|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
|
OP
|
$2.50
|
|
|
Service Code
|
NDC 62756-277-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Adventist Health Commercial |
$0.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.52
|
| Rate for Payer: Blue Shield of California EPN |
$1.22
|
| Rate for Payer: Cash Price |
$1.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.12
|
| Rate for Payer: Dignity Health Senior |
$2.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.55
|
| Rate for Payer: Heritage Provider Network Senior |
$1.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.75
|
| Rate for Payer: Multiplan Commercial |
$1.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.00
|
| Rate for Payer: TriValley Medical Group Senior |
$1.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2.12
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
|
IP
|
$3.85
|
|
|
Service Code
|
NDC 0093-5955-56
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$2.89 |
| Rate for Payer: Adventist Health Commercial |
$0.77
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.61
|
| Rate for Payer: Heritage Provider Network Senior |
$2.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$2.89
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
|
OP
|
$11.82
|
|
|
Service Code
|
NDC 63402-911-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$10.05 |
| Rate for Payer: Adventist Health Commercial |
$2.36
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.87
|
| Rate for Payer: Blue Shield of California Commercial |
$7.21
|
| Rate for Payer: Blue Shield of California EPN |
$5.77
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.05
|
| Rate for Payer: Dignity Health Senior |
$10.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.32
|
| Rate for Payer: Heritage Provider Network Senior |
$7.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.27
|
| Rate for Payer: Multiplan Commercial |
$8.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.73
|
| Rate for Payer: TriValley Medical Group Senior |
$4.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.05
|
| Rate for Payer: Vantage Medical Group Senior |
$10.05
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
|
OP
|
$11.82
|
|
|
Service Code
|
NDC 63402-911-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$10.05 |
| Rate for Payer: Adventist Health Commercial |
$2.36
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.87
|
| Rate for Payer: Blue Shield of California Commercial |
$7.21
|
| Rate for Payer: Blue Shield of California EPN |
$5.77
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.05
|
| Rate for Payer: Dignity Health Senior |
$10.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.32
|
| Rate for Payer: Heritage Provider Network Senior |
$7.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.27
|
| Rate for Payer: Multiplan Commercial |
$8.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.73
|
| Rate for Payer: TriValley Medical Group Senior |
$4.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.05
|
| Rate for Payer: Vantage Medical Group Senior |
$10.05
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
|
OP
|
$2.50
|
|
|
Service Code
|
NDC 62756-277-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Adventist Health Commercial |
$0.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.52
|
| Rate for Payer: Blue Shield of California EPN |
$1.22
|
| Rate for Payer: Cash Price |
$1.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.12
|
| Rate for Payer: Dignity Health Senior |
$2.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.55
|
| Rate for Payer: Heritage Provider Network Senior |
$1.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.75
|
| Rate for Payer: Multiplan Commercial |
$1.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.00
|
| Rate for Payer: TriValley Medical Group Senior |
$1.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2.12
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
|
IP
|
$11.82
|
|
|
Service Code
|
NDC 63402-911-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$8.87 |
| Rate for Payer: Adventist Health Commercial |
$2.36
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.00
|
| Rate for Payer: Heritage Provider Network Senior |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.96
|
| Rate for Payer: Multiplan Commercial |
$8.87
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
|
OP
|
$12.17
|
|
|
Service Code
|
NDC 27437-060-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$10.34 |
| Rate for Payer: Adventist Health Commercial |
$2.43
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.13
|
| Rate for Payer: Blue Shield of California Commercial |
$7.42
|
| Rate for Payer: Blue Shield of California EPN |
$5.94
|
| Rate for Payer: Cash Price |
$6.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.34
|
| Rate for Payer: Dignity Health Senior |
$10.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.53
|
| Rate for Payer: Heritage Provider Network Senior |
$7.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.52
|
| Rate for Payer: Multiplan Commercial |
$9.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.87
|
| Rate for Payer: TriValley Medical Group Senior |
$4.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.34
|
| Rate for Payer: Vantage Medical Group Senior |
$10.34
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
|
IP
|
$12.17
|
|
|
Service Code
|
NDC 27437-060-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$9.13 |
| Rate for Payer: Adventist Health Commercial |
$2.43
|
| Rate for Payer: Cash Price |
$6.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.24
|
| Rate for Payer: Heritage Provider Network Senior |
$8.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.04
|
| Rate for Payer: Multiplan Commercial |
$9.13
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
|
IP
|
$1.50
|
|
|
Service Code
|
NDC 69097-168-64
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.12 |
| Rate for Payer: Adventist Health Commercial |
$0.30
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.02
|
| Rate for Payer: Heritage Provider Network Senior |
$1.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$1.12
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
|
IP
|
$1.40
|
|
|
Service Code
|
NDC 70748-175-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.95
|
| Rate for Payer: Heritage Provider Network Senior |
$0.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.05
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
|
OP
|
$11.82
|
|
|
Service Code
|
NDC 63402-911-64
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$10.05 |
| Rate for Payer: Adventist Health Commercial |
$2.36
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.87
|
| Rate for Payer: Blue Shield of California Commercial |
$7.21
|
| Rate for Payer: Blue Shield of California EPN |
$5.77
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.05
|
| Rate for Payer: Dignity Health Senior |
$10.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.32
|
| Rate for Payer: Heritage Provider Network Senior |
$7.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.27
|
| Rate for Payer: Multiplan Commercial |
$8.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.73
|
| Rate for Payer: TriValley Medical Group Senior |
$4.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.05
|
| Rate for Payer: Vantage Medical Group Senior |
$10.05
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
|
IP
|
$12.17
|
|
|
Service Code
|
NDC 27437-060-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$9.13 |
| Rate for Payer: Adventist Health Commercial |
$2.43
|
| Rate for Payer: Cash Price |
$6.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.24
|
| Rate for Payer: Heritage Provider Network Senior |
$8.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.04
|
| Rate for Payer: Multiplan Commercial |
$9.13
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
|
IP
|
$11.82
|
|
|
Service Code
|
NDC 63402-911-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$8.87 |
| Rate for Payer: Adventist Health Commercial |
$2.36
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.00
|
| Rate for Payer: Heritage Provider Network Senior |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.96
|
| Rate for Payer: Multiplan Commercial |
$8.87
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
|
OP
|
$1.50
|
|
|
Service Code
|
NDC 69097-168-48
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.27 |
| Rate for Payer: Adventist Health Commercial |
$0.30
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.92
|
| Rate for Payer: Blue Shield of California EPN |
$0.73
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.27
|
| Rate for Payer: Dignity Health Senior |
$1.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.93
|
| Rate for Payer: Heritage Provider Network Senior |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.05
|
| Rate for Payer: Multiplan Commercial |
$1.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.60
|
| Rate for Payer: TriValley Medical Group Senior |
$0.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.27
|
| Rate for Payer: Vantage Medical Group Senior |
$1.27
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
|
OP
|
$3.85
|
|
|
Service Code
|
NDC 0093-5955-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$3.27 |
| Rate for Payer: Adventist Health Commercial |
$0.77
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.89
|
| Rate for Payer: Blue Shield of California Commercial |
$2.35
|
| Rate for Payer: Blue Shield of California EPN |
$1.88
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.27
|
| Rate for Payer: Dignity Health Senior |
$3.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.38
|
| Rate for Payer: Heritage Provider Network Senior |
$2.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.69
|
| Rate for Payer: Multiplan Commercial |
$2.89
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.54
|
| Rate for Payer: TriValley Medical Group Senior |
$1.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.27
|
| Rate for Payer: Vantage Medical Group Senior |
$3.27
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
|
IP
|
$3.85
|
|
|
Service Code
|
NDC 0093-5955-06
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$2.89 |
| Rate for Payer: Adventist Health Commercial |
$0.77
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.61
|
| Rate for Payer: Heritage Provider Network Senior |
$2.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$2.89
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
|
OP
|
$1.40
|
|
|
Service Code
|
NDC 70748-175-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.19 |
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.85
|
| Rate for Payer: Blue Shield of California EPN |
$0.68
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.19
|
| Rate for Payer: Dignity Health Senior |
$1.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.87
|
| Rate for Payer: Heritage Provider Network Senior |
$0.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.98
|
| Rate for Payer: Multiplan Commercial |
$1.05
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.56
|
| Rate for Payer: TriValley Medical Group Senior |
$0.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.19
|
| Rate for Payer: Vantage Medical Group Senior |
$1.19
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
|
OP
|
$3.85
|
|
|
Service Code
|
NDC 0093-5955-06
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$3.27 |
| Rate for Payer: Adventist Health Commercial |
$0.77
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.89
|
| Rate for Payer: Blue Shield of California Commercial |
$2.35
|
| Rate for Payer: Blue Shield of California EPN |
$1.88
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.27
|
| Rate for Payer: Dignity Health Senior |
$3.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.38
|
| Rate for Payer: Heritage Provider Network Senior |
$2.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.69
|
| Rate for Payer: Multiplan Commercial |
$2.89
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.54
|
| Rate for Payer: TriValley Medical Group Senior |
$1.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.27
|
| Rate for Payer: Vantage Medical Group Senior |
$3.27
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
|
IP
|
$11.82
|
|
|
Service Code
|
NDC 63402-911-64
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$8.87 |
| Rate for Payer: Adventist Health Commercial |
$2.36
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.00
|
| Rate for Payer: Heritage Provider Network Senior |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.96
|
| Rate for Payer: Multiplan Commercial |
$8.87
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
|
OP
|
$3.85
|
|
|
Service Code
|
NDC 0093-5955-56
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$3.27 |
| Rate for Payer: Adventist Health Commercial |
$0.77
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.89
|
| Rate for Payer: Blue Shield of California Commercial |
$2.35
|
| Rate for Payer: Blue Shield of California EPN |
$1.88
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.27
|
| Rate for Payer: Dignity Health Senior |
$3.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.38
|
| Rate for Payer: Heritage Provider Network Senior |
$2.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.69
|
| Rate for Payer: Multiplan Commercial |
$2.89
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.54
|
| Rate for Payer: TriValley Medical Group Senior |
$1.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.27
|
| Rate for Payer: Vantage Medical Group Senior |
$3.27
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
|
OP
|
$1.50
|
|
|
Service Code
|
NDC 69097-168-64
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.27 |
| Rate for Payer: Adventist Health Commercial |
$0.30
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.92
|
| Rate for Payer: Blue Shield of California EPN |
$0.73
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.27
|
| Rate for Payer: Dignity Health Senior |
$1.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.93
|
| Rate for Payer: Heritage Provider Network Senior |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.05
|
| Rate for Payer: Multiplan Commercial |
$1.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.60
|
| Rate for Payer: TriValley Medical Group Senior |
$0.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.27
|
| Rate for Payer: Vantage Medical Group Senior |
$1.27
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
|
IP
|
$3.85
|
|
|
Service Code
|
NDC 0093-5955-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$2.89 |
| Rate for Payer: Adventist Health Commercial |
$0.77
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.61
|
| Rate for Payer: Heritage Provider Network Senior |
$2.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$2.89
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
|
IP
|
$2.50
|
|
|
Service Code
|
NDC 62756-277-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: Adventist Health Commercial |
$0.50
|
| Rate for Payer: Cash Price |
$1.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.69
|
| Rate for Payer: Heritage Provider Network Senior |
$1.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.63
|
| Rate for Payer: Multiplan Commercial |
$1.88
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]
|
Facility
|
IP
|
$1.50
|
|
|
Service Code
|
NDC 69097-168-48
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.12 |
| Rate for Payer: Adventist Health Commercial |
$0.30
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.02
|
| Rate for Payer: Heritage Provider Network Senior |
$1.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$1.12
|
|
|
ARGATROBAN 100 MG/ML INTRAVENOUS SOLUTION [28947]
|
Facility
|
OP
|
$130.41
|
|
|
Service Code
|
HCPCS J0883
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$97.81 |
| Rate for Payer: Adventist Health Commercial |
$26.08
|
| Rate for Payer: Adventist Health Commercial |
$48.96
|
| Rate for Payer: Aetna of CA Gatekeeper |
$69.70
|
| Rate for Payer: Aetna of CA Gatekeeper |
$130.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$89.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$168.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.68
|
| Rate for Payer: Blue Shield of California Commercial |
$2.24
|
| Rate for Payer: Blue Shield of California Commercial |
$2.24
|
| Rate for Payer: Blue Shield of California EPN |
$2.24
|
| Rate for Payer: Blue Shield of California EPN |
$2.24
|
| Rate for Payer: Cash Price |
$134.64
|
| Rate for Payer: Cash Price |
$71.73
|
| Rate for Payer: Cash Price |
$134.64
|
| Rate for Payer: Cash Price |
$71.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$59.99
|
| Rate for Payer: Cigna of CA HMO/PPO |
$112.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.81
|
| Rate for Payer: Dignity Health Senior |
$0.81
|
| Rate for Payer: Dignity Health Senior |
$0.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.67
|
| Rate for Payer: EPIC Health Plan Medicare |
$0.74
|
| Rate for Payer: EPIC Health Plan Medicare |
$0.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$113.34
|
| Rate for Payer: Heritage Provider Network Senior |
$60.38
|
| Rate for Payer: Heritage Provider Network Senior |
$113.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$116.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$62.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.93
|
| Rate for Payer: Multiplan Commercial |
$97.81
|
| Rate for Payer: Multiplan Commercial |
$183.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$97.92
|
| Rate for Payer: TriValley Medical Group Commercial |
$52.16
|
| Rate for Payer: TriValley Medical Group Senior |
$52.16
|
| Rate for Payer: TriValley Medical Group Senior |
$97.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$88.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$47.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$43.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$81.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.81
|
| Rate for Payer: Vantage Medical Group Senior |
$0.81
|
| Rate for Payer: Vantage Medical Group Senior |
$0.81
|
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