|
TEMAZEPAM 15 MG CAPSULE [7753]
|
Facility
|
IP
|
$0.11
|
|
|
Service Code
|
NDC 6787714601
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.07
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
|
|
TEMAZEPAM 15 MG CAPSULE [7753]
|
Facility
|
IP
|
$0.11
|
|
|
Service Code
|
NDC 0228207610
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.07
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
|
|
TEMAZEPAM 15 MG CAPSULE [7753]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 6787714605
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
|
|
TEMAZEPAM 30 MG CAPSULE [7754]
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
NDC 0378505001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Senior |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.12
|
|
|
TEMAZEPAM 30 MG CAPSULE [7754]
|
Facility
|
IP
|
$0.14
|
|
|
Service Code
|
NDC 0378505001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.09
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Senior |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
|
|
TEMAZEPAM 7.5 MG CAPSULE [11500]
|
Facility
|
OP
|
$4.20
|
|
|
Service Code
|
NDC 0904643604
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.10
|
| Rate for Payer: Blue Shield of California Commercial |
$2.56
|
| Rate for Payer: Blue Shield of California EPN |
$2.05
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.60
|
| Rate for Payer: Heritage Provider Network Senior |
$2.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.94
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.68
|
| Rate for Payer: TriValley Medical Group Senior |
$1.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.57
|
| Rate for Payer: Vantage Medical Group Senior |
$3.57
|
|
|
TEMAZEPAM 7.5 MG CAPSULE [11500]
|
Facility
|
IP
|
$4.20
|
|
|
Service Code
|
NDC 0904643604
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.15 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.70
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.84
|
| Rate for Payer: Heritage Provider Network Senior |
$2.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.05
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
|
|
TEMOZOLOMIDE 100 MG INTRAVENOUS SOLUTION [97260]
|
Facility
|
OP
|
$1,203.73
|
|
|
Service Code
|
HCPCS J9328
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.23 |
| Max. Negotiated Rate |
$902.80 |
| Rate for Payer: Adventist Health Commercial |
$240.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$743.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.47
|
| Rate for Payer: Blue Shield of California Commercial |
$10.23
|
| Rate for Payer: Blue Shield of California EPN |
$10.23
|
| Rate for Payer: Cash Price |
$541.68
|
| Rate for Payer: Cash Price |
$541.68
|
| Rate for Payer: Cigna of CA HMO/PPO |
$553.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$770.39
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$557.33
|
| Rate for Payer: Heritage Provider Network Senior |
$557.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$574.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$217.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.95
|
| Rate for Payer: Multiplan Commercial |
$902.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$481.49
|
| Rate for Payer: TriValley Medical Group Senior |
$481.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$434.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$398.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.45
|
| Rate for Payer: Vantage Medical Group Senior |
$11.45
|
|
|
TEMOZOLOMIDE 100 MG INTRAVENOUS SOLUTION [97260]
|
Facility
|
IP
|
$1,203.73
|
|
|
Service Code
|
HCPCS J9328
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$217.88 |
| Max. Negotiated Rate |
$902.80 |
| Rate for Payer: Adventist Health Commercial |
$240.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$775.20
|
| Rate for Payer: Cash Price |
$541.68
|
| Rate for Payer: Cigna of CA HMO/PPO |
$553.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$650.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$557.33
|
| Rate for Payer: Heritage Provider Network Senior |
$557.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$217.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.93
|
| Rate for Payer: Multiplan Commercial |
$902.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$434.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$398.56
|
|
|
TEMOZOLOMIDE ORAL SUSPENSION COMPOUND 10 MG/ML [4080346]
|
Facility
|
IP
|
$26.03
|
|
|
Service Code
|
HCPCS J8700
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.71 |
| Max. Negotiated Rate |
$19.52 |
| Rate for Payer: Adventist Health Commercial |
$5.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.76
|
| Rate for Payer: Cash Price |
$11.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.05
|
| Rate for Payer: Heritage Provider Network Senior |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.51
|
| Rate for Payer: Multiplan Commercial |
$19.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.62
|
|
|
TEMOZOLOMIDE ORAL SUSPENSION COMPOUND 10 MG/ML [4080346]
|
Facility
|
OP
|
$26.03
|
|
|
Service Code
|
HCPCS J8700
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$22.13 |
| Rate for Payer: Adventist Health Commercial |
$5.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.23
|
| Rate for Payer: Blue Shield of California Commercial |
$2.70
|
| Rate for Payer: Blue Shield of California EPN |
$2.70
|
| Rate for Payer: Cash Price |
$11.71
|
| Rate for Payer: Cash Price |
$11.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.05
|
| Rate for Payer: Heritage Provider Network Senior |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.22
|
| Rate for Payer: Multiplan Commercial |
$19.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.41
|
| Rate for Payer: TriValley Medical Group Senior |
$10.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.13
|
| Rate for Payer: Vantage Medical Group Senior |
$22.13
|
|
|
TEMPORARY CLOSURE OF EYELIDS BY SUTURE (EG, FROST SUTURE)
|
Facility
|
OP
|
$8,962.13
|
|
|
Service Code
|
CPT 67875
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,282.15 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,923.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,410.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,282.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$1,923.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,410.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,282.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,282.15
|
| Rate for Payer: Heritage Provider Network Senior |
$1,577.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,282.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,436.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,474.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,718.08
|
| Rate for Payer: Multiplan WC |
$1,960.77
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,410.37
|
| Rate for Payer: TriValley Medical Group Senior |
$1,410.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,923.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,410.37
|
| Rate for Payer: Vantage Medical Group Senior |
$1,282.15
|
|
|
TEMSIROLIMUS 25 MG/ML (MUST BE DILUTED TO 10 MG/ML) INTRAVENOUS SOLN [82228]
|
Facility
|
OP
|
$1,547.87
|
|
|
Service Code
|
HCPCS J9330
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.68 |
| Max. Negotiated Rate |
$1,160.90 |
| Rate for Payer: Adventist Health Commercial |
$309.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$956.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$49.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$116.43
|
| Rate for Payer: Blue Shield of California Commercial |
$51.13
|
| Rate for Payer: Blue Shield of California EPN |
$51.13
|
| Rate for Payer: Cash Price |
$696.54
|
| Rate for Payer: Cash Price |
$696.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$712.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$990.64
|
| Rate for Payer: EPIC Health Plan Medicare |
$32.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$716.66
|
| Rate for Payer: Heritage Provider Network Senior |
$716.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$32.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$738.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$280.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$386.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$43.79
|
| Rate for Payer: Multiplan Commercial |
$1,160.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$619.15
|
| Rate for Payer: TriValley Medical Group Senior |
$619.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$559.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$512.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.95
|
| Rate for Payer: Vantage Medical Group Senior |
$35.95
|
|
|
TEMSIROLIMUS 25 MG/ML (MUST BE DILUTED TO 10 MG/ML) INTRAVENOUS SOLN [82228]
|
Facility
|
IP
|
$1,547.87
|
|
|
Service Code
|
HCPCS J9330
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$280.16 |
| Max. Negotiated Rate |
$1,160.90 |
| Rate for Payer: Adventist Health Commercial |
$309.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$996.83
|
| Rate for Payer: Cash Price |
$696.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$712.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$835.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$716.66
|
| Rate for Payer: Heritage Provider Network Senior |
$716.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$280.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$386.97
|
| Rate for Payer: Multiplan Commercial |
$1,160.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$559.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$512.50
|
|
|
TENDONITIS, MYOSITIS AND BURSITIS WITH MCC
|
Facility
|
IP
|
$23,533.66
|
|
|
Service Code
|
MSDRG 557
|
| Min. Negotiated Rate |
$17,562.43 |
| Max. Negotiated Rate |
$23,533.66 |
| Rate for Payer: EPIC Health Plan Medicare |
$17,562.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17,562.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,196.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23,533.66
|
|
|
TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC
|
Facility
|
IP
|
$14,417.10
|
|
|
Service Code
|
MSDRG 558
|
| Min. Negotiated Rate |
$10,759.03 |
| Max. Negotiated Rate |
$14,417.10 |
| Rate for Payer: EPIC Health Plan Medicare |
$10,759.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,759.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,372.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14,417.10
|
|
|
TENDON SHEATH INCISION (EG, FOR TRIGGER FINGER)
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 26055
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,068.15 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,068.15
|
| 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 |
$3,102.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,274.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,068.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,068.15
|
| Rate for Payer: Heritage Provider Network Senior |
$2,543.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,929.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,378.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,771.32
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,274.97
|
| Rate for Payer: TriValley Medical Group Senior |
$2,274.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2,068.15
|
|
|
TENECTEPLASE 50 MG INTRAVENOUS SOLUTION [220772]
|
Facility
|
OP
|
$9,956.71
|
|
|
Service Code
|
HCPCS J3101
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$121.46 |
| Max. Negotiated Rate |
$7,467.53 |
| Rate for Payer: Adventist Health Commercial |
$1,991.34
|
| Rate for Payer: Adventist Health Commercial |
$2,051.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,337.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,153.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$271.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$271.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$239.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$239.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.46
|
| Rate for Payer: Blue Shield of California Commercial |
$159.68
|
| Rate for Payer: Blue Shield of California Commercial |
$159.68
|
| Rate for Payer: Blue Shield of California EPN |
$159.68
|
| Rate for Payer: Blue Shield of California EPN |
$159.68
|
| Rate for Payer: Cash Price |
$4,480.52
|
| Rate for Payer: Cash Price |
$4,480.52
|
| Rate for Payer: Cash Price |
$4,614.94
|
| Rate for Payer: Cash Price |
$4,614.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,580.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,717.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$271.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$271.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$239.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$239.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,372.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,563.47
|
| Rate for Payer: EPIC Health Plan Medicare |
$217.42
|
| Rate for Payer: EPIC Health Plan Medicare |
$217.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,609.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,748.26
|
| Rate for Payer: Heritage Provider Network Senior |
$4,609.96
|
| Rate for Payer: Heritage Provider Network Senior |
$4,748.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,749.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,891.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,856.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,802.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$250.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$250.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,489.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,563.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$291.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$291.34
|
| Rate for Payer: Multiplan Commercial |
$7,467.53
|
| Rate for Payer: Multiplan Commercial |
$7,691.56
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,102.17
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,982.68
|
| Rate for Payer: TriValley Medical Group Senior |
$4,102.17
|
| Rate for Payer: TriValley Medical Group Senior |
$3,982.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,597.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,705.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,296.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,395.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$271.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$271.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.16
|
| Rate for Payer: Vantage Medical Group Senior |
$239.16
|
| Rate for Payer: Vantage Medical Group Senior |
$239.16
|
|
|
TENECTEPLASE 50 MG INTRAVENOUS SOLUTION [220772]
|
Facility
|
IP
|
$10,255.42
|
|
|
Service Code
|
HCPCS J3101
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,856.23 |
| Max. Negotiated Rate |
$7,691.56 |
| Rate for Payer: Adventist Health Commercial |
$2,051.08
|
| Rate for Payer: Adventist Health Commercial |
$1,991.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,412.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,604.49
|
| Rate for Payer: Cash Price |
$4,480.52
|
| Rate for Payer: Cash Price |
$4,614.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,717.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,580.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,537.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,748.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,609.96
|
| Rate for Payer: Heritage Provider Network Senior |
$4,609.96
|
| Rate for Payer: Heritage Provider Network Senior |
$4,748.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,802.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,856.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,563.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,489.18
|
| Rate for Payer: Multiplan Commercial |
$7,467.53
|
| Rate for Payer: Multiplan Commercial |
$7,691.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,705.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,597.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,296.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,395.57
|
|
|
TENODESIS OF LONG TENDON OF BICEPS
|
Facility
|
OP
|
$17,732.13
|
|
|
Service Code
|
CPT 23430
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,178.49 |
| Max. Negotiated Rate |
$17,732.13 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| 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 |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,332.70
|
| Rate for Payer: Heritage Provider Network Senior |
$11,479.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17,732.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,732.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,505.82
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$10,265.97
|
| Rate for Payer: TriValley Medical Group Senior |
$10,265.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,150.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,259.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
TENOFOVIR ALAFENAMIDE 25 MG TABLET [216415]
|
Facility
|
IP
|
$64.67
|
|
|
Service Code
|
NDC 6195823011
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.71 |
| Max. Negotiated Rate |
$48.50 |
| Rate for Payer: Adventist Health Commercial |
$12.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.65
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.78
|
| Rate for Payer: Heritage Provider Network Senior |
$43.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.17
|
| Rate for Payer: Multiplan Commercial |
$48.50
|
|
|
TENOFOVIR ALAFENAMIDE 25 MG TABLET [216415]
|
Facility
|
OP
|
$64.67
|
|
|
Service Code
|
NDC 6195823011
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.71 |
| Max. Negotiated Rate |
$54.97 |
| Rate for Payer: Adventist Health Commercial |
$12.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.35
|
| Rate for Payer: Blue Shield of California Commercial |
$39.45
|
| Rate for Payer: Blue Shield of California EPN |
$31.56
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$42.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$54.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.03
|
| Rate for Payer: Heritage Provider Network Senior |
$40.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$30.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$45.27
|
| Rate for Payer: Multiplan Commercial |
$48.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.87
|
| Rate for Payer: TriValley Medical Group Senior |
$25.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$32.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$32.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$54.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.97
|
| Rate for Payer: Vantage Medical Group Senior |
$54.97
|
|
|
TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [31684]
|
Facility
|
OP
|
$1.15
|
|
|
Service Code
|
NDC 6909753302
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.58
|
| Rate for Payer: Blue Shield of California Commercial |
$0.70
|
| Rate for Payer: Blue Shield of California EPN |
$0.56
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.71
|
| Rate for Payer: Heritage Provider Network Senior |
$0.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.81
|
| Rate for Payer: Multiplan Commercial |
$0.86
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.46
|
| Rate for Payer: TriValley Medical Group Senior |
$0.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.98
|
| Rate for Payer: Vantage Medical Group Senior |
$0.98
|
|
|
TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [31684]
|
Facility
|
IP
|
$1.15
|
|
|
Service Code
|
NDC 6909753302
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.86 |
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.74
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.78
|
| Rate for Payer: Heritage Provider Network Senior |
$0.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.86
|
|
|
TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [31684]
|
Facility
|
OP
|
$2.82
|
|
|
Service Code
|
NDC 5026875812
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: Adventist Health Commercial |
$0.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.41
|
| Rate for Payer: Blue Shield of California Commercial |
$1.72
|
| Rate for Payer: Blue Shield of California EPN |
$1.38
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.75
|
| Rate for Payer: Heritage Provider Network Senior |
$1.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.97
|
| Rate for Payer: Multiplan Commercial |
$2.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.13
|
| Rate for Payer: TriValley Medical Group Senior |
$1.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.40
|
| Rate for Payer: Vantage Medical Group Senior |
$2.40
|
|
