|
CHLORHEXIDINE GLUCONATE 4 % TOPICAL LIQUID [28188]
|
Facility
OP
|
$0.04
|
|
|
Service Code
|
NDC 0116-1061-04
|
| Hospital Charge Code |
NDG28188B
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: BCBS Transplant Transplant |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.03
|
| Rate for Payer: IEHP medi-cal |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: Riverside University Health MISP |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
CHLORHEXIDINE GLUCONATE 4 % TOPICAL LIQUID [28188]
|
Facility
IP
|
$0.04
|
|
|
Service Code
|
NDC 0116-1061-04
|
| Hospital Charge Code |
NDG28188B
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
CHLORHEXIDINE GLUCONATE 4 % TOPICAL LIQUID [28188]
|
Facility
OP
|
$0.06
|
|
|
Service Code
|
NDC 67618-200-04
|
| Hospital Charge Code |
NDG28188B
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.03
|
| 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: BCBS Transplant Transplant |
$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 |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.05
|
| Rate for Payer: IEHP medi-cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$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 |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: Riverside University Health MISP |
$0.02
|
| 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 |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
|
CHLORHEXIDINE GLUCONATE 4 % TOPICAL LIQUID [28188]
|
Facility
IP
|
$0.03
|
|
|
Service Code
|
NDC 8770141193
|
| Hospital Charge Code |
1719215
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
CHLORHEXIDINE GLUCONATE 4 % TOPICAL LIQUID [28188]
|
Facility
IP
|
$0.06
|
|
|
Service Code
|
NDC 67618-200-04
|
| Hospital Charge Code |
NDG28188B
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$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 |
$0.03
|
| Rate for Payer: Central Health Plan Commercial |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$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 |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
|
|
CHLORHEXIDINE GLUCONATE 4 % TOPICAL LIQUID [28188]
|
Facility
OP
|
$0.03
|
|
|
Service Code
|
NDC 0234-0575-08
|
| Hospital Charge Code |
1719215
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: BCBS Transplant Transplant |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.03
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.02
|
| Rate for Payer: IEHP medi-cal |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: Riverside University Health MISP |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
CHLORHEXIDINE GLUCONATE 4 % TOPICAL LIQUID [28188]
|
Facility
IP
|
$0.05
|
|
|
Service Code
|
NDC 46122-137-34
|
| Hospital Charge Code |
1719215
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| 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 |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
|
|
CHLORHEXIDINE GLUCONATE 4 % TOPICAL LIQUID [28188]
|
Facility
IP
|
$0.03
|
|
|
Service Code
|
NDC 0234-0575-08
|
| Hospital Charge Code |
1719215
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
CHLORHEXIDINE GLUCONATE 4 % TOPICAL LIQUID [28188]
|
Facility
IP
|
$0.04
|
|
|
Service Code
|
NDC 0234-0575-04
|
| Hospital Charge Code |
NDG28188B
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
CHLORHEXIDINE GLUCONATE 4 % TOPICAL LIQUID [28188]
|
Facility
OP
|
$0.04
|
|
|
Service Code
|
NDC 0234-0575-04
|
| Hospital Charge Code |
NDG28188B
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: BCBS Transplant Transplant |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.03
|
| Rate for Payer: IEHP medi-cal |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: Riverside University Health MISP |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
CHLORHEXIDINE GLUCONATE 4 % TOPICAL LIQUID [28188]
|
Facility
OP
|
$0.03
|
|
|
Service Code
|
NDC 8770141193
|
| Hospital Charge Code |
1719215
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: BCBS Transplant Transplant |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.03
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.02
|
| Rate for Payer: IEHP medi-cal |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: Riverside University Health MISP |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
CHLORHEXIDINE (PERIDEX) 0.12% ALCHOHOL-FREE ORAL SYRINGE [4081169]
|
Facility
IP
|
$0.02
|
|
|
Service Code
|
NDC 52376-021-02
|
| Hospital Charge Code |
NDG4081169
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.02
|
|
|
CHLORHEXIDINE (PERIDEX) 0.12% ALCHOHOL-FREE ORAL SYRINGE [4081169]
|
Facility
OP
|
$0.02
|
|
|
Service Code
|
NDC 52376-021-02
|
| Hospital Charge Code |
NDG4081169
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: BCBS Transplant Transplant |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.02
|
| Rate for Payer: IEHP medi-cal |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.02
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: Riverside University Health MISP |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Vantage Medical Group Senior |
$0.02
|
|
|
CHLOROPROCAINE 20 MG/ML (2 %) INJECTION SOLUTION [110537]
|
Facility
IP
|
$0.74
|
|
|
Service Code
|
CPT J2401
|
| Hospital Charge Code |
1721143
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: Blue Shield of California Commercial |
$0.56
|
| Rate for Payer: Blue Shield of California EPN |
$0.40
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Central Health Plan Commercial |
$0.59
|
| Rate for Payer: Cigna of CA HMO |
$0.52
|
| Rate for Payer: Cigna of CA PPO |
$0.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.30
|
| Rate for Payer: Galaxy Health WC |
$0.63
|
| Rate for Payer: Global Benefits Group Commercial |
$0.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.56
|
| Rate for Payer: Networks By Design Commercial |
$0.37
|
| Rate for Payer: Prime Health Services Commercial |
$0.63
|
|
|
CHLOROPROCAINE 20 MG/ML (2 %) INJECTION SOLUTION [110537]
|
Facility
OP
|
$0.74
|
|
|
Service Code
|
CPT J2401
|
| Hospital Charge Code |
1721143
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: Adventist Health Medi-Cal |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
| Rate for Payer: BCBS Transplant Transplant |
$0.44
|
| Rate for Payer: Blue Shield of California Commercial |
$0.47
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| Rate for Payer: Caremore Medicare Advantage |
$0.04
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Central Health Plan Commercial |
$0.59
|
| Rate for Payer: Cigna of CA HMO |
$0.52
|
| Rate for Payer: Cigna of CA PPO |
$0.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.63
|
| Rate for Payer: Global Benefits Group Commercial |
$0.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.67
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.56
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$0.06
|
| Rate for Payer: IEHP medi-cal |
$0.06
|
| Rate for Payer: IEHP Medicare Advantage |
$0.04
|
| Rate for Payer: Innovage PACE Commercial |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.56
|
| Rate for Payer: Networks By Design Commercial |
$0.37
|
| Rate for Payer: Prime Health Services Commercial |
$0.63
|
| Rate for Payer: Prime Health Services Medicare |
$0.04
|
| Rate for Payer: Riverside University Health MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.37
|
| Rate for Payer: United Healthcare All Other HMO |
$0.37
|
| Rate for Payer: United Healthcare HMO Rider |
$0.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.04
|
|
|
CHLOROPROCAINE (PF) 10 MG/ML (1 %) INTRATHECAL SOLUTION [222772]
|
Facility
OP
|
$3.69
|
|
|
Service Code
|
CPT J2402
|
| Hospital Charge Code |
NDG222772
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.70
|
| Rate for Payer: BCBS Transplant Transplant |
$2.21
|
| Rate for Payer: Blue Shield of California Commercial |
$2.32
|
| Rate for Payer: Blue Shield of California EPN |
$1.80
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Central Health Plan Commercial |
$2.95
|
| Rate for Payer: Cigna of CA HMO |
$2.58
|
| Rate for Payer: Cigna of CA PPO |
$2.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.48
|
| Rate for Payer: Galaxy Health WC |
$3.14
|
| Rate for Payer: Global Benefits Group Commercial |
$2.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.32
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.77
|
| Rate for Payer: IEHP medi-cal |
$1.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$2.77
|
| Rate for Payer: Networks By Design Commercial |
$1.84
|
| Rate for Payer: Prime Health Services Commercial |
$3.14
|
| Rate for Payer: Riverside University Health MISP |
$1.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.84
|
| Rate for Payer: United Healthcare All Other HMO |
$1.84
|
| Rate for Payer: United Healthcare HMO Rider |
$1.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.14
|
| Rate for Payer: Vantage Medical Group Senior |
$3.14
|
|
|
CHLOROPROCAINE (PF) 10 MG/ML (1 %) INTRATHECAL SOLUTION [222772]
|
Facility
IP
|
$3.69
|
|
|
Service Code
|
CPT J2402
|
| Hospital Charge Code |
NDG222772
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Blue Shield of California EPN |
$1.97
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Central Health Plan Commercial |
$2.95
|
| Rate for Payer: Cigna of CA HMO |
$2.58
|
| Rate for Payer: Cigna of CA PPO |
$2.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.48
|
| Rate for Payer: Galaxy Health WC |
$3.14
|
| Rate for Payer: Global Benefits Group Commercial |
$2.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$2.77
|
| Rate for Payer: Networks By Design Commercial |
$1.84
|
| Rate for Payer: Prime Health Services Commercial |
$3.14
|
|
|
CHLOROPROCAINE (PF) 30 MG/ML (3 %) INJECTION SOLUTION [1635]
|
Facility
OP
|
$1.34
|
|
|
Service Code
|
CPT J2401
|
| Hospital Charge Code |
1721145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$1.21 |
| Rate for Payer: Adventist Health Medi-Cal |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
| Rate for Payer: BCBS Transplant Transplant |
$0.80
|
| Rate for Payer: Blue Shield of California Commercial |
$0.84
|
| Rate for Payer: Blue Shield of California EPN |
$0.66
|
| Rate for Payer: Caremore Medicare Advantage |
$0.04
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Central Health Plan Commercial |
$1.07
|
| Rate for Payer: Cigna of CA HMO |
$0.94
|
| Rate for Payer: Cigna of CA PPO |
$0.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$1.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.21
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$0.06
|
| Rate for Payer: IEHP medi-cal |
$0.06
|
| Rate for Payer: IEHP Medicare Advantage |
$0.04
|
| Rate for Payer: Innovage PACE Commercial |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$1.00
|
| Rate for Payer: Networks By Design Commercial |
$0.67
|
| Rate for Payer: Prime Health Services Commercial |
$1.14
|
| Rate for Payer: Prime Health Services Medicare |
$0.04
|
| Rate for Payer: Riverside University Health MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.67
|
| Rate for Payer: United Healthcare All Other HMO |
$0.67
|
| Rate for Payer: United Healthcare HMO Rider |
$0.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.04
|
|
|
CHLOROPROCAINE (PF) 30 MG/ML (3 %) INJECTION SOLUTION [1635]
|
Facility
IP
|
$1.34
|
|
|
Service Code
|
CPT J2401
|
| Hospital Charge Code |
1721145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.21 |
| Rate for Payer: Blue Shield of California Commercial |
$1.00
|
| Rate for Payer: Blue Shield of California EPN |
$0.72
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Central Health Plan Commercial |
$1.07
|
| Rate for Payer: Cigna of CA HMO |
$0.94
|
| Rate for Payer: Cigna of CA PPO |
$0.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.54
|
| Rate for Payer: Galaxy Health WC |
$1.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$1.00
|
| Rate for Payer: Networks By Design Commercial |
$0.67
|
| Rate for Payer: Prime Health Services Commercial |
$1.14
|
|
|
CHLOROQUINE ORAL SUSPENSION COMPOUND 15 MG/ML [4080254]
|
Facility
OP
|
$0.16
|
|
|
Service Code
|
NDC 9994-0802-54
|
| Hospital Charge Code |
1715014
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
| Rate for Payer: BCBS Transplant Transplant |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Central Health Plan Commercial |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.14
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.12
|
| Rate for Payer: IEHP medi-cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: Riverside University Health MISP |
$0.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
CHLOROQUINE ORAL SUSPENSION COMPOUND 15 MG/ML [4080254]
|
Facility
IP
|
$0.16
|
|
|
Service Code
|
NDC 9994-0802-54
|
| Hospital Charge Code |
1715014
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Central Health Plan Commercial |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
|
CHLOROTHIAZIDE 250 MG/5 ML ORAL SUSPENSION [9525]
|
Facility
OP
|
$0.35
|
|
|
Service Code
|
NDC 65649-311-12
|
| Hospital Charge Code |
1715531
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.21
|
| Rate for Payer: BCBS Transplant Transplant |
$0.21
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Central Health Plan Commercial |
$0.28
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.30
|
| Rate for Payer: Global Benefits Group Commercial |
$0.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.32
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.26
|
| Rate for Payer: IEHP medi-cal |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.21
|
| Rate for Payer: Riverside University Health MISP |
$0.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Vantage Medical Group Senior |
$0.30
|
|
|
CHLOROTHIAZIDE 250 MG/5 ML ORAL SUSPENSION [9525]
|
Facility
IP
|
$0.35
|
|
|
Service Code
|
NDC 65649-311-12
|
| Hospital Charge Code |
1715531
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.19
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Central Health Plan Commercial |
$0.28
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.30
|
| Rate for Payer: Global Benefits Group Commercial |
$0.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.30
|
|
|
CHLOROTHIAZIDE SODIUM 500 MG INTRAVENOUS SOLUTION [9526]
|
Facility
IP
|
$192.00
|
|
|
Service Code
|
CPT J1205
|
| Hospital Charge Code |
1720125
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Blue Shield of California Commercial |
$144.00
|
| Rate for Payer: Blue Shield of California Commercial |
$89.82
|
| Rate for Payer: Blue Shield of California Commercial |
$54.00
|
| Rate for Payer: Blue Shield of California Commercial |
$43.82
|
| Rate for Payer: Blue Shield of California Commercial |
$267.93
|
| Rate for Payer: Blue Shield of California EPN |
$31.20
|
| Rate for Payer: Blue Shield of California EPN |
$63.95
|
| Rate for Payer: Blue Shield of California EPN |
$102.53
|
| Rate for Payer: Blue Shield of California EPN |
$190.77
|
| Rate for Payer: Blue Shield of California EPN |
$38.45
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$26.29
|
| Rate for Payer: Cash Price |
$160.76
|
| Rate for Payer: Cash Price |
$53.89
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: Central Health Plan Commercial |
$285.79
|
| Rate for Payer: Central Health Plan Commercial |
$46.74
|
| Rate for Payer: Central Health Plan Commercial |
$153.60
|
| Rate for Payer: Central Health Plan Commercial |
$95.81
|
| Rate for Payer: Cigna of CA HMO |
$83.83
|
| Rate for Payer: Cigna of CA HMO |
$40.90
|
| Rate for Payer: Cigna of CA HMO |
$50.40
|
| Rate for Payer: Cigna of CA HMO |
$134.40
|
| Rate for Payer: Cigna of CA HMO |
$250.07
|
| Rate for Payer: Cigna of CA PPO |
$250.07
|
| Rate for Payer: Cigna of CA PPO |
$83.83
|
| Rate for Payer: Cigna of CA PPO |
$40.90
|
| Rate for Payer: Cigna of CA PPO |
$50.40
|
| Rate for Payer: Cigna of CA PPO |
$134.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$142.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$47.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$142.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$28.80
|
| Rate for Payer: Galaxy Health WC |
$303.65
|
| Rate for Payer: Galaxy Health WC |
$163.20
|
| Rate for Payer: Galaxy Health WC |
$49.67
|
| Rate for Payer: Galaxy Health WC |
$101.80
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Global Benefits Group Commercial |
$71.86
|
| Rate for Payer: Global Benefits Group Commercial |
$35.06
|
| Rate for Payer: Global Benefits Group Commercial |
$115.20
|
| Rate for Payer: Global Benefits Group Commercial |
$214.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$107.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$321.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$172.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$79.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$238.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$43.82
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$267.93
|
| Rate for Payer: Multiplan Commercial |
$89.82
|
| Rate for Payer: Networks By Design Commercial |
$178.62
|
| Rate for Payer: Networks By Design Commercial |
$29.22
|
| Rate for Payer: Networks By Design Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$59.88
|
| Rate for Payer: Prime Health Services Commercial |
$101.80
|
| Rate for Payer: Prime Health Services Commercial |
$163.20
|
| Rate for Payer: Prime Health Services Commercial |
$303.65
|
| Rate for Payer: Prime Health Services Commercial |
$49.67
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
|
|
CHLOROTHIAZIDE SODIUM 500 MG INTRAVENOUS SOLUTION [9526]
|
Facility
OP
|
$72.00
|
|
|
Service Code
|
CPT J1205
|
| Hospital Charge Code |
1720125
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$751.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$751.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$751.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$751.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$751.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$751.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$163.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$49.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$101.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$61.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$303.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$39.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$32.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$65.87
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$196.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$105.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$65.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$105.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$32.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$39.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$196.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.94
|
| Rate for Payer: BCBS Transplant Transplant |
$214.34
|
| Rate for Payer: BCBS Transplant Transplant |
$35.06
|
| Rate for Payer: BCBS Transplant Transplant |
$43.20
|
| Rate for Payer: BCBS Transplant Transplant |
$71.86
|
| Rate for Payer: BCBS Transplant Transplant |
$115.20
|
| Rate for Payer: Blue Shield of California Commercial |
$108.22
|
| Rate for Payer: Blue Shield of California Commercial |
$108.22
|
| Rate for Payer: Blue Shield of California Commercial |
$108.22
|
| Rate for Payer: Blue Shield of California Commercial |
$108.22
|
| Rate for Payer: Blue Shield of California Commercial |
$108.22
|
| Rate for Payer: Blue Shield of California EPN |
$98.38
|
| Rate for Payer: Blue Shield of California EPN |
$98.38
|
| Rate for Payer: Blue Shield of California EPN |
$98.38
|
| Rate for Payer: Blue Shield of California EPN |
$98.38
|
| Rate for Payer: Blue Shield of California EPN |
$98.38
|
| Rate for Payer: Cash Price |
$26.29
|
| Rate for Payer: Cash Price |
$53.89
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$26.29
|
| Rate for Payer: Cash Price |
$160.76
|
| Rate for Payer: Cash Price |
$160.76
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$53.89
|
| Rate for Payer: Central Health Plan Commercial |
$285.79
|
| Rate for Payer: Central Health Plan Commercial |
$153.60
|
| Rate for Payer: Central Health Plan Commercial |
$95.81
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: Central Health Plan Commercial |
$46.74
|
| Rate for Payer: Cigna of CA HMO |
$134.40
|
| Rate for Payer: Cigna of CA HMO |
$40.90
|
| Rate for Payer: Cigna of CA HMO |
$83.83
|
| Rate for Payer: Cigna of CA HMO |
$250.07
|
| Rate for Payer: Cigna of CA HMO |
$50.40
|
| Rate for Payer: Cigna of CA PPO |
$50.40
|
| Rate for Payer: Cigna of CA PPO |
$40.90
|
| Rate for Payer: Cigna of CA PPO |
$250.07
|
| Rate for Payer: Cigna of CA PPO |
$134.40
|
| Rate for Payer: Cigna of CA PPO |
$83.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$49.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$303.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$142.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$28.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$142.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$47.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.37
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Galaxy Health WC |
$163.20
|
| Rate for Payer: Galaxy Health WC |
$49.67
|
| Rate for Payer: Galaxy Health WC |
$101.80
|
| Rate for Payer: Galaxy Health WC |
$303.65
|
| Rate for Payer: Global Benefits Group Commercial |
$71.86
|
| Rate for Payer: Global Benefits Group Commercial |
$115.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Global Benefits Group Commercial |
$214.34
|
| Rate for Payer: Global Benefits Group Commercial |
$35.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$172.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$321.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$107.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$267.93
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$144.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$54.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$43.82
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$89.82
|
| Rate for Payer: IEHP medi-cal |
$63.79
|
| Rate for Payer: IEHP medi-cal |
$63.79
|
| Rate for Payer: IEHP medi-cal |
$63.79
|
| Rate for Payer: IEHP medi-cal |
$63.79
|
| Rate for Payer: IEHP medi-cal |
$63.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$238.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$79.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.95
|
| Rate for Payer: Multiplan Commercial |
$267.93
|
| Rate for Payer: Multiplan Commercial |
$43.82
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: Multiplan Commercial |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: Networks By Design Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$29.22
|
| Rate for Payer: Networks By Design Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$178.62
|
| Rate for Payer: Networks By Design Commercial |
$59.88
|
| Rate for Payer: Prime Health Services Commercial |
$101.80
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: Prime Health Services Commercial |
$303.65
|
| Rate for Payer: Prime Health Services Commercial |
$163.20
|
| Rate for Payer: Prime Health Services Commercial |
$49.67
|
| Rate for Payer: Riverside University Health MISP |
$23.37
|
| Rate for Payer: Riverside University Health MISP |
$47.90
|
| Rate for Payer: Riverside University Health MISP |
$142.90
|
| Rate for Payer: Riverside University Health MISP |
$28.80
|
| Rate for Payer: Riverside University Health MISP |
$76.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$71.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$214.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$71.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$214.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$178.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$96.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$59.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.22
|
| Rate for Payer: United Healthcare All Other HMO |
$29.22
|
| Rate for Payer: United Healthcare All Other HMO |
$178.62
|
| Rate for Payer: United Healthcare All Other HMO |
$59.88
|
| Rate for Payer: United Healthcare All Other HMO |
$96.00
|
| Rate for Payer: United Healthcare All Other HMO |
$36.00
|
| Rate for Payer: United Healthcare HMO Rider |
$178.62
|
| Rate for Payer: United Healthcare HMO Rider |
$29.22
|
| Rate for Payer: United Healthcare HMO Rider |
$96.00
|
| Rate for Payer: United Healthcare HMO Rider |
$59.88
|
| Rate for Payer: United Healthcare HMO Rider |
$36.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$178.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$303.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$49.67
|
| Rate for Payer: Vantage Medical Group Senior |
$49.67
|
| Rate for Payer: Vantage Medical Group Senior |
$163.20
|
| Rate for Payer: Vantage Medical Group Senior |
$303.65
|
| Rate for Payer: Vantage Medical Group Senior |
$101.80
|
| Rate for Payer: Vantage Medical Group Senior |
$61.20
|
|
