|
REVISION OR REMOVAL OF PERIPHERAL NEUROSTIMULATOR ELECTRODE ARRAY
|
Facility
|
OP
|
$13,914.00
|
|
|
Service Code
|
CPT 64585
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,496.58 |
| Max. Negotiated Rate |
$13,914.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,744.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,946.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,496.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,914.00
|
| 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 |
$6,744.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,946.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,496.58
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,496.58
|
| Rate for Payer: Heritage Provider Network Senior |
$5,530.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,496.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8,543.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,171.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,025.42
|
| Rate for Payer: Multiplan WC |
$6,962.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,946.24
|
| Rate for Payer: TriValley Medical Group Senior |
$4,946.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,744.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,946.24
|
| Rate for Payer: Vantage Medical Group Senior |
$4,496.58
|
|
|
REVUMENIB 25 MG TABLET [245038]
|
Facility
|
OP
|
$415.00
|
|
|
Service Code
|
NDC 7355550000
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$75.11 |
| Max. Negotiated Rate |
$352.75 |
| Rate for Payer: Adventist Health Commercial |
$83.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$256.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$352.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$228.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$311.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$207.58
|
| Rate for Payer: Blue Shield of California Commercial |
$253.15
|
| Rate for Payer: Blue Shield of California EPN |
$202.52
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$269.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$352.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$352.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$352.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$265.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$256.88
|
| Rate for Payer: Heritage Provider Network Senior |
$256.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$197.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$75.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$290.50
|
| Rate for Payer: Multiplan Commercial |
$311.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$166.00
|
| Rate for Payer: TriValley Medical Group Senior |
$166.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$207.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$207.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$352.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$352.75
|
| Rate for Payer: Vantage Medical Group Senior |
$352.75
|
|
|
REVUMENIB 25 MG TABLET [245038]
|
Facility
|
IP
|
$415.00
|
|
|
Service Code
|
NDC 7355550000
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$75.11 |
| Max. Negotiated Rate |
$311.25 |
| Rate for Payer: Adventist Health Commercial |
$83.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$267.26
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$280.95
|
| Rate for Payer: Heritage Provider Network Senior |
$280.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$75.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.75
|
| Rate for Payer: Multiplan Commercial |
$311.25
|
|
|
RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG)/2 ML INJECTION SYRINGE [38072]
|
Facility
|
OP
|
$106.18
|
|
|
Service Code
|
HCPCS J2791
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.21 |
| Max. Negotiated Rate |
$90.25 |
| Rate for Payer: Adventist Health Commercial |
$21.24
|
| Rate for Payer: Adventist Health Commercial |
$19.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$65.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$82.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$79.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$72.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.51
|
| Rate for Payer: Blue Shield of California Commercial |
$10.21
|
| Rate for Payer: Blue Shield of California Commercial |
$10.21
|
| Rate for Payer: Blue Shield of California EPN |
$10.21
|
| Rate for Payer: Blue Shield of California EPN |
$10.21
|
| Rate for Payer: Cash Price |
$47.78
|
| Rate for Payer: Cash Price |
$43.43
|
| Rate for Payer: Cash Price |
$47.78
|
| Rate for Payer: Cash Price |
$43.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$48.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$44.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$82.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$82.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$82.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$49.16
|
| Rate for Payer: Heritage Provider Network Senior |
$44.69
|
| Rate for Payer: Heritage Provider Network Senior |
$49.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$50.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$46.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$67.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$74.33
|
| Rate for Payer: Multiplan Commercial |
$72.39
|
| Rate for Payer: Multiplan Commercial |
$79.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$42.47
|
| Rate for Payer: TriValley Medical Group Commercial |
$38.61
|
| Rate for Payer: TriValley Medical Group Senior |
$42.47
|
| Rate for Payer: TriValley Medical Group Senior |
$38.61
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$38.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$34.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$35.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$82.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$82.04
|
| Rate for Payer: Vantage Medical Group Senior |
$82.04
|
| Rate for Payer: Vantage Medical Group Senior |
$90.25
|
|
|
RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG)/2 ML INJECTION SYRINGE [38072]
|
Facility
|
IP
|
$106.18
|
|
|
Service Code
|
HCPCS J2791
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.22 |
| Max. Negotiated Rate |
$79.64 |
| Rate for Payer: Adventist Health Commercial |
$21.24
|
| Rate for Payer: Adventist Health Commercial |
$19.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$62.16
|
| Rate for Payer: Cash Price |
$47.78
|
| Rate for Payer: Cash Price |
$43.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$48.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$44.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$49.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.69
|
| Rate for Payer: Heritage Provider Network Senior |
$44.69
|
| Rate for Payer: Heritage Provider Network Senior |
$49.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.13
|
| Rate for Payer: Multiplan Commercial |
$79.64
|
| Rate for Payer: Multiplan Commercial |
$72.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$34.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$38.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$35.16
|
|
|
RIBAVIRIN 200 MG TABLET [11287]
|
Facility
|
OP
|
$0.74
|
|
|
Service Code
|
NDC 6586220768
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.63 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.46
|
| Rate for Payer: Heritage Provider Network Senior |
$0.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.52
|
| Rate for Payer: Multiplan Commercial |
$0.56
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.30
|
| Rate for Payer: TriValley Medical Group Senior |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.63
|
| Rate for Payer: Vantage Medical Group Senior |
$0.63
|
|
|
RIBAVIRIN 200 MG TABLET [11287]
|
Facility
|
IP
|
$0.74
|
|
|
Service Code
|
NDC 6586220768
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.48
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.50
|
| Rate for Payer: Heritage Provider Network Senior |
$0.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.56
|
|
|
RIBOFLAVIN (VITAMIN B2) 100 MG TABLET [11288]
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 0761003220
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Senior |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| 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 |
$0.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
|
RIBOFLAVIN (VITAMIN B2) 100 MG TABLET [11288]
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 7985420195
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Senior |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| 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 |
$0.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
|
RIBOFLAVIN (VITAMIN B2) 100 MG TABLET [11288]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 0761003220
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Senior |
$0.04
|
| 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 |
$0.05
|
|
|
RIBOFLAVIN (VITAMIN B2) 100 MG TABLET [11288]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 7985420195
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Senior |
$0.04
|
| 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 |
$0.05
|
|
|
RIBOFLAVIN (VITAMIN B2) 100 MG TABLET [11288]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 7431200640
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Senior |
$0.04
|
| 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 |
$0.05
|
|
|
RIBOFLAVIN (VITAMIN B2) 100 MG TABLET [11288]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 4329256000
|
| 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 Non-Gatekeeper |
$0.03
|
| 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 Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
|
|
RIBOFLAVIN (VITAMIN B2) 100 MG TABLET [11288]
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 7431200640
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Senior |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| 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 |
$0.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
|
RIBOFLAVIN (VITAMIN B2) 100 MG TABLET [11288]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 4329256000
|
| 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 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 |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
|
|
RIBOFLAVIN (VITAMIN B2) 25 MG TABLET [110350]
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
NDC 54629005501
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Senior |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
|
|
RIBOFLAVIN (VITAMIN B2) 25 MG TABLET [110350]
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 7985420025
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| 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 |
$0.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Senior |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| 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 |
$0.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.04
|
|
|
RIBOFLAVIN (VITAMIN B2) 25 MG TABLET [110350]
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
NDC 7985420025
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Senior |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
|
|
RIBOFLAVIN (VITAMIN B2) 25 MG TABLET [110350]
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 54629005501
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| 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 |
$0.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Senior |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| 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 |
$0.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.04
|
|
|
RIBOFLAVIN (VITAMIN B2) 50 MG TABLET [11289]
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 3504600120
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| 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 |
$0.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Senior |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| 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 |
$0.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.04
|
|
|
RIBOFLAVIN (VITAMIN B2) 50 MG TABLET [11289]
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
NDC 3504600120
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Senior |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
|
|
RIFABUTIN 150 MG CAPSULE [11290]
|
Facility
|
OP
|
$15.12
|
|
|
Service Code
|
NDC 7095404110
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$12.85 |
| Rate for Payer: Adventist Health Commercial |
$3.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.56
|
| Rate for Payer: Blue Shield of California Commercial |
$9.22
|
| Rate for Payer: Blue Shield of California EPN |
$7.38
|
| Rate for Payer: Cash Price |
$6.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.36
|
| Rate for Payer: Heritage Provider Network Senior |
$9.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.58
|
| Rate for Payer: Multiplan Commercial |
$11.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.05
|
| Rate for Payer: TriValley Medical Group Senior |
$6.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.85
|
| Rate for Payer: Vantage Medical Group Senior |
$12.85
|
|
|
RIFABUTIN 150 MG CAPSULE [11290]
|
Facility
|
IP
|
$15.12
|
|
|
Service Code
|
NDC 7095404110
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$11.34 |
| Rate for Payer: Adventist Health Commercial |
$3.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.74
|
| Rate for Payer: Cash Price |
$6.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.24
|
| Rate for Payer: Heritage Provider Network Senior |
$10.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.78
|
| Rate for Payer: Multiplan Commercial |
$11.34
|
|
|
RIFABUTIN 150 MG CAPSULE [11290]
|
Facility
|
IP
|
$16.79
|
|
|
Service Code
|
NDC 5976213501
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$12.59 |
| Rate for Payer: Adventist Health Commercial |
$3.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.81
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.37
|
| Rate for Payer: Heritage Provider Network Senior |
$11.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.20
|
| Rate for Payer: Multiplan Commercial |
$12.59
|
|
|
RIFABUTIN 150 MG CAPSULE [11290]
|
Facility
|
OP
|
$16.79
|
|
|
Service Code
|
NDC 5976213501
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$14.27 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.27
|
| Rate for Payer: Adventist Health Commercial |
$3.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.40
|
| Rate for Payer: Blue Shield of California Commercial |
$10.24
|
| Rate for Payer: Blue Shield of California EPN |
$8.19
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.39
|
| Rate for Payer: Heritage Provider Network Senior |
$10.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.75
|
| Rate for Payer: Multiplan Commercial |
$12.59
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.72
|
| Rate for Payer: TriValley Medical Group Senior |
$6.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.27
|
| Rate for Payer: Vantage Medical Group Senior |
$14.27
|
|
