|
DABRAFENIB 50 MG CAPSULE [202199]
|
Facility
|
IP
|
$130.62
|
|
|
Service Code
|
NDC 0078068266
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$26.12 |
| Max. Negotiated Rate |
$117.56 |
| Rate for Payer: Adventist Health Commercial |
$26.12
|
| Rate for Payer: Blue Shield of California Commercial |
$104.76
|
| Rate for Payer: Blue Shield of California EPN |
$65.83
|
| Rate for Payer: Cash Price |
$58.78
|
| Rate for Payer: Central Health Plan Commercial |
$104.50
|
| Rate for Payer: Cigna of CA HMO |
$91.43
|
| Rate for Payer: Cigna of CA PPO |
$91.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$91.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.25
|
| Rate for Payer: EPIC Health Plan Senior |
$52.25
|
| Rate for Payer: Galaxy Health WC |
$111.03
|
| Rate for Payer: Global Benefits Group Commercial |
$78.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$117.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$82.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.12
|
| Rate for Payer: Multiplan Commercial |
$97.97
|
| Rate for Payer: Networks By Design Commercial |
$84.90
|
| Rate for Payer: Prime Health Services Commercial |
$111.03
|
|
|
DABRAFENIB 75 MG CAPSULE [202200]
|
Facility
|
IP
|
$168.34
|
|
|
Service Code
|
NDC 0078068166
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$33.67 |
| Max. Negotiated Rate |
$151.51 |
| Rate for Payer: Adventist Health Commercial |
$33.67
|
| Rate for Payer: Blue Shield of California Commercial |
$135.01
|
| Rate for Payer: Blue Shield of California EPN |
$84.84
|
| Rate for Payer: Cash Price |
$75.75
|
| Rate for Payer: Central Health Plan Commercial |
$134.67
|
| Rate for Payer: Cigna of CA HMO |
$117.84
|
| Rate for Payer: Cigna of CA PPO |
$117.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$117.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.34
|
| Rate for Payer: EPIC Health Plan Senior |
$67.34
|
| Rate for Payer: Galaxy Health WC |
$143.09
|
| Rate for Payer: Global Benefits Group Commercial |
$101.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$151.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$106.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$99.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.67
|
| Rate for Payer: Multiplan Commercial |
$126.25
|
| Rate for Payer: Networks By Design Commercial |
$109.42
|
| Rate for Payer: Prime Health Services Commercial |
$143.09
|
|
|
DABRAFENIB 75 MG CAPSULE [202200]
|
Facility
|
OP
|
$168.34
|
|
|
Service Code
|
NDC 0078068166
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$33.67 |
| Max. Negotiated Rate |
$151.51 |
| Rate for Payer: Adventist Health Commercial |
$33.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$102.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$143.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$92.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$126.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$81.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.92
|
| Rate for Payer: Blue Shield of California Commercial |
$106.73
|
| Rate for Payer: Blue Shield of California EPN |
$67.17
|
| Rate for Payer: Cash Price |
$75.75
|
| Rate for Payer: Central Health Plan Commercial |
$134.67
|
| Rate for Payer: Cigna of CA HMO |
$117.84
|
| Rate for Payer: Cigna of CA PPO |
$117.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$143.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$143.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$143.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$117.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.34
|
| Rate for Payer: EPIC Health Plan Senior |
$67.34
|
| Rate for Payer: Galaxy Health WC |
$143.09
|
| Rate for Payer: Global Benefits Group Commercial |
$101.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$151.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$106.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$61.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$99.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$117.84
|
| Rate for Payer: Multiplan Commercial |
$126.25
|
| Rate for Payer: Networks By Design Commercial |
$109.42
|
| Rate for Payer: Prime Health Services Commercial |
$143.09
|
| Rate for Payer: Riverside University Health System MISP |
$67.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$101.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$101.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$84.17
|
| Rate for Payer: United Healthcare All Other HMO |
$84.17
|
| Rate for Payer: United Healthcare HMO Rider |
$84.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$84.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$143.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$143.09
|
| Rate for Payer: Vantage Medical Group Senior |
$143.09
|
|
|
DACARBAZINE 100 MG INTRAVENOUS SOLUTION [2090]
|
Facility
|
IP
|
$14.87
|
|
|
Service Code
|
HCPCS J9130
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$13.38 |
| Rate for Payer: Adventist Health Commercial |
$2.97
|
| Rate for Payer: Blue Shield of California Commercial |
$11.93
|
| Rate for Payer: Blue Shield of California EPN |
$7.49
|
| Rate for Payer: Cash Price |
$6.69
|
| Rate for Payer: Central Health Plan Commercial |
$11.90
|
| Rate for Payer: Cigna of CA HMO |
$10.41
|
| Rate for Payer: Cigna of CA PPO |
$10.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.95
|
| Rate for Payer: EPIC Health Plan Senior |
$5.95
|
| Rate for Payer: Galaxy Health WC |
$12.64
|
| Rate for Payer: Global Benefits Group Commercial |
$8.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.97
|
| Rate for Payer: Multiplan Commercial |
$11.15
|
| Rate for Payer: Networks By Design Commercial |
$7.43
|
| Rate for Payer: Prime Health Services Commercial |
$12.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.58
|
| Rate for Payer: United Healthcare All Other HMO |
$5.43
|
| Rate for Payer: United Healthcare HMO Rider |
$5.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.87
|
|
|
DACARBAZINE 100 MG INTRAVENOUS SOLUTION [2090]
|
Facility
|
OP
|
$14.87
|
|
|
Service Code
|
HCPCS J9130
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$31.70 |
| Rate for Payer: Adventist Health Commercial |
$2.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.70
|
| Rate for Payer: Blue Shield of California Commercial |
$7.92
|
| Rate for Payer: Blue Shield of California EPN |
$7.20
|
| Rate for Payer: Cash Price |
$6.69
|
| Rate for Payer: Cash Price |
$6.69
|
| Rate for Payer: Central Health Plan Commercial |
$11.90
|
| Rate for Payer: Cigna of CA HMO |
$10.41
|
| Rate for Payer: Cigna of CA PPO |
$10.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.95
|
| Rate for Payer: EPIC Health Plan Senior |
$5.95
|
| Rate for Payer: Galaxy Health WC |
$12.64
|
| Rate for Payer: Global Benefits Group Commercial |
$8.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.41
|
| Rate for Payer: Multiplan Commercial |
$11.15
|
| Rate for Payer: Networks By Design Commercial |
$7.43
|
| Rate for Payer: Prime Health Services Commercial |
$12.64
|
| Rate for Payer: Riverside University Health System MISP |
$5.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.58
|
| Rate for Payer: United Healthcare All Other HMO |
$5.43
|
| Rate for Payer: United Healthcare HMO Rider |
$5.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.64
|
| Rate for Payer: Vantage Medical Group Senior |
$12.64
|
|
|
DACARBAZINE 200 MG INTRAVENOUS SOLUTION [2091]
|
Facility
|
IP
|
$14.40
|
|
|
Service Code
|
HCPCS J9130
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$12.96 |
| Rate for Payer: Adventist Health Commercial |
$2.88
|
| Rate for Payer: Blue Shield of California Commercial |
$11.55
|
| Rate for Payer: Blue Shield of California EPN |
$7.26
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Central Health Plan Commercial |
$11.52
|
| Rate for Payer: Cigna of CA HMO |
$10.08
|
| Rate for Payer: Cigna of CA PPO |
$10.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Senior |
$5.76
|
| Rate for Payer: Galaxy Health WC |
$12.24
|
| Rate for Payer: Global Benefits Group Commercial |
$8.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$10.80
|
| Rate for Payer: Networks By Design Commercial |
$7.20
|
| Rate for Payer: Prime Health Services Commercial |
$12.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.40
|
| Rate for Payer: United Healthcare All Other HMO |
$5.26
|
| Rate for Payer: United Healthcare HMO Rider |
$5.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.72
|
|
|
DACARBAZINE 200 MG INTRAVENOUS SOLUTION [2091]
|
Facility
|
OP
|
$14.40
|
|
|
Service Code
|
HCPCS J9130
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$31.70 |
| Rate for Payer: Adventist Health Commercial |
$2.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.70
|
| Rate for Payer: Blue Shield of California Commercial |
$7.92
|
| Rate for Payer: Blue Shield of California EPN |
$7.20
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Central Health Plan Commercial |
$11.52
|
| Rate for Payer: Cigna of CA HMO |
$10.08
|
| Rate for Payer: Cigna of CA PPO |
$10.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Senior |
$5.76
|
| Rate for Payer: Galaxy Health WC |
$12.24
|
| Rate for Payer: Global Benefits Group Commercial |
$8.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.08
|
| Rate for Payer: Multiplan Commercial |
$10.80
|
| Rate for Payer: Networks By Design Commercial |
$7.20
|
| Rate for Payer: Prime Health Services Commercial |
$12.24
|
| Rate for Payer: Riverside University Health System MISP |
$5.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.40
|
| Rate for Payer: United Healthcare All Other HMO |
$5.26
|
| Rate for Payer: United Healthcare HMO Rider |
$5.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.24
|
| Rate for Payer: Vantage Medical Group Senior |
$12.24
|
|
|
DACOMITINIB 15 MG TABLET [222938]
|
Facility
|
OP
|
$693.42
|
|
|
Service Code
|
NDC 0069019730
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$138.68 |
| Max. Negotiated Rate |
$624.08 |
| Rate for Payer: Adventist Health Commercial |
$138.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$421.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$589.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$381.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$520.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$335.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$403.36
|
| Rate for Payer: Blue Shield of California Commercial |
$439.63
|
| Rate for Payer: Blue Shield of California EPN |
$276.67
|
| Rate for Payer: Cash Price |
$312.04
|
| Rate for Payer: Central Health Plan Commercial |
$554.74
|
| Rate for Payer: Cigna of CA HMO |
$485.39
|
| Rate for Payer: Cigna of CA PPO |
$485.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$589.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$589.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$589.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$485.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$277.37
|
| Rate for Payer: EPIC Health Plan Senior |
$277.37
|
| Rate for Payer: Galaxy Health WC |
$589.41
|
| Rate for Payer: Global Benefits Group Commercial |
$416.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$624.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$440.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$251.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$409.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$485.39
|
| Rate for Payer: Multiplan Commercial |
$520.07
|
| Rate for Payer: Networks By Design Commercial |
$450.72
|
| Rate for Payer: Prime Health Services Commercial |
$589.41
|
| Rate for Payer: Riverside University Health System MISP |
$277.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$416.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$416.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$346.71
|
| Rate for Payer: United Healthcare All Other HMO |
$346.71
|
| Rate for Payer: United Healthcare HMO Rider |
$346.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$346.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$589.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$589.41
|
| Rate for Payer: Vantage Medical Group Senior |
$589.41
|
|
|
DACOMITINIB 15 MG TABLET [222938]
|
Facility
|
IP
|
$693.42
|
|
|
Service Code
|
NDC 0069019730
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$138.68 |
| Max. Negotiated Rate |
$624.08 |
| Rate for Payer: Adventist Health Commercial |
$138.68
|
| Rate for Payer: Blue Shield of California Commercial |
$556.12
|
| Rate for Payer: Blue Shield of California EPN |
$349.48
|
| Rate for Payer: Cash Price |
$312.04
|
| Rate for Payer: Central Health Plan Commercial |
$554.74
|
| Rate for Payer: Cigna of CA HMO |
$485.39
|
| Rate for Payer: Cigna of CA PPO |
$485.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$485.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$277.37
|
| Rate for Payer: EPIC Health Plan Senior |
$277.37
|
| Rate for Payer: Galaxy Health WC |
$589.41
|
| Rate for Payer: Global Benefits Group Commercial |
$416.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$624.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$440.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$409.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.68
|
| Rate for Payer: Multiplan Commercial |
$520.07
|
| Rate for Payer: Networks By Design Commercial |
$450.72
|
| Rate for Payer: Prime Health Services Commercial |
$589.41
|
|
|
DACOMITINIB 30 MG TABLET [222939]
|
Facility
|
OP
|
$693.42
|
|
|
Service Code
|
NDC 0069119830
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$138.68 |
| Max. Negotiated Rate |
$624.08 |
| Rate for Payer: Adventist Health Commercial |
$138.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$421.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$589.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$381.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$520.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$335.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$403.36
|
| Rate for Payer: Blue Shield of California Commercial |
$439.63
|
| Rate for Payer: Blue Shield of California EPN |
$276.67
|
| Rate for Payer: Cash Price |
$312.04
|
| Rate for Payer: Central Health Plan Commercial |
$554.74
|
| Rate for Payer: Cigna of CA HMO |
$485.39
|
| Rate for Payer: Cigna of CA PPO |
$485.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$589.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$589.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$589.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$485.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$277.37
|
| Rate for Payer: EPIC Health Plan Senior |
$277.37
|
| Rate for Payer: Galaxy Health WC |
$589.41
|
| Rate for Payer: Global Benefits Group Commercial |
$416.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$624.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$440.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$251.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$409.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$485.39
|
| Rate for Payer: Multiplan Commercial |
$520.07
|
| Rate for Payer: Networks By Design Commercial |
$450.72
|
| Rate for Payer: Prime Health Services Commercial |
$589.41
|
| Rate for Payer: Riverside University Health System MISP |
$277.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$416.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$416.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$346.71
|
| Rate for Payer: United Healthcare All Other HMO |
$346.71
|
| Rate for Payer: United Healthcare HMO Rider |
$346.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$346.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$589.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$589.41
|
| Rate for Payer: Vantage Medical Group Senior |
$589.41
|
|
|
DACOMITINIB 30 MG TABLET [222939]
|
Facility
|
IP
|
$693.42
|
|
|
Service Code
|
NDC 0069119830
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$138.68 |
| Max. Negotiated Rate |
$624.08 |
| Rate for Payer: Adventist Health Commercial |
$138.68
|
| Rate for Payer: Blue Shield of California Commercial |
$556.12
|
| Rate for Payer: Blue Shield of California EPN |
$349.48
|
| Rate for Payer: Cash Price |
$312.04
|
| Rate for Payer: Central Health Plan Commercial |
$554.74
|
| Rate for Payer: Cigna of CA HMO |
$485.39
|
| Rate for Payer: Cigna of CA PPO |
$485.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$485.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$277.37
|
| Rate for Payer: EPIC Health Plan Senior |
$277.37
|
| Rate for Payer: Galaxy Health WC |
$589.41
|
| Rate for Payer: Global Benefits Group Commercial |
$416.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$624.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$440.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$409.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.68
|
| Rate for Payer: Multiplan Commercial |
$520.07
|
| Rate for Payer: Networks By Design Commercial |
$450.72
|
| Rate for Payer: Prime Health Services Commercial |
$589.41
|
|
|
DACOMITINIB 45 MG TABLET [222940]
|
Facility
|
OP
|
$693.42
|
|
|
Service Code
|
NDC 0069229930
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$138.68 |
| Max. Negotiated Rate |
$624.08 |
| Rate for Payer: Adventist Health Commercial |
$138.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$421.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$589.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$381.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$520.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$335.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$403.36
|
| Rate for Payer: Blue Shield of California Commercial |
$439.63
|
| Rate for Payer: Blue Shield of California EPN |
$276.67
|
| Rate for Payer: Cash Price |
$312.04
|
| Rate for Payer: Central Health Plan Commercial |
$554.74
|
| Rate for Payer: Cigna of CA HMO |
$485.39
|
| Rate for Payer: Cigna of CA PPO |
$485.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$589.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$589.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$589.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$485.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$277.37
|
| Rate for Payer: EPIC Health Plan Senior |
$277.37
|
| Rate for Payer: Galaxy Health WC |
$589.41
|
| Rate for Payer: Global Benefits Group Commercial |
$416.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$624.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$440.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$251.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$409.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$485.39
|
| Rate for Payer: Multiplan Commercial |
$520.07
|
| Rate for Payer: Networks By Design Commercial |
$450.72
|
| Rate for Payer: Prime Health Services Commercial |
$589.41
|
| Rate for Payer: Riverside University Health System MISP |
$277.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$416.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$416.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$346.71
|
| Rate for Payer: United Healthcare All Other HMO |
$346.71
|
| Rate for Payer: United Healthcare HMO Rider |
$346.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$346.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$589.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$589.41
|
| Rate for Payer: Vantage Medical Group Senior |
$589.41
|
|
|
DACOMITINIB 45 MG TABLET [222940]
|
Facility
|
IP
|
$693.42
|
|
|
Service Code
|
NDC 0069229930
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$138.68 |
| Max. Negotiated Rate |
$624.08 |
| Rate for Payer: Adventist Health Commercial |
$138.68
|
| Rate for Payer: Blue Shield of California Commercial |
$556.12
|
| Rate for Payer: Blue Shield of California EPN |
$349.48
|
| Rate for Payer: Cash Price |
$312.04
|
| Rate for Payer: Central Health Plan Commercial |
$554.74
|
| Rate for Payer: Cigna of CA HMO |
$485.39
|
| Rate for Payer: Cigna of CA PPO |
$485.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$485.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$277.37
|
| Rate for Payer: EPIC Health Plan Senior |
$277.37
|
| Rate for Payer: Galaxy Health WC |
$589.41
|
| Rate for Payer: Global Benefits Group Commercial |
$416.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$624.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$440.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$409.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.68
|
| Rate for Payer: Multiplan Commercial |
$520.07
|
| Rate for Payer: Networks By Design Commercial |
$450.72
|
| Rate for Payer: Prime Health Services Commercial |
$589.41
|
|
|
DACRYOCYSTORHINOSTOMY (FISTULIZATION OF LACRIMAL SAC TO NASAL CAVITY)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 68720
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$900.33 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,056.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,584.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,562.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,056.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,634.30
|
| Rate for Payer: Blue Shield of California Commercial |
$6,228.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,584.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,562.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,056.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,343.11
|
| Rate for Payer: EPIC Health Plan Senior |
$5,562.07
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8,292.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$900.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,056.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$994.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,079.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,775.62
|
| Rate for Payer: Multiplan WC |
$7,634.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5,056.43
|
| Rate for Payer: Preferred Health Network WC |
$7,790.10
|
| Rate for Payer: Prime Health Services Medicare |
$5,359.82
|
| Rate for Payer: Prime Health Services WC |
$7,556.40
|
| Rate for Payer: Riverside University Health System MISP |
$5,562.07
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$5,056.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,584.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,562.07
|
| Rate for Payer: Vantage Medical Group Senior |
$5,056.43
|
|
|
DACTINOMYCIN 0.5 MG INTRAVENOUS SOLUTION [28912]
|
Facility
|
OP
|
$885.00
|
|
|
Service Code
|
HCPCS J9120
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.12 |
| Max. Negotiated Rate |
$973.50 |
| Rate for Payer: Adventist Health Commercial |
$177.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$307.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$568.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$461.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$338.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.09
|
| Rate for Payer: Blue Shield of California Commercial |
$973.50
|
| Rate for Payer: Blue Shield of California EPN |
$885.00
|
| Rate for Payer: Cash Price |
$398.25
|
| Rate for Payer: Cash Price |
$398.25
|
| Rate for Payer: Central Health Plan Commercial |
$708.00
|
| Rate for Payer: Cigna of CA HMO |
$619.50
|
| Rate for Payer: Cigna of CA PPO |
$619.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$384.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$338.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$338.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$619.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$507.23
|
| Rate for Payer: EPIC Health Plan Senior |
$338.15
|
| Rate for Payer: Galaxy Health WC |
$752.25
|
| Rate for Payer: Global Benefits Group Commercial |
$531.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$796.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$504.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$307.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$561.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$585.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$430.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.93
|
| Rate for Payer: Multiplan Commercial |
$663.75
|
| Rate for Payer: Networks By Design Commercial |
$442.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.41
|
| Rate for Payer: Prime Health Services Commercial |
$752.25
|
| Rate for Payer: Prime Health Services Medicare |
$325.85
|
| Rate for Payer: Riverside University Health System MISP |
$338.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$531.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$531.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$332.14
|
| Rate for Payer: United Healthcare All Other HMO |
$323.29
|
| Rate for Payer: United Healthcare HMO Rider |
$316.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$289.84
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$384.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$338.15
|
| Rate for Payer: Vantage Medical Group Senior |
$338.15
|
|
|
DACTINOMYCIN 0.5 MG INTRAVENOUS SOLUTION [28912]
|
Facility
|
IP
|
$885.00
|
|
|
Service Code
|
HCPCS J9120
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$177.00 |
| Max. Negotiated Rate |
$796.50 |
| Rate for Payer: Adventist Health Commercial |
$177.00
|
| Rate for Payer: Blue Shield of California Commercial |
$709.77
|
| Rate for Payer: Blue Shield of California EPN |
$446.04
|
| Rate for Payer: Cash Price |
$398.25
|
| Rate for Payer: Central Health Plan Commercial |
$708.00
|
| Rate for Payer: Cigna of CA HMO |
$619.50
|
| Rate for Payer: Cigna of CA PPO |
$619.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$619.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$354.00
|
| Rate for Payer: EPIC Health Plan Senior |
$354.00
|
| Rate for Payer: Galaxy Health WC |
$752.25
|
| Rate for Payer: Global Benefits Group Commercial |
$531.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$796.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$561.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$522.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.00
|
| Rate for Payer: Multiplan Commercial |
$663.75
|
| Rate for Payer: Networks By Design Commercial |
$442.50
|
| Rate for Payer: Prime Health Services Commercial |
$752.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$332.14
|
| Rate for Payer: United Healthcare All Other HMO |
$323.29
|
| Rate for Payer: United Healthcare HMO Rider |
$316.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$289.84
|
|
|
DALBAVANCIN 500 MG INTRAVENOUS SOLUTION [206124]
|
Facility
|
OP
|
$2,134.96
|
|
|
Service Code
|
HCPCS J0875
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.29 |
| Max. Negotiated Rate |
$1,921.46 |
| Rate for Payer: Adventist Health Commercial |
$426.99
|
| Rate for Payer: Adventist Health Commercial |
$384.29
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.29
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$29.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$29.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.82
|
| Rate for Payer: Blue Shield of California Commercial |
$23.48
|
| Rate for Payer: Blue Shield of California Commercial |
$23.48
|
| Rate for Payer: Blue Shield of California EPN |
$21.35
|
| Rate for Payer: Blue Shield of California EPN |
$21.35
|
| Rate for Payer: Cash Price |
$960.73
|
| Rate for Payer: Cash Price |
$864.66
|
| Rate for Payer: Cash Price |
$864.66
|
| Rate for Payer: Cash Price |
$960.73
|
| Rate for Payer: Central Health Plan Commercial |
$1,707.97
|
| Rate for Payer: Central Health Plan Commercial |
$1,537.17
|
| Rate for Payer: Cigna of CA HMO |
$1,494.47
|
| Rate for Payer: Cigna of CA HMO |
$1,345.02
|
| Rate for Payer: Cigna of CA PPO |
$1,494.47
|
| Rate for Payer: Cigna of CA PPO |
$1,345.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,345.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,494.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.63
|
| Rate for Payer: EPIC Health Plan Senior |
$12.42
|
| Rate for Payer: EPIC Health Plan Senior |
$12.42
|
| Rate for Payer: Galaxy Health WC |
$1,633.24
|
| Rate for Payer: Galaxy Health WC |
$1,814.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1,280.98
|
| Rate for Payer: Global Benefits Group Commercial |
$1,152.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,729.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,921.46
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.52
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,220.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,355.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$426.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.13
|
| Rate for Payer: Multiplan Commercial |
$1,441.10
|
| Rate for Payer: Multiplan Commercial |
$1,601.22
|
| Rate for Payer: Networks By Design Commercial |
$960.73
|
| Rate for Payer: Networks By Design Commercial |
$1,067.48
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.29
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.29
|
| Rate for Payer: Prime Health Services Commercial |
$1,633.24
|
| Rate for Payer: Prime Health Services Commercial |
$1,814.72
|
| Rate for Payer: Prime Health Services Medicare |
$11.97
|
| Rate for Payer: Prime Health Services Medicare |
$11.97
|
| Rate for Payer: Riverside University Health System MISP |
$12.42
|
| Rate for Payer: Riverside University Health System MISP |
$12.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,152.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,280.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,280.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,152.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$721.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$801.25
|
| Rate for Payer: United Healthcare All Other HMO |
$701.91
|
| Rate for Payer: United Healthcare All Other HMO |
$779.90
|
| Rate for Payer: United Healthcare HMO Rider |
$763.03
|
| Rate for Payer: United Healthcare HMO Rider |
$686.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$699.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$629.28
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.29
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.42
|
| Rate for Payer: Vantage Medical Group Senior |
$12.42
|
| Rate for Payer: Vantage Medical Group Senior |
$12.42
|
|
|
DALBAVANCIN 500 MG INTRAVENOUS SOLUTION [206124]
|
Facility
|
IP
|
$2,134.96
|
|
|
Service Code
|
HCPCS J0875
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$426.99 |
| Max. Negotiated Rate |
$1,921.46 |
| Rate for Payer: Adventist Health Commercial |
$426.99
|
| Rate for Payer: Adventist Health Commercial |
$384.29
|
| Rate for Payer: Blue Shield of California Commercial |
$1,712.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1,541.01
|
| Rate for Payer: Blue Shield of California EPN |
$968.42
|
| Rate for Payer: Blue Shield of California EPN |
$1,076.02
|
| Rate for Payer: Cash Price |
$960.73
|
| Rate for Payer: Cash Price |
$864.66
|
| Rate for Payer: Central Health Plan Commercial |
$1,707.97
|
| Rate for Payer: Central Health Plan Commercial |
$1,537.17
|
| Rate for Payer: Cigna of CA HMO |
$1,345.02
|
| Rate for Payer: Cigna of CA HMO |
$1,494.47
|
| Rate for Payer: Cigna of CA PPO |
$1,345.02
|
| Rate for Payer: Cigna of CA PPO |
$1,494.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,345.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,494.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$768.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$853.98
|
| Rate for Payer: EPIC Health Plan Senior |
$768.58
|
| Rate for Payer: EPIC Health Plan Senior |
$853.98
|
| Rate for Payer: Galaxy Health WC |
$1,814.72
|
| Rate for Payer: Galaxy Health WC |
$1,633.24
|
| Rate for Payer: Global Benefits Group Commercial |
$1,152.88
|
| Rate for Payer: Global Benefits Group Commercial |
$1,280.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,729.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,921.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,355.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,220.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,133.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,259.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$426.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.29
|
| Rate for Payer: Multiplan Commercial |
$1,441.10
|
| Rate for Payer: Multiplan Commercial |
$1,601.22
|
| Rate for Payer: Networks By Design Commercial |
$960.73
|
| Rate for Payer: Networks By Design Commercial |
$1,067.48
|
| Rate for Payer: Prime Health Services Commercial |
$1,814.72
|
| Rate for Payer: Prime Health Services Commercial |
$1,633.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$721.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$801.25
|
| Rate for Payer: United Healthcare All Other HMO |
$779.90
|
| Rate for Payer: United Healthcare All Other HMO |
$701.91
|
| Rate for Payer: United Healthcare HMO Rider |
$686.73
|
| Rate for Payer: United Healthcare HMO Rider |
$763.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$629.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$699.20
|
|
|
DANAZOL 200 MG CAPSULE [2120]
|
Facility
|
OP
|
$8.64
|
|
|
Service Code
|
NDC 0527136906
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$7.78 |
| Rate for Payer: Adventist Health Commercial |
$1.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.03
|
| Rate for Payer: Blue Shield of California Commercial |
$5.48
|
| Rate for Payer: Blue Shield of California EPN |
$3.45
|
| Rate for Payer: Cash Price |
$3.89
|
| Rate for Payer: Central Health Plan Commercial |
$6.91
|
| Rate for Payer: Cigna of CA HMO |
$6.05
|
| Rate for Payer: Cigna of CA PPO |
$6.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.46
|
| Rate for Payer: EPIC Health Plan Senior |
$3.46
|
| Rate for Payer: Galaxy Health WC |
$7.34
|
| Rate for Payer: Global Benefits Group Commercial |
$5.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.05
|
| Rate for Payer: Multiplan Commercial |
$6.48
|
| Rate for Payer: Networks By Design Commercial |
$5.62
|
| Rate for Payer: Prime Health Services Commercial |
$7.34
|
| Rate for Payer: Riverside University Health System MISP |
$3.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.32
|
| Rate for Payer: United Healthcare All Other HMO |
$4.32
|
| Rate for Payer: United Healthcare HMO Rider |
$4.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.34
|
| Rate for Payer: Vantage Medical Group Senior |
$7.34
|
|
|
DANAZOL 200 MG CAPSULE [2120]
|
Facility
|
IP
|
$8.64
|
|
|
Service Code
|
NDC 0527136906
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$7.78 |
| Rate for Payer: Adventist Health Commercial |
$1.73
|
| Rate for Payer: Blue Shield of California Commercial |
$6.93
|
| Rate for Payer: Blue Shield of California EPN |
$4.35
|
| Rate for Payer: Cash Price |
$3.89
|
| Rate for Payer: Central Health Plan Commercial |
$6.91
|
| Rate for Payer: Cigna of CA HMO |
$6.05
|
| Rate for Payer: Cigna of CA PPO |
$6.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.46
|
| Rate for Payer: EPIC Health Plan Senior |
$3.46
|
| Rate for Payer: Galaxy Health WC |
$7.34
|
| Rate for Payer: Global Benefits Group Commercial |
$5.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: Multiplan Commercial |
$6.48
|
| Rate for Payer: Networks By Design Commercial |
$5.62
|
| Rate for Payer: Prime Health Services Commercial |
$7.34
|
|
|
DANAZOL 200 MG CAPSULE [2120]
|
Facility
|
OP
|
$7.61
|
|
|
Service Code
|
NDC 0527136901
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$6.85 |
| Rate for Payer: Adventist Health Commercial |
$1.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.43
|
| Rate for Payer: Blue Shield of California Commercial |
$4.82
|
| Rate for Payer: Blue Shield of California EPN |
$3.04
|
| Rate for Payer: Cash Price |
$3.42
|
| Rate for Payer: Central Health Plan Commercial |
$6.09
|
| Rate for Payer: Cigna of CA HMO |
$5.33
|
| Rate for Payer: Cigna of CA PPO |
$5.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.04
|
| Rate for Payer: EPIC Health Plan Senior |
$3.04
|
| Rate for Payer: Galaxy Health WC |
$6.47
|
| Rate for Payer: Global Benefits Group Commercial |
$4.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.33
|
| Rate for Payer: Multiplan Commercial |
$5.71
|
| Rate for Payer: Networks By Design Commercial |
$4.95
|
| Rate for Payer: Prime Health Services Commercial |
$6.47
|
| Rate for Payer: Riverside University Health System MISP |
$3.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.81
|
| Rate for Payer: United Healthcare All Other HMO |
$3.81
|
| Rate for Payer: United Healthcare HMO Rider |
$3.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.47
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
DANAZOL 200 MG CAPSULE [2120]
|
Facility
|
IP
|
$7.61
|
|
|
Service Code
|
NDC 0527136901
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$6.85 |
| Rate for Payer: Adventist Health Commercial |
$1.52
|
| Rate for Payer: Blue Shield of California Commercial |
$6.10
|
| Rate for Payer: Blue Shield of California EPN |
$3.84
|
| Rate for Payer: Cash Price |
$3.42
|
| Rate for Payer: Central Health Plan Commercial |
$6.09
|
| Rate for Payer: Cigna of CA HMO |
$5.33
|
| Rate for Payer: Cigna of CA PPO |
$5.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.04
|
| Rate for Payer: EPIC Health Plan Senior |
$3.04
|
| Rate for Payer: Galaxy Health WC |
$6.47
|
| Rate for Payer: Global Benefits Group Commercial |
$4.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.52
|
| Rate for Payer: Multiplan Commercial |
$5.71
|
| Rate for Payer: Networks By Design Commercial |
$4.95
|
| Rate for Payer: Prime Health Services Commercial |
$6.47
|
|
|
DANTROLENE 100 MG CAPSULE [9717]
|
Facility
|
IP
|
$1.58
|
|
|
Service Code
|
NDC 4988436401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.42 |
| Rate for Payer: Adventist Health Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.80
|
| Rate for Payer: Cash Price |
$0.71
|
| Rate for Payer: Central Health Plan Commercial |
$1.26
|
| Rate for Payer: Cigna of CA HMO |
$1.11
|
| Rate for Payer: Cigna of CA PPO |
$1.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.63
|
| Rate for Payer: EPIC Health Plan Senior |
$0.63
|
| Rate for Payer: Galaxy Health WC |
$1.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$1.19
|
| Rate for Payer: Networks By Design Commercial |
$1.03
|
| Rate for Payer: Prime Health Services Commercial |
$1.34
|
|
|
DANTROLENE 100 MG CAPSULE [9717]
|
Facility
|
OP
|
$1.58
|
|
|
Service Code
|
NDC 4988436401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.42 |
| Rate for Payer: Adventist Health Commercial |
$0.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.92
|
| Rate for Payer: Blue Shield of California Commercial |
$1.00
|
| Rate for Payer: Blue Shield of California EPN |
$0.63
|
| Rate for Payer: Cash Price |
$0.71
|
| Rate for Payer: Central Health Plan Commercial |
$1.26
|
| Rate for Payer: Cigna of CA HMO |
$1.11
|
| Rate for Payer: Cigna of CA PPO |
$1.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.63
|
| Rate for Payer: EPIC Health Plan Senior |
$0.63
|
| Rate for Payer: Galaxy Health WC |
$1.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.11
|
| Rate for Payer: Multiplan Commercial |
$1.19
|
| Rate for Payer: Networks By Design Commercial |
$1.03
|
| Rate for Payer: Prime Health Services Commercial |
$1.34
|
| Rate for Payer: Riverside University Health System MISP |
$0.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.79
|
| Rate for Payer: United Healthcare All Other HMO |
$0.79
|
| Rate for Payer: United Healthcare HMO Rider |
$0.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1.34
|
|
|
DANTROLENE 100 MG CAPSULE [9717]
|
Facility
|
OP
|
$1.97
|
|
|
Service Code
|
NDC 0115443301
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.77 |
| Rate for Payer: Adventist Health Commercial |
$0.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.15
|
| Rate for Payer: Blue Shield of California Commercial |
$1.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.79
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Central Health Plan Commercial |
$1.58
|
| Rate for Payer: Cigna of CA HMO |
$1.38
|
| Rate for Payer: Cigna of CA PPO |
$1.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.79
|
| Rate for Payer: EPIC Health Plan Senior |
$0.79
|
| Rate for Payer: Galaxy Health WC |
$1.67
|
| Rate for Payer: Global Benefits Group Commercial |
$1.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.38
|
| Rate for Payer: Multiplan Commercial |
$1.48
|
| Rate for Payer: Networks By Design Commercial |
$1.28
|
| Rate for Payer: Prime Health Services Commercial |
$1.67
|
| Rate for Payer: Riverside University Health System MISP |
$0.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.99
|
| Rate for Payer: United Healthcare All Other HMO |
$0.99
|
| Rate for Payer: United Healthcare HMO Rider |
$0.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.67
|
| Rate for Payer: Vantage Medical Group Senior |
$1.67
|
|
