118.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$161.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$104.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$126.25
|
| Rate for Payer: Blue Shield of California Commercial |
$131.34
|
| Rate for Payer: Blue Shield of California EPN |
$85.77
|
| Rate for Payer: Cash Price |
$118.23
|
| Rate for Payer: Central Health Plan Commercial |
$171.97
|
| Rate for Payer: Cigna of CA HMO |
$150.47
|
| Rate for Payer: Cigna of CA PPO |
$150.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$182.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$182.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.98
|
| Rate for Payer: EPIC Health Plan Senior |
$85.98
|
| Rate for Payer: Galaxy Health WC |
$182.72
|
| Rate for Payer: Global Benefits Group Commercial |
$128.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$193.46
|
| Rate for Payer: InnovAge PACE Commercial |
$107.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$143.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$150.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$150.47
|
| Rate for Payer: Multiplan Commercial |
$161.22
|
| Rate for Payer: Networks By Design Commercial |
$139.72
|
| Rate for Payer: Prime Health Services Commercial |
$182.72
|
| Rate for Payer: Riverside University Health System MISP |
$85.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$128.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$128.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$107.48
|
| Rate for Payer: United Healthcare All Other HMO |
$107.48
|
| Rate for Payer: United Healthcare HMO Rider |
$107.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$107.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$182.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.72
|
| Rate for Payer: Vantage Medical Group Senior |
$182.72
|
|
|
BOSUTINIB 400 MG TABLET [220449]
|
Facility
|
IP
|
$859.83
|
|
|
Service Code
|
NDC 0069-0193-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$171.97 |
| Max. Negotiated Rate |
$773.85 |
| Rate for Payer: Adventist Health Commercial |
$171.97
|
| Rate for Payer: Blue Shield of California Commercial |
$664.65
|
| Rate for Payer: Blue Shield of California EPN |
$433.35
|
| Rate for Payer: Cash Price |
$472.91
|
| Rate for Payer: Central Health Plan Commercial |
$687.86
|
| Rate for Payer: Cigna of CA HMO |
$601.88
|
| Rate for Payer: Cigna of CA PPO |
$601.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.93
|
| Rate for Payer: EPIC Health Plan Senior |
$343.93
|
| Rate for Payer: Galaxy Health WC |
$730.86
|
| Rate for Payer: Global Benefits Group Commercial |
$515.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$773.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$573.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$327.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$532.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.97
|
| Rate for Payer: Multiplan Commercial |
$644.87
|
| Rate for Payer: Networks By Design Commercial |
$558.89
|
| Rate for Payer: Prime Health Services Commercial |
$730.86
|
|
|
BOSUTINIB 400 MG TABLET [220449]
|
Facility
|
OP
|
$859.83
|
|
|
Service Code
|
NDC 0069-0193-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$171.97 |
| Max. Negotiated Rate |
$773.85 |
| Rate for Payer: Adventist Health Commercial |
$171.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$522.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$730.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$472.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$644.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$416.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$504.98
|
| Rate for Payer: Blue Shield of California Commercial |
$525.36
|
| Rate for Payer: Blue Shield of California EPN |
$343.07
|
| Rate for Payer: Cash Price |
$472.91
|
| Rate for Payer: Central Health Plan Commercial |
$687.86
|
| Rate for Payer: Cigna of CA HMO |
$601.88
|
| Rate for Payer: Cigna of CA PPO |
$601.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$730.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$730.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$730.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.93
|
| Rate for Payer: EPIC Health Plan Senior |
$343.93
|
| Rate for Payer: Galaxy Health WC |
$730.86
|
| Rate for Payer: Global Benefits Group Commercial |
$515.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$773.85
|
| Rate for Payer: InnovAge PACE Commercial |
$429.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$573.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$327.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$532.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$601.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$601.88
|
| Rate for Payer: Multiplan Commercial |
$644.87
|
| Rate for Payer: Networks By Design Commercial |
$558.89
|
| Rate for Payer: Prime Health Services Commercial |
$730.86
|
| Rate for Payer: Riverside University Health System MISP |
$343.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$515.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$515.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$429.92
|
| Rate for Payer: United Healthcare All Other HMO |
$429.92
|
| Rate for Payer: United Healthcare HMO Rider |
$429.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$429.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$730.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$730.86
|
| Rate for Payer: Vantage Medical Group Senior |
$730.86
|
|
|
BOSUTINIB 500 MG TABLET [197247]
|
Facility
|
IP
|
$859.83
|
|
|
Service Code
|
NDC 0069-0136-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$171.97 |
| Max. Negotiated Rate |
$773.85 |
| Rate for Payer: Adventist Health Commercial |
$171.97
|
| Rate for Payer: Blue Shield of California Commercial |
$664.65
|
| Rate for Payer: Blue Shield of California EPN |
$433.35
|
| Rate for Payer: Cash Price |
$472.91
|
| Rate for Payer: Central Health Plan Commercial |
$687.86
|
| Rate for Payer: Cigna of CA HMO |
$601.88
|
| Rate for Payer: Cigna of CA PPO |
$601.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.93
|
| Rate for Payer: EPIC Health Plan Senior |
$343.93
|
| Rate for Payer: Galaxy Health WC |
$730.86
|
| Rate for Payer: Global Benefits Group Commercial |
$515.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$773.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$573.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$327.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$532.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.97
|
| Rate for Payer: Multiplan Commercial |
$644.87
|
| Rate for Payer: Networks By Design Commercial |
$558.89
|
| Rate for Payer: Prime Health Services Commercial |
$730.86
|
|
|
BOSUTINIB 500 MG TABLET [197247]
|
Facility
|
OP
|
$859.83
|
|
|
Service Code
|
NDC 0069-0136-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$171.97 |
| Max. Negotiated Rate |
$773.85 |
| Rate for Payer: Adventist Health Commercial |
$171.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$522.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$730.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$472.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$644.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$416.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$504.98
|
| Rate for Payer: Blue Shield of California Commercial |
$525.36
|
| Rate for Payer: Blue Shield of California EPN |
$343.07
|
| Rate for Payer: Cash Price |
$472.91
|
| Rate for Payer: Central Health Plan Commercial |
$687.86
|
| Rate for Payer: Cigna of CA HMO |
$601.88
|
| Rate for Payer: Cigna of CA PPO |
$601.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$730.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$730.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$730.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.93
|
| Rate for Payer: EPIC Health Plan Senior |
$343.93
|
| Rate for Payer: Galaxy Health WC |
$730.86
|
| Rate for Payer: Global Benefits Group Commercial |
$515.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$773.85
|
| Rate for Payer: InnovAge PACE Commercial |
$429.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$573.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$327.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$532.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$601.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$601.88
|
| Rate for Payer: Multiplan Commercial |
$644.87
|
| Rate for Payer: Networks By Design Commercial |
$558.89
|
| Rate for Payer: Prime Health Services Commercial |
$730.86
|
| Rate for Payer: Riverside University Health System MISP |
$343.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$515.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$515.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$429.92
|
| Rate for Payer: United Healthcare All Other HMO |
$429.92
|
| Rate for Payer: United Healthcare HMO Rider |
$429.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$429.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$730.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$730.86
|
| Rate for Payer: Vantage Medical Group Senior |
$730.86
|
|
