|
NEGATIVE PRESSURE WOUND THERAPY (EG, VACUUM ASSISTED DRAINAGE COLLECTION), UTILIZING DURABLE MEDICAL EQUIPMENT (DME), INCLUDING TOPICAL APPLICATION(S), WOUND ASSESSMENT, AND INSTRUCTION(S) FOR ONGOING CARE, PER SESSION; TOTAL WOUND(S) SURFACE AREA LESS THAN OR EQUAL TO 50 SQUARE CENTIMETERS
|
Facility
|
OP
|
$8,962.13
|
|
|
Service Code
|
CPT 97605
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$258.05 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$258.05
|
| Rate for Payer: Heritage Provider Network Senior |
$317.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$490.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$283.86
|
| Rate for Payer: TriValley Medical Group Senior |
$283.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
NELARABINE 5 MG/ML INTRAVENOUS SOLUTION [70267]
|
Facility
|
IP
|
$15.86
|
|
|
Service Code
|
HCPCS J9261
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.87 |
| Max. Negotiated Rate |
$11.89 |
| Rate for Payer: Adventist Health Commercial |
$3.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.21
|
| Rate for Payer: Cash Price |
$7.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.34
|
| Rate for Payer: Heritage Provider Network Senior |
$7.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.96
|
| Rate for Payer: Multiplan Commercial |
$11.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.25
|
|
|
NELARABINE 5 MG/ML INTRAVENOUS SOLUTION [70267]
|
Facility
|
OP
|
$15.86
|
|
|
Service Code
|
HCPCS J9261
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.87 |
| Max. Negotiated Rate |
$202.06 |
| Rate for Payer: Adventist Health Commercial |
$3.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$98.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$71.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$202.06
|
| Rate for Payer: Blue Shield of California Commercial |
$134.81
|
| Rate for Payer: Blue Shield of California EPN |
$134.81
|
| Rate for Payer: Cash Price |
$7.14
|
| Rate for Payer: Cash Price |
$7.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$71.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$71.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$65.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.34
|
| Rate for Payer: Heritage Provider Network Senior |
$7.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$65.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$75.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$87.65
|
| Rate for Payer: Multiplan Commercial |
$11.89
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.34
|
| Rate for Payer: TriValley Medical Group Senior |
$6.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$71.95
|
| Rate for Payer: Vantage Medical Group Senior |
$71.95
|
|
|
NELFINAVIR 250 MG TABLET [20032]
|
Facility
|
IP
|
$4.86
|
|
|
Service Code
|
NDC 6301001030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$3.65 |
| Rate for Payer: Adventist Health Commercial |
$0.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.13
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.29
|
| Rate for Payer: Heritage Provider Network Senior |
$3.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.22
|
| Rate for Payer: Multiplan Commercial |
$3.65
|
|
|
NELFINAVIR 250 MG TABLET [20032]
|
Facility
|
OP
|
$4.86
|
|
|
Service Code
|
NDC 6301001030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Adventist Health Commercial |
$0.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.43
|
| Rate for Payer: Blue Shield of California Commercial |
$2.96
|
| Rate for Payer: Blue Shield of California EPN |
$2.37
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.01
|
| Rate for Payer: Heritage Provider Network Senior |
$3.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.40
|
| Rate for Payer: Multiplan Commercial |
$3.65
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.94
|
| Rate for Payer: TriValley Medical Group Senior |
$1.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.13
|
| Rate for Payer: Vantage Medical Group Senior |
$4.13
|
|
|
NEOMY-BACIT-POLYMYX-PRAMOXINE 3.5 MG-500 UNIT-10,000 UNIT/G TOP OINT [21070]
|
Facility
|
IP
|
$0.16
|
|
|
Service Code
|
NDC 2438514303
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.10
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Senior |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
|
|
NEOMY-BACIT-POLYMYX-PRAMOXINE 3.5 MG-500 UNIT-10,000 UNIT/G TOP OINT [21070]
|
Facility
|
OP
|
$0.15
|
|
|
Service Code
|
NDC 0713062231
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Senior |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Vantage Medical Group Senior |
$0.13
|
|
|
NEOMY-BACIT-POLYMYX-PRAMOXINE 3.5 MG-500 UNIT-10,000 UNIT/G TOP OINT [21070]
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
NDC 2438514303
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Senior |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
NEOMY-BACIT-POLYMYX-PRAMOXINE 3.5 MG-500 UNIT-10,000 UNIT/G TOP OINT [21070]
|
Facility
|
IP
|
$0.15
|
|
|
Service Code
|
NDC 0713062231
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.10
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Senior |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
|
|
NEOMY-BACIT-POLYMYX-PRAMOXINE 3.5 MG-500 UNIT-10,000 UNIT/G TOP OINT [21070]
|
Facility
|
IP
|
$0.16
|
|
|
Service Code
|
NDC 8770194584
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.10
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Senior |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
|
|
NEOMY-BACIT-POLYMYX-PRAMOXINE 3.5 MG-500 UNIT-10,000 UNIT/G TOP OINT [21070]
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
NDC 8770194584
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Senior |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
NEOMYCIN 1.75 MG-POLYMYXIN 10,000 UNIT-GRAMICIDIN 0.025MG/ML EYE DROPS [5474]
|
Facility
|
IP
|
$6.13
|
|
|
Service Code
|
NDC 2420879062
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Adventist Health Commercial |
$1.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.95
|
| Rate for Payer: Cash Price |
$2.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.15
|
| Rate for Payer: Heritage Provider Network Senior |
$4.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.53
|
| Rate for Payer: Multiplan Commercial |
$4.60
|
|
|
NEOMYCIN 1.75 MG-POLYMYXIN 10,000 UNIT-GRAMICIDIN 0.025MG/ML EYE DROPS [5474]
|
Facility
|
OP
|
$6.13
|
|
|
Service Code
|
NDC 2420879062
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$5.21 |
| Rate for Payer: Adventist Health Commercial |
$1.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.07
|
| Rate for Payer: Blue Shield of California Commercial |
$3.74
|
| Rate for Payer: Blue Shield of California EPN |
$2.99
|
| Rate for Payer: Cash Price |
$2.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.79
|
| Rate for Payer: Heritage Provider Network Senior |
$3.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.29
|
| Rate for Payer: Multiplan Commercial |
$4.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.45
|
| Rate for Payer: TriValley Medical Group Senior |
$2.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.21
|
| Rate for Payer: Vantage Medical Group Senior |
$5.21
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT [106249]
|
Facility
|
IP
|
$6.17
|
|
|
Service Code
|
NDC 6131463136
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$4.63 |
| Rate for Payer: Adventist Health Commercial |
$1.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.97
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.18
|
| Rate for Payer: Heritage Provider Network Senior |
$4.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.54
|
| Rate for Payer: Multiplan Commercial |
$4.63
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT [106249]
|
Facility
|
OP
|
$6.17
|
|
|
Service Code
|
NDC 6131463136
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$5.24 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Adventist Health Commercial |
$1.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.09
|
| Rate for Payer: Blue Shield of California Commercial |
$3.76
|
| Rate for Payer: Blue Shield of California EPN |
$3.01
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.82
|
| Rate for Payer: Heritage Provider Network Senior |
$3.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.32
|
| Rate for Payer: Multiplan Commercial |
$4.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.47
|
| Rate for Payer: TriValley Medical Group Senior |
$2.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.24
|
| Rate for Payer: Vantage Medical Group Senior |
$5.24
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT [106249]
|
Facility
|
OP
|
$5.45
|
|
|
Service Code
|
NDC 2420879535
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$4.63 |
| Rate for Payer: Adventist Health Commercial |
$1.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.73
|
| Rate for Payer: Blue Shield of California Commercial |
$3.32
|
| Rate for Payer: Blue Shield of California EPN |
$2.66
|
| Rate for Payer: Cash Price |
$2.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.37
|
| Rate for Payer: Heritage Provider Network Senior |
$3.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.81
|
| Rate for Payer: Multiplan Commercial |
$4.09
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.18
|
| Rate for Payer: TriValley Medical Group Senior |
$2.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4.63
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT [106249]
|
Facility
|
IP
|
$5.45
|
|
|
Service Code
|
NDC 2420879535
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Adventist Health Commercial |
$1.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.51
|
| Rate for Payer: Cash Price |
$2.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.69
|
| Rate for Payer: Heritage Provider Network Senior |
$3.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.36
|
| Rate for Payer: Multiplan Commercial |
$4.09
|
|
|
NEOMYCIN 3.5 MG-POLYMYXIN 10,000 UNIT-HYDROCORT 10 MG/ML EYE DROP,SUSP [35126]
|
Facility
|
OP
|
$23.95
|
|
|
Service Code
|
NDC 6131464175
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.33 |
| Max. Negotiated Rate |
$20.36 |
| Rate for Payer: Adventist Health Commercial |
$4.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.98
|
| Rate for Payer: Blue Shield of California Commercial |
$14.61
|
| Rate for Payer: Blue Shield of California EPN |
$11.69
|
| Rate for Payer: Cash Price |
$10.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.83
|
| Rate for Payer: Heritage Provider Network Senior |
$14.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.77
|
| Rate for Payer: Multiplan Commercial |
$17.96
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.58
|
| Rate for Payer: TriValley Medical Group Senior |
$9.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.36
|
| Rate for Payer: Vantage Medical Group Senior |
$20.36
|
|
|
NEOMYCIN 3.5 MG-POLYMYXIN 10,000 UNIT-HYDROCORT 10 MG/ML EYE DROP,SUSP [35126]
|
Facility
|
IP
|
$23.95
|
|
|
Service Code
|
NDC 6131464175
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.33 |
| Max. Negotiated Rate |
$17.96 |
| Rate for Payer: Adventist Health Commercial |
$4.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.42
|
| Rate for Payer: Cash Price |
$10.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.21
|
| Rate for Payer: Heritage Provider Network Senior |
$16.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.99
|
| Rate for Payer: Multiplan Commercial |
$17.96
|
|
|
NEOMYCIN 40 MG-POLYMYXIN B 200,000 UNIT/ML GU IRRIGATION SOLUTION [70678]
|
Facility
|
OP
|
$13.11
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$11.14 |
| Rate for Payer: Adventist Health Commercial |
$2.62
|
| Rate for Payer: Adventist Health Commercial |
$2.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.83
|
| Rate for Payer: Blue Shield of California Commercial |
$8.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8.27
|
| Rate for Payer: Blue Shield of California EPN |
$6.62
|
| Rate for Payer: Blue Shield of California EPN |
$6.40
|
| Rate for Payer: Cash Price |
$6.10
|
| Rate for Payer: Cash Price |
$5.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.28
|
| Rate for Payer: Heritage Provider Network Senior |
$6.07
|
| Rate for Payer: Heritage Provider Network Senior |
$6.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.18
|
| Rate for Payer: Multiplan Commercial |
$10.17
|
| Rate for Payer: Multiplan Commercial |
$9.83
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.24
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.42
|
| Rate for Payer: TriValley Medical Group Senior |
$5.24
|
| Rate for Payer: TriValley Medical Group Senior |
$5.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.53
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
| Rate for Payer: Vantage Medical Group Senior |
$11.14
|
|
|
NEOMYCIN 40 MG-POLYMYXIN B 200,000 UNIT/ML GU IRRIGATION SOLUTION [70678]
|
Facility
|
IP
|
$13.56
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$10.17 |
| Rate for Payer: Adventist Health Commercial |
$2.71
|
| Rate for Payer: Adventist Health Commercial |
$2.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.73
|
| Rate for Payer: Cash Price |
$5.90
|
| Rate for Payer: Cash Price |
$6.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.28
|
| Rate for Payer: Heritage Provider Network Senior |
$6.28
|
| Rate for Payer: Heritage Provider Network Senior |
$6.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.39
|
| Rate for Payer: Multiplan Commercial |
$9.83
|
| Rate for Payer: Multiplan Commercial |
$10.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.34
|
|
|
NEOMYCIN 500 MG TABLET [5472]
|
Facility
|
OP
|
$1.33
|
|
|
Service Code
|
NDC 0093117701
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.13 |
| Rate for Payer: Adventist Health Commercial |
$0.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.67
|
| Rate for Payer: Blue Shield of California Commercial |
$0.81
|
| Rate for Payer: Blue Shield of California EPN |
$0.65
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.82
|
| Rate for Payer: Heritage Provider Network Senior |
$0.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.93
|
| Rate for Payer: Multiplan Commercial |
$1.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.53
|
| Rate for Payer: TriValley Medical Group Senior |
$0.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.13
|
| Rate for Payer: Vantage Medical Group Senior |
$1.13
|
|
|
NEOMYCIN 500 MG TABLET [5472]
|
Facility
|
IP
|
$1.33
|
|
|
Service Code
|
NDC 0093117701
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Adventist Health Commercial |
$0.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.86
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.90
|
| Rate for Payer: Heritage Provider Network Senior |
$0.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Multiplan Commercial |
$1.00
|
|
|
NEOMYCIN-BACITRACIN-POLY-HC 3.5 MG-400-10,000 UNIT/G-1 % EYE OINTMENT [849]
|
Facility
|
IP
|
$17.84
|
|
|
Service Code
|
NDC 2420878555
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$13.38 |
| Rate for Payer: Adventist Health Commercial |
$3.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.49
|
| Rate for Payer: Cash Price |
$8.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.08
|
| Rate for Payer: Heritage Provider Network Senior |
$12.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.46
|
| Rate for Payer: Multiplan Commercial |
$13.38
|
|
|
NEOMYCIN-BACITRACIN-POLY-HC 3.5 MG-400-10,000 UNIT/G-1 % EYE OINTMENT [849]
|
Facility
|
OP
|
$17.84
|
|
|
Service Code
|
NDC 2420878555
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$15.16 |
| Rate for Payer: Adventist Health Commercial |
$3.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.92
|
| Rate for Payer: Blue Shield of California Commercial |
$10.88
|
| Rate for Payer: Blue Shield of California EPN |
$8.71
|
| Rate for Payer: Cash Price |
$8.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.04
|
| Rate for Payer: Heritage Provider Network Senior |
$11.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.49
|
| Rate for Payer: Multiplan Commercial |
$13.38
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.14
|
| Rate for Payer: TriValley Medical Group Senior |
$7.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.16
|
| Rate for Payer: Vantage Medical Group Senior |
$15.16
|
|
