|
PLERIXAFOR 24 MG/1.2 ML (20 MG/ML) SUBCUTANEOUS SOLUTION [95849]
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS J2562
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$90.50 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Adventist Health Commercial |
$100.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$230.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$231.50
|
| Rate for Payer: Heritage Provider Network Senior |
$231.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.00
|
| Rate for Payer: Multiplan Commercial |
$375.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$180.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$165.55
|
|
|
PLERIXAFOR 24 MG/1.2 ML (20 MG/ML) SUBCUTANEOUS SOLUTION [95849]
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS J2562
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.98 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Adventist Health Commercial |
$100.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$267.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$343.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$149.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$131.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$131.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.02
|
| Rate for Payer: Blue Shield of California Commercial |
$36.61
|
| Rate for Payer: Blue Shield of California EPN |
$36.61
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$230.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$149.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$131.42
|
| Rate for Payer: Dignity Health Senior |
$131.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$320.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$119.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$231.50
|
| Rate for Payer: Heritage Provider Network Senior |
$231.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$119.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$238.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$150.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$150.53
|
| Rate for Payer: Multiplan Commercial |
$375.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$200.00
|
| Rate for Payer: TriValley Medical Group Senior |
$200.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$180.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$165.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$149.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$131.42
|
| Rate for Payer: Vantage Medical Group Senior |
$131.42
|
|
|
PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE [231988]
|
Facility
|
IP
|
$657.24
|
|
|
Service Code
|
HCPCS 90677
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$118.96 |
| Max. Negotiated Rate |
$492.93 |
| Rate for Payer: Adventist Health Commercial |
$131.45
|
| Rate for Payer: Adventist Health Commercial |
$135.58
|
| Rate for Payer: Cash Price |
$372.85
|
| Rate for Payer: Cash Price |
$361.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$302.33
|
| Rate for Payer: Cigna of CA HMO/PPO |
$311.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$354.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$366.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$313.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$304.30
|
| Rate for Payer: Heritage Provider Network Senior |
$304.30
|
| Rate for Payer: Heritage Provider Network Senior |
$313.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.31
|
| Rate for Payer: Multiplan Commercial |
$508.43
|
| Rate for Payer: Multiplan Commercial |
$492.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$237.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$244.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$224.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$217.61
|
|
|
PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE [231988]
|
Facility
|
OP
|
$677.90
|
|
|
Service Code
|
HCPCS 90677
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$122.70 |
| Max. Negotiated Rate |
$710.88 |
| Rate for Payer: Adventist Health Commercial |
$135.58
|
| Rate for Payer: Adventist Health Commercial |
$131.45
|
| Rate for Payer: Aetna of CA Gatekeeper |
$351.29
|
| Rate for Payer: Aetna of CA Gatekeeper |
$362.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$465.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$451.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$576.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$558.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$372.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$361.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$508.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$492.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$710.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$710.88
|
| Rate for Payer: Blue Shield of California Commercial |
$266.70
|
| Rate for Payer: Blue Shield of California Commercial |
$266.70
|
| Rate for Payer: Blue Shield of California EPN |
$266.70
|
| Rate for Payer: Blue Shield of California EPN |
$266.70
|
| Rate for Payer: Cash Price |
$372.85
|
| Rate for Payer: Cash Price |
$361.48
|
| Rate for Payer: Cash Price |
$361.48
|
| Rate for Payer: Cash Price |
$372.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$302.33
|
| Rate for Payer: Cigna of CA HMO/PPO |
$311.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$558.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$576.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$576.22
|
| Rate for Payer: Dignity Health Senior |
$558.65
|
| Rate for Payer: Dignity Health Senior |
$576.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$433.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$420.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$313.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$304.30
|
| Rate for Payer: Heritage Provider Network Senior |
$304.30
|
| Rate for Payer: Heritage Provider Network Senior |
$313.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$312.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$312.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$323.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$313.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$474.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$460.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$460.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$474.53
|
| Rate for Payer: Multiplan Commercial |
$508.43
|
| Rate for Payer: Multiplan Commercial |
$492.93
|
| Rate for Payer: TriValley Medical Group Commercial |
$271.16
|
| Rate for Payer: TriValley Medical Group Commercial |
$262.90
|
| Rate for Payer: TriValley Medical Group Senior |
$262.90
|
| Rate for Payer: TriValley Medical Group Senior |
$271.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$244.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$237.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$217.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$224.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$576.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$558.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$576.22
|
| Rate for Payer: Vantage Medical Group Senior |
$558.65
|
| Rate for Payer: Vantage Medical Group Senior |
$576.22
|
|
|
PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION SYRINGE [113995]
|
Facility
|
IP
|
$280.99
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.86 |
| Max. Negotiated Rate |
$210.74 |
| Rate for Payer: Adventist Health Commercial |
$56.20
|
| Rate for Payer: Cash Price |
$154.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$129.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$130.10
|
| Rate for Payer: Heritage Provider Network Senior |
$130.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.25
|
| Rate for Payer: Multiplan Commercial |
$210.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$101.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$93.04
|
|
|
PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION SYRINGE [113995]
|
Facility
|
OP
|
$280.99
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.86 |
| Max. Negotiated Rate |
$303.24 |
| Rate for Payer: Adventist Health Commercial |
$56.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$150.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$193.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$238.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$210.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$303.24
|
| Rate for Payer: Blue Shield of California Commercial |
$119.42
|
| Rate for Payer: Blue Shield of California EPN |
$119.42
|
| Rate for Payer: Cash Price |
$154.55
|
| Rate for Payer: Cash Price |
$154.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$129.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.84
|
| Rate for Payer: Dignity Health Senior |
$238.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$130.10
|
| Rate for Payer: Heritage Provider Network Senior |
$130.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$133.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$134.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$196.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$196.69
|
| Rate for Payer: Multiplan Commercial |
$210.74
|
| Rate for Payer: TriValley Medical Group Commercial |
$112.40
|
| Rate for Payer: TriValley Medical Group Senior |
$112.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$101.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$93.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$238.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.84
|
| Rate for Payer: Vantage Medical Group Senior |
$238.84
|
|
|
PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION WRAP. [408113995]
|
Facility
|
OP
|
$280.99
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.86 |
| Max. Negotiated Rate |
$303.24 |
| Rate for Payer: Adventist Health Commercial |
$56.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$150.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$193.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$238.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$210.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$303.24
|
| Rate for Payer: Blue Shield of California Commercial |
$119.42
|
| Rate for Payer: Blue Shield of California EPN |
$119.42
|
| Rate for Payer: Cash Price |
$154.55
|
| Rate for Payer: Cash Price |
$154.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$129.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.84
|
| Rate for Payer: Dignity Health Senior |
$238.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$130.10
|
| Rate for Payer: Heritage Provider Network Senior |
$130.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$133.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$134.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$196.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$196.69
|
| Rate for Payer: Multiplan Commercial |
$210.74
|
| Rate for Payer: TriValley Medical Group Commercial |
$112.40
|
| Rate for Payer: TriValley Medical Group Senior |
$112.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$101.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$93.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$238.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.84
|
| Rate for Payer: Vantage Medical Group Senior |
$238.84
|
|
|
PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION WRAP. [408113995]
|
Facility
|
IP
|
$280.99
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.86 |
| Max. Negotiated Rate |
$210.74 |
| Rate for Payer: Adventist Health Commercial |
$56.20
|
| Rate for Payer: Cash Price |
$154.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$129.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$130.10
|
| Rate for Payer: Heritage Provider Network Senior |
$130.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.25
|
| Rate for Payer: Multiplan Commercial |
$210.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$101.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$93.04
|
|
|
POLIOVIRUS VACCINE 40 UNIT-8 UNIT-32 UNIT/0.5 ML INJECTION SUSPENSION [108127]
|
Facility
|
OP
|
$105.56
|
|
|
Service Code
|
HCPCS 90713
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.11 |
| Max. Negotiated Rate |
$115.53 |
| Rate for Payer: Adventist Health Commercial |
$21.11
|
| Rate for Payer: Aetna of CA Gatekeeper |
$56.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$79.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.53
|
| Rate for Payer: Blue Shield of California Commercial |
$43.37
|
| Rate for Payer: Blue Shield of California EPN |
$43.37
|
| Rate for Payer: Cash Price |
$58.06
|
| Rate for Payer: Cash Price |
$58.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$48.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$89.73
|
| Rate for Payer: Dignity Health Senior |
$89.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.87
|
| Rate for Payer: Heritage Provider Network Senior |
$48.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$78.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$50.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$73.89
|
| Rate for Payer: Multiplan Commercial |
$79.17
|
| Rate for Payer: TriValley Medical Group Commercial |
$42.22
|
| Rate for Payer: TriValley Medical Group Senior |
$42.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$38.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$34.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$89.73
|
| Rate for Payer: Vantage Medical Group Senior |
$89.73
|
|
|
POLIOVIRUS VACCINE 40 UNIT-8 UNIT-32 UNIT/0.5 ML INJECTION SUSPENSION [108127]
|
Facility
|
IP
|
$105.56
|
|
|
Service Code
|
HCPCS 90713
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.11 |
| Max. Negotiated Rate |
$79.17 |
| Rate for Payer: Adventist Health Commercial |
$21.11
|
| Rate for Payer: Cash Price |
$58.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$48.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.87
|
| Rate for Payer: Heritage Provider Network Senior |
$48.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.39
|
| Rate for Payer: Multiplan Commercial |
$79.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$38.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$34.95
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWDER [24984]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 43386-312-08
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Senior |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWDER [24984]
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 45802-868-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Senior |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWDER [24984]
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 45802-868-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Senior |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Senior |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWDER [24984]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 43386-312-08
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Senior |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Senior |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET [25424]
|
Facility
|
IP
|
$1.92
|
|
|
Service Code
|
NDC 60687-431-92
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.44 |
| Rate for Payer: Adventist Health Commercial |
$0.38
|
| Rate for Payer: Cash Price |
$1.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.30
|
| Rate for Payer: Heritage Provider Network Senior |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.44
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET [25424]
|
Facility
|
OP
|
$1.49
|
|
|
Service Code
|
NDC 11523-7268-3
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.27 |
| Rate for Payer: Adventist Health Commercial |
$0.30
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.91
|
| Rate for Payer: Blue Shield of California EPN |
$0.73
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.27
|
| Rate for Payer: Dignity Health Senior |
$1.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.92
|
| Rate for Payer: Heritage Provider Network Senior |
$0.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.04
|
| Rate for Payer: Multiplan Commercial |
$1.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.60
|
| Rate for Payer: TriValley Medical Group Senior |
$0.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.27
|
| Rate for Payer: Vantage Medical Group Senior |
$1.27
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET [25424]
|
Facility
|
OP
|
$2.46
|
|
|
Service Code
|
NDC 45802-868-00
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.09 |
| Rate for Payer: Adventist Health Commercial |
$0.49
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1.50
|
| Rate for Payer: Blue Shield of California EPN |
$1.20
|
| Rate for Payer: Cash Price |
$1.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.09
|
| Rate for Payer: Dignity Health Senior |
$2.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.52
|
| Rate for Payer: Heritage Provider Network Senior |
$1.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.72
|
| Rate for Payer: Multiplan Commercial |
$1.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.98
|
| Rate for Payer: TriValley Medical Group Senior |
$0.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2.09
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET [25424]
|
Facility
|
OP
|
$1.92
|
|
|
Service Code
|
NDC 60687-431-92
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.63 |
| Rate for Payer: Adventist Health Commercial |
$0.38
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.44
|
| Rate for Payer: Blue Shield of California Commercial |
$1.17
|
| Rate for Payer: Blue Shield of California EPN |
$0.94
|
| Rate for Payer: Cash Price |
$1.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.63
|
| Rate for Payer: Dignity Health Senior |
$1.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.19
|
| Rate for Payer: Heritage Provider Network Senior |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.34
|
| Rate for Payer: Multiplan Commercial |
$1.44
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.77
|
| Rate for Payer: TriValley Medical Group Senior |
$0.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.63
|
| Rate for Payer: Vantage Medical Group Senior |
$1.63
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET [25424]
|
Facility
|
IP
|
$1.75
|
|
|
Service Code
|
NDC 60687-431-99
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.31 |
| Rate for Payer: Adventist Health Commercial |
$0.35
|
| Rate for Payer: Cash Price |
$0.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.18
|
| Rate for Payer: Heritage Provider Network Senior |
$1.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: Multiplan Commercial |
$1.31
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET [25424]
|
Facility
|
OP
|
$1.75
|
|
|
Service Code
|
NDC 60687-431-99
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.49 |
| Rate for Payer: Adventist Health Commercial |
$0.35
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.31
|
| Rate for Payer: Blue Shield of California Commercial |
$1.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.85
|
| Rate for Payer: Cash Price |
$0.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.49
|
| Rate for Payer: Dignity Health Senior |
$1.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.08
|
| Rate for Payer: Heritage Provider Network Senior |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.23
|
| Rate for Payer: Multiplan Commercial |
$1.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.70
|
| Rate for Payer: TriValley Medical Group Senior |
$0.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.49
|
| Rate for Payer: Vantage Medical Group Senior |
$1.49
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET [25424]
|
Facility
|
IP
|
$1.06
|
|
|
Service Code
|
NDC 9999-9321-54
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Cash Price |
$0.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.72
|
| Rate for Payer: Heritage Provider Network Senior |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET [25424]
|
Facility
|
IP
|
$2.46
|
|
|
Service Code
|
NDC 45802-868-66
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Adventist Health Commercial |
$0.49
|
| Rate for Payer: Cash Price |
$1.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.67
|
| Rate for Payer: Heritage Provider Network Senior |
$1.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Multiplan Commercial |
$1.84
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET [25424]
|
Facility
|
IP
|
$2.46
|
|
|
Service Code
|
NDC 45802-868-00
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Adventist Health Commercial |
$0.49
|
| Rate for Payer: Cash Price |
$1.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.67
|
| Rate for Payer: Heritage Provider Network Senior |
$1.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Multiplan Commercial |
$1.84
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET [25424]
|
Facility
|
IP
|
$2.02
|
|
|
Service Code
|
NDC 60687-431-98
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.51 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.37
|
| Rate for Payer: Heritage Provider Network Senior |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.51
|
| Rate for Payer: Multiplan Commercial |
$1.51
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET [25424]
|
Facility
|
IP
|
$1.06
|
|
|
Service Code
|
NDC 9999-9254-24
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Cash Price |
$0.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.72
|
| Rate for Payer: Heritage Provider Network Senior |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
|
