|
ELTROMBOPAG OLAMINE 50 MG TABLET [94580]
|
Facility
|
IP
|
$566.53
|
|
|
Service Code
|
NDC 0078068615
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$113.31 |
| Max. Negotiated Rate |
$509.88 |
| Rate for Payer: Adventist Health Commercial |
$113.31
|
| Rate for Payer: Blue Shield of California Commercial |
$454.36
|
| Rate for Payer: Blue Shield of California EPN |
$285.53
|
| Rate for Payer: Cash Price |
$254.94
|
| Rate for Payer: Central Health Plan Commercial |
$453.22
|
| Rate for Payer: Cigna of CA HMO |
$396.57
|
| Rate for Payer: Cigna of CA PPO |
$396.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$396.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.61
|
| Rate for Payer: EPIC Health Plan Senior |
$226.61
|
| Rate for Payer: Galaxy Health WC |
$481.55
|
| Rate for Payer: Global Benefits Group Commercial |
$339.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$509.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$359.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$334.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.31
|
| Rate for Payer: Multiplan Commercial |
$424.90
|
| Rate for Payer: Networks By Design Commercial |
$368.24
|
| Rate for Payer: Prime Health Services Commercial |
$481.55
|
|
|
ELTROMBOPAG OLAMINE 50 MG TABLET [94580]
|
Facility
|
OP
|
$566.53
|
|
|
Service Code
|
NDC 0078068615
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$113.31 |
| Max. Negotiated Rate |
$509.88 |
| Rate for Payer: Adventist Health Commercial |
$113.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$344.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$481.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$311.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$424.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$274.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$329.55
|
| Rate for Payer: Blue Shield of California Commercial |
$359.18
|
| Rate for Payer: Blue Shield of California EPN |
$226.05
|
| Rate for Payer: Cash Price |
$254.94
|
| Rate for Payer: Central Health Plan Commercial |
$453.22
|
| Rate for Payer: Cigna of CA HMO |
$396.57
|
| Rate for Payer: Cigna of CA PPO |
$396.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$481.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$481.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$481.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$396.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.61
|
| Rate for Payer: EPIC Health Plan Senior |
$226.61
|
| Rate for Payer: Galaxy Health WC |
$481.55
|
| Rate for Payer: Global Benefits Group Commercial |
$339.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$509.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$359.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$205.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$334.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$396.57
|
| Rate for Payer: Multiplan Commercial |
$424.90
|
| Rate for Payer: Networks By Design Commercial |
$368.24
|
| Rate for Payer: Prime Health Services Commercial |
$481.55
|
| Rate for Payer: Riverside University Health System MISP |
$226.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$339.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$339.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$283.26
|
| Rate for Payer: United Healthcare All Other HMO |
$283.26
|
| Rate for Payer: United Healthcare HMO Rider |
$283.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$283.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$481.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$481.55
|
| Rate for Payer: Vantage Medical Group Senior |
$481.55
|
|
|
EMAPALUMAB-LZSG 5 MG/ML INTRAVENOUS SOLUTION [223872]
|
Facility
|
IP
|
$2,226.60
|
|
|
Service Code
|
HCPCS J9210
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$445.32 |
| Max. Negotiated Rate |
$2,003.94 |
| Rate for Payer: Adventist Health Commercial |
$445.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1,785.73
|
| Rate for Payer: Blue Shield of California EPN |
$1,122.21
|
| Rate for Payer: Cash Price |
$1,001.97
|
| Rate for Payer: Central Health Plan Commercial |
$1,781.28
|
| Rate for Payer: Cigna of CA HMO |
$1,558.62
|
| Rate for Payer: Cigna of CA PPO |
$1,558.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,558.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$890.64
|
| Rate for Payer: EPIC Health Plan Senior |
$890.64
|
| Rate for Payer: Galaxy Health WC |
$1,892.61
|
| Rate for Payer: Global Benefits Group Commercial |
$1,335.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,003.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,413.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,313.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$445.32
|
| Rate for Payer: Multiplan Commercial |
$1,669.95
|
| Rate for Payer: Networks By Design Commercial |
$1,113.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,892.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$835.64
|
| Rate for Payer: United Healthcare All Other HMO |
$813.38
|
| Rate for Payer: United Healthcare HMO Rider |
$795.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$729.21
|
|
|
EMAPALUMAB-LZSG 5 MG/ML INTRAVENOUS SOLUTION [223872]
|
Facility
|
OP
|
$2,226.60
|
|
|
Service Code
|
HCPCS J9210
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$392.78 |
| Max. Negotiated Rate |
$2,364.21 |
| Rate for Payer: Adventist Health Commercial |
$445.32
|
| Rate for Payer: Adventist Health Medi-Cal |
$392.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$589.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$432.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$668.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$834.04
|
| Rate for Payer: Blue Shield of California Commercial |
$445.76
|
| Rate for Payer: Blue Shield of California EPN |
$405.24
|
| Rate for Payer: Cash Price |
$1,001.97
|
| Rate for Payer: Cash Price |
$1,001.97
|
| Rate for Payer: Central Health Plan Commercial |
$1,781.28
|
| Rate for Payer: Cigna of CA HMO |
$1,558.62
|
| Rate for Payer: Cigna of CA PPO |
$1,558.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$490.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$432.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$432.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,558.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.09
|
| Rate for Payer: EPIC Health Plan Senior |
$432.06
|
| Rate for Payer: Galaxy Health WC |
$1,892.61
|
| Rate for Payer: Global Benefits Group Commercial |
$1,335.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,003.94
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$644.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$392.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,413.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$729.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$549.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$445.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$526.33
|
| Rate for Payer: Multiplan Commercial |
$1,669.95
|
| Rate for Payer: Networks By Design Commercial |
$1,113.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$392.78
|
| Rate for Payer: Prime Health Services Commercial |
$1,892.61
|
| Rate for Payer: Prime Health Services Medicare |
$416.35
|
| Rate for Payer: Riverside University Health System MISP |
$432.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,335.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,335.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$835.64
|
| Rate for Payer: United Healthcare All Other HMO |
$813.38
|
| Rate for Payer: United Healthcare HMO Rider |
$795.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$729.21
|
| Rate for Payer: Upland Medical Group Pediatric |
$392.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$490.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$432.06
|
| Rate for Payer: Vantage Medical Group Senior |
$432.06
|
|
|
EMICIZUMAB-KXWH 105 MG/0.7 ML SUBCUTANEOUS SOLUTION [220371]
|
Facility
|
OP
|
$22,742.13
|
|
|
Service Code
|
HCPCS J7170
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.03 |
| Max. Negotiated Rate |
$20,467.92 |
| Rate for Payer: Adventist Health Commercial |
$4,548.43
|
| Rate for Payer: Adventist Health Medi-Cal |
$58.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$322.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$63.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$98.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.46
|
| Rate for Payer: Blue Shield of California Commercial |
$73.89
|
| Rate for Payer: Blue Shield of California EPN |
$67.17
|
| Rate for Payer: Cash Price |
$10,233.96
|
| Rate for Payer: Cash Price |
$10,233.96
|
| Rate for Payer: Central Health Plan Commercial |
$18,193.70
|
| Rate for Payer: Cigna of CA HMO |
$15,919.49
|
| Rate for Payer: Cigna of CA PPO |
$15,919.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$63.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$63.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15,919.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.75
|
| Rate for Payer: EPIC Health Plan Senior |
$63.83
|
| Rate for Payer: Galaxy Health WC |
$19,330.81
|
| Rate for Payer: Global Benefits Group Commercial |
$13,645.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,467.92
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$95.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$58.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,441.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$115.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,548.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$77.76
|
| Rate for Payer: Multiplan Commercial |
$17,056.60
|
| Rate for Payer: Networks By Design Commercial |
$11,371.07
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$58.03
|
| Rate for Payer: Prime Health Services Commercial |
$19,330.81
|
| Rate for Payer: Prime Health Services Medicare |
$61.51
|
| Rate for Payer: Riverside University Health System MISP |
$63.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,645.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13,645.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,535.12
|
| Rate for Payer: United Healthcare All Other HMO |
$8,307.70
|
| Rate for Payer: United Healthcare HMO Rider |
$8,128.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,448.05
|
| Rate for Payer: Upland Medical Group Pediatric |
$58.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.83
|
| Rate for Payer: Vantage Medical Group Senior |
$63.83
|
|
|
EMICIZUMAB-KXWH 105 MG/0.7 ML SUBCUTANEOUS SOLUTION [220371]
|
Facility
|
IP
|
$22,742.13
|
|
|
Service Code
|
HCPCS J7170
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,548.43 |
| Max. Negotiated Rate |
$20,467.92 |
| Rate for Payer: Adventist Health Commercial |
$4,548.43
|
| Rate for Payer: Blue Shield of California Commercial |
$18,239.19
|
| Rate for Payer: Blue Shield of California EPN |
$11,462.03
|
| Rate for Payer: Cash Price |
$10,233.96
|
| Rate for Payer: Central Health Plan Commercial |
$18,193.70
|
| Rate for Payer: Cigna of CA HMO |
$15,919.49
|
| Rate for Payer: Cigna of CA PPO |
$15,919.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15,919.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,096.85
|
| Rate for Payer: EPIC Health Plan Senior |
$9,096.85
|
| Rate for Payer: Galaxy Health WC |
$19,330.81
|
| Rate for Payer: Global Benefits Group Commercial |
$13,645.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,467.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,441.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,417.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,548.43
|
| Rate for Payer: Multiplan Commercial |
$17,056.60
|
| Rate for Payer: Networks By Design Commercial |
$11,371.07
|
| Rate for Payer: Prime Health Services Commercial |
$19,330.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,535.12
|
| Rate for Payer: United Healthcare All Other HMO |
$8,307.70
|
| Rate for Payer: United Healthcare HMO Rider |
$8,128.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,448.05
|
|
|
EMOLLIENT COMBINATION NO.10 TOPICAL EMULSION [42944]
|
Facility
|
OP
|
$0.58
|
|
|
Service Code
|
NDC 5898096012
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Central Health Plan Commercial |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Senior |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: Networks By Design Commercial |
$0.38
|
| Rate for Payer: Prime Health Services Commercial |
$0.49
|
| Rate for Payer: Riverside University Health System MISP |
$0.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.29
|
| Rate for Payer: United Healthcare All Other HMO |
$0.29
|
| Rate for Payer: United Healthcare HMO Rider |
$0.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.49
|
| Rate for Payer: Vantage Medical Group Senior |
$0.49
|
|
|
EMOLLIENT COMBINATION NO.10 TOPICAL EMULSION [42944]
|
Facility
|
IP
|
$0.58
|
|
|
Service Code
|
NDC 5898096012
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.47
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Central Health Plan Commercial |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Senior |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: Networks By Design Commercial |
$0.38
|
| Rate for Payer: Prime Health Services Commercial |
$0.49
|
|
|
EMOLLIENT COMBINATION NO.69 TOPICAL CREAM [196535]
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 7214063378
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| 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 |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Riverside University Health System MISP |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
EMOLLIENT COMBINATION NO.69 TOPICAL CREAM [196535]
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 7214063378
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
EMOLLIENTS BAG BALM OINTMENT [4080770]
|
Facility
|
OP
|
$5.11
|
|
|
Service Code
|
NDC 9940877002
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Adventist Health Commercial |
$1.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.97
|
| Rate for Payer: Blue Shield of California Commercial |
$3.24
|
| Rate for Payer: Blue Shield of California EPN |
$2.04
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Central Health Plan Commercial |
$4.09
|
| Rate for Payer: Cigna of CA HMO |
$3.58
|
| Rate for Payer: Cigna of CA PPO |
$3.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.04
|
| Rate for Payer: EPIC Health Plan Senior |
$2.04
|
| Rate for Payer: Galaxy Health WC |
$4.34
|
| Rate for Payer: Global Benefits Group Commercial |
$3.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.58
|
| Rate for Payer: Multiplan Commercial |
$3.83
|
| Rate for Payer: Networks By Design Commercial |
$3.32
|
| Rate for Payer: Prime Health Services Commercial |
$4.34
|
| Rate for Payer: Riverside University Health System MISP |
$2.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.56
|
| Rate for Payer: United Healthcare All Other HMO |
$2.56
|
| Rate for Payer: United Healthcare HMO Rider |
$2.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Vantage Medical Group Senior |
$4.34
|
|
|
EMOLLIENTS BAG BALM OINTMENT [4080770]
|
Facility
|
OP
|
$35.74
|
|
|
Service Code
|
NDC 9819300017
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$32.17 |
| Rate for Payer: Adventist Health Commercial |
$7.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.79
|
| Rate for Payer: Blue Shield of California Commercial |
$22.66
|
| Rate for Payer: Blue Shield of California EPN |
$14.26
|
| Rate for Payer: Cash Price |
$16.08
|
| Rate for Payer: Central Health Plan Commercial |
$28.59
|
| Rate for Payer: Cigna of CA HMO |
$25.02
|
| Rate for Payer: Cigna of CA PPO |
$25.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: EPIC Health Plan Senior |
$14.30
|
| Rate for Payer: Galaxy Health WC |
$30.38
|
| Rate for Payer: Global Benefits Group Commercial |
$21.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.02
|
| Rate for Payer: Multiplan Commercial |
$26.80
|
| Rate for Payer: Networks By Design Commercial |
$23.23
|
| Rate for Payer: Prime Health Services Commercial |
$30.38
|
| Rate for Payer: Riverside University Health System MISP |
$14.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.87
|
| Rate for Payer: United Healthcare All Other HMO |
$17.87
|
| Rate for Payer: United Healthcare HMO Rider |
$17.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.38
|
| Rate for Payer: Vantage Medical Group Senior |
$30.38
|
|
|
EMOLLIENTS BAG BALM OINTMENT [4080770]
|
Facility
|
OP
|
$4.73
|
|
|
Service Code
|
NDC 9819300005
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$4.26 |
| Rate for Payer: Adventist Health Commercial |
$0.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.75
|
| Rate for Payer: Blue Shield of California Commercial |
$3.00
|
| Rate for Payer: Blue Shield of California EPN |
$1.89
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Central Health Plan Commercial |
$3.78
|
| Rate for Payer: Cigna of CA HMO |
$3.31
|
| Rate for Payer: Cigna of CA PPO |
$3.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.89
|
| Rate for Payer: EPIC Health Plan Senior |
$1.89
|
| Rate for Payer: Galaxy Health WC |
$4.02
|
| Rate for Payer: Global Benefits Group Commercial |
$2.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.31
|
| Rate for Payer: Multiplan Commercial |
$3.55
|
| Rate for Payer: Networks By Design Commercial |
$3.07
|
| Rate for Payer: Prime Health Services Commercial |
$4.02
|
| Rate for Payer: Riverside University Health System MISP |
$1.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.37
|
| Rate for Payer: United Healthcare All Other HMO |
$2.37
|
| Rate for Payer: United Healthcare HMO Rider |
$2.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.02
|
| Rate for Payer: Vantage Medical Group Senior |
$4.02
|
|
|
EMOLLIENTS BAG BALM OINTMENT [4080770]
|
Facility
|
IP
|
$4.73
|
|
|
Service Code
|
NDC 9819300005
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$4.26 |
| Rate for Payer: Adventist Health Commercial |
$0.95
|
| Rate for Payer: Blue Shield of California Commercial |
$3.79
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Central Health Plan Commercial |
$3.78
|
| Rate for Payer: Cigna of CA HMO |
$3.31
|
| Rate for Payer: Cigna of CA PPO |
$3.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.89
|
| Rate for Payer: EPIC Health Plan Senior |
$1.89
|
| Rate for Payer: Galaxy Health WC |
$4.02
|
| Rate for Payer: Global Benefits Group Commercial |
$2.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Multiplan Commercial |
$3.55
|
| Rate for Payer: Networks By Design Commercial |
$3.07
|
| Rate for Payer: Prime Health Services Commercial |
$4.02
|
|
|
EMOLLIENTS BAG BALM OINTMENT [4080770]
|
Facility
|
IP
|
$3.36
|
|
|
Service Code
|
NDC 9994080770
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Adventist Health Commercial |
$0.67
|
| Rate for Payer: Blue Shield of California Commercial |
$2.69
|
| Rate for Payer: Blue Shield of California EPN |
$1.69
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Central Health Plan Commercial |
$2.69
|
| Rate for Payer: Cigna of CA HMO |
$2.35
|
| Rate for Payer: Cigna of CA PPO |
$2.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.34
|
| Rate for Payer: EPIC Health Plan Senior |
$1.34
|
| Rate for Payer: Galaxy Health WC |
$2.86
|
| Rate for Payer: Global Benefits Group Commercial |
$2.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.67
|
| Rate for Payer: Multiplan Commercial |
$2.52
|
| Rate for Payer: Networks By Design Commercial |
$2.18
|
| Rate for Payer: Prime Health Services Commercial |
$2.86
|
|
|
EMOLLIENTS BAG BALM OINTMENT [4080770]
|
Facility
|
OP
|
$3.36
|
|
|
Service Code
|
NDC 9994080770
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Adventist Health Commercial |
$0.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.95
|
| Rate for Payer: Blue Shield of California Commercial |
$2.13
|
| Rate for Payer: Blue Shield of California EPN |
$1.34
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Central Health Plan Commercial |
$2.69
|
| Rate for Payer: Cigna of CA HMO |
$2.35
|
| Rate for Payer: Cigna of CA PPO |
$2.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.34
|
| Rate for Payer: EPIC Health Plan Senior |
$1.34
|
| Rate for Payer: Galaxy Health WC |
$2.86
|
| Rate for Payer: Global Benefits Group Commercial |
$2.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.35
|
| Rate for Payer: Multiplan Commercial |
$2.52
|
| Rate for Payer: Networks By Design Commercial |
$2.18
|
| Rate for Payer: Prime Health Services Commercial |
$2.86
|
| Rate for Payer: Riverside University Health System MISP |
$1.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.68
|
| Rate for Payer: United Healthcare All Other HMO |
$1.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.86
|
| Rate for Payer: Vantage Medical Group Senior |
$2.86
|
|
|
EMOLLIENTS BAG BALM OINTMENT [4080770]
|
Facility
|
IP
|
$5.11
|
|
|
Service Code
|
NDC 9940877002
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Adventist Health Commercial |
$1.02
|
| Rate for Payer: Blue Shield of California Commercial |
$4.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.58
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Central Health Plan Commercial |
$4.09
|
| Rate for Payer: Cigna of CA HMO |
$3.58
|
| Rate for Payer: Cigna of CA PPO |
$3.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.04
|
| Rate for Payer: EPIC Health Plan Senior |
$2.04
|
| Rate for Payer: Galaxy Health WC |
$4.34
|
| Rate for Payer: Global Benefits Group Commercial |
$3.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: Multiplan Commercial |
$3.83
|
| Rate for Payer: Networks By Design Commercial |
$3.32
|
| Rate for Payer: Prime Health Services Commercial |
$4.34
|
|
|
EMOLLIENTS BAG BALM OINTMENT [4080770]
|
Facility
|
IP
|
$35.74
|
|
|
Service Code
|
NDC 9819300017
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$32.17 |
| Rate for Payer: Adventist Health Commercial |
$7.15
|
| Rate for Payer: Blue Shield of California Commercial |
$28.66
|
| Rate for Payer: Blue Shield of California EPN |
$18.01
|
| Rate for Payer: Cash Price |
$16.08
|
| Rate for Payer: Central Health Plan Commercial |
$28.59
|
| Rate for Payer: Cigna of CA HMO |
$25.02
|
| Rate for Payer: Cigna of CA PPO |
$25.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: EPIC Health Plan Senior |
$14.30
|
| Rate for Payer: Galaxy Health WC |
$30.38
|
| Rate for Payer: Global Benefits Group Commercial |
$21.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.15
|
| Rate for Payer: Multiplan Commercial |
$26.80
|
| Rate for Payer: Networks By Design Commercial |
$23.23
|
| Rate for Payer: Prime Health Services Commercial |
$30.38
|
|
|
EMTRICITABINE 200 MG CAPSULE [36252]
|
Facility
|
IP
|
$19.28
|
|
|
Service Code
|
NDC 6586230130
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$17.35 |
| Rate for Payer: Adventist Health Commercial |
$3.86
|
| Rate for Payer: Blue Shield of California Commercial |
$15.46
|
| Rate for Payer: Blue Shield of California EPN |
$9.72
|
| Rate for Payer: Cash Price |
$8.68
|
| Rate for Payer: Central Health Plan Commercial |
$15.42
|
| Rate for Payer: Cigna of CA HMO |
$13.50
|
| Rate for Payer: Cigna of CA PPO |
$13.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.71
|
| Rate for Payer: EPIC Health Plan Senior |
$7.71
|
| Rate for Payer: Galaxy Health WC |
$16.39
|
| Rate for Payer: Global Benefits Group Commercial |
$11.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.86
|
| Rate for Payer: Multiplan Commercial |
$14.46
|
| Rate for Payer: Networks By Design Commercial |
$12.53
|
| Rate for Payer: Prime Health Services Commercial |
$16.39
|
|
|
EMTRICITABINE 200 MG CAPSULE [36252]
|
Facility
|
OP
|
$18.54
|
|
|
Service Code
|
NDC 6909764202
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$16.69 |
| Rate for Payer: Adventist Health Commercial |
$3.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.78
|
| Rate for Payer: Blue Shield of California Commercial |
$11.75
|
| Rate for Payer: Blue Shield of California EPN |
$7.40
|
| Rate for Payer: Cash Price |
$8.34
|
| Rate for Payer: Central Health Plan Commercial |
$14.83
|
| Rate for Payer: Cigna of CA HMO |
$12.98
|
| Rate for Payer: Cigna of CA PPO |
$12.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.42
|
| Rate for Payer: EPIC Health Plan Senior |
$7.42
|
| Rate for Payer: Galaxy Health WC |
$15.76
|
| Rate for Payer: Global Benefits Group Commercial |
$11.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.98
|
| Rate for Payer: Multiplan Commercial |
$13.90
|
| Rate for Payer: Networks By Design Commercial |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$15.76
|
| Rate for Payer: Riverside University Health System MISP |
$7.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.27
|
| Rate for Payer: United Healthcare All Other HMO |
$9.27
|
| Rate for Payer: United Healthcare HMO Rider |
$9.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.76
|
| Rate for Payer: Vantage Medical Group Senior |
$15.76
|
|
|
EMTRICITABINE 200 MG CAPSULE [36252]
|
Facility
|
OP
|
$19.28
|
|
|
Service Code
|
NDC 6586230130
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$17.35 |
| Rate for Payer: Adventist Health Commercial |
$3.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.22
|
| Rate for Payer: Blue Shield of California Commercial |
$12.22
|
| Rate for Payer: Blue Shield of California EPN |
$7.69
|
| Rate for Payer: Cash Price |
$8.68
|
| Rate for Payer: Central Health Plan Commercial |
$15.42
|
| Rate for Payer: Cigna of CA HMO |
$13.50
|
| Rate for Payer: Cigna of CA PPO |
$13.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.71
|
| Rate for Payer: EPIC Health Plan Senior |
$7.71
|
| Rate for Payer: Galaxy Health WC |
$16.39
|
| Rate for Payer: Global Benefits Group Commercial |
$11.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.50
|
| Rate for Payer: Multiplan Commercial |
$14.46
|
| Rate for Payer: Networks By Design Commercial |
$12.53
|
| Rate for Payer: Prime Health Services Commercial |
$16.39
|
| Rate for Payer: Riverside University Health System MISP |
$7.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.64
|
| Rate for Payer: United Healthcare All Other HMO |
$9.64
|
| Rate for Payer: United Healthcare HMO Rider |
$9.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.39
|
| Rate for Payer: Vantage Medical Group Senior |
$16.39
|
|
|
EMTRICITABINE 200 MG CAPSULE [36252]
|
Facility
|
IP
|
$18.54
|
|
|
Service Code
|
NDC 6909764202
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$16.69 |
| Rate for Payer: Adventist Health Commercial |
$3.71
|
| Rate for Payer: Blue Shield of California Commercial |
$14.87
|
| Rate for Payer: Blue Shield of California EPN |
$9.34
|
| Rate for Payer: Cash Price |
$8.34
|
| Rate for Payer: Central Health Plan Commercial |
$14.83
|
| Rate for Payer: Cigna of CA HMO |
$12.98
|
| Rate for Payer: Cigna of CA PPO |
$12.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.42
|
| Rate for Payer: EPIC Health Plan Senior |
$7.42
|
| Rate for Payer: Galaxy Health WC |
$15.76
|
| Rate for Payer: Global Benefits Group Commercial |
$11.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.71
|
| Rate for Payer: Multiplan Commercial |
$13.90
|
| Rate for Payer: Networks By Design Commercial |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$15.76
|
|
|
EMTRICITABINE 200 MG-TENOFOVIR ALAFENAMIDE FUMARATE 25 MG TABLET [214124]
|
Facility
|
OP
|
$88.09
|
|
|
Service Code
|
NDC 6195820021
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.62 |
| Max. Negotiated Rate |
$79.28 |
| Rate for Payer: Adventist Health Commercial |
$17.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$66.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$42.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.24
|
| Rate for Payer: Blue Shield of California Commercial |
$55.85
|
| Rate for Payer: Blue Shield of California EPN |
$35.15
|
| Rate for Payer: Cash Price |
$39.64
|
| Rate for Payer: Central Health Plan Commercial |
$70.47
|
| Rate for Payer: Cigna of CA HMO |
$61.66
|
| Rate for Payer: Cigna of CA PPO |
$61.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$74.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.24
|
| Rate for Payer: EPIC Health Plan Senior |
$35.24
|
| Rate for Payer: Galaxy Health WC |
$74.88
|
| Rate for Payer: Global Benefits Group Commercial |
$52.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$61.66
|
| Rate for Payer: Multiplan Commercial |
$66.07
|
| Rate for Payer: Networks By Design Commercial |
$57.26
|
| Rate for Payer: Prime Health Services Commercial |
$74.88
|
| Rate for Payer: Riverside University Health System MISP |
$35.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$44.05
|
| Rate for Payer: United Healthcare All Other HMO |
$44.05
|
| Rate for Payer: United Healthcare HMO Rider |
$44.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.88
|
| Rate for Payer: Vantage Medical Group Senior |
$74.88
|
|
|
EMTRICITABINE 200 MG-TENOFOVIR ALAFENAMIDE FUMARATE 25 MG TABLET [214124]
|
Facility
|
IP
|
$88.09
|
|
|
Service Code
|
NDC 6195820021
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.62 |
| Max. Negotiated Rate |
$79.28 |
| Rate for Payer: Adventist Health Commercial |
$17.62
|
| Rate for Payer: Blue Shield of California Commercial |
$70.65
|
| Rate for Payer: Blue Shield of California EPN |
$44.40
|
| Rate for Payer: Cash Price |
$39.64
|
| Rate for Payer: Central Health Plan Commercial |
$70.47
|
| Rate for Payer: Cigna of CA HMO |
$61.66
|
| Rate for Payer: Cigna of CA PPO |
$61.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.24
|
| Rate for Payer: EPIC Health Plan Senior |
$35.24
|
| Rate for Payer: Galaxy Health WC |
$74.88
|
| Rate for Payer: Global Benefits Group Commercial |
$52.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.62
|
| Rate for Payer: Multiplan Commercial |
$66.07
|
| Rate for Payer: Networks By Design Commercial |
$57.26
|
| Rate for Payer: Prime Health Services Commercial |
$74.88
|
|
|
EMTRICITABINE 200 MG-TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [39255]
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
HCPCS J0750
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$7.92 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$0.45
|
| Rate for Payer: Adventist Health Medi-Cal |
$0.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.36
|
| Rate for Payer: Blue Shield of California Commercial |
$1.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1.32
|
| Rate for Payer: Blue Shield of California EPN |
$1.20
|
| Rate for Payer: Blue Shield of California EPN |
$1.20
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Central Health Plan Commercial |
$0.96
|
| Rate for Payer: Central Health Plan Commercial |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.74
|
| Rate for Payer: EPIC Health Plan Senior |
$0.50
|
| Rate for Payer: EPIC Health Plan Senior |
$0.50
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.08
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$0.74
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$0.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.60
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: Networks By Design Commercial |
$0.50
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$0.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$0.45
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
| Rate for Payer: Prime Health Services Medicare |
$0.48
|
| Rate for Payer: Prime Health Services Medicare |
$0.48
|
| Rate for Payer: Riverside University Health System MISP |
$0.50
|
| Rate for Payer: Riverside University Health System MISP |
$0.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.45
|
| Rate for Payer: United Healthcare All Other HMO |
$0.37
|
| Rate for Payer: United Healthcare All Other HMO |
$0.44
|
| Rate for Payer: United Healthcare HMO Rider |
$0.43
|
| Rate for Payer: United Healthcare HMO Rider |
$0.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.33
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.45
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: Vantage Medical Group Senior |
$0.50
|
| Rate for Payer: Vantage Medical Group Senior |
$0.50
|
|
