|
IMETELSTAT 47 MG INTRAVENOUS SOLUTION [241930]
|
Facility
|
IP
|
$3,193.14
|
|
|
Service Code
|
HCPCS J0870
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$638.63 |
| Max. Negotiated Rate |
$2,873.83 |
| Rate for Payer: Adventist Health Commercial |
$638.63
|
| Rate for Payer: Blue Shield of California Commercial |
$2,560.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,609.34
|
| Rate for Payer: Cash Price |
$1,436.91
|
| Rate for Payer: Central Health Plan Commercial |
$2,554.51
|
| Rate for Payer: Cigna of CA HMO |
$2,235.20
|
| Rate for Payer: Cigna of CA PPO |
$2,235.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,235.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,277.26
|
| Rate for Payer: EPIC Health Plan Senior |
$1,277.26
|
| Rate for Payer: Galaxy Health WC |
$2,714.17
|
| Rate for Payer: Global Benefits Group Commercial |
$1,915.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,873.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,027.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,883.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$638.63
|
| Rate for Payer: Multiplan Commercial |
$2,394.86
|
| Rate for Payer: Networks By Design Commercial |
$1,596.57
|
| Rate for Payer: Prime Health Services Commercial |
$2,714.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,198.39
|
| Rate for Payer: United Healthcare All Other HMO |
$1,166.45
|
| Rate for Payer: United Healthcare HMO Rider |
$1,141.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,045.75
|
|
|
IMIGLUCERASE 400 UNIT INTRAVENOUS SOLUTION [26431]
|
Facility
|
IP
|
$2,101.76
|
|
|
Service Code
|
HCPCS J1786
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$420.35 |
| Max. Negotiated Rate |
$1,891.58 |
| Rate for Payer: Adventist Health Commercial |
$420.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1,685.61
|
| Rate for Payer: Blue Shield of California EPN |
$1,059.29
|
| Rate for Payer: Cash Price |
$945.79
|
| Rate for Payer: Central Health Plan Commercial |
$1,681.41
|
| Rate for Payer: Cigna of CA HMO |
$1,471.23
|
| Rate for Payer: Cigna of CA PPO |
$1,471.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,471.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$840.70
|
| Rate for Payer: EPIC Health Plan Senior |
$840.70
|
| Rate for Payer: Galaxy Health WC |
$1,786.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,261.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,891.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,334.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,240.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$420.35
|
| Rate for Payer: Multiplan Commercial |
$1,576.32
|
| Rate for Payer: Networks By Design Commercial |
$1,050.88
|
| Rate for Payer: Prime Health Services Commercial |
$1,786.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$788.79
|
| Rate for Payer: United Healthcare All Other HMO |
$767.77
|
| Rate for Payer: United Healthcare HMO Rider |
$751.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$688.33
|
|
|
IMIGLUCERASE 400 UNIT INTRAVENOUS SOLUTION [26431]
|
Facility
|
OP
|
$2,101.76
|
|
|
Service Code
|
HCPCS J1786
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.33 |
| Max. Negotiated Rate |
$1,891.58 |
| Rate for Payer: Adventist Health Commercial |
$420.35
|
| Rate for Payer: Adventist Health Medi-Cal |
$43.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$267.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$78.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.97
|
| Rate for Payer: Blue Shield of California Commercial |
$56.66
|
| Rate for Payer: Blue Shield of California EPN |
$51.51
|
| Rate for Payer: Cash Price |
$945.79
|
| Rate for Payer: Cash Price |
$945.79
|
| Rate for Payer: Central Health Plan Commercial |
$1,681.41
|
| Rate for Payer: Cigna of CA HMO |
$1,471.23
|
| Rate for Payer: Cigna of CA PPO |
$1,471.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$47.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,471.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.49
|
| Rate for Payer: EPIC Health Plan Senior |
$47.66
|
| Rate for Payer: Galaxy Health WC |
$1,786.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,261.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,891.58
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$71.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$43.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$43.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,334.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$60.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$420.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$58.06
|
| Rate for Payer: Multiplan Commercial |
$1,576.32
|
| Rate for Payer: Networks By Design Commercial |
$1,050.88
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$43.33
|
| Rate for Payer: Prime Health Services Commercial |
$1,786.50
|
| Rate for Payer: Prime Health Services Medicare |
$45.93
|
| Rate for Payer: Riverside University Health System MISP |
$47.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,261.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,261.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$788.79
|
| Rate for Payer: United Healthcare All Other HMO |
$767.77
|
| Rate for Payer: United Healthcare HMO Rider |
$751.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$688.33
|
| Rate for Payer: Upland Medical Group Pediatric |
$43.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$54.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.66
|
| Rate for Payer: Vantage Medical Group Senior |
$47.66
|
|
|
IMIPENEM-CILASTATIN 250 MG INTRAVENOUS SOLUTION [9602]
|
Facility
|
IP
|
$20.51
|
|
|
Service Code
|
HCPCS J0743
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.10 |
| Max. Negotiated Rate |
$18.46 |
| Rate for Payer: Adventist Health Commercial |
$4.10
|
| Rate for Payer: Blue Shield of California Commercial |
$16.45
|
| Rate for Payer: Blue Shield of California EPN |
$10.34
|
| Rate for Payer: Cash Price |
$9.23
|
| Rate for Payer: Central Health Plan Commercial |
$16.41
|
| Rate for Payer: Cigna of CA HMO |
$14.36
|
| Rate for Payer: Cigna of CA PPO |
$14.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.20
|
| Rate for Payer: EPIC Health Plan Senior |
$8.20
|
| Rate for Payer: Galaxy Health WC |
$17.43
|
| Rate for Payer: Global Benefits Group Commercial |
$12.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.10
|
| Rate for Payer: Multiplan Commercial |
$15.38
|
| Rate for Payer: Networks By Design Commercial |
$10.26
|
| Rate for Payer: Prime Health Services Commercial |
$17.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.70
|
| Rate for Payer: United Healthcare All Other HMO |
$7.49
|
| Rate for Payer: United Healthcare HMO Rider |
$7.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.72
|
|
|
IMIPENEM-CILASTATIN 250 MG INTRAVENOUS SOLUTION [9602]
|
Facility
|
OP
|
$20.51
|
|
|
Service Code
|
HCPCS J0743
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.10 |
| Max. Negotiated Rate |
$45.47 |
| Rate for Payer: Adventist Health Commercial |
$4.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.06
|
| Rate for Payer: Blue Shield of California Commercial |
$14.13
|
| Rate for Payer: Blue Shield of California EPN |
$12.85
|
| Rate for Payer: Cash Price |
$9.23
|
| Rate for Payer: Cash Price |
$9.23
|
| Rate for Payer: Central Health Plan Commercial |
$16.41
|
| Rate for Payer: Cigna of CA HMO |
$14.36
|
| Rate for Payer: Cigna of CA PPO |
$14.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.20
|
| Rate for Payer: EPIC Health Plan Senior |
$8.20
|
| Rate for Payer: Galaxy Health WC |
$17.43
|
| Rate for Payer: Global Benefits Group Commercial |
$12.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.36
|
| Rate for Payer: Multiplan Commercial |
$15.38
|
| Rate for Payer: Networks By Design Commercial |
$10.26
|
| Rate for Payer: Prime Health Services Commercial |
$17.43
|
| Rate for Payer: Riverside University Health System MISP |
$8.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.70
|
| Rate for Payer: United Healthcare All Other HMO |
$7.49
|
| Rate for Payer: United Healthcare HMO Rider |
$7.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.43
|
| Rate for Payer: Vantage Medical Group Senior |
$17.43
|
|
|
IMIPENEM-CILASTATIN 500 MG INTRAVENOUS SOLUTION [9603]
|
Facility
|
IP
|
$35.98
|
|
|
Service Code
|
HCPCS J0743
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$32.38 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Adventist Health Commercial |
$6.56
|
| Rate for Payer: Blue Shield of California Commercial |
$28.86
|
| Rate for Payer: Blue Shield of California Commercial |
$26.32
|
| Rate for Payer: Blue Shield of California EPN |
$16.54
|
| Rate for Payer: Blue Shield of California EPN |
$18.13
|
| Rate for Payer: Cash Price |
$16.19
|
| Rate for Payer: Cash Price |
$14.77
|
| Rate for Payer: Central Health Plan Commercial |
$28.78
|
| Rate for Payer: Central Health Plan Commercial |
$26.26
|
| Rate for Payer: Cigna of CA HMO |
$22.97
|
| Rate for Payer: Cigna of CA HMO |
$25.19
|
| Rate for Payer: Cigna of CA PPO |
$22.97
|
| Rate for Payer: Cigna of CA PPO |
$25.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.39
|
| Rate for Payer: EPIC Health Plan Senior |
$13.13
|
| Rate for Payer: EPIC Health Plan Senior |
$14.39
|
| Rate for Payer: Galaxy Health WC |
$30.58
|
| Rate for Payer: Galaxy Health WC |
$27.90
|
| Rate for Payer: Global Benefits Group Commercial |
$19.69
|
| Rate for Payer: Global Benefits Group Commercial |
$21.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.56
|
| Rate for Payer: Multiplan Commercial |
$24.61
|
| Rate for Payer: Multiplan Commercial |
$26.98
|
| Rate for Payer: Networks By Design Commercial |
$16.41
|
| Rate for Payer: Networks By Design Commercial |
$17.99
|
| Rate for Payer: Prime Health Services Commercial |
$30.58
|
| Rate for Payer: Prime Health Services Commercial |
$27.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.50
|
| Rate for Payer: United Healthcare All Other HMO |
$13.14
|
| Rate for Payer: United Healthcare All Other HMO |
$11.99
|
| Rate for Payer: United Healthcare HMO Rider |
$11.73
|
| Rate for Payer: United Healthcare HMO Rider |
$12.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.78
|
|
|
IMIPENEM-CILASTATIN 500 MG INTRAVENOUS SOLUTION [9603]
|
Facility
|
OP
|
$32.82
|
|
|
Service Code
|
HCPCS J0743
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$45.47 |
| Rate for Payer: Adventist Health Commercial |
$6.56
|
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.06
|
| Rate for Payer: Blue Shield of California Commercial |
$14.13
|
| Rate for Payer: Blue Shield of California Commercial |
$14.13
|
| Rate for Payer: Blue Shield of California EPN |
$12.85
|
| Rate for Payer: Blue Shield of California EPN |
$12.85
|
| Rate for Payer: Cash Price |
$14.77
|
| Rate for Payer: Cash Price |
$16.19
|
| Rate for Payer: Cash Price |
$14.77
|
| Rate for Payer: Cash Price |
$16.19
|
| Rate for Payer: Central Health Plan Commercial |
$28.78
|
| Rate for Payer: Central Health Plan Commercial |
$26.26
|
| Rate for Payer: Cigna of CA HMO |
$22.97
|
| Rate for Payer: Cigna of CA HMO |
$25.19
|
| Rate for Payer: Cigna of CA PPO |
$22.97
|
| Rate for Payer: Cigna of CA PPO |
$25.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.13
|
| Rate for Payer: EPIC Health Plan Senior |
$14.39
|
| Rate for Payer: EPIC Health Plan Senior |
$13.13
|
| Rate for Payer: Galaxy Health WC |
$27.90
|
| Rate for Payer: Galaxy Health WC |
$30.58
|
| Rate for Payer: Global Benefits Group Commercial |
$21.59
|
| Rate for Payer: Global Benefits Group Commercial |
$19.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.97
|
| Rate for Payer: Multiplan Commercial |
$26.98
|
| Rate for Payer: Multiplan Commercial |
$24.61
|
| Rate for Payer: Networks By Design Commercial |
$17.99
|
| Rate for Payer: Networks By Design Commercial |
$16.41
|
| Rate for Payer: Prime Health Services Commercial |
$30.58
|
| Rate for Payer: Prime Health Services Commercial |
$27.90
|
| Rate for Payer: Riverside University Health System MISP |
$13.13
|
| Rate for Payer: Riverside University Health System MISP |
$14.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.50
|
| Rate for Payer: United Healthcare All Other HMO |
$13.14
|
| Rate for Payer: United Healthcare All Other HMO |
$11.99
|
| Rate for Payer: United Healthcare HMO Rider |
$12.86
|
| Rate for Payer: United Healthcare HMO Rider |
$11.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.58
|
| Rate for Payer: Vantage Medical Group Senior |
$30.58
|
| Rate for Payer: Vantage Medical Group Senior |
$27.90
|
|
|
IMIPRAMINE 10 MG TABLET [3860]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 6931513301
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Central Health Plan Commercial |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
|
|
IMIPRAMINE 10 MG TABLET [3860]
|
Facility
|
OP
|
$0.07
|
|
|
Service Code
|
NDC 6958442510
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$0.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.06
|
| Rate for Payer: Riverside University Health System MISP |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Vantage Medical Group Senior |
$0.06
|
|
|
IMIPRAMINE 10 MG TABLET [3860]
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
NDC 6958442510
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$0.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.06
|
|
|
IMIPRAMINE 10 MG TABLET [3860]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 6931513301
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Central Health Plan Commercial |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
| Rate for Payer: Riverside University Health System MISP |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
|
|
IMIPRAMINE 25 MG TABLET [3861]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 6958442610
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
|
|
IMIPRAMINE 25 MG TABLET [3861]
|
Facility
|
IP
|
$0.29
|
|
|
Service Code
|
NDC 6931513401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Central Health Plan Commercial |
$0.23
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.25
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.19
|
| Rate for Payer: Prime Health Services Commercial |
$0.25
|
|
|
IMIPRAMINE 25 MG TABLET [3861]
|
Facility
|
OP
|
$0.29
|
|
|
Service Code
|
NDC 6931513401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Central Health Plan Commercial |
$0.23
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.25
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.19
|
| Rate for Payer: Prime Health Services Commercial |
$0.25
|
| Rate for Payer: Riverside University Health System MISP |
$0.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.15
|
| Rate for Payer: United Healthcare All Other HMO |
$0.15
|
| Rate for Payer: United Healthcare HMO Rider |
$0.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: Vantage Medical Group Senior |
$0.25
|
|
|
IMIPRAMINE 25 MG TABLET [3861]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 6958442610
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
| Rate for Payer: Riverside University Health System MISP |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
IMIQUIMOD 5 % TOPICAL CREAM PACKET [20718]
|
Facility
|
OP
|
$2.50
|
|
|
Service Code
|
NDC 4580236800
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Adventist Health Commercial |
$0.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.45
|
| Rate for Payer: Blue Shield of California Commercial |
$1.58
|
| Rate for Payer: Blue Shield of California EPN |
$1.00
|
| Rate for Payer: Cash Price |
$1.12
|
| Rate for Payer: Central Health Plan Commercial |
$2.00
|
| Rate for Payer: Cigna of CA HMO |
$1.75
|
| Rate for Payer: Cigna of CA PPO |
$1.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1.00
|
| Rate for Payer: Galaxy Health WC |
$2.12
|
| Rate for Payer: Global Benefits Group Commercial |
$1.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.75
|
| Rate for Payer: Multiplan Commercial |
$1.88
|
| Rate for Payer: Networks By Design Commercial |
$1.62
|
| Rate for Payer: Prime Health Services Commercial |
$2.12
|
| Rate for Payer: Riverside University Health System MISP |
$1.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.25
|
| Rate for Payer: United Healthcare All Other HMO |
$1.25
|
| Rate for Payer: United Healthcare HMO Rider |
$1.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2.12
|
|
|
IMIQUIMOD 5 % TOPICAL CREAM PACKET [20718]
|
Facility
|
IP
|
$2.50
|
|
|
Service Code
|
NDC 4580236800
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Adventist Health Commercial |
$0.50
|
| Rate for Payer: Blue Shield of California Commercial |
$2.00
|
| Rate for Payer: Blue Shield of California EPN |
$1.26
|
| Rate for Payer: Cash Price |
$1.12
|
| Rate for Payer: Central Health Plan Commercial |
$2.00
|
| Rate for Payer: Cigna of CA HMO |
$1.75
|
| Rate for Payer: Cigna of CA PPO |
$1.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1.00
|
| Rate for Payer: Galaxy Health WC |
$2.12
|
| Rate for Payer: Global Benefits Group Commercial |
$1.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$1.88
|
| Rate for Payer: Networks By Design Commercial |
$1.62
|
| Rate for Payer: Prime Health Services Commercial |
$2.12
|
|
|
IMIQUIMOD 5 % TOPICAL CREAM PACKET [20718]
|
Facility
|
IP
|
$2.50
|
|
|
Service Code
|
NDC 4580236862
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Adventist Health Commercial |
$0.50
|
| Rate for Payer: Blue Shield of California Commercial |
$2.00
|
| Rate for Payer: Blue Shield of California EPN |
$1.26
|
| Rate for Payer: Cash Price |
$1.12
|
| Rate for Payer: Central Health Plan Commercial |
$2.00
|
| Rate for Payer: Cigna of CA HMO |
$1.75
|
| Rate for Payer: Cigna of CA PPO |
$1.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1.00
|
| Rate for Payer: Galaxy Health WC |
$2.12
|
| Rate for Payer: Global Benefits Group Commercial |
$1.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$1.88
|
| Rate for Payer: Networks By Design Commercial |
$1.62
|
| Rate for Payer: Prime Health Services Commercial |
$2.12
|
|
|
IMIQUIMOD 5 % TOPICAL CREAM PACKET [20718]
|
Facility
|
OP
|
$2.50
|
|
|
Service Code
|
NDC 4580236862
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Adventist Health Commercial |
$0.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.45
|
| Rate for Payer: Blue Shield of California Commercial |
$1.58
|
| Rate for Payer: Blue Shield of California EPN |
$1.00
|
| Rate for Payer: Cash Price |
$1.12
|
| Rate for Payer: Central Health Plan Commercial |
$2.00
|
| Rate for Payer: Cigna of CA HMO |
$1.75
|
| Rate for Payer: Cigna of CA PPO |
$1.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1.00
|
| Rate for Payer: Galaxy Health WC |
$2.12
|
| Rate for Payer: Global Benefits Group Commercial |
$1.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.75
|
| Rate for Payer: Multiplan Commercial |
$1.88
|
| Rate for Payer: Networks By Design Commercial |
$1.62
|
| Rate for Payer: Prime Health Services Commercial |
$2.12
|
| Rate for Payer: Riverside University Health System MISP |
$1.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.25
|
| Rate for Payer: United Healthcare All Other HMO |
$1.25
|
| Rate for Payer: United Healthcare HMO Rider |
$1.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2.12
|
|
|
IMMUNE GLOB G 1 GRAM/5 ML(20 %)-PROL-IGA 0-50 MCG/ML SUBCUTANEOUS SOLN [108090]
|
Facility
|
OP
|
$61.07
|
|
|
Service Code
|
HCPCS J1559
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.21 |
| Max. Negotiated Rate |
$84.55 |
| Rate for Payer: Adventist Health Commercial |
$12.21
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$84.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.05
|
| Rate for Payer: Blue Shield of California Commercial |
$30.02
|
| Rate for Payer: Blue Shield of California EPN |
$27.29
|
| Rate for Payer: Cash Price |
$27.48
|
| Rate for Payer: Cash Price |
$27.48
|
| Rate for Payer: Central Health Plan Commercial |
$48.86
|
| Rate for Payer: Cigna of CA HMO |
$42.75
|
| Rate for Payer: Cigna of CA PPO |
$42.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.55
|
| Rate for Payer: EPIC Health Plan Senior |
$16.37
|
| Rate for Payer: Galaxy Health WC |
$51.91
|
| Rate for Payer: Global Benefits Group Commercial |
$36.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.96
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.94
|
| Rate for Payer: Multiplan Commercial |
$45.80
|
| Rate for Payer: Networks By Design Commercial |
$30.54
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.88
|
| Rate for Payer: Prime Health Services Commercial |
$51.91
|
| Rate for Payer: Prime Health Services Medicare |
$15.77
|
| Rate for Payer: Riverside University Health System MISP |
$16.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.92
|
| Rate for Payer: United Healthcare All Other HMO |
$22.31
|
| Rate for Payer: United Healthcare HMO Rider |
$21.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.37
|
| Rate for Payer: Vantage Medical Group Senior |
$16.37
|
|
|
IMMUNE GLOB G 1 GRAM/5 ML(20 %)-PROL-IGA 0-50 MCG/ML SUBCUTANEOUS SOLN [108090]
|
Facility
|
IP
|
$61.07
|
|
|
Service Code
|
HCPCS J1559
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.21 |
| Max. Negotiated Rate |
$54.96 |
| Rate for Payer: Adventist Health Commercial |
$12.21
|
| Rate for Payer: Blue Shield of California Commercial |
$48.98
|
| Rate for Payer: Blue Shield of California EPN |
$30.78
|
| Rate for Payer: Cash Price |
$27.48
|
| Rate for Payer: Central Health Plan Commercial |
$48.86
|
| Rate for Payer: Cigna of CA HMO |
$42.75
|
| Rate for Payer: Cigna of CA PPO |
$42.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.43
|
| Rate for Payer: EPIC Health Plan Senior |
$24.43
|
| Rate for Payer: Galaxy Health WC |
$51.91
|
| Rate for Payer: Global Benefits Group Commercial |
$36.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.21
|
| Rate for Payer: Multiplan Commercial |
$45.80
|
| Rate for Payer: Networks By Design Commercial |
$30.54
|
| Rate for Payer: Prime Health Services Commercial |
$51.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.92
|
| Rate for Payer: United Healthcare All Other HMO |
$22.31
|
| Rate for Payer: United Healthcare HMO Rider |
$21.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.00
|
|
|
IMMUNE GLOB G 20 GRAM/200 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN [107754]
|
Facility
|
IP
|
$18.38
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$16.54 |
| Rate for Payer: Adventist Health Commercial |
$3.68
|
| Rate for Payer: Blue Shield of California Commercial |
$14.74
|
| Rate for Payer: Blue Shield of California EPN |
$9.26
|
| Rate for Payer: Cash Price |
$8.27
|
| Rate for Payer: Central Health Plan Commercial |
$14.70
|
| Rate for Payer: Cigna of CA HMO |
$12.87
|
| Rate for Payer: Cigna of CA PPO |
$12.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.35
|
| Rate for Payer: EPIC Health Plan Senior |
$7.35
|
| Rate for Payer: Galaxy Health WC |
$15.62
|
| Rate for Payer: Global Benefits Group Commercial |
$11.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.68
|
| Rate for Payer: Multiplan Commercial |
$13.79
|
| Rate for Payer: Networks By Design Commercial |
$9.19
|
| Rate for Payer: Prime Health Services Commercial |
$15.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.90
|
| Rate for Payer: United Healthcare All Other HMO |
$6.71
|
| Rate for Payer: United Healthcare HMO Rider |
$6.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.02
|
|
|
IMMUNE GLOB G 20 GRAM/200 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN [107754]
|
Facility
|
OP
|
$18.38
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$299.61 |
| Rate for Payer: Adventist Health Commercial |
$3.68
|
| Rate for Payer: Adventist Health Medi-Cal |
$49.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$299.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$89.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.25
|
| Rate for Payer: Blue Shield of California Commercial |
$93.56
|
| Rate for Payer: Blue Shield of California EPN |
$85.05
|
| Rate for Payer: Cash Price |
$8.27
|
| Rate for Payer: Cash Price |
$8.27
|
| Rate for Payer: Central Health Plan Commercial |
$14.70
|
| Rate for Payer: Cigna of CA HMO |
$12.87
|
| Rate for Payer: Cigna of CA PPO |
$12.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$53.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.87
|
| Rate for Payer: EPIC Health Plan Senior |
$53.91
|
| Rate for Payer: Galaxy Health WC |
$15.62
|
| Rate for Payer: Global Benefits Group Commercial |
$11.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.54
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$80.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$49.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$49.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$93.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$68.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$65.67
|
| Rate for Payer: Multiplan Commercial |
$13.79
|
| Rate for Payer: Networks By Design Commercial |
$9.19
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$49.01
|
| Rate for Payer: Prime Health Services Commercial |
$15.62
|
| Rate for Payer: Prime Health Services Medicare |
$51.95
|
| Rate for Payer: Riverside University Health System MISP |
$53.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.90
|
| Rate for Payer: United Healthcare All Other HMO |
$6.71
|
| Rate for Payer: United Healthcare HMO Rider |
$6.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.02
|
| Rate for Payer: Upland Medical Group Pediatric |
$49.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.91
|
| Rate for Payer: Vantage Medical Group Senior |
$53.91
|
|
|
IMMUNE GLOB G 40 GRAM/400 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN [207906]
|
Facility
|
IP
|
$18.38
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$16.54 |
| Rate for Payer: Adventist Health Commercial |
$3.68
|
| Rate for Payer: Blue Shield of California Commercial |
$14.74
|
| Rate for Payer: Blue Shield of California EPN |
$9.26
|
| Rate for Payer: Cash Price |
$8.27
|
| Rate for Payer: Central Health Plan Commercial |
$14.70
|
| Rate for Payer: Cigna of CA HMO |
$12.87
|
| Rate for Payer: Cigna of CA PPO |
$12.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.35
|
| Rate for Payer: EPIC Health Plan Senior |
$7.35
|
| Rate for Payer: Galaxy Health WC |
$15.62
|
| Rate for Payer: Global Benefits Group Commercial |
$11.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.68
|
| Rate for Payer: Multiplan Commercial |
$13.79
|
| Rate for Payer: Networks By Design Commercial |
$9.19
|
| Rate for Payer: Prime Health Services Commercial |
$15.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.90
|
| Rate for Payer: United Healthcare All Other HMO |
$6.71
|
| Rate for Payer: United Healthcare HMO Rider |
$6.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.02
|
|
|
IMMUNE GLOB G 40 GRAM/400 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN [207906]
|
Facility
|
OP
|
$18.38
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$299.61 |
| Rate for Payer: Adventist Health Commercial |
$3.68
|
| Rate for Payer: Adventist Health Medi-Cal |
$49.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$299.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$89.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.25
|
| Rate for Payer: Blue Shield of California Commercial |
$93.56
|
| Rate for Payer: Blue Shield of California EPN |
$85.05
|
| Rate for Payer: Cash Price |
$8.27
|
| Rate for Payer: Cash Price |
$8.27
|
| Rate for Payer: Central Health Plan Commercial |
$14.70
|
| Rate for Payer: Cigna of CA HMO |
$12.87
|
| Rate for Payer: Cigna of CA PPO |
$12.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$53.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.87
|
| Rate for Payer: EPIC Health Plan Senior |
$53.91
|
| Rate for Payer: Galaxy Health WC |
$15.62
|
| Rate for Payer: Global Benefits Group Commercial |
$11.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.54
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$80.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$49.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$49.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$93.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$68.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$65.67
|
| Rate for Payer: Multiplan Commercial |
$13.79
|
| Rate for Payer: Networks By Design Commercial |
$9.19
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$49.01
|
| Rate for Payer: Prime Health Services Commercial |
$15.62
|
| Rate for Payer: Prime Health Services Medicare |
$51.95
|
| Rate for Payer: Riverside University Health System MISP |
$53.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.90
|
| Rate for Payer: United Healthcare All Other HMO |
$6.71
|
| Rate for Payer: United Healthcare HMO Rider |
$6.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.02
|
| Rate for Payer: Upland Medical Group Pediatric |
$49.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.91
|
| Rate for Payer: Vantage Medical Group Senior |
$53.91
|
|
