|
BUTT PASTE OINT (LLUMC) [4080617]
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
NDC 9994080617
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$12.75 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.27
|
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.50
|
| Rate for Payer: Blue Shield of California Commercial |
$9.15
|
| Rate for Payer: Blue Shield of California EPN |
$7.32
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.29
|
| Rate for Payer: Heritage Provider Network Senior |
$9.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.50
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.00
|
| Rate for Payer: TriValley Medical Group Senior |
$6.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.75
|
| Rate for Payer: Vantage Medical Group Senior |
$12.75
|
|
|
C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT [192162]
|
Facility
|
IP
|
$5,330.96
|
|
|
Service Code
|
HCPCS J0597
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$964.90 |
| Max. Negotiated Rate |
$3,998.22 |
| Rate for Payer: Adventist Health Commercial |
$1,066.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,433.14
|
| Rate for Payer: Cash Price |
$2,398.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,452.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,878.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,468.23
|
| Rate for Payer: Heritage Provider Network Senior |
$2,468.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$964.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,332.74
|
| Rate for Payer: Multiplan Commercial |
$3,998.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,926.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,765.08
|
|
|
C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT [192162]
|
Facility
|
OP
|
$5,330.96
|
|
|
Service Code
|
HCPCS J0597
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.26 |
| Max. Negotiated Rate |
$3,998.22 |
| Rate for Payer: Adventist Health Commercial |
$1,066.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,294.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$99.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$87.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$87.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.59
|
| Rate for Payer: Blue Shield of California Commercial |
$82.99
|
| Rate for Payer: Blue Shield of California EPN |
$82.99
|
| Rate for Payer: Cash Price |
$2,398.93
|
| Rate for Payer: Cash Price |
$2,398.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,452.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$99.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$87.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$87.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,411.81
|
| Rate for Payer: EPIC Health Plan Medicare |
$79.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,468.23
|
| Rate for Payer: Heritage Provider Network Senior |
$2,468.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$79.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,542.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$964.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$91.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,332.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$106.21
|
| Rate for Payer: Multiplan Commercial |
$3,998.22
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,132.38
|
| Rate for Payer: TriValley Medical Group Senior |
$2,132.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,926.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,765.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$99.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$87.19
|
| Rate for Payer: Vantage Medical Group Senior |
$87.19
|
|
|
C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS SOLUTION [196347]
|
Facility
|
OP
|
$5,330.96
|
|
|
Service Code
|
HCPCS J0597
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.26 |
| Max. Negotiated Rate |
$3,998.22 |
| Rate for Payer: Adventist Health Commercial |
$1,066.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,294.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$99.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$87.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$87.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.59
|
| Rate for Payer: Blue Shield of California Commercial |
$82.99
|
| Rate for Payer: Blue Shield of California EPN |
$82.99
|
| Rate for Payer: Cash Price |
$2,398.93
|
| Rate for Payer: Cash Price |
$2,398.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,452.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$99.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$87.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$87.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,411.81
|
| Rate for Payer: EPIC Health Plan Medicare |
$79.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,468.23
|
| Rate for Payer: Heritage Provider Network Senior |
$2,468.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$79.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,542.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$964.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$91.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,332.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$106.21
|
| Rate for Payer: Multiplan Commercial |
$3,998.22
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,132.38
|
| Rate for Payer: TriValley Medical Group Senior |
$2,132.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,926.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,765.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$99.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$87.19
|
| Rate for Payer: Vantage Medical Group Senior |
$87.19
|
|
|
C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS SOLUTION [196347]
|
Facility
|
IP
|
$5,330.96
|
|
|
Service Code
|
HCPCS J0597
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$964.90 |
| Max. Negotiated Rate |
$3,998.22 |
| Rate for Payer: Adventist Health Commercial |
$1,066.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,433.14
|
| Rate for Payer: Cash Price |
$2,398.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,452.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,878.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,468.23
|
| Rate for Payer: Heritage Provider Network Senior |
$2,468.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$964.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,332.74
|
| Rate for Payer: Multiplan Commercial |
$3,998.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,926.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,765.08
|
|
|
C1 ESTERASE INHIBITOR, RECOMBINANT 2,100 UNIT INTRAVENOUS SOLUTION [207371]
|
Facility
|
OP
|
$9,984.00
|
|
|
Service Code
|
HCPCS J0596
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.03 |
| Max. Negotiated Rate |
$7,488.00 |
| Rate for Payer: Adventist Health Commercial |
$1,996.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,170.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$47.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.01
|
| Rate for Payer: Blue Shield of California Commercial |
$37.03
|
| Rate for Payer: Blue Shield of California EPN |
$37.03
|
| Rate for Payer: Cash Price |
$4,492.80
|
| Rate for Payer: Cash Price |
$4,492.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,592.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$47.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,389.76
|
| Rate for Payer: EPIC Health Plan Medicare |
$37.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,622.59
|
| Rate for Payer: Heritage Provider Network Senior |
$4,622.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,762.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,807.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$43.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,496.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$50.69
|
| Rate for Payer: Multiplan Commercial |
$7,488.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,993.60
|
| Rate for Payer: TriValley Medical Group Senior |
$3,993.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,607.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,305.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$47.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.61
|
| Rate for Payer: Vantage Medical Group Senior |
$41.61
|
|
|
C1 ESTERASE INHIBITOR, RECOMBINANT 2,100 UNIT INTRAVENOUS SOLUTION [207371]
|
Facility
|
IP
|
$9,984.00
|
|
|
Service Code
|
HCPCS J0596
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,807.10 |
| Max. Negotiated Rate |
$7,488.00 |
| Rate for Payer: Adventist Health Commercial |
$1,996.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,429.70
|
| Rate for Payer: Cash Price |
$4,492.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,592.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,391.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,622.59
|
| Rate for Payer: Heritage Provider Network Senior |
$4,622.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,807.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,496.00
|
| Rate for Payer: Multiplan Commercial |
$7,488.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,607.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,305.70
|
|
|
CABAZITAXEL 60 MG/1.5ML (MUST BE DILUTED TO 10 MG/ML) INTRAVENOUS SOLN [105644]
|
Facility
|
OP
|
$11,775.88
|
|
|
Service Code
|
HCPCS J9043
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$233.73 |
| Max. Negotiated Rate |
$8,831.91 |
| Rate for Payer: TriValley Medical Group Senior |
$4,710.35
|
| Rate for Payer: Adventist Health Commercial |
$2,355.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,277.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$350.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$257.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$233.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$326.50
|
| Rate for Payer: Blue Shield of California Commercial |
$240.49
|
| Rate for Payer: Blue Shield of California EPN |
$240.49
|
| Rate for Payer: Cash Price |
$5,299.15
|
| Rate for Payer: Cash Price |
$5,299.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,416.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$257.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$257.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,536.56
|
| Rate for Payer: EPIC Health Plan Medicare |
$233.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,452.23
|
| Rate for Payer: Heritage Provider Network Senior |
$5,452.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$233.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5,617.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,131.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$268.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,943.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$313.20
|
| Rate for Payer: Multiplan Commercial |
$8,831.91
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,710.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,254.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,898.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$257.10
|
| Rate for Payer: Vantage Medical Group Senior |
$257.10
|
|
|
CABAZITAXEL 60 MG/1.5ML (MUST BE DILUTED TO 10 MG/ML) INTRAVENOUS SOLN [105644]
|
Facility
|
IP
|
$11,775.88
|
|
|
Service Code
|
HCPCS J9043
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,131.43 |
| Max. Negotiated Rate |
$8,831.91 |
| Rate for Payer: Adventist Health Commercial |
$2,355.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,583.67
|
| Rate for Payer: Cash Price |
$5,299.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,416.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,358.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,452.23
|
| Rate for Payer: Heritage Provider Network Senior |
$5,452.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,131.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,943.97
|
| Rate for Payer: Multiplan Commercial |
$8,831.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,254.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,898.99
|
|
|
CABERGOLINE 0.25 MG 1/2 TABLET [4081952]
|
Facility
|
OP
|
$5.59
|
|
|
Service Code
|
NDC 9994081952
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Adventist Health Commercial |
$1.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3.41
|
| Rate for Payer: Blue Shield of California EPN |
$2.73
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.46
|
| Rate for Payer: Heritage Provider Network Senior |
$3.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.91
|
| Rate for Payer: Multiplan Commercial |
$4.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.24
|
| Rate for Payer: TriValley Medical Group Senior |
$2.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
CABERGOLINE 0.25 MG 1/2 TABLET [4081952]
|
Facility
|
IP
|
$5.59
|
|
|
Service Code
|
NDC 9994081952
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$4.19 |
| Rate for Payer: Adventist Health Commercial |
$1.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.60
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.78
|
| Rate for Payer: Heritage Provider Network Senior |
$3.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.40
|
| Rate for Payer: Multiplan Commercial |
$4.19
|
|
|
CABERGOLINE 0.5 MG TABLET [19226]
|
Facility
|
IP
|
$3.75
|
|
|
Service Code
|
NDC 7006982408
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.42
|
| Rate for Payer: Cash Price |
$1.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.54
|
| Rate for Payer: Heritage Provider Network Senior |
$2.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.94
|
| Rate for Payer: Multiplan Commercial |
$2.81
|
|
|
CABERGOLINE 0.5 MG TABLET [19226]
|
Facility
|
IP
|
$3.75
|
|
|
Service Code
|
NDC 5074211808
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.42
|
| Rate for Payer: Cash Price |
$1.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.54
|
| Rate for Payer: Heritage Provider Network Senior |
$2.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.94
|
| Rate for Payer: Multiplan Commercial |
$2.81
|
|
|
CABERGOLINE 0.5 MG TABLET [19226]
|
Facility
|
OP
|
$3.75
|
|
|
Service Code
|
NDC 7006982408
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$3.19 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2.29
|
| Rate for Payer: Blue Shield of California EPN |
$1.83
|
| Rate for Payer: Cash Price |
$1.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.32
|
| Rate for Payer: Heritage Provider Network Senior |
$2.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.62
|
| Rate for Payer: Multiplan Commercial |
$2.81
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.50
|
| Rate for Payer: TriValley Medical Group Senior |
$1.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.19
|
| Rate for Payer: Vantage Medical Group Senior |
$3.19
|
|
|
CABERGOLINE 0.5 MG TABLET [19226]
|
Facility
|
OP
|
$3.75
|
|
|
Service Code
|
NDC 5074211808
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$3.19 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2.29
|
| Rate for Payer: Blue Shield of California EPN |
$1.83
|
| Rate for Payer: Cash Price |
$1.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.32
|
| Rate for Payer: Heritage Provider Network Senior |
$2.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.62
|
| Rate for Payer: Multiplan Commercial |
$2.81
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.50
|
| Rate for Payer: TriValley Medical Group Senior |
$1.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.19
|
| Rate for Payer: Vantage Medical Group Senior |
$3.19
|
|
|
CABERGOLINE 0.5 MG TABLET [19226]
|
Facility
|
OP
|
$7.50
|
|
|
Service Code
|
NDC 0093542088
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$6.38 |
| Rate for Payer: Adventist Health Commercial |
$1.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.75
|
| Rate for Payer: Blue Shield of California Commercial |
$4.58
|
| Rate for Payer: Blue Shield of California EPN |
$3.66
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.64
|
| Rate for Payer: Heritage Provider Network Senior |
$4.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.25
|
| Rate for Payer: Multiplan Commercial |
$5.62
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.00
|
| Rate for Payer: TriValley Medical Group Senior |
$3.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.38
|
| Rate for Payer: Vantage Medical Group Senior |
$6.38
|
|
|
CABERGOLINE 0.5 MG TABLET [19226]
|
Facility
|
OP
|
$2.44
|
|
|
Service Code
|
NDC 2315582373
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$2.07 |
| Rate for Payer: Adventist Health Commercial |
$0.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1.49
|
| Rate for Payer: Blue Shield of California EPN |
$1.19
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.51
|
| Rate for Payer: Heritage Provider Network Senior |
$1.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.71
|
| Rate for Payer: Multiplan Commercial |
$1.83
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.98
|
| Rate for Payer: TriValley Medical Group Senior |
$0.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2.07
|
|
|
CABERGOLINE 0.5 MG TABLET [19226]
|
Facility
|
IP
|
$7.50
|
|
|
Service Code
|
NDC 0093542088
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$5.62 |
| Rate for Payer: Adventist Health Commercial |
$1.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.83
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.08
|
| Rate for Payer: Heritage Provider Network Senior |
$5.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.88
|
| Rate for Payer: Multiplan Commercial |
$5.62
|
|
|
CABERGOLINE 0.5 MG TABLET [19226]
|
Facility
|
IP
|
$2.44
|
|
|
Service Code
|
NDC 2315582373
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$1.83 |
| Rate for Payer: Adventist Health Commercial |
$0.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.57
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.65
|
| Rate for Payer: Heritage Provider Network Senior |
$1.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.61
|
| Rate for Payer: Multiplan Commercial |
$1.83
|
|
|
CADEXOMER IODINE 0.9 % TOPICAL GEL [12858]
|
Facility
|
IP
|
$3.40
|
|
|
Service Code
|
NDC 4056512249
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: Adventist Health Commercial |
$0.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.19
|
| Rate for Payer: Cash Price |
$1.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.30
|
| Rate for Payer: Heritage Provider Network Senior |
$2.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.85
|
| Rate for Payer: Multiplan Commercial |
$2.55
|
|
|
CADEXOMER IODINE 0.9 % TOPICAL GEL [12858]
|
Facility
|
OP
|
$3.40
|
|
|
Service Code
|
NDC 4056512249
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.89 |
| Rate for Payer: Adventist Health Commercial |
$0.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.70
|
| Rate for Payer: Blue Shield of California Commercial |
$2.07
|
| Rate for Payer: Blue Shield of California EPN |
$1.66
|
| Rate for Payer: Cash Price |
$1.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.10
|
| Rate for Payer: Heritage Provider Network Senior |
$2.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.38
|
| Rate for Payer: Multiplan Commercial |
$2.55
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.36
|
| Rate for Payer: TriValley Medical Group Senior |
$1.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.89
|
| Rate for Payer: Vantage Medical Group Senior |
$2.89
|
|
|
CAFFEINE 200 MG TABLET [1259]
|
Facility
|
OP
|
$0.11
|
|
|
Service Code
|
NDC 4612245773
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
CAFFEINE 200 MG TABLET [1259]
|
Facility
|
IP
|
$6.61
|
|
|
Service Code
|
NDC 7117901860
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$4.96 |
| Rate for Payer: Adventist Health Commercial |
$1.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.26
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.47
|
| Rate for Payer: Heritage Provider Network Senior |
$4.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.65
|
| Rate for Payer: Multiplan Commercial |
$4.96
|
|
|
CAFFEINE 200 MG TABLET [1259]
|
Facility
|
OP
|
$6.61
|
|
|
Service Code
|
NDC 7117901860
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$5.62 |
| Rate for Payer: Adventist Health Commercial |
$1.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.31
|
| Rate for Payer: Blue Shield of California Commercial |
$4.03
|
| Rate for Payer: Blue Shield of California EPN |
$3.23
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.09
|
| Rate for Payer: Heritage Provider Network Senior |
$4.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.63
|
| Rate for Payer: Multiplan Commercial |
$4.96
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.64
|
| Rate for Payer: TriValley Medical Group Senior |
$2.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.62
|
| Rate for Payer: Vantage Medical Group Senior |
$5.62
|
|
|
CAFFEINE 200 MG TABLET [1259]
|
Facility
|
IP
|
$0.11
|
|
|
Service Code
|
NDC 4612245773
|
| 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
|
|
