|
ITRACONAZOLE 100 MG CAPSULE [10364]
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 6516263003
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.29
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.35
|
| Rate for Payer: Heritage Provider Network Senior |
$1.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
|
|
ITRACONAZOLE 100 MG CAPSULE [10364]
|
Facility
|
IP
|
$35.31
|
|
|
Service Code
|
NDC 5045829001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.39 |
| Max. Negotiated Rate |
$26.48 |
| Rate for Payer: Adventist Health Commercial |
$7.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22.74
|
| Rate for Payer: Cash Price |
$15.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.90
|
| Rate for Payer: Heritage Provider Network Senior |
$23.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.83
|
| Rate for Payer: Multiplan Commercial |
$26.48
|
|
|
ITRACONAZOLE 10 MG/ML ORAL SOLUTION [19928]
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 3172200631
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.29
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.35
|
| Rate for Payer: Heritage Provider Network Senior |
$1.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
|
|
ITRACONAZOLE 10 MG/ML ORAL SOLUTION [19928]
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
NDC 3172200631
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.98
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.24
|
| Rate for Payer: Heritage Provider Network Senior |
$1.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.40
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.80
|
| Rate for Payer: TriValley Medical Group Senior |
$0.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1.70
|
|
|
ITRACONAZOLE 10 MG/ML ORAL SOLUTION [19928]
|
Facility
|
IP
|
$2.35
|
|
|
Service Code
|
NDC 6516208774
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.76 |
| Rate for Payer: Adventist Health Commercial |
$0.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.51
|
| Rate for Payer: Cash Price |
$1.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.59
|
| Rate for Payer: Heritage Provider Network Senior |
$1.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: Multiplan Commercial |
$1.76
|
|
|
ITRACONAZOLE 10 MG/ML ORAL SOLUTION [19928]
|
Facility
|
OP
|
$2.35
|
|
|
Service Code
|
NDC 6516208774
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.00
|
| Rate for Payer: Adventist Health Commercial |
$0.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.18
|
| Rate for Payer: Blue Shield of California Commercial |
$1.43
|
| Rate for Payer: Blue Shield of California EPN |
$1.15
|
| Rate for Payer: Cash Price |
$1.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.45
|
| Rate for Payer: Heritage Provider Network Senior |
$1.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.65
|
| Rate for Payer: Multiplan Commercial |
$1.76
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.94
|
| Rate for Payer: TriValley Medical Group Senior |
$0.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2.00
|
|
|
IVABRADINE 2.5 MG PARTIAL TABLET [4082315]
|
Facility
|
OP
|
$6.26
|
|
|
Service Code
|
NDC 9994082315
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$5.32 |
| Rate for Payer: Adventist Health Commercial |
$1.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.13
|
| Rate for Payer: Blue Shield of California Commercial |
$3.82
|
| Rate for Payer: Blue Shield of California EPN |
$3.05
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.87
|
| Rate for Payer: Heritage Provider Network Senior |
$3.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.38
|
| Rate for Payer: Multiplan Commercial |
$4.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.50
|
| Rate for Payer: TriValley Medical Group Senior |
$2.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.32
|
| Rate for Payer: Vantage Medical Group Senior |
$5.32
|
|
|
IVABRADINE 2.5 MG PARTIAL TABLET [4082315]
|
Facility
|
IP
|
$6.26
|
|
|
Service Code
|
NDC 9994082315
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$4.70 |
| Rate for Payer: Adventist Health Commercial |
$1.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.03
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.24
|
| Rate for Payer: Heritage Provider Network Senior |
$4.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$4.70
|
|
|
IVABRADINE 5 MG TABLET [204605]
|
Facility
|
OP
|
$0.90
|
|
|
Service Code
|
NDC 5074236260
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.45
|
| Rate for Payer: Blue Shield of California Commercial |
$0.55
|
| Rate for Payer: Blue Shield of California EPN |
$0.44
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.56
|
| Rate for Payer: Heritage Provider Network Senior |
$0.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.63
|
| Rate for Payer: Multiplan Commercial |
$0.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.36
|
| Rate for Payer: TriValley Medical Group Senior |
$0.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.77
|
| Rate for Payer: Vantage Medical Group Senior |
$0.77
|
|
|
IVABRADINE 5 MG TABLET [204605]
|
Facility
|
IP
|
$12.65
|
|
|
Service Code
|
NDC 6068786221
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$9.49 |
| Rate for Payer: Adventist Health Commercial |
$2.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.15
|
| Rate for Payer: Cash Price |
$5.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.56
|
| Rate for Payer: Heritage Provider Network Senior |
$8.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.16
|
| Rate for Payer: Multiplan Commercial |
$9.49
|
|
|
IVABRADINE 5 MG TABLET [204605]
|
Facility
|
OP
|
$12.65
|
|
|
Service Code
|
NDC 6068786221
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$10.75 |
| Rate for Payer: Adventist Health Commercial |
$2.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.33
|
| Rate for Payer: Blue Shield of California Commercial |
$7.72
|
| Rate for Payer: Blue Shield of California EPN |
$6.17
|
| Rate for Payer: Cash Price |
$5.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.83
|
| Rate for Payer: Heritage Provider Network Senior |
$7.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.86
|
| Rate for Payer: Multiplan Commercial |
$9.49
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.06
|
| Rate for Payer: TriValley Medical Group Senior |
$5.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.75
|
| Rate for Payer: Vantage Medical Group Senior |
$10.75
|
|
|
IVABRADINE 5 MG TABLET [204605]
|
Facility
|
IP
|
$0.90
|
|
|
Service Code
|
NDC 5074236260
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.58
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.61
|
| Rate for Payer: Heritage Provider Network Senior |
$0.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.68
|
|
|
IVABRADINE 5 MG TABLET [204605]
|
Facility
|
OP
|
$12.65
|
|
|
Service Code
|
NDC 6068786211
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$10.75 |
| Rate for Payer: Adventist Health Commercial |
$2.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.33
|
| Rate for Payer: Blue Shield of California Commercial |
$7.72
|
| Rate for Payer: Blue Shield of California EPN |
$6.17
|
| Rate for Payer: Cash Price |
$5.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.83
|
| Rate for Payer: Heritage Provider Network Senior |
$7.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.86
|
| Rate for Payer: Multiplan Commercial |
$9.49
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.06
|
| Rate for Payer: TriValley Medical Group Senior |
$5.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.75
|
| Rate for Payer: Vantage Medical Group Senior |
$10.75
|
|
|
IVABRADINE 5 MG TABLET [204605]
|
Facility
|
IP
|
$12.65
|
|
|
Service Code
|
NDC 6068786211
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$9.49 |
| Rate for Payer: Adventist Health Commercial |
$2.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.15
|
| Rate for Payer: Cash Price |
$5.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.56
|
| Rate for Payer: Heritage Provider Network Senior |
$8.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.16
|
| Rate for Payer: Multiplan Commercial |
$9.49
|
|
|
IVABRADINE 5 MG TABLET [204605]
|
Facility
|
IP
|
$2.70
|
|
|
Service Code
|
NDC 6233267960
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$2.02 |
| Rate for Payer: Adventist Health Commercial |
$0.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.74
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.83
|
| Rate for Payer: Heritage Provider Network Senior |
$1.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: Multiplan Commercial |
$2.02
|
|
|
IVABRADINE 5 MG TABLET [204605]
|
Facility
|
OP
|
$2.70
|
|
|
Service Code
|
NDC 6233267960
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: Adventist Health Commercial |
$0.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1.65
|
| Rate for Payer: Blue Shield of California EPN |
$1.32
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.67
|
| Rate for Payer: Heritage Provider Network Senior |
$1.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.89
|
| Rate for Payer: Multiplan Commercial |
$2.02
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.08
|
| Rate for Payer: TriValley Medical Group Senior |
$1.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.29
|
| Rate for Payer: Vantage Medical Group Senior |
$2.29
|
|
|
IVABRADINE 7.5 MG TABLET [204608]
|
Facility
|
IP
|
$12.52
|
|
|
Service Code
|
NDC 5551381060
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.27 |
| Max. Negotiated Rate |
$9.39 |
| Rate for Payer: Adventist Health Commercial |
$2.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.06
|
| Rate for Payer: Cash Price |
$5.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.48
|
| Rate for Payer: Heritage Provider Network Senior |
$8.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.13
|
| Rate for Payer: Multiplan Commercial |
$9.39
|
|
|
IVABRADINE 7.5 MG TABLET [204608]
|
Facility
|
OP
|
$12.52
|
|
|
Service Code
|
NDC 5551381060
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.27 |
| Max. Negotiated Rate |
$10.64 |
| Rate for Payer: Adventist Health Commercial |
$2.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.26
|
| Rate for Payer: Blue Shield of California Commercial |
$7.64
|
| Rate for Payer: Blue Shield of California EPN |
$6.11
|
| Rate for Payer: Cash Price |
$5.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.75
|
| Rate for Payer: Heritage Provider Network Senior |
$7.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.76
|
| Rate for Payer: Multiplan Commercial |
$9.39
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.01
|
| Rate for Payer: TriValley Medical Group Senior |
$5.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.64
|
| Rate for Payer: Vantage Medical Group Senior |
$10.64
|
|
|
IVERMECTIN 3 MG TABLET [25820]
|
Facility
|
OP
|
$4.97
|
|
|
Service Code
|
NDC 4279980601
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$4.22 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.07
|
| Rate for Payer: Adventist Health Commercial |
$0.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.49
|
| Rate for Payer: Blue Shield of California Commercial |
$3.03
|
| Rate for Payer: Blue Shield of California EPN |
$2.43
|
| Rate for Payer: Cash Price |
$2.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.08
|
| Rate for Payer: Heritage Provider Network Senior |
$3.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.48
|
| Rate for Payer: Multiplan Commercial |
$3.73
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.99
|
| Rate for Payer: TriValley Medical Group Senior |
$1.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.22
|
|
|
IVERMECTIN 3 MG TABLET [25820]
|
Facility
|
IP
|
$4.97
|
|
|
Service Code
|
NDC 4279980601
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$3.73 |
| Rate for Payer: Adventist Health Commercial |
$0.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.20
|
| Rate for Payer: Cash Price |
$2.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.36
|
| Rate for Payer: Heritage Provider Network Senior |
$3.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.24
|
| Rate for Payer: Multiplan Commercial |
$3.73
|
|
|
IXABEPILONE 45 MG INTRAVENOUS SOLUTION [88653]
|
Facility
|
OP
|
$7,252.42
|
|
|
Service Code
|
HCPCS J9207
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$134.30 |
| Max. Negotiated Rate |
$5,439.31 |
| Rate for Payer: Adventist Health Commercial |
$1,450.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,482.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$209.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$153.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$139.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.24
|
| Rate for Payer: Blue Shield of California Commercial |
$134.30
|
| Rate for Payer: Blue Shield of California EPN |
$134.30
|
| Rate for Payer: Cash Price |
$3,263.59
|
| Rate for Payer: Cash Price |
$3,263.59
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,336.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$174.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$153.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$153.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,641.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$139.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,357.87
|
| Rate for Payer: Heritage Provider Network Senior |
$3,357.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$139.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,459.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,312.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$160.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,813.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$187.26
|
| Rate for Payer: Multiplan Commercial |
$5,439.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,900.97
|
| Rate for Payer: TriValley Medical Group Senior |
$2,900.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,620.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,401.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$174.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$153.72
|
| Rate for Payer: Vantage Medical Group Senior |
$153.72
|
|
|
IXABEPILONE 45 MG INTRAVENOUS SOLUTION [88653]
|
Facility
|
IP
|
$7,252.42
|
|
|
Service Code
|
HCPCS J9207
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,312.69 |
| Max. Negotiated Rate |
$5,439.31 |
| Rate for Payer: Adventist Health Commercial |
$1,450.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,670.56
|
| Rate for Payer: Cash Price |
$3,263.59
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,336.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,916.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,357.87
|
| Rate for Payer: Heritage Provider Network Senior |
$3,357.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,312.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,813.11
|
| Rate for Payer: Multiplan Commercial |
$5,439.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,620.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,401.28
|
|
|
KARAYA GUM TOPICAL POWDER [111957]
|
Facility
|
IP
|
$0.18
|
|
|
Service Code
|
NDC 8380007905
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.12
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Senior |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
|
|
KARAYA GUM TOPICAL POWDER [111957]
|
Facility
|
OP
|
$0.18
|
|
|
Service Code
|
NDC 8380007905
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Senior |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Vantage Medical Group Senior |
$0.15
|
|
|
KETAMINE 100 MG/ML INJECTION SOLUTION [4237]
|
Facility
|
OP
|
$2.46
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.09 |
| Rate for Payer: Adventist Health Commercial |
$0.49
|
| Rate for Payer: Adventist Health Commercial |
$0.61
|
| Rate for Payer: Adventist Health Commercial |
$0.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.29
|
| Rate for Payer: Blue Shield of California Commercial |
$1.50
|
| Rate for Payer: Blue Shield of California Commercial |
$2.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1.87
|
| Rate for Payer: Blue Shield of California EPN |
$1.20
|
| Rate for Payer: Blue Shield of California EPN |
$1.49
|
| Rate for Payer: Blue Shield of California EPN |
$1.81
|
| Rate for Payer: Cash Price |
$1.67
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Cash Price |
$1.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.72
|
| Rate for Payer: Heritage Provider Network Senior |
$1.42
|
| Rate for Payer: Heritage Provider Network Senior |
$1.14
|
| Rate for Payer: Heritage Provider Network Senior |
$1.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.14
|
| Rate for Payer: Multiplan Commercial |
$1.84
|
| Rate for Payer: Multiplan Commercial |
$2.29
|
| Rate for Payer: Multiplan Commercial |
$2.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.98
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.48
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.22
|
| Rate for Payer: TriValley Medical Group Senior |
$1.22
|
| Rate for Payer: TriValley Medical Group Senior |
$1.48
|
| Rate for Payer: TriValley Medical Group Senior |
$0.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.15
|
| Rate for Payer: Vantage Medical Group Senior |
$3.15
|
| Rate for Payer: Vantage Medical Group Senior |
$2.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2.60
|
|
