|
APPLICATION OF SKIN SUBSTITUTE GRAFT TO FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS, FEET, AND/OR MULTIPLE DIGITS, TOTAL WOUND SURFACE AREA UP TO 100 SQ CM; EACH ADDITIONAL 25 SQ CM WOUND SURFACE AREA, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 15276
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$35.23 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.91
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
|
|
APPLICATION OF SKIN SUBSTITUTE GRAFT TO FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS, FEET, AND/OR MULTIPLE DIGITS, TOTAL WOUND SURFACE AREA UP TO 100 SQ CM; FIRST 25 SQ CM OR LESS WOUND SURFACE AREA
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 15275
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$142.79 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$950.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$950.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,703.23
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,045.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$950.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,568.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1,045.63
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,558.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$142.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$950.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$157.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,330.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,273.76
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$950.57
|
| Rate for Payer: Preferred Health Network WC |
$3,778.81
|
| Rate for Payer: Prime Health Services Medicare |
$1,007.60
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Riverside University Health System MISP |
$1,045.63
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$950.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Vantage Medical Group Senior |
$950.57
|
|
|
APPLICATION OF SKIN SUBSTITUTE GRAFT TO TRUNK, ARMS, LEGS, TOTAL WOUND SURFACE AREA UP TO 100 SQ CM; FIRST 25 SQ CM OR LESS WOUND SURFACE AREA
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 15271
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$124.24 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Prime Health Services Medicare |
$1,007.60
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Adventist Health Medi-Cal |
$950.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$950.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,703.23
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,045.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$950.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,568.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1,045.63
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,558.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$124.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$950.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$137.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,330.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,273.76
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$950.57
|
| Rate for Payer: Preferred Health Network WC |
$3,778.81
|
| Rate for Payer: Riverside University Health System MISP |
$1,045.63
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$950.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Vantage Medical Group Senior |
$950.57
|
|
|
APRACLONIDINE 0.5 % EYE DROPS [9119]
|
Facility
|
OP
|
$15.42
|
|
|
Service Code
|
NDC 6131466505
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$13.88 |
| Rate for Payer: Adventist Health Commercial |
$3.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.97
|
| Rate for Payer: Blue Shield of California Commercial |
$9.78
|
| Rate for Payer: Blue Shield of California EPN |
$6.15
|
| Rate for Payer: Cash Price |
$6.94
|
| Rate for Payer: Central Health Plan Commercial |
$12.34
|
| Rate for Payer: Cigna of CA HMO |
$10.79
|
| Rate for Payer: Cigna of CA PPO |
$10.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.17
|
| Rate for Payer: EPIC Health Plan Senior |
$6.17
|
| Rate for Payer: Galaxy Health WC |
$13.11
|
| Rate for Payer: Global Benefits Group Commercial |
$9.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.79
|
| Rate for Payer: Multiplan Commercial |
$11.56
|
| Rate for Payer: Networks By Design Commercial |
$10.02
|
| Rate for Payer: Prime Health Services Commercial |
$13.11
|
| Rate for Payer: Riverside University Health System MISP |
$6.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.71
|
| Rate for Payer: United Healthcare All Other HMO |
$7.71
|
| Rate for Payer: United Healthcare HMO Rider |
$7.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.11
|
| Rate for Payer: Vantage Medical Group Senior |
$13.11
|
|
|
APRACLONIDINE 0.5 % EYE DROPS [9119]
|
Facility
|
IP
|
$15.42
|
|
|
Service Code
|
NDC 6131466505
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$13.88 |
| Rate for Payer: Adventist Health Commercial |
$3.08
|
| Rate for Payer: Blue Shield of California Commercial |
$12.37
|
| Rate for Payer: Blue Shield of California EPN |
$7.77
|
| Rate for Payer: Cash Price |
$6.94
|
| Rate for Payer: Central Health Plan Commercial |
$12.34
|
| Rate for Payer: Cigna of CA HMO |
$10.79
|
| Rate for Payer: Cigna of CA PPO |
$10.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.17
|
| Rate for Payer: EPIC Health Plan Senior |
$6.17
|
| Rate for Payer: Galaxy Health WC |
$13.11
|
| Rate for Payer: Global Benefits Group Commercial |
$9.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.08
|
| Rate for Payer: Multiplan Commercial |
$11.56
|
| Rate for Payer: Networks By Design Commercial |
$10.02
|
| Rate for Payer: Prime Health Services Commercial |
$13.11
|
|
|
APREPITANT 130 MG/18 ML (7.2 MG/ML) INTRAVENOUS EMULSION [220348]
|
Facility
|
IP
|
$31.53
|
|
|
Service Code
|
HCPCS J0185
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.31 |
| Max. Negotiated Rate |
$28.38 |
| Rate for Payer: Adventist Health Commercial |
$6.31
|
| Rate for Payer: Blue Shield of California Commercial |
$25.29
|
| Rate for Payer: Blue Shield of California EPN |
$15.89
|
| Rate for Payer: Cash Price |
$14.19
|
| Rate for Payer: Central Health Plan Commercial |
$25.22
|
| Rate for Payer: Cigna of CA HMO |
$22.07
|
| Rate for Payer: Cigna of CA PPO |
$22.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.61
|
| Rate for Payer: EPIC Health Plan Senior |
$12.61
|
| Rate for Payer: Galaxy Health WC |
$26.80
|
| Rate for Payer: Global Benefits Group Commercial |
$18.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.31
|
| Rate for Payer: Multiplan Commercial |
$23.65
|
| Rate for Payer: Networks By Design Commercial |
$15.77
|
| Rate for Payer: Prime Health Services Commercial |
$26.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.83
|
| Rate for Payer: United Healthcare All Other HMO |
$11.52
|
| Rate for Payer: United Healthcare HMO Rider |
$11.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.33
|
|
|
APREPITANT 130 MG/18 ML (7.2 MG/ML) INTRAVENOUS EMULSION [220348]
|
Facility
|
OP
|
$31.53
|
|
|
Service Code
|
HCPCS J0185
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$28.38 |
| Rate for Payer: Adventist Health Commercial |
$6.31
|
| Rate for Payer: Adventist Health Medi-Cal |
$1.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.08
|
| Rate for Payer: Blue Shield of California Commercial |
$4.43
|
| Rate for Payer: Blue Shield of California EPN |
$4.03
|
| Rate for Payer: Cash Price |
$14.19
|
| Rate for Payer: Cash Price |
$14.19
|
| Rate for Payer: Central Health Plan Commercial |
$25.22
|
| Rate for Payer: Cigna of CA HMO |
$22.07
|
| Rate for Payer: Cigna of CA PPO |
$22.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.62
|
| Rate for Payer: EPIC Health Plan Senior |
$1.75
|
| Rate for Payer: Galaxy Health WC |
$26.80
|
| Rate for Payer: Global Benefits Group Commercial |
$18.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.38
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.13
|
| Rate for Payer: Multiplan Commercial |
$23.65
|
| Rate for Payer: Networks By Design Commercial |
$15.77
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1.59
|
| Rate for Payer: Prime Health Services Commercial |
$26.80
|
| Rate for Payer: Prime Health Services Medicare |
$1.69
|
| Rate for Payer: Riverside University Health System MISP |
$1.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.83
|
| Rate for Payer: United Healthcare All Other HMO |
$11.52
|
| Rate for Payer: United Healthcare HMO Rider |
$11.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.33
|
| Rate for Payer: Upland Medical Group Pediatric |
$1.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1.75
|
|
|
AQUEOUS SHUNT TO EXTRAOCULAR EQUATORIAL PLATE RESERVOIR, EXTERNAL APPROACH; WITH GRAFT
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 66180
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,921.07 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,844.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,266.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,528.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,844.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$10,445.70
|
| Rate for Payer: Blue Shield of California Commercial |
$7,080.44
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,266.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,528.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,844.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,292.75
|
| Rate for Payer: EPIC Health Plan Senior |
$7,528.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,224.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,921.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,844.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,122.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,581.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,171.08
|
| Rate for Payer: Multiplan WC |
$10,445.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6,844.09
|
| Rate for Payer: Preferred Health Network WC |
$10,658.88
|
| Rate for Payer: Prime Health Services Medicare |
$7,254.74
|
| Rate for Payer: Prime Health Services WC |
$10,339.11
|
| Rate for Payer: Riverside University Health System MISP |
$7,528.50
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$6,844.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,266.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,528.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6,844.09
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
|
OP
|
$11.82
|
|
|
Service Code
|
NDC 6340291101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$10.64 |
| Rate for Payer: Adventist Health Commercial |
$2.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.88
|
| Rate for Payer: Blue Shield of California Commercial |
$7.49
|
| Rate for Payer: Blue Shield of California EPN |
$4.72
|
| Rate for Payer: Cash Price |
$5.32
|
| Rate for Payer: Central Health Plan Commercial |
$9.46
|
| Rate for Payer: Cigna of CA HMO |
$8.27
|
| Rate for Payer: Cigna of CA PPO |
$8.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4.73
|
| Rate for Payer: Galaxy Health WC |
$10.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.27
|
| Rate for Payer: Multiplan Commercial |
$8.87
|
| Rate for Payer: Networks By Design Commercial |
$7.68
|
| Rate for Payer: Prime Health Services Commercial |
$10.05
|
| Rate for Payer: Riverside University Health System MISP |
$4.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.91
|
| Rate for Payer: United Healthcare All Other HMO |
$5.91
|
| Rate for Payer: United Healthcare HMO Rider |
$5.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.05
|
| Rate for Payer: Vantage Medical Group Senior |
$10.05
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
|
OP
|
$1.40
|
|
|
Service Code
|
NDC 4359877730
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.81
|
| Rate for Payer: Blue Shield of California Commercial |
$0.89
|
| Rate for Payer: Blue Shield of California EPN |
$0.56
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Central Health Plan Commercial |
$1.12
|
| Rate for Payer: Cigna of CA HMO |
$0.98
|
| Rate for Payer: Cigna of CA PPO |
$0.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Senior |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$1.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.98
|
| Rate for Payer: Multiplan Commercial |
$1.05
|
| Rate for Payer: Networks By Design Commercial |
$0.91
|
| Rate for Payer: Prime Health Services Commercial |
$1.19
|
| Rate for Payer: Riverside University Health System MISP |
$0.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.70
|
| Rate for Payer: United Healthcare All Other HMO |
$0.70
|
| Rate for Payer: United Healthcare HMO Rider |
$0.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.19
|
| Rate for Payer: Vantage Medical Group Senior |
$1.19
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
|
IP
|
$11.82
|
|
|
Service Code
|
NDC 6340291101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$10.64 |
| Rate for Payer: Adventist Health Commercial |
$2.36
|
| Rate for Payer: Blue Shield of California Commercial |
$9.48
|
| Rate for Payer: Blue Shield of California EPN |
$5.96
|
| Rate for Payer: Cash Price |
$5.32
|
| Rate for Payer: Central Health Plan Commercial |
$9.46
|
| Rate for Payer: Cigna of CA HMO |
$8.27
|
| Rate for Payer: Cigna of CA PPO |
$8.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4.73
|
| Rate for Payer: Galaxy Health WC |
$10.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.36
|
| Rate for Payer: Multiplan Commercial |
$8.87
|
| Rate for Payer: Networks By Design Commercial |
$7.68
|
| Rate for Payer: Prime Health Services Commercial |
$10.05
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
|
OP
|
$1.40
|
|
|
Service Code
|
NDC 7226625930
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.81
|
| Rate for Payer: Blue Shield of California Commercial |
$0.89
|
| Rate for Payer: Blue Shield of California EPN |
$0.56
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Central Health Plan Commercial |
$1.12
|
| Rate for Payer: Cigna of CA HMO |
$0.98
|
| Rate for Payer: Cigna of CA PPO |
$0.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Senior |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$1.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.98
|
| Rate for Payer: Multiplan Commercial |
$1.05
|
| Rate for Payer: Networks By Design Commercial |
$0.91
|
| Rate for Payer: Prime Health Services Commercial |
$1.19
|
| Rate for Payer: Riverside University Health System MISP |
$0.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.70
|
| Rate for Payer: United Healthcare All Other HMO |
$0.70
|
| Rate for Payer: United Healthcare HMO Rider |
$0.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.19
|
| Rate for Payer: Vantage Medical Group Senior |
$1.19
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
|
IP
|
$1.40
|
|
|
Service Code
|
NDC 4359877730
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Blue Shield of California Commercial |
$1.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.71
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Central Health Plan Commercial |
$1.12
|
| Rate for Payer: Cigna of CA HMO |
$0.98
|
| Rate for Payer: Cigna of CA PPO |
$0.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Senior |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$1.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$1.05
|
| Rate for Payer: Networks By Design Commercial |
$0.91
|
| Rate for Payer: Prime Health Services Commercial |
$1.19
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
|
IP
|
$1.40
|
|
|
Service Code
|
NDC 4359877711
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Blue Shield of California Commercial |
$1.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.71
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Central Health Plan Commercial |
$1.12
|
| Rate for Payer: Cigna of CA HMO |
$0.98
|
| Rate for Payer: Cigna of CA PPO |
$0.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Senior |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$1.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$1.05
|
| Rate for Payer: Networks By Design Commercial |
$0.91
|
| Rate for Payer: Prime Health Services Commercial |
$1.19
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
|
IP
|
$1.40
|
|
|
Service Code
|
NDC 7226625930
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Blue Shield of California Commercial |
$1.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.71
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Central Health Plan Commercial |
$1.12
|
| Rate for Payer: Cigna of CA HMO |
$0.98
|
| Rate for Payer: Cigna of CA PPO |
$0.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Senior |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$1.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$1.05
|
| Rate for Payer: Networks By Design Commercial |
$0.91
|
| Rate for Payer: Prime Health Services Commercial |
$1.19
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
|
OP
|
$1.40
|
|
|
Service Code
|
NDC 7074817530
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.81
|
| Rate for Payer: Blue Shield of California Commercial |
$0.89
|
| Rate for Payer: Blue Shield of California EPN |
$0.56
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Central Health Plan Commercial |
$1.12
|
| Rate for Payer: Cigna of CA HMO |
$0.98
|
| Rate for Payer: Cigna of CA PPO |
$0.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Senior |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$1.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.98
|
| Rate for Payer: Multiplan Commercial |
$1.05
|
| Rate for Payer: Networks By Design Commercial |
$0.91
|
| Rate for Payer: Prime Health Services Commercial |
$1.19
|
| Rate for Payer: Riverside University Health System MISP |
$0.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.70
|
| Rate for Payer: United Healthcare All Other HMO |
$0.70
|
| Rate for Payer: United Healthcare HMO Rider |
$0.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.19
|
| Rate for Payer: Vantage Medical Group Senior |
$1.19
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
|
OP
|
$1.40
|
|
|
Service Code
|
NDC 4359877711
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.81
|
| Rate for Payer: Blue Shield of California Commercial |
$0.89
|
| Rate for Payer: Blue Shield of California EPN |
$0.56
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Central Health Plan Commercial |
$1.12
|
| Rate for Payer: Cigna of CA HMO |
$0.98
|
| Rate for Payer: Cigna of CA PPO |
$0.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Senior |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$1.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.98
|
| Rate for Payer: Multiplan Commercial |
$1.05
|
| Rate for Payer: Networks By Design Commercial |
$0.91
|
| Rate for Payer: Prime Health Services Commercial |
$1.19
|
| Rate for Payer: Riverside University Health System MISP |
$0.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.70
|
| Rate for Payer: United Healthcare All Other HMO |
$0.70
|
| Rate for Payer: United Healthcare HMO Rider |
$0.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.19
|
| Rate for Payer: Vantage Medical Group Senior |
$1.19
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
|
IP
|
$1.40
|
|
|
Service Code
|
NDC 7074817501
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Blue Shield of California Commercial |
$1.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.71
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Central Health Plan Commercial |
$1.12
|
| Rate for Payer: Cigna of CA HMO |
$0.98
|
| Rate for Payer: Cigna of CA PPO |
$0.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Senior |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$1.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$1.05
|
| Rate for Payer: Networks By Design Commercial |
$0.91
|
| Rate for Payer: Prime Health Services Commercial |
$1.19
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
|
OP
|
$1.40
|
|
|
Service Code
|
NDC 7074817501
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.81
|
| Rate for Payer: Blue Shield of California Commercial |
$0.89
|
| Rate for Payer: Blue Shield of California EPN |
$0.56
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Central Health Plan Commercial |
$1.12
|
| Rate for Payer: Cigna of CA HMO |
$0.98
|
| Rate for Payer: Cigna of CA PPO |
$0.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Senior |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$1.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.98
|
| Rate for Payer: Multiplan Commercial |
$1.05
|
| Rate for Payer: Networks By Design Commercial |
$0.91
|
| Rate for Payer: Prime Health Services Commercial |
$1.19
|
| Rate for Payer: Riverside University Health System MISP |
$0.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.70
|
| Rate for Payer: United Healthcare All Other HMO |
$0.70
|
| Rate for Payer: United Healthcare HMO Rider |
$0.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.19
|
| Rate for Payer: Vantage Medical Group Senior |
$1.19
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
|
IP
|
$1.40
|
|
|
Service Code
|
NDC 7074817530
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Blue Shield of California Commercial |
$1.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.71
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Central Health Plan Commercial |
$1.12
|
| Rate for Payer: Cigna of CA HMO |
$0.98
|
| Rate for Payer: Cigna of CA PPO |
$0.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Senior |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$1.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$1.05
|
| Rate for Payer: Networks By Design Commercial |
$0.91
|
| Rate for Payer: Prime Health Services Commercial |
$1.19
|
|
|
ARGATROBAN 100 MG/ML INTRAVENOUS SOLUTION [28947]
|
Facility
|
IP
|
$244.80
|
|
|
Service Code
|
HCPCS J0883
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.96 |
| Max. Negotiated Rate |
$220.32 |
| Rate for Payer: Adventist Health Commercial |
$48.96
|
| Rate for Payer: Adventist Health Commercial |
$26.08
|
| Rate for Payer: Blue Shield of California Commercial |
$196.33
|
| Rate for Payer: Blue Shield of California Commercial |
$104.59
|
| Rate for Payer: Blue Shield of California EPN |
$65.73
|
| Rate for Payer: Blue Shield of California EPN |
$123.38
|
| Rate for Payer: Cash Price |
$110.16
|
| Rate for Payer: Cash Price |
$58.68
|
| Rate for Payer: Central Health Plan Commercial |
$195.84
|
| Rate for Payer: Central Health Plan Commercial |
$104.33
|
| Rate for Payer: Cigna of CA HMO |
$91.29
|
| Rate for Payer: Cigna of CA HMO |
$171.36
|
| Rate for Payer: Cigna of CA PPO |
$91.29
|
| Rate for Payer: Cigna of CA PPO |
$171.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$91.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$171.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.92
|
| Rate for Payer: EPIC Health Plan Senior |
$52.16
|
| Rate for Payer: EPIC Health Plan Senior |
$97.92
|
| Rate for Payer: Galaxy Health WC |
$208.08
|
| Rate for Payer: Galaxy Health WC |
$110.85
|
| Rate for Payer: Global Benefits Group Commercial |
$78.25
|
| Rate for Payer: Global Benefits Group Commercial |
$146.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$117.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$220.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$155.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$82.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$144.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.08
|
| Rate for Payer: Multiplan Commercial |
$97.81
|
| Rate for Payer: Multiplan Commercial |
$183.60
|
| Rate for Payer: Networks By Design Commercial |
$65.20
|
| Rate for Payer: Networks By Design Commercial |
$122.40
|
| Rate for Payer: Prime Health Services Commercial |
$208.08
|
| Rate for Payer: Prime Health Services Commercial |
$110.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.87
|
| Rate for Payer: United Healthcare All Other HMO |
$89.43
|
| Rate for Payer: United Healthcare All Other HMO |
$47.64
|
| Rate for Payer: United Healthcare HMO Rider |
$46.61
|
| Rate for Payer: United Healthcare HMO Rider |
$87.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$80.17
|
|
|
ARGATROBAN 100 MG/ML INTRAVENOUS SOLUTION [28947]
|
Facility
|
OP
|
$244.80
|
|
|
Service Code
|
HCPCS J0883
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$220.32 |
| Rate for Payer: Adventist Health Commercial |
$48.96
|
| Rate for Payer: Adventist Health Commercial |
$26.08
|
| Rate for Payer: Adventist Health Medi-Cal |
$0.86
|
| Rate for Payer: Adventist Health Medi-Cal |
$0.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.21
|
| Rate for Payer: Blue Shield of California Commercial |
$2.89
|
| Rate for Payer: Blue Shield of California Commercial |
$2.89
|
| Rate for Payer: Blue Shield of California EPN |
$2.63
|
| Rate for Payer: Blue Shield of California EPN |
$2.63
|
| Rate for Payer: Cash Price |
$110.16
|
| Rate for Payer: Cash Price |
$58.68
|
| Rate for Payer: Cash Price |
$58.68
|
| Rate for Payer: Cash Price |
$110.16
|
| Rate for Payer: Central Health Plan Commercial |
$195.84
|
| Rate for Payer: Central Health Plan Commercial |
$104.33
|
| Rate for Payer: Cigna of CA HMO |
$171.36
|
| Rate for Payer: Cigna of CA HMO |
$91.29
|
| Rate for Payer: Cigna of CA PPO |
$171.36
|
| Rate for Payer: Cigna of CA PPO |
$91.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$91.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$171.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.42
|
| Rate for Payer: EPIC Health Plan Senior |
$0.95
|
| Rate for Payer: EPIC Health Plan Senior |
$0.95
|
| Rate for Payer: Galaxy Health WC |
$110.85
|
| Rate for Payer: Galaxy Health WC |
$208.08
|
| Rate for Payer: Global Benefits Group Commercial |
$146.88
|
| Rate for Payer: Global Benefits Group Commercial |
$78.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$117.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$220.32
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1.41
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$82.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$155.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.15
|
| Rate for Payer: Multiplan Commercial |
$97.81
|
| Rate for Payer: Multiplan Commercial |
$183.60
|
| Rate for Payer: Networks By Design Commercial |
$65.20
|
| Rate for Payer: Networks By Design Commercial |
$122.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$0.86
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$0.86
|
| Rate for Payer: Prime Health Services Commercial |
$110.85
|
| Rate for Payer: Prime Health Services Commercial |
$208.08
|
| Rate for Payer: Prime Health Services Medicare |
$0.91
|
| Rate for Payer: Prime Health Services Medicare |
$0.91
|
| Rate for Payer: Riverside University Health System MISP |
$0.95
|
| Rate for Payer: Riverside University Health System MISP |
$0.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$78.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$146.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$146.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$78.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.87
|
| Rate for Payer: United Healthcare All Other HMO |
$47.64
|
| Rate for Payer: United Healthcare All Other HMO |
$89.43
|
| Rate for Payer: United Healthcare HMO Rider |
$87.49
|
| Rate for Payer: United Healthcare HMO Rider |
$46.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$80.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.86
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.95
|
| Rate for Payer: Vantage Medical Group Senior |
$0.95
|
| Rate for Payer: Vantage Medical Group Senior |
$0.95
|
|
|
ARGININE 25 MG/ML-LYSINE 25 MG/ML IN 0.9 % NACL INTRAVENOUS SOLUTION [223945]
|
Facility
|
IP
|
$0.45
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Central Health Plan Commercial |
$0.36
|
| Rate for Payer: Cigna of CA HMO |
$0.32
|
| Rate for Payer: Cigna of CA PPO |
$0.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Senior |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.38
|
| Rate for Payer: Global Benefits Group Commercial |
$0.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.34
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO |
$0.16
|
| Rate for Payer: United Healthcare HMO Rider |
$0.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.15
|
|
|
ARGININE 25 MG/ML-LYSINE 25 MG/ML IN 0.9 % NACL INTRAVENOUS SOLUTION [223945]
|
Facility
|
OP
|
$0.45
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Central Health Plan Commercial |
$0.36
|
| Rate for Payer: Cigna of CA HMO |
$0.32
|
| Rate for Payer: Cigna of CA PPO |
$0.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Senior |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.38
|
| Rate for Payer: Global Benefits Group Commercial |
$0.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$0.34
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.38
|
| Rate for Payer: Riverside University Health System MISP |
$0.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO |
$0.16
|
| Rate for Payer: United Healthcare HMO Rider |
$0.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.38
|
| Rate for Payer: Vantage Medical Group Senior |
$0.38
|
|
|
ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT [220244]
|
Facility
|
IP
|
$2.84
|
|
|
Service Code
|
NDC 5978166694
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.56 |
| Rate for Payer: Adventist Health Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California Commercial |
$2.28
|
| Rate for Payer: Blue Shield of California EPN |
$1.43
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: Central Health Plan Commercial |
$2.27
|
| Rate for Payer: Cigna of CA HMO |
$1.99
|
| Rate for Payer: Cigna of CA PPO |
$1.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.14
|
| Rate for Payer: EPIC Health Plan Senior |
$1.14
|
| Rate for Payer: Galaxy Health WC |
$2.41
|
| Rate for Payer: Global Benefits Group Commercial |
$1.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$2.13
|
| Rate for Payer: Networks By Design Commercial |
$1.85
|
| Rate for Payer: Prime Health Services Commercial |
$2.41
|
|
