|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR [81426]
|
Facility
IP
|
$1.42
|
|
|
Service Code
|
NDC 50268-260-11
|
| Hospital Charge Code |
1711851
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.28 |
| Rate for Payer: Blue Shield of California Commercial |
$1.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.76
|
| Rate for Payer: Cash Price |
$0.64
|
| Rate for Payer: Central Health Plan Commercial |
$1.14
|
| Rate for Payer: Cigna of CA HMO |
$0.99
|
| Rate for Payer: Cigna of CA PPO |
$0.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.57
|
| Rate for Payer: Galaxy Health WC |
$1.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$1.06
|
| Rate for Payer: Networks By Design Commercial |
$0.92
|
| Rate for Payer: Prime Health Services Commercial |
$1.21
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR [81426]
|
Facility
IP
|
$2.98
|
|
|
Service Code
|
NDC 51079-767-08
|
| Hospital Charge Code |
1711851
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2.68 |
| Rate for Payer: Blue Shield of California Commercial |
$2.24
|
| Rate for Payer: Blue Shield of California EPN |
$1.59
|
| Rate for Payer: Cash Price |
$1.34
|
| Rate for Payer: Central Health Plan Commercial |
$2.38
|
| Rate for Payer: Cigna of CA HMO |
$2.09
|
| Rate for Payer: Cigna of CA PPO |
$2.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.19
|
| Rate for Payer: Galaxy Health WC |
$2.53
|
| Rate for Payer: Global Benefits Group Commercial |
$1.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.60
|
| Rate for Payer: Multiplan Commercial |
$2.24
|
| Rate for Payer: Networks By Design Commercial |
$1.94
|
| Rate for Payer: Prime Health Services Commercial |
$2.53
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR [81426]
|
Facility
IP
|
$0.29
|
|
|
Service Code
|
NDC 65862-595-01
|
| Hospital Charge Code |
1711851
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Central Health Plan Commercial |
$0.23
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.25
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.19
|
| Rate for Payer: Prime Health Services Commercial |
$0.25
|
|
|
DIVERTICULITIS AND DIVERTICULOSIS
|
Facility
IP
|
$12,214.40
|
|
|
Service Code
|
APR-DRG 2443
|
| Min. Negotiated Rate |
$10,249.85 |
| Max. Negotiated Rate |
$12,214.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$10,249.85
|
| Rate for Payer: IEHP medi-cal |
$12,214.40
|
|
|
DIVERTICULITIS AND DIVERTICULOSIS
|
Facility
IP
|
$6,182.62
|
|
|
Service Code
|
APR-DRG 2441
|
| Min. Negotiated Rate |
$5,188.21 |
| Max. Negotiated Rate |
$6,182.62 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,188.21
|
| Rate for Payer: IEHP medi-cal |
$6,182.62
|
|
|
DIVERTICULITIS AND DIVERTICULOSIS
|
Facility
IP
|
$8,077.98
|
|
|
Service Code
|
APR-DRG 2442
|
| Min. Negotiated Rate |
$6,778.73 |
| Max. Negotiated Rate |
$8,077.98 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,778.73
|
| Rate for Payer: IEHP medi-cal |
$8,077.98
|
|
|
DIVERTICULITIS AND DIVERTICULOSIS
|
Facility
IP
|
$20,906.37
|
|
|
Service Code
|
APR-DRG 2444
|
| Min. Negotiated Rate |
$17,543.81 |
| Max. Negotiated Rate |
$20,906.37 |
| Rate for Payer: Adventist Health Medi-Cal |
$17,543.81
|
| Rate for Payer: IEHP medi-cal |
$20,906.37
|
|
|
DOBUTAMINE 250 MG/20 ML (12.5 MG/ML) INTRAVENOUS SOLUTION [9892]
|
Facility
OP
|
$0.42
|
|
|
Service Code
|
CPT J1250
|
| Hospital Charge Code |
1757187
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$61.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$61.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.16
|
| Rate for Payer: BCBS Transplant Transplant |
$0.25
|
| Rate for Payer: Blue Shield of California Commercial |
$7.33
|
| Rate for Payer: Blue Shield of California EPN |
$6.66
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Central Health Plan Commercial |
$0.34
|
| Rate for Payer: Cigna of CA HMO |
$0.29
|
| Rate for Payer: Cigna of CA PPO |
$0.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.17
|
| Rate for Payer: Galaxy Health WC |
$0.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.38
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.32
|
| Rate for Payer: IEHP medi-cal |
$7.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.32
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.36
|
| Rate for Payer: Riverside University Health MISP |
$0.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.21
|
| Rate for Payer: United Healthcare All Other HMO |
$0.21
|
| Rate for Payer: United Healthcare HMO Rider |
$0.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: Vantage Medical Group Senior |
$0.36
|
|
|
DOBUTAMINE 250 MG/20 ML (12.5 MG/ML) INTRAVENOUS SOLUTION [9892]
|
Facility
IP
|
$0.42
|
|
|
Service Code
|
CPT J1250
|
| Hospital Charge Code |
1757187
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Central Health Plan Commercial |
$0.34
|
| Rate for Payer: Cigna of CA HMO |
$0.29
|
| Rate for Payer: Cigna of CA PPO |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.17
|
| Rate for Payer: Galaxy Health WC |
$0.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.32
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.36
|
|
|
DOBUTAMINE 250 MG/250 ML (1 MG/ML) IN 5 % DEXTROSE INTRAVENOUS [15981]
|
Facility
IP
|
$0.04
|
|
|
Service Code
|
CPT J1250
|
| Hospital Charge Code |
1759122
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
DOBUTAMINE 250 MG/250 ML (1 MG/ML) IN 5 % DEXTROSE INTRAVENOUS [15981]
|
Facility
OP
|
$0.04
|
|
|
Service Code
|
CPT J1250
|
| Hospital Charge Code |
1759122
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$61.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$61.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$61.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$61.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.16
|
| Rate for Payer: BCBS Transplant Transplant |
$0.02
|
| Rate for Payer: BCBS Transplant Transplant |
$0.07
|
| Rate for Payer: BCBS Transplant Transplant |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$7.33
|
| Rate for Payer: Blue Shield of California Commercial |
$7.33
|
| Rate for Payer: Blue Shield of California Commercial |
$7.33
|
| Rate for Payer: Blue Shield of California EPN |
$6.66
|
| Rate for Payer: Blue Shield of California EPN |
$6.66
|
| Rate for Payer: Blue Shield of California EPN |
$6.66
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.03
|
| Rate for Payer: Central Health Plan Commercial |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.08
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.06
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.03
|
| Rate for Payer: IEHP medi-cal |
$7.58
|
| Rate for Payer: IEHP medi-cal |
$7.58
|
| Rate for Payer: IEHP medi-cal |
$7.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Riverside University Health MISP |
$0.02
|
| Rate for Payer: Riverside University Health MISP |
$0.04
|
| Rate for Payer: Riverside University Health MISP |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
DOBUTAMINE 500 MG/250 ML (2,000 MCG/ML) IN 5 % DEXTROSE IV [18315]
|
Facility
IP
|
$0.19
|
|
|
Service Code
|
CPT J1250
|
| Hospital Charge Code |
1759123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.06
|
|
|
DOBUTAMINE 500 MG/250 ML (2,000 MCG/ML) IN 5 % DEXTROSE IV [18315]
|
Facility
OP
|
$0.07
|
|
|
Service Code
|
CPT J1250
|
| Hospital Charge Code |
1759123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$61.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$61.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$61.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.16
|
| Rate for Payer: BCBS Transplant Transplant |
$0.04
|
| Rate for Payer: BCBS Transplant Transplant |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$7.33
|
| Rate for Payer: Blue Shield of California Commercial |
$7.33
|
| Rate for Payer: Blue Shield of California EPN |
$6.66
|
| Rate for Payer: Blue Shield of California EPN |
$6.66
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.17
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.14
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.05
|
| Rate for Payer: IEHP medi-cal |
$7.58
|
| Rate for Payer: IEHP medi-cal |
$7.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.06
|
| Rate for Payer: Riverside University Health MISP |
$0.03
|
| Rate for Payer: Riverside University Health MISP |
$0.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Vantage Medical Group Senior |
$0.06
|
| Rate for Payer: Vantage Medical Group Senior |
$0.16
|
|
|
DOCETAXEL 160 MG/16 ML (10 MG/ML) INTRAVENOUS SOLUTION [108908]
|
Facility
IP
|
$43.09
|
|
|
Service Code
|
CPT J9171
|
| Hospital Charge Code |
NDG108908
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$38.78 |
| Rate for Payer: Blue Shield of California Commercial |
$32.32
|
| Rate for Payer: Blue Shield of California Commercial |
$18.00
|
| Rate for Payer: Blue Shield of California Commercial |
$15.36
|
| Rate for Payer: Blue Shield of California EPN |
$10.94
|
| Rate for Payer: Blue Shield of California EPN |
$23.01
|
| Rate for Payer: Blue Shield of California EPN |
$12.82
|
| Rate for Payer: Cash Price |
$19.39
|
| Rate for Payer: Cash Price |
$9.22
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Central Health Plan Commercial |
$34.47
|
| Rate for Payer: Central Health Plan Commercial |
$16.38
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Cigna of CA HMO |
$14.34
|
| Rate for Payer: Cigna of CA HMO |
$30.16
|
| Rate for Payer: Cigna of CA HMO |
$16.80
|
| Rate for Payer: Cigna of CA PPO |
$16.80
|
| Rate for Payer: Cigna of CA PPO |
$30.16
|
| Rate for Payer: Cigna of CA PPO |
$14.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.24
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Galaxy Health WC |
$36.63
|
| Rate for Payer: Galaxy Health WC |
$17.41
|
| Rate for Payer: Global Benefits Group Commercial |
$12.29
|
| Rate for Payer: Global Benefits Group Commercial |
$25.85
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.10
|
| Rate for Payer: Multiplan Commercial |
$32.32
|
| Rate for Payer: Multiplan Commercial |
$15.36
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$21.54
|
| Rate for Payer: Networks By Design Commercial |
$10.24
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Prime Health Services Commercial |
$36.63
|
| Rate for Payer: Prime Health Services Commercial |
$17.41
|
|
|
DOCETAXEL 160 MG/16 ML (10 MG/ML) INTRAVENOUS SOLUTION [108908]
|
Facility
OP
|
$24.00
|
|
|
Service Code
|
CPT J9171
|
| Hospital Charge Code |
NDG108908
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$41.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$36.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$23.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$23.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$38.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$38.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$38.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.99
|
| Rate for Payer: BCBS Transplant Transplant |
$25.85
|
| Rate for Payer: BCBS Transplant Transplant |
$12.29
|
| Rate for Payer: BCBS Transplant Transplant |
$14.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4.54
|
| Rate for Payer: Blue Shield of California Commercial |
$4.54
|
| Rate for Payer: Blue Shield of California Commercial |
$4.54
|
| Rate for Payer: Blue Shield of California EPN |
$4.13
|
| Rate for Payer: Blue Shield of California EPN |
$4.13
|
| Rate for Payer: Blue Shield of California EPN |
$4.13
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$19.39
|
| Rate for Payer: Cash Price |
$9.22
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$9.22
|
| Rate for Payer: Cash Price |
$19.39
|
| Rate for Payer: Central Health Plan Commercial |
$34.47
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Central Health Plan Commercial |
$16.38
|
| Rate for Payer: Cigna of CA HMO |
$16.80
|
| Rate for Payer: Cigna of CA HMO |
$14.34
|
| Rate for Payer: Cigna of CA HMO |
$30.16
|
| Rate for Payer: Cigna of CA PPO |
$30.16
|
| Rate for Payer: Cigna of CA PPO |
$14.34
|
| Rate for Payer: Cigna of CA PPO |
$16.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$36.63
|
| Rate for Payer: Galaxy Health WC |
$17.41
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$12.29
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Global Benefits Group Commercial |
$25.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.78
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$18.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$32.32
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15.36
|
| Rate for Payer: IEHP medi-cal |
$0.86
|
| Rate for Payer: IEHP medi-cal |
$0.86
|
| Rate for Payer: IEHP medi-cal |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.10
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$32.32
|
| Rate for Payer: Multiplan Commercial |
$15.36
|
| Rate for Payer: Networks By Design Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$10.24
|
| Rate for Payer: Networks By Design Commercial |
$21.54
|
| Rate for Payer: Prime Health Services Commercial |
$36.63
|
| Rate for Payer: Prime Health Services Commercial |
$17.41
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Riverside University Health MISP |
$9.60
|
| Rate for Payer: Riverside University Health MISP |
$17.24
|
| Rate for Payer: Riverside University Health MISP |
$8.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.24
|
| Rate for Payer: United Healthcare All Other HMO |
$12.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10.24
|
| Rate for Payer: United Healthcare All Other HMO |
$21.54
|
| Rate for Payer: United Healthcare HMO Rider |
$12.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10.24
|
| Rate for Payer: United Healthcare HMO Rider |
$21.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.41
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$17.41
|
| Rate for Payer: Vantage Medical Group Senior |
$36.63
|
|
|
DOCETAXEL 160 MG/8 ML (20 MG/ML) INTRAVENOUS SOLUTION [196796]
|
Facility
OP
|
$25.50
|
|
|
Service Code
|
CPT J9171
|
| Hospital Charge Code |
NDG196796
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$41.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$38.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.99
|
| Rate for Payer: BCBS Transplant Transplant |
$15.30
|
| Rate for Payer: Blue Shield of California Commercial |
$4.54
|
| Rate for Payer: Blue Shield of California EPN |
$4.13
|
| Rate for Payer: Cash Price |
$11.48
|
| Rate for Payer: Cash Price |
$11.48
|
| Rate for Payer: Central Health Plan Commercial |
$20.40
|
| Rate for Payer: Cigna of CA HMO |
$17.85
|
| Rate for Payer: Cigna of CA PPO |
$17.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.20
|
| Rate for Payer: Galaxy Health WC |
$21.68
|
| Rate for Payer: Global Benefits Group Commercial |
$15.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.95
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$19.12
|
| Rate for Payer: IEHP medi-cal |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.10
|
| Rate for Payer: Multiplan Commercial |
$19.12
|
| Rate for Payer: Networks By Design Commercial |
$12.75
|
| Rate for Payer: Prime Health Services Commercial |
$21.68
|
| Rate for Payer: Riverside University Health MISP |
$10.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.75
|
| Rate for Payer: United Healthcare All Other HMO |
$12.75
|
| Rate for Payer: United Healthcare HMO Rider |
$12.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.68
|
| Rate for Payer: Vantage Medical Group Senior |
$21.68
|
|
|
DOCETAXEL 160 MG/8 ML (20 MG/ML) INTRAVENOUS SOLUTION [196796]
|
Facility
IP
|
$25.50
|
|
|
Service Code
|
CPT J9171
|
| Hospital Charge Code |
NDG196796
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Blue Shield of California Commercial |
$19.12
|
| Rate for Payer: Blue Shield of California EPN |
$13.62
|
| Rate for Payer: Cash Price |
$11.48
|
| Rate for Payer: Central Health Plan Commercial |
$20.40
|
| Rate for Payer: Cigna of CA HMO |
$17.85
|
| Rate for Payer: Cigna of CA PPO |
$17.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.20
|
| Rate for Payer: Galaxy Health WC |
$21.68
|
| Rate for Payer: Global Benefits Group Commercial |
$15.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.10
|
| Rate for Payer: Multiplan Commercial |
$19.12
|
| Rate for Payer: Networks By Design Commercial |
$12.75
|
| Rate for Payer: Prime Health Services Commercial |
$21.68
|
|
|
DOCETAXEL 20 MG/2 ML (10 MG/ML) INTRAVENOUS SOLUTION [108910]
|
Facility
IP
|
$43.09
|
|
|
Service Code
|
CPT J9171
|
| Hospital Charge Code |
NDG108910
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$38.78 |
| Rate for Payer: Blue Shield of California Commercial |
$32.32
|
| Rate for Payer: Blue Shield of California EPN |
$23.01
|
| Rate for Payer: Cash Price |
$19.39
|
| Rate for Payer: Central Health Plan Commercial |
$34.47
|
| Rate for Payer: Cigna of CA HMO |
$30.16
|
| Rate for Payer: Cigna of CA PPO |
$30.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.24
|
| Rate for Payer: Galaxy Health WC |
$36.63
|
| Rate for Payer: Global Benefits Group Commercial |
$25.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.62
|
| Rate for Payer: Multiplan Commercial |
$32.32
|
| Rate for Payer: Networks By Design Commercial |
$21.54
|
| Rate for Payer: Prime Health Services Commercial |
$36.63
|
|
|
DOCETAXEL 20 MG/2 ML (10 MG/ML) INTRAVENOUS SOLUTION [108910]
|
Facility
OP
|
$43.09
|
|
|
Service Code
|
CPT J9171
|
| Hospital Charge Code |
NDG108910
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$41.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$36.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$23.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$23.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$38.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.99
|
| Rate for Payer: BCBS Transplant Transplant |
$25.85
|
| Rate for Payer: Blue Shield of California Commercial |
$4.54
|
| Rate for Payer: Blue Shield of California EPN |
$4.13
|
| Rate for Payer: Cash Price |
$19.39
|
| Rate for Payer: Cash Price |
$19.39
|
| Rate for Payer: Central Health Plan Commercial |
$34.47
|
| Rate for Payer: Cigna of CA HMO |
$30.16
|
| Rate for Payer: Cigna of CA PPO |
$30.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.24
|
| Rate for Payer: Galaxy Health WC |
$36.63
|
| Rate for Payer: Global Benefits Group Commercial |
$25.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.78
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$32.32
|
| Rate for Payer: IEHP medi-cal |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.62
|
| Rate for Payer: Multiplan Commercial |
$32.32
|
| Rate for Payer: Networks By Design Commercial |
$21.54
|
| Rate for Payer: Prime Health Services Commercial |
$36.63
|
| Rate for Payer: Riverside University Health MISP |
$17.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.54
|
| Rate for Payer: United Healthcare All Other HMO |
$21.54
|
| Rate for Payer: United Healthcare HMO Rider |
$21.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.63
|
| Rate for Payer: Vantage Medical Group Senior |
$36.63
|
|
|
DOCETAXEL 20 MG/ML (1 ML) INTRAVENOUS SOLUTION [106443]
|
Facility
IP
|
$30.00
|
|
|
Service Code
|
CPT J9171
|
| Hospital Charge Code |
1755764
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Blue Shield of California Commercial |
$22.50
|
| Rate for Payer: Blue Shield of California EPN |
$16.02
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: Cigna of CA HMO |
$21.00
|
| Rate for Payer: Cigna of CA PPO |
$21.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$15.00
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
|
|
DOCETAXEL 20 MG/ML (1 ML) INTRAVENOUS SOLUTION [106443]
|
Facility
OP
|
$30.00
|
|
|
Service Code
|
CPT J9171
|
| Hospital Charge Code |
1755764
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$41.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$38.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.99
|
| Rate for Payer: BCBS Transplant Transplant |
$18.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4.54
|
| Rate for Payer: Blue Shield of California EPN |
$4.13
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: Cigna of CA HMO |
$21.00
|
| Rate for Payer: Cigna of CA PPO |
$21.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$22.50
|
| Rate for Payer: IEHP medi-cal |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$15.00
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Riverside University Health MISP |
$12.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15.00
|
| Rate for Payer: United Healthcare HMO Rider |
$15.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.50
|
| Rate for Payer: Vantage Medical Group Senior |
$25.50
|
|
|
DOCETAXEL 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION [108122]
|
Facility
IP
|
$130.50
|
|
|
Service Code
|
CPT J9171
|
| Hospital Charge Code |
1755766
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.10 |
| Max. Negotiated Rate |
$117.45 |
| Rate for Payer: Blue Shield of California Commercial |
$97.88
|
| Rate for Payer: Blue Shield of California Commercial |
$19.12
|
| Rate for Payer: Blue Shield of California EPN |
$13.62
|
| Rate for Payer: Blue Shield of California EPN |
$69.69
|
| Rate for Payer: Cash Price |
$11.48
|
| Rate for Payer: Cash Price |
$58.73
|
| Rate for Payer: Central Health Plan Commercial |
$20.40
|
| Rate for Payer: Central Health Plan Commercial |
$104.40
|
| Rate for Payer: Cigna of CA HMO |
$91.35
|
| Rate for Payer: Cigna of CA HMO |
$17.85
|
| Rate for Payer: Cigna of CA PPO |
$17.85
|
| Rate for Payer: Cigna of CA PPO |
$91.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$52.20
|
| Rate for Payer: Galaxy Health WC |
$21.68
|
| Rate for Payer: Galaxy Health WC |
$110.92
|
| Rate for Payer: Global Benefits Group Commercial |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$78.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$117.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$87.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.10
|
| Rate for Payer: Multiplan Commercial |
$19.12
|
| Rate for Payer: Multiplan Commercial |
$97.88
|
| Rate for Payer: Networks By Design Commercial |
$65.25
|
| Rate for Payer: Networks By Design Commercial |
$12.75
|
| Rate for Payer: Prime Health Services Commercial |
$21.68
|
| Rate for Payer: Prime Health Services Commercial |
$110.92
|
|
|
DOCETAXEL 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION [108122]
|
Facility
OP
|
$130.50
|
|
|
Service Code
|
CPT J9171
|
| Hospital Charge Code |
1755766
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$117.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$110.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$71.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$71.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$38.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$38.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.99
|
| Rate for Payer: BCBS Transplant Transplant |
$15.30
|
| Rate for Payer: BCBS Transplant Transplant |
$78.30
|
| Rate for Payer: Blue Shield of California Commercial |
$4.54
|
| Rate for Payer: Blue Shield of California Commercial |
$4.54
|
| Rate for Payer: Blue Shield of California EPN |
$4.13
|
| Rate for Payer: Blue Shield of California EPN |
$4.13
|
| Rate for Payer: Cash Price |
$58.73
|
| Rate for Payer: Cash Price |
$11.48
|
| Rate for Payer: Cash Price |
$58.73
|
| Rate for Payer: Cash Price |
$11.48
|
| Rate for Payer: Central Health Plan Commercial |
$104.40
|
| Rate for Payer: Central Health Plan Commercial |
$20.40
|
| Rate for Payer: Cigna of CA HMO |
$17.85
|
| Rate for Payer: Cigna of CA HMO |
$91.35
|
| Rate for Payer: Cigna of CA PPO |
$17.85
|
| Rate for Payer: Cigna of CA PPO |
$91.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$110.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$52.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.20
|
| Rate for Payer: Galaxy Health WC |
$110.92
|
| Rate for Payer: Galaxy Health WC |
$21.68
|
| Rate for Payer: Global Benefits Group Commercial |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$78.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$117.45
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$97.88
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$19.12
|
| Rate for Payer: IEHP medi-cal |
$0.86
|
| Rate for Payer: IEHP medi-cal |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$87.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.10
|
| Rate for Payer: Multiplan Commercial |
$97.88
|
| Rate for Payer: Multiplan Commercial |
$19.12
|
| Rate for Payer: Networks By Design Commercial |
$65.25
|
| Rate for Payer: Networks By Design Commercial |
$12.75
|
| Rate for Payer: Prime Health Services Commercial |
$21.68
|
| Rate for Payer: Prime Health Services Commercial |
$110.92
|
| Rate for Payer: Riverside University Health MISP |
$52.20
|
| Rate for Payer: Riverside University Health MISP |
$10.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$78.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$78.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$65.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.75
|
| Rate for Payer: United Healthcare All Other HMO |
$12.75
|
| Rate for Payer: United Healthcare All Other HMO |
$65.25
|
| Rate for Payer: United Healthcare HMO Rider |
$65.25
|
| Rate for Payer: United Healthcare HMO Rider |
$12.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$110.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.68
|
| Rate for Payer: Vantage Medical Group Senior |
$110.92
|
| Rate for Payer: Vantage Medical Group Senior |
$21.68
|
|
|
DOCETAXEL 80 MG/8 ML (10 MG/ML) INTRAVENOUS SOLUTION [108907]
|
Facility
IP
|
$24.00
|
|
|
Service Code
|
CPT J9171
|
| Hospital Charge Code |
NDG108907
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Blue Shield of California Commercial |
$18.00
|
| Rate for Payer: Blue Shield of California Commercial |
$32.32
|
| Rate for Payer: Blue Shield of California EPN |
$23.01
|
| Rate for Payer: Blue Shield of California EPN |
$12.82
|
| Rate for Payer: Cash Price |
$19.39
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Central Health Plan Commercial |
$34.47
|
| Rate for Payer: Cigna of CA HMO |
$16.80
|
| Rate for Payer: Cigna of CA HMO |
$30.16
|
| Rate for Payer: Cigna of CA PPO |
$16.80
|
| Rate for Payer: Cigna of CA PPO |
$30.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$36.63
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Global Benefits Group Commercial |
$25.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.62
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$32.32
|
| Rate for Payer: Networks By Design Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$21.54
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Prime Health Services Commercial |
$36.63
|
|
|
DOCETAXEL 80 MG/8 ML (10 MG/ML) INTRAVENOUS SOLUTION [108907]
|
Facility
OP
|
$24.00
|
|
|
Service Code
|
CPT J9171
|
| Hospital Charge Code |
NDG108907
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$41.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$36.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$23.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$23.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$38.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$38.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.99
|
| Rate for Payer: BCBS Transplant Transplant |
$14.40
|
| Rate for Payer: BCBS Transplant Transplant |
$25.85
|
| Rate for Payer: Blue Shield of California Commercial |
$4.54
|
| Rate for Payer: Blue Shield of California Commercial |
$4.54
|
| Rate for Payer: Blue Shield of California EPN |
$4.13
|
| Rate for Payer: Blue Shield of California EPN |
$4.13
|
| Rate for Payer: Cash Price |
$19.39
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$19.39
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Central Health Plan Commercial |
$34.47
|
| Rate for Payer: Cigna of CA HMO |
$16.80
|
| Rate for Payer: Cigna of CA HMO |
$30.16
|
| Rate for Payer: Cigna of CA PPO |
$16.80
|
| Rate for Payer: Cigna of CA PPO |
$30.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.24
|
| Rate for Payer: Galaxy Health WC |
$36.63
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$25.85
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$18.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$32.32
|
| Rate for Payer: IEHP medi-cal |
$0.86
|
| Rate for Payer: IEHP medi-cal |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.62
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$32.32
|
| Rate for Payer: Networks By Design Commercial |
$21.54
|
| Rate for Payer: Networks By Design Commercial |
$12.00
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Prime Health Services Commercial |
$36.63
|
| Rate for Payer: Riverside University Health MISP |
$17.24
|
| Rate for Payer: Riverside University Health MISP |
$9.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.00
|
| Rate for Payer: United Healthcare All Other HMO |
$21.54
|
| Rate for Payer: United Healthcare All Other HMO |
$12.00
|
| Rate for Payer: United Healthcare HMO Rider |
$21.54
|
| Rate for Payer: United Healthcare HMO Rider |
$12.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.63
|
| Rate for Payer: Vantage Medical Group Senior |
$36.63
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
