|
PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE [6257]
|
Facility
|
OP
|
$0.30
|
|
|
Service Code
|
NDC 51672-4111-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.27 |
| 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 |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.18
|
| 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 |
$0.16
|
| Rate for Payer: Central Health Plan Commercial |
$0.24
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.27
|
| Rate for Payer: InnovAge PACE Commercial |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: Riverside University Health System MISP |
$0.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.18
|
| 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 |
$0.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
|
PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE [6257]
|
Facility
|
IP
|
$0.30
|
|
|
Service Code
|
NDC 57664-808-88
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.27 |
| 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 |
$0.16
|
| Rate for Payer: Central Health Plan Commercial |
$0.24
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
|
|
PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE [6257]
|
Facility
|
OP
|
$1.87
|
|
|
Service Code
|
NDC 60687-841-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.68 |
| Rate for Payer: Adventist Health Commercial |
$0.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.10
|
| Rate for Payer: Blue Shield of California Commercial |
$1.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.75
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Central Health Plan Commercial |
$1.50
|
| Rate for Payer: Cigna of CA HMO |
$1.31
|
| Rate for Payer: Cigna of CA PPO |
$1.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.75
|
| Rate for Payer: EPIC Health Plan Senior |
$0.75
|
| Rate for Payer: Galaxy Health WC |
$1.59
|
| Rate for Payer: Global Benefits Group Commercial |
$1.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.68
|
| Rate for Payer: InnovAge PACE Commercial |
$0.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.31
|
| Rate for Payer: Multiplan Commercial |
$1.40
|
| Rate for Payer: Networks By Design Commercial |
$1.22
|
| Rate for Payer: Prime Health Services Commercial |
$1.59
|
| Rate for Payer: Riverside University Health System MISP |
$0.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.94
|
| Rate for Payer: United Healthcare All Other HMO |
$0.94
|
| Rate for Payer: United Healthcare HMO Rider |
$0.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.59
|
| Rate for Payer: Vantage Medical Group Senior |
$1.59
|
|
|
PHENYTOIN SODIUM EXTENDED 30 MG CAPSULE [11019]
|
Facility
|
OP
|
$1.79
|
|
|
Service Code
|
NDC 0071-3740-66
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.61 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.05
|
| Rate for Payer: Blue Shield of California Commercial |
$1.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.71
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Central Health Plan Commercial |
$1.43
|
| Rate for Payer: Cigna of CA HMO |
$1.25
|
| Rate for Payer: Cigna of CA PPO |
$1.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Senior |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$1.52
|
| Rate for Payer: Global Benefits Group Commercial |
$1.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.61
|
| Rate for Payer: InnovAge PACE Commercial |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.25
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Networks By Design Commercial |
$1.16
|
| Rate for Payer: Prime Health Services Commercial |
$1.52
|
| Rate for Payer: Riverside University Health System MISP |
$0.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.90
|
| Rate for Payer: United Healthcare All Other HMO |
$0.90
|
| Rate for Payer: United Healthcare HMO Rider |
$0.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.52
|
| Rate for Payer: Vantage Medical Group Senior |
$1.52
|
|
|
PHENYTOIN SODIUM EXTENDED 30 MG CAPSULE [11019]
|
Facility
|
IP
|
$1.79
|
|
|
Service Code
|
NDC 0071-3740-66
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.61 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$1.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.90
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Central Health Plan Commercial |
$1.43
|
| Rate for Payer: Cigna of CA HMO |
$1.25
|
| Rate for Payer: Cigna of CA PPO |
$1.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Senior |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$1.52
|
| Rate for Payer: Global Benefits Group Commercial |
$1.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Networks By Design Commercial |
$1.16
|
| Rate for Payer: Prime Health Services Commercial |
$1.52
|
|
|
PHOS-NAK ORAL SOLN CMPND 25 MG/ML (0.8 MMOL/ML) [4080310]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 9994-0803-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| 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: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.02
|
| 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
|
|
|
PHOS-NAK ORAL SOLN CMPND 25 MG/ML (0.8 MMOL/ML) [4080310]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 9994-0803-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| 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: Blue Shield of California Commercial |
$0.02
|
| 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: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$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: InnovAge PACE Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.03
|
| 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: Riverside University Health System 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 Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
PHOSPHATE DIALYSIS SOLN WITHOUT DEXTR K 4 MEQ-CA 2.5 MEQ-PO4 1 MMOL/L [212681]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 24571-116-05
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| 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 |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
PHOSPHATE DIALYSIS SOLN WITHOUT DEXTR K 4 MEQ-CA 2.5 MEQ-PO4 1 MMOL/L [212681]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 24571-116-06
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: InnovAge PACE Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.00
|
| 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 Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
PHOSPHATE DIALYSIS SOLN WITHOUT DEXTR K 4 MEQ-CA 2.5 MEQ-PO4 1 MMOL/L [212681]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 24571-116-06
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| 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 |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
PHOSPHATE DIALYSIS SOLN WITHOUT DEXTR K 4 MEQ-CA 2.5 MEQ-PO4 1 MMOL/L [212681]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 24571-116-05
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: InnovAge PACE Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.00
|
| 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 Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
PHOSPHATE DIALY SOLN W-OUT CALCIUM,DEX K 4 MEQ-MG 1.5 MEQ-PO4 1 MMOL/L [212682]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 24571-117-05
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| 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 |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
PHOSPHATE DIALY SOLN W-OUT CALCIUM,DEX K 4 MEQ-MG 1.5 MEQ-PO4 1 MMOL/L [212682]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 24571-117-05
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: InnovAge PACE Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.00
|
| 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 Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION [11023]
|
Facility
|
OP
|
$51.32
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$46.19 |
| Rate for Payer: Adventist Health Commercial |
$10.26
|
| Rate for Payer: Adventist Health Commercial |
$11.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$49.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.05
|
| Rate for Payer: Blue Shield of California Commercial |
$7.09
|
| Rate for Payer: Blue Shield of California Commercial |
$7.09
|
| Rate for Payer: Blue Shield of California EPN |
$6.45
|
| Rate for Payer: Blue Shield of California EPN |
$6.45
|
| Rate for Payer: Cash Price |
$28.23
|
| Rate for Payer: Cash Price |
$28.23
|
| Rate for Payer: Cash Price |
$32.32
|
| Rate for Payer: Cash Price |
$32.32
|
| Rate for Payer: Central Health Plan Commercial |
$41.06
|
| Rate for Payer: Central Health Plan Commercial |
$47.01
|
| Rate for Payer: Cigna of CA HMO |
$41.13
|
| Rate for Payer: Cigna of CA HMO |
$35.92
|
| Rate for Payer: Cigna of CA PPO |
$41.13
|
| Rate for Payer: Cigna of CA PPO |
$35.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$49.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$49.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$43.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$49.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.53
|
| Rate for Payer: EPIC Health Plan Senior |
$20.53
|
| Rate for Payer: EPIC Health Plan Senior |
$23.50
|
| Rate for Payer: Galaxy Health WC |
$49.95
|
| Rate for Payer: Galaxy Health WC |
$43.62
|
| Rate for Payer: Global Benefits Group Commercial |
$35.26
|
| Rate for Payer: Global Benefits Group Commercial |
$30.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.44
|
| Rate for Payer: InnovAge PACE Commercial |
$25.66
|
| Rate for Payer: InnovAge PACE Commercial |
$29.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.92
|
| Rate for Payer: Multiplan Commercial |
$38.49
|
| Rate for Payer: Multiplan Commercial |
$44.07
|
| Rate for Payer: Networks By Design Commercial |
$29.38
|
| Rate for Payer: Networks By Design Commercial |
$25.66
|
| Rate for Payer: Prime Health Services Commercial |
$49.95
|
| Rate for Payer: Prime Health Services Commercial |
$43.62
|
| Rate for Payer: Riverside University Health System MISP |
$20.53
|
| Rate for Payer: Riverside University Health System MISP |
$23.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.26
|
| Rate for Payer: United Healthcare All Other HMO |
$18.75
|
| Rate for Payer: United Healthcare All Other HMO |
$21.47
|
| Rate for Payer: United Healthcare HMO Rider |
$18.34
|
| Rate for Payer: United Healthcare HMO Rider |
$21.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$49.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$49.95
|
| Rate for Payer: Vantage Medical Group Senior |
$43.62
|
| Rate for Payer: Vantage Medical Group Senior |
$49.95
|
|
|
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION [11023]
|
Facility
|
IP
|
$58.76
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.75 |
| Max. Negotiated Rate |
$52.88 |
| Rate for Payer: Adventist Health Commercial |
$11.75
|
| Rate for Payer: Adventist Health Commercial |
$10.26
|
| Rate for Payer: Blue Shield of California Commercial |
$45.42
|
| Rate for Payer: Blue Shield of California Commercial |
$39.67
|
| Rate for Payer: Blue Shield of California EPN |
$25.87
|
| Rate for Payer: Blue Shield of California EPN |
$29.62
|
| Rate for Payer: Cash Price |
$32.32
|
| Rate for Payer: Cash Price |
$28.23
|
| Rate for Payer: Central Health Plan Commercial |
$47.01
|
| Rate for Payer: Central Health Plan Commercial |
$41.06
|
| Rate for Payer: Cigna of CA HMO |
$35.92
|
| Rate for Payer: Cigna of CA HMO |
$41.13
|
| Rate for Payer: Cigna of CA PPO |
$35.92
|
| Rate for Payer: Cigna of CA PPO |
$41.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.50
|
| Rate for Payer: EPIC Health Plan Senior |
$20.53
|
| Rate for Payer: EPIC Health Plan Senior |
$23.50
|
| Rate for Payer: Galaxy Health WC |
$43.62
|
| Rate for Payer: Galaxy Health WC |
$49.95
|
| Rate for Payer: Global Benefits Group Commercial |
$35.26
|
| Rate for Payer: Global Benefits Group Commercial |
$30.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.26
|
| Rate for Payer: Multiplan Commercial |
$38.49
|
| Rate for Payer: Multiplan Commercial |
$44.07
|
| Rate for Payer: Networks By Design Commercial |
$25.66
|
| Rate for Payer: Networks By Design Commercial |
$29.38
|
| Rate for Payer: Prime Health Services Commercial |
$49.95
|
| Rate for Payer: Prime Health Services Commercial |
$43.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.05
|
| Rate for Payer: United Healthcare All Other HMO |
$21.47
|
| Rate for Payer: United Healthcare All Other HMO |
$18.75
|
| Rate for Payer: United Healthcare HMO Rider |
$18.34
|
| Rate for Payer: United Healthcare HMO Rider |
$21.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.24
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SOLUTION [110478]
|
Facility
|
IP
|
$11.39
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$10.25 |
| Rate for Payer: Adventist Health Commercial |
$2.28
|
| Rate for Payer: Blue Shield of California Commercial |
$8.80
|
| Rate for Payer: Blue Shield of California EPN |
$5.74
|
| Rate for Payer: Cash Price |
$6.26
|
| Rate for Payer: Central Health Plan Commercial |
$9.11
|
| Rate for Payer: Cigna of CA HMO |
$7.97
|
| Rate for Payer: Cigna of CA PPO |
$7.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.56
|
| Rate for Payer: EPIC Health Plan Senior |
$4.56
|
| Rate for Payer: Galaxy Health WC |
$9.68
|
| Rate for Payer: Global Benefits Group Commercial |
$6.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.28
|
| Rate for Payer: Multiplan Commercial |
$8.54
|
| Rate for Payer: Networks By Design Commercial |
$5.70
|
| Rate for Payer: Prime Health Services Commercial |
$9.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.27
|
| Rate for Payer: United Healthcare All Other HMO |
$4.16
|
| Rate for Payer: United Healthcare HMO Rider |
$4.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.73
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SOLUTION [110478]
|
Facility
|
OP
|
$11.39
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$13.19 |
| Rate for Payer: Adventist Health Commercial |
$2.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.05
|
| Rate for Payer: Blue Shield of California Commercial |
$7.09
|
| Rate for Payer: Blue Shield of California EPN |
$6.45
|
| Rate for Payer: Cash Price |
$6.26
|
| Rate for Payer: Cash Price |
$6.26
|
| Rate for Payer: Central Health Plan Commercial |
$9.11
|
| Rate for Payer: Cigna of CA HMO |
$7.97
|
| Rate for Payer: Cigna of CA PPO |
$7.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.56
|
| Rate for Payer: EPIC Health Plan Senior |
$4.56
|
| Rate for Payer: Galaxy Health WC |
$9.68
|
| Rate for Payer: Global Benefits Group Commercial |
$6.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.44
|
| Rate for Payer: InnovAge PACE Commercial |
$5.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.97
|
| Rate for Payer: Multiplan Commercial |
$8.54
|
| Rate for Payer: Networks By Design Commercial |
$5.70
|
| Rate for Payer: Prime Health Services Commercial |
$9.68
|
| Rate for Payer: Riverside University Health System MISP |
$4.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.27
|
| Rate for Payer: United Healthcare All Other HMO |
$4.16
|
| Rate for Payer: United Healthcare HMO Rider |
$4.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.68
|
| Rate for Payer: Vantage Medical Group Senior |
$9.68
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SYRINGE [6271]
|
Facility
|
IP
|
$59.35
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.87 |
| Max. Negotiated Rate |
$53.41 |
| Rate for Payer: Adventist Health Commercial |
$11.87
|
| Rate for Payer: Blue Shield of California Commercial |
$45.88
|
| Rate for Payer: Blue Shield of California EPN |
$29.91
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Central Health Plan Commercial |
$47.48
|
| Rate for Payer: Cigna of CA HMO |
$41.55
|
| Rate for Payer: Cigna of CA PPO |
$41.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.74
|
| Rate for Payer: EPIC Health Plan Senior |
$23.74
|
| Rate for Payer: Galaxy Health WC |
$50.45
|
| Rate for Payer: Global Benefits Group Commercial |
$35.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.87
|
| Rate for Payer: Multiplan Commercial |
$44.51
|
| Rate for Payer: Networks By Design Commercial |
$29.68
|
| Rate for Payer: Prime Health Services Commercial |
$50.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.27
|
| Rate for Payer: United Healthcare All Other HMO |
$21.68
|
| Rate for Payer: United Healthcare HMO Rider |
$21.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.44
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SYRINGE [6271]
|
Facility
|
OP
|
$59.35
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$53.41 |
| Rate for Payer: Adventist Health Commercial |
$11.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.05
|
| Rate for Payer: Blue Shield of California Commercial |
$7.09
|
| Rate for Payer: Blue Shield of California EPN |
$6.45
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Central Health Plan Commercial |
$47.48
|
| Rate for Payer: Cigna of CA HMO |
$41.55
|
| Rate for Payer: Cigna of CA PPO |
$41.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.74
|
| Rate for Payer: EPIC Health Plan Senior |
$23.74
|
| Rate for Payer: Galaxy Health WC |
$50.45
|
| Rate for Payer: Global Benefits Group Commercial |
$35.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.44
|
| Rate for Payer: InnovAge PACE Commercial |
$29.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.55
|
| Rate for Payer: Multiplan Commercial |
$44.51
|
| Rate for Payer: Networks By Design Commercial |
$29.68
|
| Rate for Payer: Prime Health Services Commercial |
$50.45
|
| Rate for Payer: Riverside University Health System MISP |
$23.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.27
|
| Rate for Payer: United Healthcare All Other HMO |
$21.68
|
| Rate for Payer: United Healthcare HMO Rider |
$21.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.45
|
| Rate for Payer: Vantage Medical Group Senior |
$50.45
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML ORAL SYRINGE [4081654]
|
Facility
|
OP
|
$59.35
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$53.41 |
| Rate for Payer: Adventist Health Commercial |
$11.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.05
|
| Rate for Payer: Blue Shield of California Commercial |
$7.09
|
| Rate for Payer: Blue Shield of California EPN |
$6.45
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Central Health Plan Commercial |
$47.48
|
| Rate for Payer: Cigna of CA HMO |
$41.55
|
| Rate for Payer: Cigna of CA PPO |
$41.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.74
|
| Rate for Payer: EPIC Health Plan Senior |
$23.74
|
| Rate for Payer: Galaxy Health WC |
$50.45
|
| Rate for Payer: Global Benefits Group Commercial |
$35.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.44
|
| Rate for Payer: InnovAge PACE Commercial |
$29.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.55
|
| Rate for Payer: Multiplan Commercial |
$44.51
|
| Rate for Payer: Networks By Design Commercial |
$29.68
|
| Rate for Payer: Prime Health Services Commercial |
$50.45
|
| Rate for Payer: Riverside University Health System MISP |
$23.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.27
|
| Rate for Payer: United Healthcare All Other HMO |
$21.68
|
| Rate for Payer: United Healthcare HMO Rider |
$21.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.45
|
| Rate for Payer: Vantage Medical Group Senior |
$50.45
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML ORAL SYRINGE [4081654]
|
Facility
|
IP
|
$59.35
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.87 |
| Max. Negotiated Rate |
$53.41 |
| Rate for Payer: Adventist Health Commercial |
$11.87
|
| Rate for Payer: Blue Shield of California Commercial |
$45.88
|
| Rate for Payer: Blue Shield of California EPN |
$29.91
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Central Health Plan Commercial |
$47.48
|
| Rate for Payer: Cigna of CA HMO |
$41.55
|
| Rate for Payer: Cigna of CA PPO |
$41.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.74
|
| Rate for Payer: EPIC Health Plan Senior |
$23.74
|
| Rate for Payer: Galaxy Health WC |
$50.45
|
| Rate for Payer: Global Benefits Group Commercial |
$35.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.87
|
| Rate for Payer: Multiplan Commercial |
$44.51
|
| Rate for Payer: Networks By Design Commercial |
$29.68
|
| Rate for Payer: Prime Health Services Commercial |
$50.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.27
|
| Rate for Payer: United Healthcare All Other HMO |
$21.68
|
| Rate for Payer: United Healthcare HMO Rider |
$21.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.44
|
|
|
PHYTONADIONE (VITAMIN K1) 5 MG TABLET [11024]
|
Facility
|
IP
|
$33.76
|
|
|
Service Code
|
NDC 70710-1014-3
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$30.38 |
| Rate for Payer: Adventist Health Commercial |
$6.75
|
| Rate for Payer: Blue Shield of California Commercial |
$26.10
|
| Rate for Payer: Blue Shield of California EPN |
$17.02
|
| Rate for Payer: Cash Price |
$18.57
|
| Rate for Payer: Central Health Plan Commercial |
$27.01
|
| Rate for Payer: Cigna of CA HMO |
$23.63
|
| Rate for Payer: Cigna of CA PPO |
$23.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.50
|
| Rate for Payer: EPIC Health Plan Senior |
$13.50
|
| Rate for Payer: Galaxy Health WC |
$28.70
|
| Rate for Payer: Global Benefits Group Commercial |
$20.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.75
|
| Rate for Payer: Multiplan Commercial |
$25.32
|
| Rate for Payer: Networks By Design Commercial |
$21.94
|
| Rate for Payer: Prime Health Services Commercial |
$28.70
|
|
|
PHYTONADIONE (VITAMIN K1) 5 MG TABLET [11024]
|
Facility
|
OP
|
$80.85
|
|
|
Service Code
|
NDC 60687-381-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.17 |
| Max. Negotiated Rate |
$72.77 |
| Rate for Payer: Adventist Health Commercial |
$16.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.48
|
| Rate for Payer: Blue Shield of California Commercial |
$49.40
|
| Rate for Payer: Blue Shield of California EPN |
$32.26
|
| Rate for Payer: Cash Price |
$44.47
|
| Rate for Payer: Central Health Plan Commercial |
$64.68
|
| Rate for Payer: Cigna of CA HMO |
$56.59
|
| Rate for Payer: Cigna of CA PPO |
$56.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$68.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.34
|
| Rate for Payer: EPIC Health Plan Senior |
$32.34
|
| Rate for Payer: Galaxy Health WC |
$68.72
|
| Rate for Payer: Global Benefits Group Commercial |
$48.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.77
|
| Rate for Payer: InnovAge PACE Commercial |
$40.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$56.59
|
| Rate for Payer: Multiplan Commercial |
$60.64
|
| Rate for Payer: Networks By Design Commercial |
$52.55
|
| Rate for Payer: Prime Health Services Commercial |
$68.72
|
| Rate for Payer: Riverside University Health System MISP |
$32.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.42
|
| Rate for Payer: United Healthcare All Other HMO |
$40.42
|
| Rate for Payer: United Healthcare HMO Rider |
$40.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$40.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.72
|
| Rate for Payer: Vantage Medical Group Senior |
$68.72
|
|
|
PHYTONADIONE (VITAMIN K1) 5 MG TABLET [11024]
|
Facility
|
OP
|
$80.85
|
|
|
Service Code
|
NDC 60687-381-94
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.17 |
| Max. Negotiated Rate |
$72.77 |
| Rate for Payer: Adventist Health Commercial |
$16.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.48
|
| Rate for Payer: Blue Shield of California Commercial |
$49.40
|
| Rate for Payer: Blue Shield of California EPN |
$32.26
|
| Rate for Payer: Cash Price |
$44.47
|
| Rate for Payer: Central Health Plan Commercial |
$64.68
|
| Rate for Payer: Cigna of CA HMO |
$56.59
|
| Rate for Payer: Cigna of CA PPO |
$56.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$68.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.34
|
| Rate for Payer: EPIC Health Plan Senior |
$32.34
|
| Rate for Payer: Galaxy Health WC |
$68.72
|
| Rate for Payer: Global Benefits Group Commercial |
$48.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.77
|
| Rate for Payer: InnovAge PACE Commercial |
$40.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$56.59
|
| Rate for Payer: Multiplan Commercial |
$60.64
|
| Rate for Payer: Networks By Design Commercial |
$52.55
|
| Rate for Payer: Prime Health Services Commercial |
$68.72
|
| Rate for Payer: Riverside University Health System MISP |
$32.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.42
|
| Rate for Payer: United Healthcare All Other HMO |
$40.42
|
| Rate for Payer: United Healthcare HMO Rider |
$40.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$40.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.72
|
| Rate for Payer: Vantage Medical Group Senior |
$68.72
|
|
|
PHYTONADIONE (VITAMIN K1) 5 MG TABLET [11024]
|
Facility
|
OP
|
$33.76
|
|
|
Service Code
|
NDC 70710-1014-3
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$30.38 |
| Rate for Payer: Adventist Health Commercial |
$6.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.83
|
| Rate for Payer: Blue Shield of California Commercial |
$20.63
|
| Rate for Payer: Blue Shield of California EPN |
$13.47
|
| Rate for Payer: Cash Price |
$18.57
|
| Rate for Payer: Central Health Plan Commercial |
$27.01
|
| Rate for Payer: Cigna of CA HMO |
$23.63
|
| Rate for Payer: Cigna of CA PPO |
$23.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.50
|
| Rate for Payer: EPIC Health Plan Senior |
$13.50
|
| Rate for Payer: Galaxy Health WC |
$28.70
|
| Rate for Payer: Global Benefits Group Commercial |
$20.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.38
|
| Rate for Payer: InnovAge PACE Commercial |
$16.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.63
|
| Rate for Payer: Multiplan Commercial |
$25.32
|
| Rate for Payer: Networks By Design Commercial |
$21.94
|
| Rate for Payer: Prime Health Services Commercial |
$28.70
|
| Rate for Payer: Riverside University Health System MISP |
$13.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.88
|
| Rate for Payer: United Healthcare All Other HMO |
$16.88
|
| Rate for Payer: United Healthcare HMO Rider |
$16.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.70
|
| Rate for Payer: Vantage Medical Group Senior |
$28.70
|
|
