|
MITOMYCIN 5 MG INTRAVENOUS SOLUTION [10632]
|
Facility
|
IP
|
$291.92
|
|
|
Service Code
|
HCPCS J9280
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.84 |
| Max. Negotiated Rate |
$218.94 |
| Rate for Payer: Adventist Health Commercial |
$58.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$188.00
|
| Rate for Payer: Cash Price |
$131.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$134.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$135.16
|
| Rate for Payer: Heritage Provider Network Senior |
$135.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.98
|
| Rate for Payer: Multiplan Commercial |
$218.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$105.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$96.65
|
|
|
MITOMYCIN 5 MG INTRAVENOUS SOLUTION [10632]
|
Facility
|
OP
|
$291.92
|
|
|
Service Code
|
HCPCS J9280
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.11 |
| Max. Negotiated Rate |
$289.58 |
| Rate for Payer: Adventist Health Commercial |
$58.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$180.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$37.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$289.58
|
| Rate for Payer: Blue Shield of California Commercial |
$149.85
|
| Rate for Payer: Blue Shield of California EPN |
$149.85
|
| Rate for Payer: Cash Price |
$131.36
|
| Rate for Payer: Cash Price |
$131.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$134.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$186.83
|
| Rate for Payer: EPIC Health Plan Medicare |
$34.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$135.16
|
| Rate for Payer: Heritage Provider Network Senior |
$135.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$34.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$139.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$39.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$45.71
|
| Rate for Payer: Multiplan Commercial |
$218.94
|
| Rate for Payer: TriValley Medical Group Commercial |
$116.77
|
| Rate for Payer: TriValley Medical Group Senior |
$116.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$105.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$96.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.52
|
| Rate for Payer: Vantage Medical Group Senior |
$37.52
|
|
|
MITOMYCIN (BULK) POWDER [24011]
|
Facility
|
OP
|
$56,293.48
|
|
|
Service Code
|
NDC 3877905536
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10,189.12 |
| Max. Negotiated Rate |
$47,849.46 |
| Rate for Payer: Adventist Health Commercial |
$11,258.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34,789.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$47,849.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30,961.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42,220.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$34,339.02
|
| Rate for Payer: Blue Shield of California EPN |
$27,471.22
|
| Rate for Payer: Cash Price |
$25,332.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$36,590.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$47,849.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$47,849.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$47,849.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$36,027.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$34,845.66
|
| Rate for Payer: Heritage Provider Network Senior |
$34,845.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$26,851.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,189.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,073.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$39,405.44
|
| Rate for Payer: Multiplan Commercial |
$42,220.11
|
| Rate for Payer: TriValley Medical Group Commercial |
$22,517.39
|
| Rate for Payer: TriValley Medical Group Senior |
$22,517.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$28,146.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28,146.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$47,849.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47,849.46
|
| Rate for Payer: Vantage Medical Group Senior |
$47,849.46
|
|
|
MITOMYCIN (BULK) POWDER [24011]
|
Facility
|
IP
|
$56,293.48
|
|
|
Service Code
|
NDC 3877905536
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10,189.12 |
| Max. Negotiated Rate |
$42,220.11 |
| Rate for Payer: Adventist Health Commercial |
$11,258.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36,253.00
|
| Rate for Payer: Cash Price |
$25,332.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,398.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$38,110.69
|
| Rate for Payer: Heritage Provider Network Senior |
$38,110.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,189.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,073.37
|
| Rate for Payer: Multiplan Commercial |
$42,220.11
|
|
|
MITOMYCIN IN NS 0.04 % (0.4 MG/ML) TOPICAL [4080715]
|
Facility
|
IP
|
$13.25
|
|
|
Service Code
|
NDC 9994080715
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$9.94 |
| Rate for Payer: Adventist Health Commercial |
$2.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.53
|
| Rate for Payer: Cash Price |
$5.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.97
|
| Rate for Payer: Heritage Provider Network Senior |
$8.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.31
|
| Rate for Payer: Multiplan Commercial |
$9.94
|
|
|
MITOMYCIN IN NS 0.04 % (0.4 MG/ML) TOPICAL [4080715]
|
Facility
|
IP
|
$13.25
|
|
|
Service Code
|
NDC 9994080717
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$9.94 |
| Rate for Payer: Adventist Health Commercial |
$2.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.53
|
| Rate for Payer: Cash Price |
$5.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.97
|
| Rate for Payer: Heritage Provider Network Senior |
$8.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.31
|
| Rate for Payer: Multiplan Commercial |
$9.94
|
|
|
MITOMYCIN IN NS 0.04 % (0.4 MG/ML) TOPICAL [4080715]
|
Facility
|
OP
|
$13.25
|
|
|
Service Code
|
NDC 9994080715
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$11.26 |
| Rate for Payer: Adventist Health Commercial |
$2.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.63
|
| Rate for Payer: Blue Shield of California Commercial |
$8.08
|
| Rate for Payer: Blue Shield of California EPN |
$6.47
|
| Rate for Payer: Cash Price |
$5.96
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.20
|
| Rate for Payer: Heritage Provider Network Senior |
$8.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.28
|
| Rate for Payer: Multiplan Commercial |
$9.94
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.30
|
| Rate for Payer: TriValley Medical Group Senior |
$5.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.26
|
| Rate for Payer: Vantage Medical Group Senior |
$11.26
|
|
|
MITOMYCIN IN NS 0.04 % (0.4 MG/ML) TOPICAL [4080715]
|
Facility
|
OP
|
$13.25
|
|
|
Service Code
|
NDC 9994080717
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$11.26 |
| Rate for Payer: Adventist Health Commercial |
$2.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.63
|
| Rate for Payer: Blue Shield of California Commercial |
$8.08
|
| Rate for Payer: Blue Shield of California EPN |
$6.47
|
| Rate for Payer: Cash Price |
$5.96
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.20
|
| Rate for Payer: Heritage Provider Network Senior |
$8.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.28
|
| Rate for Payer: Multiplan Commercial |
$9.94
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.30
|
| Rate for Payer: TriValley Medical Group Senior |
$5.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.26
|
| Rate for Payer: Vantage Medical Group Senior |
$11.26
|
|
|
MITOMYCIN IN STERILE WATER 0.01 % (0.1 MG/ML) TOPICAL [4080716]
|
Facility
|
IP
|
$142.55
|
|
|
Service Code
|
NDC 9994080716
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$106.91 |
| Rate for Payer: Adventist Health Commercial |
$28.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$91.80
|
| Rate for Payer: Cash Price |
$64.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$96.51
|
| Rate for Payer: Heritage Provider Network Senior |
$96.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.64
|
| Rate for Payer: Multiplan Commercial |
$106.91
|
|
|
MITOMYCIN IN STERILE WATER 0.01 % (0.1 MG/ML) TOPICAL [4080716]
|
Facility
|
OP
|
$142.55
|
|
|
Service Code
|
NDC 9994080716
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$121.17 |
| Rate for Payer: Adventist Health Commercial |
$28.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$88.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$121.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$78.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$106.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.30
|
| Rate for Payer: Blue Shield of California Commercial |
$86.96
|
| Rate for Payer: Blue Shield of California EPN |
$69.56
|
| Rate for Payer: Cash Price |
$64.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$92.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$121.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$121.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$121.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$88.24
|
| Rate for Payer: Heritage Provider Network Senior |
$88.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$68.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$99.78
|
| Rate for Payer: Multiplan Commercial |
$106.91
|
| Rate for Payer: TriValley Medical Group Commercial |
$57.02
|
| Rate for Payer: TriValley Medical Group Senior |
$57.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$121.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$121.17
|
| Rate for Payer: Vantage Medical Group Senior |
$121.17
|
|
|
MITOMYCIN IN STERILE WATER 0.02 % (0.2 MG/ML) TOPICAL [4081078]
|
Facility
|
OP
|
$1.43
|
|
|
Service Code
|
NDC 9994081078
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.72
|
| Rate for Payer: Blue Shield of California Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$0.70
|
| Rate for Payer: Cash Price |
$0.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.89
|
| Rate for Payer: Heritage Provider Network Senior |
$0.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.00
|
| Rate for Payer: Multiplan Commercial |
$1.07
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.57
|
| Rate for Payer: TriValley Medical Group Senior |
$0.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.22
|
| Rate for Payer: Vantage Medical Group Senior |
$1.22
|
|
|
MITOMYCIN IN STERILE WATER 0.02 % (0.2 MG/ML) TOPICAL [4081078]
|
Facility
|
IP
|
$1.43
|
|
|
Service Code
|
NDC 9994081078
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.07 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.92
|
| Rate for Payer: Cash Price |
$0.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.97
|
| Rate for Payer: Heritage Provider Network Senior |
$0.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.07
|
|
|
MITOXANTRONE 2 MG/ML CONCENTRATE,INTRAVENOUS [10634]
|
Facility
|
IP
|
$20.71
|
|
|
Service Code
|
HCPCS J9293
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.75 |
| Max. Negotiated Rate |
$15.53 |
| Rate for Payer: Adventist Health Commercial |
$4.14
|
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.34
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$9.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.61
|
| Rate for Payer: Heritage Provider Network Senior |
$23.61
|
| Rate for Payer: Heritage Provider Network Senior |
$9.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.75
|
| Rate for Payer: Multiplan Commercial |
$38.25
|
| Rate for Payer: Multiplan Commercial |
$15.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.86
|
|
|
MITOXANTRONE 2 MG/ML CONCENTRATE,INTRAVENOUS [10634]
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
HCPCS J9293
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.23 |
| Max. Negotiated Rate |
$566.11 |
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Adventist Health Commercial |
$4.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$566.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$566.11
|
| Rate for Payer: Blue Shield of California Commercial |
$73.98
|
| Rate for Payer: Blue Shield of California Commercial |
$73.98
|
| Rate for Payer: Blue Shield of California EPN |
$73.98
|
| Rate for Payer: Blue Shield of California EPN |
$73.98
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$9.32
|
| Rate for Payer: Cash Price |
$9.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$29.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$29.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.59
|
| Rate for Payer: Heritage Provider Network Senior |
$23.61
|
| Rate for Payer: Heritage Provider Network Senior |
$9.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$24.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$39.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$39.80
|
| Rate for Payer: Multiplan Commercial |
$38.25
|
| Rate for Payer: Multiplan Commercial |
$15.53
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.40
|
| Rate for Payer: TriValley Medical Group Senior |
$8.28
|
| Rate for Payer: TriValley Medical Group Senior |
$20.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.67
|
| Rate for Payer: Vantage Medical Group Senior |
$32.67
|
| Rate for Payer: Vantage Medical Group Senior |
$32.67
|
|
|
MODAFINIL 100 MG TABLET [24702]
|
Facility
|
OP
|
$13.20
|
|
|
Service Code
|
NDC 6808462111
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.60
|
| Rate for Payer: Blue Shield of California Commercial |
$8.05
|
| Rate for Payer: Blue Shield of California EPN |
$6.44
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.17
|
| Rate for Payer: Heritage Provider Network Senior |
$8.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.28
|
| Rate for Payer: TriValley Medical Group Senior |
$5.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: Vantage Medical Group Senior |
$11.22
|
|
|
MODAFINIL 100 MG TABLET [24702]
|
Facility
|
IP
|
$13.20
|
|
|
Service Code
|
NDC 6808462121
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.50
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.94
|
| Rate for Payer: Heritage Provider Network Senior |
$8.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.30
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
|
|
MODAFINIL 100 MG TABLET [24702]
|
Facility
|
OP
|
$0.36
|
|
|
Service Code
|
NDC 6945234213
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Senior |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
|
MODAFINIL 100 MG TABLET [24702]
|
Facility
|
IP
|
$0.36
|
|
|
Service Code
|
NDC 6945234213
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.23
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.24
|
| Rate for Payer: Heritage Provider Network Senior |
$0.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
|
|
MODAFINIL 100 MG TABLET [24702]
|
Facility
|
OP
|
$13.20
|
|
|
Service Code
|
NDC 6808462121
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.60
|
| Rate for Payer: Blue Shield of California Commercial |
$8.05
|
| Rate for Payer: Blue Shield of California EPN |
$6.44
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.17
|
| Rate for Payer: Heritage Provider Network Senior |
$8.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.28
|
| Rate for Payer: TriValley Medical Group Senior |
$5.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: Vantage Medical Group Senior |
$11.22
|
|
|
MODAFINIL 100 MG TABLET [24702]
|
Facility
|
IP
|
$13.20
|
|
|
Service Code
|
NDC 6808462111
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.50
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.94
|
| Rate for Payer: Heritage Provider Network Senior |
$8.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.30
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
|
|
MODIFIED LANOLIN 100 % TOPICAL CREAM [225322]
|
Facility
|
IP
|
$0.20
|
|
|
Service Code
|
NDC 4467710020
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.13
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Senior |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
|
|
MODIFIED LANOLIN 100 % TOPICAL CREAM [225322]
|
Facility
|
OP
|
$0.20
|
|
|
Service Code
|
NDC 4467710020
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Senior |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Vantage Medical Group Senior |
$0.17
|
|
|
MOMETASONE 0.1 % TOPICAL OINTMENT [10648]
|
Facility
|
OP
|
$0.78
|
|
|
Service Code
|
NDC 4580211942
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.39
|
| Rate for Payer: Blue Shield of California Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California EPN |
$0.38
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.48
|
| Rate for Payer: Heritage Provider Network Senior |
$0.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.31
|
| Rate for Payer: TriValley Medical Group Senior |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: Vantage Medical Group Senior |
$0.66
|
|
|
MOMETASONE 0.1 % TOPICAL OINTMENT [10648]
|
Facility
|
IP
|
$0.78
|
|
|
Service Code
|
NDC 4580211942
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.50
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.53
|
| Rate for Payer: Heritage Provider Network Senior |
$0.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
|
|
MONTELUKAST 10 MG TABLET [22509]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 3334210207
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Senior |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
|
