|
SUMATRIPTAN 25 MG TABLET [15327]
|
Facility
|
IP
|
$0.40
|
|
|
Service Code
|
NDC 6586214636
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.26
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.27
|
| Rate for Payer: Heritage Provider Network Senior |
$0.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.30
|
|
|
SUMATRIPTAN 25 MG TABLET [15327]
|
Facility
|
IP
|
$1.48
|
|
|
Service Code
|
NDC 5511129109
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.11 |
| Rate for Payer: Adventist Health Commercial |
$0.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.95
|
| Rate for Payer: Cash Price |
$0.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Multiplan Commercial |
$1.11
|
|
|
SUMATRIPTAN 25 MG TABLET [15327]
|
Facility
|
OP
|
$1.48
|
|
|
Service Code
|
NDC 5511129109
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Adventist Health Commercial |
$0.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.74
|
| Rate for Payer: Blue Shield of California Commercial |
$0.90
|
| Rate for Payer: Blue Shield of California EPN |
$0.72
|
| Rate for Payer: Cash Price |
$0.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.26
|
| 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 Foundation Hospitals Commercial |
$0.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.04
|
| Rate for Payer: Multiplan Commercial |
$1.11
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.59
|
| Rate for Payer: TriValley Medical Group Senior |
$0.59
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.26
|
| Rate for Payer: Vantage Medical Group Senior |
$1.26
|
|
|
SUMATRIPTAN 50 MG TABLET [15328]
|
Facility
|
OP
|
$0.53
|
|
|
Service Code
|
NDC 6586214736
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.27
|
| Rate for Payer: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.33
|
| Rate for Payer: Heritage Provider Network Senior |
$0.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.37
|
| Rate for Payer: Multiplan Commercial |
$0.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.21
|
| Rate for Payer: TriValley Medical Group Senior |
$0.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: Vantage Medical Group Senior |
$0.45
|
|
|
SUMATRIPTAN 50 MG TABLET [15328]
|
Facility
|
OP
|
$2.13
|
|
|
Service Code
|
NDC 6275652169
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.81 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.81
|
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.07
|
| Rate for Payer: Blue Shield of California Commercial |
$1.30
|
| Rate for Payer: Blue Shield of California EPN |
$1.04
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.32
|
| Rate for Payer: Heritage Provider Network Senior |
$1.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.49
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.85
|
| Rate for Payer: TriValley Medical Group Senior |
$0.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.81
|
| Rate for Payer: Vantage Medical Group Senior |
$1.81
|
|
|
SUMATRIPTAN 50 MG TABLET [15328]
|
Facility
|
IP
|
$0.53
|
|
|
Service Code
|
NDC 6586214736
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.34
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.36
|
| Rate for Payer: Heritage Provider Network Senior |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.40
|
|
|
SUMATRIPTAN 50 MG TABLET [15328]
|
Facility
|
IP
|
$2.13
|
|
|
Service Code
|
NDC 6275652169
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.37
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.44
|
| Rate for Payer: Heritage Provider Network Senior |
$1.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
|
|
SUMATRIPTAN 50 MG TABLET [15328]
|
Facility
|
OP
|
$2.11
|
|
|
Service Code
|
NDC 6330409819
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.79 |
| Rate for Payer: Adventist Health Commercial |
$0.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.06
|
| Rate for Payer: Blue Shield of California Commercial |
$1.29
|
| Rate for Payer: Blue Shield of California EPN |
$1.03
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.48
|
| Rate for Payer: Multiplan Commercial |
$1.58
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.84
|
| Rate for Payer: TriValley Medical Group Senior |
$0.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.79
|
| Rate for Payer: Vantage Medical Group Senior |
$1.79
|
|
|
SUMATRIPTAN 50 MG TABLET [15328]
|
Facility
|
IP
|
$2.11
|
|
|
Service Code
|
NDC 6330409819
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.58 |
| Rate for Payer: Adventist Health Commercial |
$0.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.36
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.43
|
| Rate for Payer: Heritage Provider Network Senior |
$1.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: Multiplan Commercial |
$1.58
|
|
|
SUMATRIPTAN 6 MG/0.5 ML SUBCUTANEOUS PEN INJECTOR [11467]
|
Facility
|
IP
|
$183.60
|
|
|
Service Code
|
HCPCS J3030
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.23 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Adventist Health Commercial |
$36.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$118.24
|
| Rate for Payer: Cash Price |
$82.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$84.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.01
|
| Rate for Payer: Heritage Provider Network Senior |
$85.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.90
|
| Rate for Payer: Multiplan Commercial |
$137.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$66.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$60.79
|
|
|
SUMATRIPTAN 6 MG/0.5 ML SUBCUTANEOUS PEN INJECTOR [11467]
|
Facility
|
OP
|
$183.60
|
|
|
Service Code
|
HCPCS J3030
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.23 |
| Max. Negotiated Rate |
$156.06 |
| Rate for Payer: Adventist Health Commercial |
$36.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$113.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$156.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$100.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.71
|
| Rate for Payer: Blue Shield of California Commercial |
$49.98
|
| Rate for Payer: Blue Shield of California EPN |
$49.98
|
| Rate for Payer: Cash Price |
$82.62
|
| Rate for Payer: Cash Price |
$82.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$84.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$156.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$156.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$156.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.01
|
| Rate for Payer: Heritage Provider Network Senior |
$85.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$87.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$128.52
|
| Rate for Payer: Multiplan Commercial |
$137.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$73.44
|
| Rate for Payer: TriValley Medical Group Senior |
$73.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$66.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$60.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$156.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$156.06
|
| Rate for Payer: Vantage Medical Group Senior |
$156.06
|
|
|
SUMATRIPTAN 6 MG/0.5 ML SUBCUTANEOUS SOLUTION [97342]
|
Facility
|
IP
|
$117.60
|
|
|
Service Code
|
HCPCS J3030
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.29 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Adventist Health Commercial |
$23.52
|
| Rate for Payer: Adventist Health Commercial |
$5.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$75.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.00
|
| Rate for Payer: Cash Price |
$52.92
|
| Rate for Payer: Cash Price |
$11.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$54.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.22
|
| Rate for Payer: Heritage Provider Network Senior |
$12.22
|
| Rate for Payer: Heritage Provider Network Senior |
$54.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.60
|
| Rate for Payer: Multiplan Commercial |
$88.20
|
| Rate for Payer: Multiplan Commercial |
$19.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$42.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$38.94
|
|
|
SUMATRIPTAN 6 MG/0.5 ML SUBCUTANEOUS SOLUTION [97342]
|
Facility
|
OP
|
$117.60
|
|
|
Service Code
|
HCPCS J3030
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.29 |
| Max. Negotiated Rate |
$99.96 |
| Rate for Payer: Adventist Health Commercial |
$23.52
|
| Rate for Payer: Adventist Health Commercial |
$5.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$99.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$88.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.71
|
| Rate for Payer: Blue Shield of California Commercial |
$49.98
|
| Rate for Payer: Blue Shield of California Commercial |
$49.98
|
| Rate for Payer: Blue Shield of California EPN |
$49.98
|
| Rate for Payer: Blue Shield of California EPN |
$49.98
|
| Rate for Payer: Cash Price |
$52.92
|
| Rate for Payer: Cash Price |
$11.88
|
| Rate for Payer: Cash Price |
$52.92
|
| Rate for Payer: Cash Price |
$11.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$54.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$99.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$99.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.45
|
| Rate for Payer: Heritage Provider Network Senior |
$12.22
|
| Rate for Payer: Heritage Provider Network Senior |
$54.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$56.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$82.32
|
| Rate for Payer: Multiplan Commercial |
$19.80
|
| Rate for Payer: Multiplan Commercial |
$88.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$47.04
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.56
|
| Rate for Payer: TriValley Medical Group Senior |
$47.04
|
| Rate for Payer: TriValley Medical Group Senior |
$10.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$42.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$38.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$99.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.44
|
| Rate for Payer: Vantage Medical Group Senior |
$22.44
|
| Rate for Payer: Vantage Medical Group Senior |
$99.96
|
|
|
SUMATRIPTAN ORAL SUSPENSION COMPOUND 5 MG/ML [4080344]
|
Facility
|
OP
|
$1.26
|
|
|
Service Code
|
NDC 9994080344
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$1.07 |
| Rate for Payer: Adventist Health Commercial |
$0.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.63
|
| Rate for Payer: Blue Shield of California Commercial |
$0.77
|
| Rate for Payer: Blue Shield of California EPN |
$0.61
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.78
|
| Rate for Payer: Heritage Provider Network Senior |
$0.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.88
|
| Rate for Payer: Multiplan Commercial |
$0.95
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.50
|
| Rate for Payer: TriValley Medical Group Senior |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.07
|
| Rate for Payer: Vantage Medical Group Senior |
$1.07
|
|
|
SUMATRIPTAN ORAL SUSPENSION COMPOUND 5 MG/ML [4080344]
|
Facility
|
IP
|
$1.26
|
|
|
Service Code
|
NDC 9994080344
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Adventist Health Commercial |
$0.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.81
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.85
|
| Rate for Payer: Heritage Provider Network Senior |
$0.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$0.95
|
|
|
SUNITINIB MALATE 12.5 MG CAPSULE [70424]
|
Facility
|
IP
|
$276.70
|
|
|
Service Code
|
NDC 0069055038
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$50.08 |
| Max. Negotiated Rate |
$207.53 |
| Rate for Payer: Adventist Health Commercial |
$55.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$178.19
|
| Rate for Payer: Cash Price |
$124.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$187.33
|
| Rate for Payer: Heritage Provider Network Senior |
$187.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.17
|
| Rate for Payer: Multiplan Commercial |
$207.53
|
|
|
SUNITINIB MALATE 12.5 MG CAPSULE [70424]
|
Facility
|
OP
|
$276.70
|
|
|
Service Code
|
NDC 0069055038
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$50.08 |
| Max. Negotiated Rate |
$235.19 |
| Rate for Payer: Adventist Health Commercial |
$55.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$235.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$152.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$207.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.41
|
| Rate for Payer: Blue Shield of California Commercial |
$168.79
|
| Rate for Payer: Blue Shield of California EPN |
$135.03
|
| Rate for Payer: Cash Price |
$124.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$179.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$235.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$235.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$235.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$177.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$171.28
|
| Rate for Payer: Heritage Provider Network Senior |
$171.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$131.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$193.69
|
| Rate for Payer: Multiplan Commercial |
$207.53
|
| Rate for Payer: TriValley Medical Group Commercial |
$110.68
|
| Rate for Payer: TriValley Medical Group Senior |
$110.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$138.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$138.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$235.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$235.19
|
| Rate for Payer: Vantage Medical Group Senior |
$235.19
|
|
|
SUNITINIB MALATE 25 MG CAPSULE [70425]
|
Facility
|
OP
|
$553.41
|
|
|
Service Code
|
NDC 0069077038
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$100.17 |
| Max. Negotiated Rate |
$470.40 |
| Rate for Payer: Adventist Health Commercial |
$110.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$342.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$470.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$304.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$415.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$276.82
|
| Rate for Payer: Blue Shield of California Commercial |
$337.58
|
| Rate for Payer: Blue Shield of California EPN |
$270.06
|
| Rate for Payer: Cash Price |
$249.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$359.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$470.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$470.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$470.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$354.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$342.56
|
| Rate for Payer: Heritage Provider Network Senior |
$342.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$263.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$100.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$387.39
|
| Rate for Payer: Multiplan Commercial |
$415.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$221.36
|
| Rate for Payer: TriValley Medical Group Senior |
$221.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$276.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$276.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$470.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$470.40
|
| Rate for Payer: Vantage Medical Group Senior |
$470.40
|
|
|
SUNITINIB MALATE 25 MG CAPSULE [70425]
|
Facility
|
IP
|
$553.41
|
|
|
Service Code
|
NDC 0069077038
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$100.17 |
| Max. Negotiated Rate |
$415.06 |
| Rate for Payer: Adventist Health Commercial |
$110.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$356.40
|
| Rate for Payer: Cash Price |
$249.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$374.66
|
| Rate for Payer: Heritage Provider Network Senior |
$374.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$100.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.35
|
| Rate for Payer: Multiplan Commercial |
$415.06
|
|
|
SUNITINIB MALATE 50 MG CAPSULE [70426]
|
Facility
|
IP
|
$963.40
|
|
|
Service Code
|
NDC 0069098038
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$174.38 |
| Max. Negotiated Rate |
$722.55 |
| Rate for Payer: Adventist Health Commercial |
$192.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$620.43
|
| Rate for Payer: Cash Price |
$433.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$520.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$652.22
|
| Rate for Payer: Heritage Provider Network Senior |
$652.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$174.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.85
|
| Rate for Payer: Multiplan Commercial |
$722.55
|
|
|
SUNITINIB MALATE 50 MG CAPSULE [70426]
|
Facility
|
OP
|
$963.40
|
|
|
Service Code
|
NDC 0069098038
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$174.38 |
| Max. Negotiated Rate |
$818.89 |
| Rate for Payer: Adventist Health Commercial |
$192.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$595.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$818.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$529.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$722.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$481.89
|
| Rate for Payer: Blue Shield of California Commercial |
$587.67
|
| Rate for Payer: Blue Shield of California EPN |
$470.14
|
| Rate for Payer: Cash Price |
$433.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$626.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$818.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$818.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$818.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$616.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$596.34
|
| Rate for Payer: Heritage Provider Network Senior |
$596.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$459.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$174.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$674.38
|
| Rate for Payer: Multiplan Commercial |
$722.55
|
| Rate for Payer: TriValley Medical Group Commercial |
$385.36
|
| Rate for Payer: TriValley Medical Group Senior |
$385.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$481.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$481.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$818.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$818.89
|
| Rate for Payer: Vantage Medical Group Senior |
$818.89
|
|
|
SUPRAHYOID LYMPHADENECTOMY
|
Facility
|
OP
|
$16,226.70
|
|
|
Service Code
|
CPT 38700
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,158.00 |
| Max. Negotiated Rate |
$16,226.70 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,810.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,394.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,540.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$12,810.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,394.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,540.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,540.37
|
| Rate for Payer: Heritage Provider Network Senior |
$10,504.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,540.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16,226.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,821.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11,444.10
|
| Rate for Payer: Multiplan WC |
$13,202.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,394.41
|
| Rate for Payer: TriValley Medical Group Senior |
$9,394.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,810.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,394.41
|
| Rate for Payer: Vantage Medical Group Senior |
$8,540.37
|
|
|
SURGICAL CLOSURE TRACHEOSTOMY OR FISTULA; WITH PLASTIC REPAIR
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 31825
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,264.23 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,264.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$6,396.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,690.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,264.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,264.23
|
| Rate for Payer: Heritage Provider Network Senior |
$5,245.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8,102.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,903.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,714.07
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,690.65
|
| Rate for Payer: TriValley Medical Group Senior |
$4,690.65
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,264.23
|
|
|
SURGICAL LUBRICANT JELLY TOPICAL [112826]
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| 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 |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.01
|
|
|
SURGICAL LUBRICANT JELLY TOPICAL [112826]
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| 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 |
$0.02
|
| 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 |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| 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 |
$0.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.01
|
| 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 |
$0.02
|
| 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 |
$0.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.01
|
| 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
|
|
