|
DEFEROXAMINE 2 GRAM SOLUTION FOR INJECTION [9722]
|
Facility
|
OP
|
$49.44
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.21 |
| Max. Negotiated Rate |
$42.02 |
| Rate for Payer: Adventist Health Commercial |
$9.89
|
| Rate for Payer: Aetna of CA Gatekeeper |
$26.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.01
|
| Rate for Payer: Blue Shield of California Commercial |
$11.53
|
| Rate for Payer: Blue Shield of California EPN |
$11.53
|
| Rate for Payer: Cash Price |
$27.19
|
| Rate for Payer: Cash Price |
$27.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.02
|
| Rate for Payer: Dignity Health Senior |
$42.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.89
|
| Rate for Payer: Heritage Provider Network Senior |
$22.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$23.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.61
|
| Rate for Payer: Multiplan Commercial |
$37.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$19.78
|
| Rate for Payer: TriValley Medical Group Senior |
$19.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.02
|
| Rate for Payer: Vantage Medical Group Senior |
$42.02
|
|
|
DEFEROXAMINE 2 GRAM SOLUTION FOR INJECTION [9722]
|
Facility
|
IP
|
$49.44
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.95 |
| Max. Negotiated Rate |
$37.08 |
| Rate for Payer: Adventist Health Commercial |
$9.89
|
| Rate for Payer: Cash Price |
$27.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.89
|
| Rate for Payer: Heritage Provider Network Senior |
$22.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.36
|
| Rate for Payer: Multiplan Commercial |
$37.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.37
|
|
|
DEFEROXAMINE 500 MG SOLN FOR INJ (MIXTURE COMPONENT) [408000012]
|
Facility
|
IP
|
$17.71
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$13.28 |
| Rate for Payer: Adventist Health Commercial |
$3.54
|
| Rate for Payer: Cash Price |
$9.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.20
|
| Rate for Payer: Heritage Provider Network Senior |
$8.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.43
|
| Rate for Payer: Multiplan Commercial |
$13.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.86
|
|
|
DEFEROXAMINE 500 MG SOLN FOR INJ (MIXTURE COMPONENT) [408000012]
|
Facility
|
OP
|
$17.71
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$31.01 |
| Rate for Payer: Adventist Health Commercial |
$3.54
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.01
|
| Rate for Payer: Blue Shield of California Commercial |
$11.53
|
| Rate for Payer: Blue Shield of California EPN |
$11.53
|
| Rate for Payer: Cash Price |
$9.74
|
| Rate for Payer: Cash Price |
$9.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.05
|
| Rate for Payer: Dignity Health Senior |
$15.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.20
|
| Rate for Payer: Heritage Provider Network Senior |
$8.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.40
|
| Rate for Payer: Multiplan Commercial |
$13.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.08
|
| Rate for Payer: TriValley Medical Group Senior |
$7.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Vantage Medical Group Senior |
$15.05
|
|
|
DEFEROXAMINE 500 MG SOLUTION FOR INJECTION [9723]
|
Facility
|
IP
|
$15.54
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.81 |
| Max. Negotiated Rate |
$11.65 |
| Rate for Payer: Adventist Health Commercial |
$3.11
|
| Rate for Payer: Adventist Health Commercial |
$3.54
|
| Rate for Payer: Cash Price |
$9.74
|
| Rate for Payer: Cash Price |
$8.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.20
|
| Rate for Payer: Heritage Provider Network Senior |
$7.20
|
| Rate for Payer: Heritage Provider Network Senior |
$8.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.88
|
| Rate for Payer: Multiplan Commercial |
$13.28
|
| Rate for Payer: Multiplan Commercial |
$11.65
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.61
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.15
|
|
|
DEFEROXAMINE 500 MG SOLUTION FOR INJECTION [9723]
|
Facility
|
OP
|
$17.71
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$31.01 |
| Rate for Payer: Adventist Health Commercial |
$3.54
|
| Rate for Payer: Adventist Health Commercial |
$3.11
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.31
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.01
|
| Rate for Payer: Blue Shield of California Commercial |
$11.53
|
| Rate for Payer: Blue Shield of California Commercial |
$11.53
|
| Rate for Payer: Blue Shield of California EPN |
$11.53
|
| Rate for Payer: Blue Shield of California EPN |
$11.53
|
| Rate for Payer: Cash Price |
$9.74
|
| Rate for Payer: Cash Price |
$8.55
|
| Rate for Payer: Cash Price |
$8.55
|
| Rate for Payer: Cash Price |
$9.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.05
|
| Rate for Payer: Dignity Health Senior |
$13.21
|
| Rate for Payer: Dignity Health Senior |
$15.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.20
|
| Rate for Payer: Heritage Provider Network Senior |
$7.20
|
| Rate for Payer: Heritage Provider Network Senior |
$8.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.40
|
| Rate for Payer: Multiplan Commercial |
$13.28
|
| Rate for Payer: Multiplan Commercial |
$11.65
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.22
|
| Rate for Payer: TriValley Medical Group Senior |
$6.22
|
| Rate for Payer: TriValley Medical Group Senior |
$7.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Vantage Medical Group Senior |
$13.21
|
| Rate for Payer: Vantage Medical Group Senior |
$15.05
|
|
|
DEFIBROTIDE 80 MG/ML INTRAVENOUS SOLUTION [214034]
|
Facility
|
IP
|
$573.60
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.82 |
| Max. Negotiated Rate |
$430.20 |
| Rate for Payer: Adventist Health Commercial |
$114.72
|
| Rate for Payer: Cash Price |
$315.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$263.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$265.58
|
| Rate for Payer: Heritage Provider Network Senior |
$265.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.40
|
| Rate for Payer: Multiplan Commercial |
$430.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$207.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$189.92
|
|
|
DEFIBROTIDE 80 MG/ML INTRAVENOUS SOLUTION [214034]
|
Facility
|
OP
|
$573.60
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.82 |
| Max. Negotiated Rate |
$487.56 |
| Rate for Payer: Adventist Health Commercial |
$114.72
|
| Rate for Payer: Aetna of CA Gatekeeper |
$306.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$394.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$487.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$315.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$430.20
|
| Rate for Payer: Blue Shield of California Commercial |
$349.90
|
| Rate for Payer: Blue Shield of California EPN |
$279.92
|
| Rate for Payer: Cash Price |
$315.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$263.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$487.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$487.56
|
| Rate for Payer: Dignity Health Senior |
$487.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$367.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$265.58
|
| Rate for Payer: Heritage Provider Network Senior |
$265.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$273.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$401.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$401.52
|
| Rate for Payer: Multiplan Commercial |
$430.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$229.44
|
| Rate for Payer: TriValley Medical Group Senior |
$229.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$207.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$189.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$487.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$487.56
|
| Rate for Payer: Vantage Medical Group Senior |
$487.56
|
|
|
DEGARELIX 80 MG SUBCUTANEOUS SOLUTION [96986]
|
Facility
|
OP
|
$586.14
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.36 |
| Max. Negotiated Rate |
$439.61 |
| Rate for Payer: Adventist Health Commercial |
$117.23
|
| Rate for Payer: Aetna of CA Gatekeeper |
$313.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$402.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.82
|
| Rate for Payer: Blue Shield of California Commercial |
$6.23
|
| Rate for Payer: Blue Shield of California EPN |
$6.23
|
| Rate for Payer: Cash Price |
$322.38
|
| Rate for Payer: Cash Price |
$322.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$269.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.80
|
| Rate for Payer: Dignity Health Senior |
$4.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$375.13
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$271.38
|
| Rate for Payer: Heritage Provider Network Senior |
$271.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$279.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.49
|
| Rate for Payer: Multiplan Commercial |
$439.61
|
| Rate for Payer: TriValley Medical Group Commercial |
$234.46
|
| Rate for Payer: TriValley Medical Group Senior |
$234.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$211.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$194.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.80
|
| Rate for Payer: Vantage Medical Group Senior |
$4.80
|
|
|
DEGARELIX 80 MG SUBCUTANEOUS SOLUTION [96986]
|
Facility
|
IP
|
$586.14
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$106.09 |
| Max. Negotiated Rate |
$439.61 |
| Rate for Payer: Adventist Health Commercial |
$117.23
|
| Rate for Payer: Cash Price |
$322.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$269.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$316.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$271.38
|
| Rate for Payer: Heritage Provider Network Senior |
$271.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.53
|
| Rate for Payer: Multiplan Commercial |
$439.61
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$211.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$194.07
|
|
|
DESIPRAMINE 25 MG TABLET [2286]
|
Facility
|
IP
|
$1.34
|
|
|
Service Code
|
NDC 45963-342-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Adventist Health Commercial |
$0.27
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.91
|
| Rate for Payer: Heritage Provider Network Senior |
$0.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.00
|
|
|
DESIPRAMINE 25 MG TABLET [2286]
|
Facility
|
IP
|
$0.18
|
|
|
Service Code
|
NDC 50742-113-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Senior |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
|
|
DESIPRAMINE 25 MG TABLET [2286]
|
Facility
|
OP
|
$1.34
|
|
|
Service Code
|
NDC 45963-342-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.14 |
| Rate for Payer: Adventist Health Commercial |
$0.27
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.00
|
| Rate for Payer: Blue Shield of California Commercial |
$0.82
|
| Rate for Payer: Blue Shield of California EPN |
$0.65
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.14
|
| Rate for Payer: Dignity Health Senior |
$1.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.83
|
| Rate for Payer: Heritage Provider Network Senior |
$0.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.94
|
| Rate for Payer: Multiplan Commercial |
$1.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.54
|
| Rate for Payer: TriValley Medical Group Senior |
$0.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.14
|
| Rate for Payer: Vantage Medical Group Senior |
$1.14
|
|
|
DESIPRAMINE 25 MG TABLET [2286]
|
Facility
|
OP
|
$0.18
|
|
|
Service Code
|
NDC 50742-113-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.15
|
| Rate for Payer: Dignity Health Senior |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Senior |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Vantage Medical Group Senior |
$0.15
|
|
|
DESMOPRESSIN 0.1 MG TABLET [16052]
|
Facility
|
IP
|
$0.88
|
|
|
Service Code
|
NDC 60505-0257-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.60
|
| Rate for Payer: Heritage Provider Network Senior |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.66
|
|
|
DESMOPRESSIN 0.1 MG TABLET [16052]
|
Facility
|
OP
|
$2.63
|
|
|
Service Code
|
NDC 60687-721-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.24 |
| Rate for Payer: Adventist Health Commercial |
$0.53
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.97
|
| Rate for Payer: Blue Shield of California Commercial |
$1.60
|
| Rate for Payer: Blue Shield of California EPN |
$1.28
|
| Rate for Payer: Cash Price |
$1.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.24
|
| Rate for Payer: Dignity Health Senior |
$2.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.63
|
| Rate for Payer: Heritage Provider Network Senior |
$1.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.84
|
| Rate for Payer: Multiplan Commercial |
$1.97
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.05
|
| Rate for Payer: TriValley Medical Group Senior |
$1.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.24
|
| Rate for Payer: Vantage Medical Group Senior |
$2.24
|
|
|
DESMOPRESSIN 0.1 MG TABLET [16052]
|
Facility
|
OP
|
$0.88
|
|
|
Service Code
|
NDC 68001-574-00
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.66
|
| Rate for Payer: Blue Shield of California Commercial |
$0.54
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.75
|
| Rate for Payer: Dignity Health Senior |
$0.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.54
|
| Rate for Payer: Heritage Provider Network Senior |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.62
|
| Rate for Payer: Multiplan Commercial |
$0.66
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.35
|
| Rate for Payer: TriValley Medical Group Senior |
$0.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.75
|
| Rate for Payer: Vantage Medical Group Senior |
$0.75
|
|
|
DESMOPRESSIN 0.1 MG TABLET [16052]
|
Facility
|
IP
|
$2.63
|
|
|
Service Code
|
NDC 60687-721-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.97 |
| Rate for Payer: Adventist Health Commercial |
$0.53
|
| Rate for Payer: Cash Price |
$1.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.78
|
| Rate for Payer: Heritage Provider Network Senior |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$1.97
|
|
|
DESMOPRESSIN 0.1 MG TABLET [16052]
|
Facility
|
OP
|
$2.63
|
|
|
Service Code
|
NDC 60687-721-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.24 |
| Rate for Payer: Adventist Health Commercial |
$0.53
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.97
|
| Rate for Payer: Blue Shield of California Commercial |
$1.60
|
| Rate for Payer: Blue Shield of California EPN |
$1.28
|
| Rate for Payer: Cash Price |
$1.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.24
|
| Rate for Payer: Dignity Health Senior |
$2.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.63
|
| Rate for Payer: Heritage Provider Network Senior |
$1.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.84
|
| Rate for Payer: Multiplan Commercial |
$1.97
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.05
|
| Rate for Payer: TriValley Medical Group Senior |
$1.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.24
|
| Rate for Payer: Vantage Medical Group Senior |
$2.24
|
|
|
DESMOPRESSIN 0.1 MG TABLET [16052]
|
Facility
|
IP
|
$2.63
|
|
|
Service Code
|
NDC 60687-721-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.97 |
| Rate for Payer: Adventist Health Commercial |
$0.53
|
| Rate for Payer: Cash Price |
$1.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.78
|
| Rate for Payer: Heritage Provider Network Senior |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$1.97
|
|
|
DESMOPRESSIN 0.1 MG TABLET [16052]
|
Facility
|
IP
|
$0.88
|
|
|
Service Code
|
NDC 68001-574-00
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.60
|
| Rate for Payer: Heritage Provider Network Senior |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.66
|
|
|
DESMOPRESSIN 0.1 MG TABLET [16052]
|
Facility
|
OP
|
$0.88
|
|
|
Service Code
|
NDC 60505-0257-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.66
|
| Rate for Payer: Blue Shield of California Commercial |
$0.54
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.75
|
| Rate for Payer: Dignity Health Senior |
$0.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.54
|
| Rate for Payer: Heritage Provider Network Senior |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.62
|
| Rate for Payer: Multiplan Commercial |
$0.66
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.35
|
| Rate for Payer: TriValley Medical Group Senior |
$0.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.75
|
| Rate for Payer: Vantage Medical Group Senior |
$0.75
|
|
|
DESMOPRESSIN 0.2 MG TABLET [16053]
|
Facility
|
OP
|
$0.99
|
|
|
Service Code
|
NDC 68001-575-00
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.84
|
| 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 |
$0.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.84
|
| Rate for Payer: Dignity Health Senior |
$0.84
|
| 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 |
$0.40
|
| Rate for Payer: TriValley Medical Group Senior |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.84
|
| Rate for Payer: Vantage Medical Group Senior |
$0.84
|
|
|
DESMOPRESSIN 0.2 MG TABLET [16053]
|
Facility
|
IP
|
$0.99
|
|
|
Service Code
|
NDC 60505-0258-1
|
| 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 |
$0.67
|
| Rate for Payer: Heritage Provider Network Senior |
$0.67
|
| 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
|
|
|
DESMOPRESSIN 0.2 MG TABLET [16053]
|
Facility
|
OP
|
$0.99
|
|
|
Service Code
|
NDC 60505-0258-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.84
|
| 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 |
$0.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.84
|
| Rate for Payer: Dignity Health Senior |
$0.84
|
| 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 |
$0.40
|
| Rate for Payer: TriValley Medical Group Senior |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.84
|
| Rate for Payer: Vantage Medical Group Senior |
$0.84
|
|
