|
COLCHICINE 0.6 MG CAPSULE [207785]
|
Facility
|
OP
|
$8.16
|
|
|
Service Code
|
NDC 60687-358-95
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$6.94 |
| Rate for Payer: Adventist Health Commercial |
$1.63
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.12
|
| Rate for Payer: Blue Shield of California Commercial |
$4.98
|
| Rate for Payer: Blue Shield of California EPN |
$3.98
|
| Rate for Payer: Cash Price |
$4.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.94
|
| Rate for Payer: Dignity Health Senior |
$6.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.05
|
| Rate for Payer: Heritage Provider Network Senior |
$5.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.71
|
| Rate for Payer: Multiplan Commercial |
$6.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.26
|
| Rate for Payer: TriValley Medical Group Senior |
$3.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.94
|
| Rate for Payer: Vantage Medical Group Senior |
$6.94
|
|
|
COLCHICINE 0.6 MG TABLET [1821]
|
Facility
|
IP
|
$0.74
|
|
|
Service Code
|
NDC 65162-710-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.50
|
| Rate for Payer: Heritage Provider Network Senior |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.56
|
|
|
COLCHICINE 0.6 MG TABLET [1821]
|
Facility
|
IP
|
$4.46
|
|
|
Service Code
|
NDC 50268-187-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$3.35 |
| Rate for Payer: Adventist Health Commercial |
$0.89
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.02
|
| Rate for Payer: Heritage Provider Network Senior |
$3.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.11
|
| Rate for Payer: Multiplan Commercial |
$3.35
|
|
|
COLCHICINE 0.6 MG TABLET [1821]
|
Facility
|
OP
|
$0.74
|
|
|
Service Code
|
NDC 65162-710-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.63 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.56
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.63
|
| Rate for Payer: Dignity Health Senior |
$0.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.46
|
| Rate for Payer: Heritage Provider Network Senior |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.52
|
| Rate for Payer: Multiplan Commercial |
$0.56
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.30
|
| Rate for Payer: TriValley Medical Group Senior |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.63
|
| Rate for Payer: Vantage Medical Group Senior |
$0.63
|
|
|
COLCHICINE 0.6 MG TABLET [1821]
|
Facility
|
IP
|
$6.74
|
|
|
Service Code
|
NDC 0254-2008-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$5.05 |
| Rate for Payer: Adventist Health Commercial |
$1.35
|
| Rate for Payer: Cash Price |
$3.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.56
|
| Rate for Payer: Heritage Provider Network Senior |
$4.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.69
|
| Rate for Payer: Multiplan Commercial |
$5.05
|
|
|
COLCHICINE 0.6 MG TABLET [1821]
|
Facility
|
IP
|
$11.15
|
|
|
Service Code
|
NDC 60687-727-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$8.36 |
| Rate for Payer: Adventist Health Commercial |
$2.23
|
| Rate for Payer: Cash Price |
$6.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.55
|
| Rate for Payer: Heritage Provider Network Senior |
$7.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.79
|
| Rate for Payer: Multiplan Commercial |
$8.36
|
|
|
COLCHICINE 0.6 MG TABLET [1821]
|
Facility
|
OP
|
$6.74
|
|
|
Service Code
|
NDC 0254-2008-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$5.73 |
| Rate for Payer: Adventist Health Commercial |
$1.35
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.05
|
| Rate for Payer: Blue Shield of California Commercial |
$4.11
|
| Rate for Payer: Blue Shield of California EPN |
$3.29
|
| Rate for Payer: Cash Price |
$3.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.73
|
| Rate for Payer: Dignity Health Senior |
$5.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.17
|
| Rate for Payer: Heritage Provider Network Senior |
$4.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.72
|
| Rate for Payer: Multiplan Commercial |
$5.05
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.70
|
| Rate for Payer: TriValley Medical Group Senior |
$2.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.73
|
| Rate for Payer: Vantage Medical Group Senior |
$5.73
|
|
|
COLCHICINE 0.6 MG TABLET [1821]
|
Facility
|
IP
|
$0.98
|
|
|
Service Code
|
NDC 0591-2562-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.74 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.66
|
| Rate for Payer: Heritage Provider Network Senior |
$0.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.74
|
|
|
COLCHICINE 0.6 MG TABLET [1821]
|
Facility
|
OP
|
$0.98
|
|
|
Service Code
|
NDC 0591-2562-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.83 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.74
|
| Rate for Payer: Blue Shield of California Commercial |
$0.60
|
| Rate for Payer: Blue Shield of California EPN |
$0.48
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.83
|
| Rate for Payer: Dignity Health Senior |
$0.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.61
|
| Rate for Payer: Heritage Provider Network Senior |
$0.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$0.74
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.39
|
| Rate for Payer: TriValley Medical Group Senior |
$0.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.83
|
| Rate for Payer: Vantage Medical Group Senior |
$0.83
|
|
|
COLCHICINE 0.6 MG TABLET [1821]
|
Facility
|
IP
|
$1.57
|
|
|
Service Code
|
NDC 43598-372-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.18 |
| Rate for Payer: Adventist Health Commercial |
$0.31
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.06
|
| Rate for Payer: Heritage Provider Network Senior |
$1.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$1.18
|
|
|
COLCHICINE 0.6 MG TABLET [1821]
|
Facility
|
OP
|
$1.57
|
|
|
Service Code
|
NDC 43598-372-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.33 |
| Rate for Payer: Adventist Health Commercial |
$0.31
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.96
|
| Rate for Payer: Blue Shield of California EPN |
$0.77
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.33
|
| Rate for Payer: Dignity Health Senior |
$1.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.97
|
| Rate for Payer: Heritage Provider Network Senior |
$0.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.10
|
| Rate for Payer: Multiplan Commercial |
$1.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.63
|
| Rate for Payer: TriValley Medical Group Senior |
$0.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.33
|
| Rate for Payer: Vantage Medical Group Senior |
$1.33
|
|
|
COLCHICINE 0.6 MG TABLET [1821]
|
Facility
|
OP
|
$4.46
|
|
|
Service Code
|
NDC 50268-187-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$3.79 |
| Rate for Payer: Adventist Health Commercial |
$0.89
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.35
|
| Rate for Payer: Blue Shield of California Commercial |
$2.72
|
| Rate for Payer: Blue Shield of California EPN |
$2.18
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.79
|
| Rate for Payer: Dignity Health Senior |
$3.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.76
|
| Rate for Payer: Heritage Provider Network Senior |
$2.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.12
|
| Rate for Payer: Multiplan Commercial |
$3.35
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.78
|
| Rate for Payer: TriValley Medical Group Senior |
$1.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.79
|
| Rate for Payer: Vantage Medical Group Senior |
$3.79
|
|
|
COLCHICINE 0.6 MG TABLET [1821]
|
Facility
|
IP
|
$11.15
|
|
|
Service Code
|
NDC 60687-727-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$8.36 |
| Rate for Payer: Adventist Health Commercial |
$2.23
|
| Rate for Payer: Cash Price |
$6.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.55
|
| Rate for Payer: Heritage Provider Network Senior |
$7.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.79
|
| Rate for Payer: Multiplan Commercial |
$8.36
|
|
|
COLCHICINE 0.6 MG TABLET [1821]
|
Facility
|
OP
|
$11.15
|
|
|
Service Code
|
NDC 60687-727-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$9.48 |
| Rate for Payer: Adventist Health Commercial |
$2.23
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.36
|
| Rate for Payer: Blue Shield of California Commercial |
$6.80
|
| Rate for Payer: Blue Shield of California EPN |
$5.44
|
| Rate for Payer: Cash Price |
$6.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.48
|
| Rate for Payer: Dignity Health Senior |
$9.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.90
|
| Rate for Payer: Heritage Provider Network Senior |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.80
|
| Rate for Payer: Multiplan Commercial |
$8.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.46
|
| Rate for Payer: TriValley Medical Group Senior |
$4.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.48
|
| Rate for Payer: Vantage Medical Group Senior |
$9.48
|
|
|
COLCHICINE 0.6 MG TABLET [1821]
|
Facility
|
OP
|
$11.15
|
|
|
Service Code
|
NDC 60687-727-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$9.48 |
| Rate for Payer: Adventist Health Commercial |
$2.23
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.36
|
| Rate for Payer: Blue Shield of California Commercial |
$6.80
|
| Rate for Payer: Blue Shield of California EPN |
$5.44
|
| Rate for Payer: Cash Price |
$6.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.48
|
| Rate for Payer: Dignity Health Senior |
$9.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.90
|
| Rate for Payer: Heritage Provider Network Senior |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.80
|
| Rate for Payer: Multiplan Commercial |
$8.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.46
|
| Rate for Payer: TriValley Medical Group Senior |
$4.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.48
|
| Rate for Payer: Vantage Medical Group Senior |
$9.48
|
|
|
COLCHICINE 0.6 MG TABLET [1821]
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
NDC 67877-589-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Senior |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
|
|
COLCHICINE 0.6 MG TABLET [1821]
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
NDC 67877-589-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: Dignity Health Senior |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Senior |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Senior |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
COLESTIPOL 1 GRAM TABLET [13884]
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
NDC 60687-715-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Adventist Health Commercial |
$1.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.75
|
| Rate for Payer: Blue Shield of California Commercial |
$3.05
|
| Rate for Payer: Blue Shield of California EPN |
$2.44
|
| Rate for Payer: Cash Price |
$2.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.25
|
| Rate for Payer: Dignity Health Senior |
$4.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.10
|
| Rate for Payer: Heritage Provider Network Senior |
$3.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.50
|
| Rate for Payer: Multiplan Commercial |
$3.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.00
|
| Rate for Payer: TriValley Medical Group Senior |
$2.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.25
|
| Rate for Payer: Vantage Medical Group Senior |
$4.25
|
|
|
COLESTIPOL 1 GRAM TABLET [13884]
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
NDC 60687-715-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Adventist Health Commercial |
$1.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.75
|
| Rate for Payer: Blue Shield of California Commercial |
$3.05
|
| Rate for Payer: Blue Shield of California EPN |
$2.44
|
| Rate for Payer: Cash Price |
$2.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.25
|
| Rate for Payer: Dignity Health Senior |
$4.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.10
|
| Rate for Payer: Heritage Provider Network Senior |
$3.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.50
|
| Rate for Payer: Multiplan Commercial |
$3.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.00
|
| Rate for Payer: TriValley Medical Group Senior |
$2.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.25
|
| Rate for Payer: Vantage Medical Group Senior |
$4.25
|
|
|
COLESTIPOL 1 GRAM TABLET [13884]
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
NDC 60687-715-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Adventist Health Commercial |
$1.00
|
| Rate for Payer: Cash Price |
$2.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.38
|
| Rate for Payer: Heritage Provider Network Senior |
$3.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.25
|
| Rate for Payer: Multiplan Commercial |
$3.75
|
|
|
COLESTIPOL 1 GRAM TABLET [13884]
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
NDC 60687-715-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Adventist Health Commercial |
$1.00
|
| Rate for Payer: Cash Price |
$2.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.38
|
| Rate for Payer: Heritage Provider Network Senior |
$3.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.25
|
| Rate for Payer: Multiplan Commercial |
$3.75
|
|
|
COLESTIPOL 5 GRAM ORAL PACKET [12218]
|
Facility
|
IP
|
$3.77
|
|
|
Service Code
|
NDC 0115-5212-18
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$2.83 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Cash Price |
$2.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.55
|
| Rate for Payer: Heritage Provider Network Senior |
$2.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.94
|
| Rate for Payer: Multiplan Commercial |
$2.83
|
|
|
COLESTIPOL 5 GRAM ORAL PACKET [12218]
|
Facility
|
OP
|
$3.77
|
|
|
Service Code
|
NDC 0115-5212-18
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.83
|
| Rate for Payer: Blue Shield of California Commercial |
$2.30
|
| Rate for Payer: Blue Shield of California EPN |
$1.84
|
| Rate for Payer: Cash Price |
$2.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.20
|
| Rate for Payer: Dignity Health Senior |
$3.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.33
|
| Rate for Payer: Heritage Provider Network Senior |
$2.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$2.83
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.51
|
| Rate for Payer: TriValley Medical Group Senior |
$1.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.20
|
| Rate for Payer: Vantage Medical Group Senior |
$3.20
|
|
|
COLISTIN (COLISTIMETHATE) 150 MG CBA SOLUTION FOR INJECTION [9681]
|
Facility
|
OP
|
$33.60
|
|
|
Service Code
|
HCPCS J0770
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.08 |
| Max. Negotiated Rate |
$70.30 |
| Rate for Payer: Adventist Health Commercial |
$6.72
|
| Rate for Payer: Adventist Health Commercial |
$6.72
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.95
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.30
|
| Rate for Payer: Blue Shield of California Commercial |
$28.14
|
| Rate for Payer: Blue Shield of California Commercial |
$28.14
|
| Rate for Payer: Blue Shield of California EPN |
$28.14
|
| Rate for Payer: Blue Shield of California EPN |
$28.14
|
| Rate for Payer: Cash Price |
$18.48
|
| Rate for Payer: Cash Price |
$18.47
|
| Rate for Payer: Cash Price |
$18.47
|
| Rate for Payer: Cash Price |
$18.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.56
|
| Rate for Payer: Dignity Health Senior |
$28.55
|
| Rate for Payer: Dignity Health Senior |
$28.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.55
|
| Rate for Payer: Heritage Provider Network Senior |
$15.55
|
| Rate for Payer: Heritage Provider Network Senior |
$15.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.52
|
| Rate for Payer: Multiplan Commercial |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$25.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.44
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.44
|
| Rate for Payer: TriValley Medical Group Senior |
$13.44
|
| Rate for Payer: TriValley Medical Group Senior |
$13.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.56
|
| Rate for Payer: Vantage Medical Group Senior |
$28.55
|
| Rate for Payer: Vantage Medical Group Senior |
$28.56
|
|
|
COLISTIN (COLISTIMETHATE) 150 MG CBA SOLUTION FOR INJECTION [9681]
|
Facility
|
IP
|
$33.59
|
|
|
Service Code
|
HCPCS J0770
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.08 |
| Max. Negotiated Rate |
$25.19 |
| Rate for Payer: Adventist Health Commercial |
$6.72
|
| Rate for Payer: Adventist Health Commercial |
$6.72
|
| Rate for Payer: Cash Price |
$18.48
|
| Rate for Payer: Cash Price |
$18.47
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.55
|
| Rate for Payer: Heritage Provider Network Senior |
$15.55
|
| Rate for Payer: Heritage Provider Network Senior |
$15.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$25.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.12
|
|
