|
BLEOMYCIN 30 UNIT SOLUTION FOR INJECTION [17012]
|
Facility
OP
|
$127.32
|
|
|
Service Code
|
CPT J9040
|
| Hospital Charge Code |
ERX17012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.14 |
| Max. Negotiated Rate |
$586.79 |
| Rate for Payer: Aetna of CA HMO/PPO |
$41.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$68.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$95.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$108.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$61.79
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$70.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$44.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$61.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$44.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$70.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$535.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$535.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$535.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$586.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$586.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$586.79
|
| Rate for Payer: BCBS Transplant Transplant |
$67.40
|
| Rate for Payer: BCBS Transplant Transplant |
$48.02
|
| Rate for Payer: BCBS Transplant Transplant |
$76.39
|
| Rate for Payer: Blue Shield of California Commercial |
$58.22
|
| Rate for Payer: Blue Shield of California Commercial |
$58.22
|
| Rate for Payer: Blue Shield of California Commercial |
$58.22
|
| Rate for Payer: Blue Shield of California EPN |
$52.93
|
| Rate for Payer: Blue Shield of California EPN |
$52.93
|
| Rate for Payer: Blue Shield of California EPN |
$52.93
|
| Rate for Payer: Cash Price |
$50.55
|
| Rate for Payer: Cash Price |
$57.29
|
| Rate for Payer: Cash Price |
$36.01
|
| Rate for Payer: Cash Price |
$36.01
|
| Rate for Payer: Cash Price |
$50.55
|
| Rate for Payer: Cash Price |
$57.29
|
| Rate for Payer: Central Health Plan Commercial |
$64.02
|
| Rate for Payer: Central Health Plan Commercial |
$89.87
|
| Rate for Payer: Central Health Plan Commercial |
$101.86
|
| Rate for Payer: Cigna of CA HMO |
$56.02
|
| Rate for Payer: Cigna of CA HMO |
$89.12
|
| Rate for Payer: Cigna of CA HMO |
$78.64
|
| Rate for Payer: Cigna of CA PPO |
$56.02
|
| Rate for Payer: Cigna of CA PPO |
$89.12
|
| Rate for Payer: Cigna of CA PPO |
$78.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$95.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$108.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$32.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$44.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$50.93
|
| Rate for Payer: Galaxy Health WC |
$108.22
|
| Rate for Payer: Galaxy Health WC |
$95.49
|
| Rate for Payer: Galaxy Health WC |
$68.03
|
| Rate for Payer: Global Benefits Group Commercial |
$76.39
|
| Rate for Payer: Global Benefits Group Commercial |
$67.40
|
| Rate for Payer: Global Benefits Group Commercial |
$48.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$114.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.03
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$60.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$84.26
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$95.49
|
| Rate for Payer: IEHP medi-cal |
$25.14
|
| Rate for Payer: IEHP medi-cal |
$25.14
|
| Rate for Payer: IEHP medi-cal |
$25.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.01
|
| Rate for Payer: Multiplan Commercial |
$95.49
|
| Rate for Payer: Multiplan Commercial |
$60.02
|
| Rate for Payer: Multiplan Commercial |
$84.26
|
| Rate for Payer: Networks By Design Commercial |
$56.17
|
| Rate for Payer: Networks By Design Commercial |
$63.66
|
| Rate for Payer: Networks By Design Commercial |
$40.02
|
| Rate for Payer: Prime Health Services Commercial |
$108.22
|
| Rate for Payer: Prime Health Services Commercial |
$68.03
|
| Rate for Payer: Prime Health Services Commercial |
$95.49
|
| Rate for Payer: Riverside University Health MISP |
$50.93
|
| Rate for Payer: Riverside University Health MISP |
$44.94
|
| Rate for Payer: Riverside University Health MISP |
$32.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.66
|
| Rate for Payer: United Healthcare All Other HMO |
$40.02
|
| Rate for Payer: United Healthcare All Other HMO |
$56.17
|
| Rate for Payer: United Healthcare All Other HMO |
$63.66
|
| Rate for Payer: United Healthcare HMO Rider |
$40.02
|
| Rate for Payer: United Healthcare HMO Rider |
$56.17
|
| Rate for Payer: United Healthcare HMO Rider |
$63.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$40.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$95.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$108.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.03
|
| Rate for Payer: Vantage Medical Group Senior |
$108.22
|
| Rate for Payer: Vantage Medical Group Senior |
$95.49
|
| Rate for Payer: Vantage Medical Group Senior |
$68.03
|
|
|
BLEOMYCIN 30 UNIT SOLUTION FOR INJECTION [17012]
|
Facility
IP
|
$112.34
|
|
|
Service Code
|
CPT J9040
|
| Hospital Charge Code |
ERX17012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.47 |
| Max. Negotiated Rate |
$101.11 |
| Rate for Payer: Blue Shield of California Commercial |
$84.26
|
| Rate for Payer: Blue Shield of California Commercial |
$95.49
|
| Rate for Payer: Blue Shield of California Commercial |
$60.02
|
| Rate for Payer: Blue Shield of California EPN |
$42.74
|
| Rate for Payer: Blue Shield of California EPN |
$67.99
|
| Rate for Payer: Blue Shield of California EPN |
$59.99
|
| Rate for Payer: Cash Price |
$50.55
|
| Rate for Payer: Cash Price |
$36.01
|
| Rate for Payer: Cash Price |
$57.29
|
| Rate for Payer: Central Health Plan Commercial |
$89.87
|
| Rate for Payer: Central Health Plan Commercial |
$101.86
|
| Rate for Payer: Central Health Plan Commercial |
$64.02
|
| Rate for Payer: Cigna of CA HMO |
$89.12
|
| Rate for Payer: Cigna of CA HMO |
$78.64
|
| Rate for Payer: Cigna of CA HMO |
$56.02
|
| Rate for Payer: Cigna of CA PPO |
$78.64
|
| Rate for Payer: Cigna of CA PPO |
$56.02
|
| Rate for Payer: Cigna of CA PPO |
$89.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$44.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$50.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$32.01
|
| Rate for Payer: Galaxy Health WC |
$108.22
|
| Rate for Payer: Galaxy Health WC |
$95.49
|
| Rate for Payer: Galaxy Health WC |
$68.03
|
| Rate for Payer: Global Benefits Group Commercial |
$76.39
|
| Rate for Payer: Global Benefits Group Commercial |
$67.40
|
| Rate for Payer: Global Benefits Group Commercial |
$48.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$114.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.47
|
| Rate for Payer: Multiplan Commercial |
$95.49
|
| Rate for Payer: Multiplan Commercial |
$84.26
|
| Rate for Payer: Multiplan Commercial |
$60.02
|
| Rate for Payer: Networks By Design Commercial |
$56.17
|
| Rate for Payer: Networks By Design Commercial |
$63.66
|
| Rate for Payer: Networks By Design Commercial |
$40.02
|
| Rate for Payer: Prime Health Services Commercial |
$108.22
|
| Rate for Payer: Prime Health Services Commercial |
$95.49
|
| Rate for Payer: Prime Health Services Commercial |
$68.03
|
|
|
Blepharoplasty, lower eyelid;
|
Facility
OP
|
$8,114.00
|
|
|
Service Code
|
CPT 15820
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,278.49 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,278.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$2,278.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,736.72
|
| Rate for Payer: IEHP medi-cal |
$3,759.51
|
| Rate for Payer: IEHP Medicare Advantage |
$2,278.49
|
| Rate for Payer: Innovage PACE Commercial |
$3,417.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,053.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,053.18
|
| Rate for Payer: Prime Health Services Medicare |
$2,415.20
|
| Rate for Payer: Riverside University Health MISP |
$2,506.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
Blepharoplasty, upper eyelid;
|
Facility
OP
|
$8,114.00
|
|
|
Service Code
|
CPT 15822
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,278.49 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,278.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$2,278.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,736.72
|
| Rate for Payer: IEHP medi-cal |
$3,759.51
|
| Rate for Payer: IEHP Medicare Advantage |
$2,278.49
|
| Rate for Payer: Innovage PACE Commercial |
$3,417.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,053.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,053.18
|
| Rate for Payer: Prime Health Services Medicare |
$2,415.20
|
| Rate for Payer: Riverside University Health MISP |
$2,506.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
Blepharoplasty, upper eyelid; with excessive skin weighting down lid
|
Facility
OP
|
$11,071.00
|
|
|
Service Code
|
CPT 15823
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,278.49 |
| Max. Negotiated Rate |
$11,071.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,278.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,621.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,755.97
|
| Rate for Payer: Caremore Medicare Advantage |
$2,278.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,736.72
|
| Rate for Payer: IEHP medi-cal |
$3,759.51
|
| Rate for Payer: IEHP Medicare Advantage |
$2,278.49
|
| Rate for Payer: Innovage PACE Commercial |
$3,417.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,053.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,053.18
|
| Rate for Payer: Prime Health Services Medicare |
$2,415.20
|
| Rate for Payer: Riverside University Health MISP |
$2,506.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
Bone graft, any donor area; major or large
|
Facility
OP
|
$19,907.00
|
|
|
Service Code
|
CPT 20902
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,183.44 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,938.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$12,220.24
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| Rate for Payer: Caremore Medicare Advantage |
$8,938.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,067.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,938.53
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,659.19
|
| Rate for Payer: IEHP medi-cal |
$14,748.57
|
| Rate for Payer: IEHP Medicare Advantage |
$8,938.53
|
| Rate for Payer: Innovage PACE Commercial |
$13,407.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,938.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,977.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,977.63
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: Preferred Health Network WC |
$12,469.63
|
| Rate for Payer: Prime Health Services Medicare |
$9,474.84
|
| Rate for Payer: Prime Health Services WC |
$12,095.54
|
| Rate for Payer: Riverside University Health MISP |
$9,832.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
Bone graft, any donor area; minor or small (eg, dowel or button)
|
Facility
OP
|
$19,907.00
|
|
|
Service Code
|
CPT 20900
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,938.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$12,220.24
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$8,938.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,067.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,938.53
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,659.19
|
| Rate for Payer: IEHP medi-cal |
$14,748.57
|
| Rate for Payer: IEHP Medicare Advantage |
$8,938.53
|
| Rate for Payer: Innovage PACE Commercial |
$13,407.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,938.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,977.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,977.63
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: Preferred Health Network WC |
$12,469.63
|
| Rate for Payer: Prime Health Services Medicare |
$9,474.84
|
| Rate for Payer: Prime Health Services WC |
$12,095.54
|
| Rate for Payer: Riverside University Health MISP |
$9,832.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
Bone graft with microvascular anastomosis; other than fibula, iliac crest, or metatarsal
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 20962
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,465.14 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
|
|
BORIC ACID (BULK) POWDER [1131]
|
Facility
OP
|
$0.95
|
|
|
Service Code
|
NDC 3877900649
|
| Hospital Charge Code |
NDG1131
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.81
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.56
|
| Rate for Payer: BCBS Transplant Transplant |
$0.57
|
| Rate for Payer: Blue Shield of California Commercial |
$0.60
|
| Rate for Payer: Blue Shield of California EPN |
$0.46
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: Central Health Plan Commercial |
$0.76
|
| Rate for Payer: Cigna of CA HMO |
$0.61
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.38
|
| Rate for Payer: Galaxy Health WC |
$0.81
|
| Rate for Payer: Global Benefits Group Commercial |
$0.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.86
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.71
|
| Rate for Payer: IEHP medi-cal |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.71
|
| Rate for Payer: Networks By Design Commercial |
$0.62
|
| Rate for Payer: Prime Health Services Commercial |
$0.81
|
| Rate for Payer: Riverside University Health MISP |
$0.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.48
|
| Rate for Payer: United Healthcare All Other HMO |
$0.48
|
| Rate for Payer: United Healthcare HMO Rider |
$0.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.81
|
| Rate for Payer: Vantage Medical Group Senior |
$0.81
|
|
|
BORIC ACID (BULK) POWDER [1131]
|
Facility
IP
|
$0.95
|
|
|
Service Code
|
NDC 3877900649
|
| Hospital Charge Code |
NDG1131
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.86 |
| Rate for Payer: Blue Shield of California Commercial |
$0.71
|
| Rate for Payer: Blue Shield of California EPN |
$0.51
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: Central Health Plan Commercial |
$0.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: Galaxy Health WC |
$0.81
|
| Rate for Payer: Global Benefits Group Commercial |
$0.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.71
|
| Rate for Payer: Networks By Design Commercial |
$0.62
|
| Rate for Payer: Prime Health Services Commercial |
$0.81
|
|
|
BORIC ACID (BULK) POWDER [1131]
|
Facility
IP
|
$0.95
|
|
|
Service Code
|
NDC 3877900648
|
| Hospital Charge Code |
NDG1131A
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.86 |
| Rate for Payer: Blue Shield of California Commercial |
$0.71
|
| Rate for Payer: Blue Shield of California EPN |
$0.51
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: Central Health Plan Commercial |
$0.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: Galaxy Health WC |
$0.81
|
| Rate for Payer: Global Benefits Group Commercial |
$0.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.71
|
| Rate for Payer: Networks By Design Commercial |
$0.62
|
| Rate for Payer: Prime Health Services Commercial |
$0.81
|
|
|
BORIC ACID (BULK) POWDER [1131]
|
Facility
OP
|
$0.95
|
|
|
Service Code
|
NDC 3877900648
|
| Hospital Charge Code |
NDG1131A
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.81
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.56
|
| Rate for Payer: BCBS Transplant Transplant |
$0.57
|
| Rate for Payer: Blue Shield of California Commercial |
$0.60
|
| Rate for Payer: Blue Shield of California EPN |
$0.46
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: Central Health Plan Commercial |
$0.76
|
| Rate for Payer: Cigna of CA HMO |
$0.61
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.38
|
| Rate for Payer: Galaxy Health WC |
$0.81
|
| Rate for Payer: Global Benefits Group Commercial |
$0.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.86
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.71
|
| Rate for Payer: IEHP medi-cal |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.71
|
| Rate for Payer: Networks By Design Commercial |
$0.62
|
| Rate for Payer: Prime Health Services Commercial |
$0.81
|
| Rate for Payer: Riverside University Health MISP |
$0.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.48
|
| Rate for Payer: United Healthcare All Other HMO |
$0.48
|
| Rate for Payer: United Healthcare HMO Rider |
$0.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.81
|
| Rate for Payer: Vantage Medical Group Senior |
$0.81
|
|
|
BORTEZOMIB 3.5 MG INJECTION POWDER FOR SOLUTION [35839]
|
Facility
IP
|
$240.00
|
|
|
Service Code
|
NDC 70860-225-10
|
| Hospital Charge Code |
ERX35839
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Blue Shield of California Commercial |
$180.00
|
| Rate for Payer: Blue Shield of California EPN |
$128.16
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Central Health Plan Commercial |
$192.00
|
| Rate for Payer: Cigna of CA HMO |
$168.00
|
| Rate for Payer: Cigna of CA PPO |
$168.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$96.00
|
| Rate for Payer: Galaxy Health WC |
$204.00
|
| Rate for Payer: Global Benefits Group Commercial |
$144.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$216.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$160.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: Networks By Design Commercial |
$120.00
|
| Rate for Payer: Prime Health Services Commercial |
$204.00
|
|
|
BORTEZOMIB 3.5 MG INJECTION POWDER FOR SOLUTION [35839]
|
Facility
IP
|
$1,923.60
|
|
|
Service Code
|
NDC 63020-049-01
|
| Hospital Charge Code |
ERX35839
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$384.72 |
| Max. Negotiated Rate |
$1,731.24 |
| Rate for Payer: Blue Shield of California Commercial |
$1,442.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,027.20
|
| Rate for Payer: Cash Price |
$865.62
|
| Rate for Payer: Central Health Plan Commercial |
$1,538.88
|
| Rate for Payer: Cigna of CA HMO |
$1,346.52
|
| Rate for Payer: Cigna of CA PPO |
$1,346.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$769.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$769.44
|
| Rate for Payer: Galaxy Health WC |
$1,635.06
|
| Rate for Payer: Global Benefits Group Commercial |
$1,154.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,731.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,283.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.72
|
| Rate for Payer: Multiplan Commercial |
$1,442.70
|
| Rate for Payer: Networks By Design Commercial |
$961.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,635.06
|
|
|
BORTEZOMIB 3.5 MG INJECTION POWDER FOR SOLUTION [35839]
|
Facility
OP
|
$240.00
|
|
|
Service Code
|
NDC 70860-225-10
|
| Hospital Charge Code |
ERX35839
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$145.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$204.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$132.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$132.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$116.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.79
|
| Rate for Payer: BCBS Transplant Transplant |
$144.00
|
| Rate for Payer: Blue Shield of California Commercial |
$150.96
|
| Rate for Payer: Blue Shield of California EPN |
$117.36
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Central Health Plan Commercial |
$192.00
|
| Rate for Payer: Cigna of CA HMO |
$168.00
|
| Rate for Payer: Cigna of CA PPO |
$168.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$204.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$96.00
|
| Rate for Payer: Galaxy Health WC |
$204.00
|
| Rate for Payer: Global Benefits Group Commercial |
$144.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$216.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$180.00
|
| Rate for Payer: IEHP medi-cal |
$84.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$160.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: Networks By Design Commercial |
$120.00
|
| Rate for Payer: Prime Health Services Commercial |
$204.00
|
| Rate for Payer: Riverside University Health MISP |
$96.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$144.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$144.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$120.00
|
| Rate for Payer: United Healthcare All Other HMO |
$120.00
|
| Rate for Payer: United Healthcare HMO Rider |
$120.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$120.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$204.00
|
| Rate for Payer: Vantage Medical Group Senior |
$204.00
|
|
|
BORTEZOMIB 3.5 MG INJECTION POWDER FOR SOLUTION [35839]
|
Facility
OP
|
$300.00
|
|
|
Service Code
|
NDC 43598-426-60
|
| Hospital Charge Code |
ERX35839
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$182.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$165.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$165.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$145.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.24
|
| Rate for Payer: BCBS Transplant Transplant |
$180.00
|
| Rate for Payer: Blue Shield of California Commercial |
$188.70
|
| Rate for Payer: Blue Shield of California EPN |
$146.70
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Central Health Plan Commercial |
$240.00
|
| Rate for Payer: Cigna of CA HMO |
$210.00
|
| Rate for Payer: Cigna of CA PPO |
$210.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$225.00
|
| Rate for Payer: IEHP medi-cal |
$105.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: Networks By Design Commercial |
$150.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: Riverside University Health MISP |
$120.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$180.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$180.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.00
|
| Rate for Payer: United Healthcare All Other HMO |
$150.00
|
| Rate for Payer: United Healthcare HMO Rider |
$150.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.00
|
| Rate for Payer: Vantage Medical Group Senior |
$255.00
|
|
|
BORTEZOMIB 3.5 MG INJECTION POWDER FOR SOLUTION [35839]
|
Facility
OP
|
$1,923.60
|
|
|
Service Code
|
NDC 63020-049-01
|
| Hospital Charge Code |
ERX35839
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$384.72 |
| Max. Negotiated Rate |
$1,731.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,168.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,635.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,057.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,057.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$931.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,136.46
|
| Rate for Payer: BCBS Transplant Transplant |
$1,154.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1,209.94
|
| Rate for Payer: Blue Shield of California EPN |
$940.64
|
| Rate for Payer: Cash Price |
$865.62
|
| Rate for Payer: Cash Price |
$865.62
|
| Rate for Payer: Central Health Plan Commercial |
$1,538.88
|
| Rate for Payer: Cigna of CA HMO |
$1,346.52
|
| Rate for Payer: Cigna of CA PPO |
$1,346.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,635.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$769.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$769.44
|
| Rate for Payer: Galaxy Health WC |
$1,635.06
|
| Rate for Payer: Global Benefits Group Commercial |
$1,154.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,731.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,442.70
|
| Rate for Payer: IEHP medi-cal |
$673.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,283.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.72
|
| Rate for Payer: Multiplan Commercial |
$1,442.70
|
| Rate for Payer: Networks By Design Commercial |
$961.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,635.06
|
| Rate for Payer: Riverside University Health MISP |
$769.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,154.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,154.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$961.80
|
| Rate for Payer: United Healthcare All Other HMO |
$961.80
|
| Rate for Payer: United Healthcare HMO Rider |
$961.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$961.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,635.06
|
| Rate for Payer: Vantage Medical Group Senior |
$1,635.06
|
|
|
BORTEZOMIB 3.5 MG INJECTION POWDER FOR SOLUTION [35839]
|
Facility
IP
|
$300.00
|
|
|
Service Code
|
NDC 43598-426-60
|
| Hospital Charge Code |
ERX35839
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Blue Shield of California Commercial |
$225.00
|
| Rate for Payer: Blue Shield of California EPN |
$160.20
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Central Health Plan Commercial |
$240.00
|
| Rate for Payer: Cigna of CA HMO |
$210.00
|
| Rate for Payer: Cigna of CA PPO |
$210.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: Networks By Design Commercial |
$150.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
|
|
BORTEZOMIB 3.5 MG INTRAVENOUS POWDER FOR SOLUTION [220799]
|
Facility
IP
|
$1,923.58
|
|
|
Service Code
|
CPT J9048
|
| Hospital Charge Code |
ERX220799
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$384.72 |
| Max. Negotiated Rate |
$1,731.22 |
| Rate for Payer: Blue Shield of California Commercial |
$1,442.68
|
| Rate for Payer: Blue Shield of California EPN |
$1,027.19
|
| Rate for Payer: Cash Price |
$865.61
|
| Rate for Payer: Central Health Plan Commercial |
$1,538.86
|
| Rate for Payer: Cigna of CA HMO |
$1,346.51
|
| Rate for Payer: Cigna of CA PPO |
$1,346.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$769.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$769.43
|
| Rate for Payer: Galaxy Health WC |
$1,635.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1,154.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,731.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,283.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.72
|
| Rate for Payer: Multiplan Commercial |
$1,442.68
|
| Rate for Payer: Networks By Design Commercial |
$961.79
|
| Rate for Payer: Prime Health Services Commercial |
$1,635.04
|
|
|
BORTEZOMIB 3.5 MG INTRAVENOUS POWDER FOR SOLUTION [220799]
|
Facility
OP
|
$1,923.58
|
|
|
Service Code
|
CPT J9048
|
| Hospital Charge Code |
ERX220799
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.55 |
| Max. Negotiated Rate |
$1,731.22 |
| Rate for Payer: Adventist Health Medi-Cal |
$48.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$279.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$60.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$53.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$53.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$90.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$99.30
|
| Rate for Payer: BCBS Transplant Transplant |
$1,154.15
|
| Rate for Payer: Blue Shield of California Commercial |
$1,209.93
|
| Rate for Payer: Blue Shield of California EPN |
$940.63
|
| Rate for Payer: Caremore Medicare Advantage |
$48.55
|
| Rate for Payer: Cash Price |
$865.61
|
| Rate for Payer: Cash Price |
$865.61
|
| Rate for Payer: Central Health Plan Commercial |
$1,538.86
|
| Rate for Payer: Cigna of CA HMO |
$1,346.51
|
| Rate for Payer: Cigna of CA PPO |
$1,346.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$48.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.55
|
| Rate for Payer: Galaxy Health WC |
$1,635.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1,154.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,731.22
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,442.68
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$79.62
|
| Rate for Payer: IEHP medi-cal |
$80.10
|
| Rate for Payer: IEHP Medicare Advantage |
$48.55
|
| Rate for Payer: Innovage PACE Commercial |
$72.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,283.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$65.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$65.05
|
| Rate for Payer: Multiplan Commercial |
$1,442.68
|
| Rate for Payer: Networks By Design Commercial |
$961.79
|
| Rate for Payer: Prime Health Services Commercial |
$1,635.04
|
| Rate for Payer: Prime Health Services Medicare |
$51.46
|
| Rate for Payer: Riverside University Health MISP |
$53.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,154.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,154.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$961.79
|
| Rate for Payer: United Healthcare All Other HMO |
$961.79
|
| Rate for Payer: United Healthcare HMO Rider |
$961.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$961.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.40
|
| Rate for Payer: Vantage Medical Group Senior |
$48.55
|
|
|
BORTEZOMIB 3.5 MG IV INJECTION. [408035839]
|
Facility
OP
|
$1,923.58
|
|
|
Service Code
|
CPT J9041
|
| Hospital Charge Code |
1755707
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$1,731.22 |
| Rate for Payer: Adventist Health Medi-Cal |
$1.96
|
| Rate for Payer: Adventist Health Medi-Cal |
$1.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$56.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$56.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.80
|
| Rate for Payer: BCBS Transplant Transplant |
$1,154.16
|
| Rate for Payer: BCBS Transplant Transplant |
$1,154.15
|
| Rate for Payer: Blue Shield of California Commercial |
$60.46
|
| Rate for Payer: Blue Shield of California Commercial |
$60.46
|
| Rate for Payer: Blue Shield of California EPN |
$54.96
|
| Rate for Payer: Blue Shield of California EPN |
$54.96
|
| Rate for Payer: Caremore Medicare Advantage |
$1.96
|
| Rate for Payer: Caremore Medicare Advantage |
$1.96
|
| Rate for Payer: Cash Price |
$865.62
|
| Rate for Payer: Cash Price |
$865.61
|
| Rate for Payer: Cash Price |
$865.61
|
| Rate for Payer: Cash Price |
$865.62
|
| Rate for Payer: Central Health Plan Commercial |
$1,538.86
|
| Rate for Payer: Central Health Plan Commercial |
$1,538.88
|
| Rate for Payer: Cigna of CA HMO |
$1,346.52
|
| Rate for Payer: Cigna of CA HMO |
$1,346.51
|
| Rate for Payer: Cigna of CA PPO |
$1,346.52
|
| Rate for Payer: Cigna of CA PPO |
$1,346.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.64
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.96
|
| Rate for Payer: Galaxy Health WC |
$1,635.04
|
| Rate for Payer: Galaxy Health WC |
$1,635.06
|
| Rate for Payer: Global Benefits Group Commercial |
$1,154.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,154.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,731.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,731.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,442.68
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,442.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3.21
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3.21
|
| Rate for Payer: IEHP medi-cal |
$3.23
|
| Rate for Payer: IEHP medi-cal |
$3.23
|
| Rate for Payer: IEHP Medicare Advantage |
$1.96
|
| Rate for Payer: IEHP Medicare Advantage |
$1.96
|
| Rate for Payer: Innovage PACE Commercial |
$2.94
|
| Rate for Payer: Innovage PACE Commercial |
$2.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,283.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,283.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.63
|
| Rate for Payer: Multiplan Commercial |
$1,442.70
|
| Rate for Payer: Multiplan Commercial |
$1,442.68
|
| Rate for Payer: Networks By Design Commercial |
$961.79
|
| Rate for Payer: Networks By Design Commercial |
$961.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,635.04
|
| Rate for Payer: Prime Health Services Commercial |
$1,635.06
|
| Rate for Payer: Prime Health Services Medicare |
$2.08
|
| Rate for Payer: Prime Health Services Medicare |
$2.08
|
| Rate for Payer: Riverside University Health MISP |
$2.15
|
| Rate for Payer: Riverside University Health MISP |
$2.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,154.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,154.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,154.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,154.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$961.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$961.79
|
| Rate for Payer: United Healthcare All Other HMO |
$961.79
|
| Rate for Payer: United Healthcare All Other HMO |
$961.80
|
| Rate for Payer: United Healthcare HMO Rider |
$961.79
|
| Rate for Payer: United Healthcare HMO Rider |
$961.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$961.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$961.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1.96
|
| Rate for Payer: Vantage Medical Group Senior |
$1.96
|
|
|
BORTEZOMIB 3.5 MG IV INJECTION. [408035839]
|
Facility
IP
|
$1,923.58
|
|
|
Service Code
|
CPT J9041
|
| Hospital Charge Code |
1755707
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$384.72 |
| Max. Negotiated Rate |
$1,731.22 |
| Rate for Payer: Blue Shield of California Commercial |
$1,442.68
|
| Rate for Payer: Blue Shield of California Commercial |
$1,442.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,027.20
|
| Rate for Payer: Blue Shield of California EPN |
$1,027.19
|
| Rate for Payer: Cash Price |
$865.61
|
| Rate for Payer: Cash Price |
$865.62
|
| Rate for Payer: Central Health Plan Commercial |
$1,538.88
|
| Rate for Payer: Central Health Plan Commercial |
$1,538.86
|
| Rate for Payer: Cigna of CA HMO |
$1,346.52
|
| Rate for Payer: Cigna of CA HMO |
$1,346.51
|
| Rate for Payer: Cigna of CA PPO |
$1,346.52
|
| Rate for Payer: Cigna of CA PPO |
$1,346.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$769.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$769.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$769.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$769.43
|
| Rate for Payer: Galaxy Health WC |
$1,635.04
|
| Rate for Payer: Galaxy Health WC |
$1,635.06
|
| Rate for Payer: Global Benefits Group Commercial |
$1,154.16
|
| Rate for Payer: Global Benefits Group Commercial |
$1,154.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,731.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,731.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,283.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,283.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.72
|
| Rate for Payer: Multiplan Commercial |
$1,442.68
|
| Rate for Payer: Multiplan Commercial |
$1,442.70
|
| Rate for Payer: Networks By Design Commercial |
$961.79
|
| Rate for Payer: Networks By Design Commercial |
$961.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,635.04
|
| Rate for Payer: Prime Health Services Commercial |
$1,635.06
|
|
|
BORTEZOMIB 3.5 MG SOLUTION FOR INJECTION SQ [40835839]
|
Facility
OP
|
$1,923.60
|
|
|
Service Code
|
CPT J9041
|
| Hospital Charge Code |
ERX40835839
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$1,731.24 |
| Rate for Payer: Adventist Health Medi-Cal |
$1.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$56.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.80
|
| Rate for Payer: BCBS Transplant Transplant |
$1,154.16
|
| Rate for Payer: Blue Shield of California Commercial |
$60.46
|
| Rate for Payer: Blue Shield of California EPN |
$54.96
|
| Rate for Payer: Caremore Medicare Advantage |
$1.96
|
| Rate for Payer: Cash Price |
$865.62
|
| Rate for Payer: Cash Price |
$865.62
|
| Rate for Payer: Central Health Plan Commercial |
$1,538.88
|
| Rate for Payer: Cigna of CA HMO |
$1,346.52
|
| Rate for Payer: Cigna of CA PPO |
$1,346.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.64
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.96
|
| Rate for Payer: Galaxy Health WC |
$1,635.06
|
| Rate for Payer: Global Benefits Group Commercial |
$1,154.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,731.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,442.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3.21
|
| Rate for Payer: IEHP medi-cal |
$3.23
|
| Rate for Payer: IEHP Medicare Advantage |
$1.96
|
| Rate for Payer: Innovage PACE Commercial |
$2.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,283.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.63
|
| Rate for Payer: Multiplan Commercial |
$1,442.70
|
| Rate for Payer: Networks By Design Commercial |
$961.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,635.06
|
| Rate for Payer: Prime Health Services Medicare |
$2.08
|
| Rate for Payer: Riverside University Health MISP |
$2.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,154.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,154.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$961.80
|
| Rate for Payer: United Healthcare All Other HMO |
$961.80
|
| Rate for Payer: United Healthcare HMO Rider |
$961.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$961.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1.96
|
|
|
BORTEZOMIB 3.5 MG SOLUTION FOR INJECTION SQ [40835839]
|
Facility
IP
|
$1,923.60
|
|
|
Service Code
|
CPT J9041
|
| Hospital Charge Code |
ERX40835839
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$384.72 |
| Max. Negotiated Rate |
$1,731.24 |
| Rate for Payer: Blue Shield of California Commercial |
$1,442.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,027.20
|
| Rate for Payer: Cash Price |
$865.62
|
| Rate for Payer: Central Health Plan Commercial |
$1,538.88
|
| Rate for Payer: Cigna of CA HMO |
$1,346.52
|
| Rate for Payer: Cigna of CA PPO |
$1,346.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$769.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$769.44
|
| Rate for Payer: Galaxy Health WC |
$1,635.06
|
| Rate for Payer: Global Benefits Group Commercial |
$1,154.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,731.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,283.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.72
|
| Rate for Payer: Multiplan Commercial |
$1,442.70
|
| Rate for Payer: Networks By Design Commercial |
$961.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,635.06
|
|
|
BOSENTAN 125 MG TABLET [31876]
|
Facility
IP
|
$23.26
|
|
|
Service Code
|
NDC 68382-447-14
|
| Hospital Charge Code |
1710988
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.65 |
| Max. Negotiated Rate |
$20.93 |
| Rate for Payer: Blue Shield of California Commercial |
$17.44
|
| Rate for Payer: Blue Shield of California EPN |
$12.42
|
| Rate for Payer: Cash Price |
$10.47
|
| Rate for Payer: Central Health Plan Commercial |
$18.61
|
| Rate for Payer: Cigna of CA HMO |
$16.28
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.30
|
| Rate for Payer: Galaxy Health WC |
$19.77
|
| Rate for Payer: Global Benefits Group Commercial |
$13.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.65
|
| Rate for Payer: Multiplan Commercial |
$17.44
|
| Rate for Payer: Networks By Design Commercial |
$15.12
|
| Rate for Payer: Prime Health Services Commercial |
$19.77
|
|
