|
DOCETAXEL 160 MG/8 ML (20 MG/ML) INTRAVENOUS SOLUTION [196796]
|
Facility
OP
|
$25.50
|
|
|
Service Code
|
CPT J9171
|
| Hospital Charge Code |
NDG196796
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$41.42 |
| Rate for Payer: Adventist Health Commercial |
$5.10
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.42
|
| Rate for Payer: Blue Shield of California Commercial |
$2.43
|
| Rate for Payer: Blue Shield of California EPN |
$2.43
|
| Rate for Payer: Cash Price |
$11.48
|
| Rate for Payer: Cash Price |
$11.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.68
|
| Rate for Payer: Dignity Health Senior |
$21.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.81
|
| Rate for Payer: Heritage Provider Network Senior |
$11.81
|
| Rate for Payer: IEHP Medi-Cal |
$8.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.38
|
| Rate for Payer: Multiplan Commercial |
$19.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.68
|
| Rate for Payer: Vantage Medical Group Senior |
$21.68
|
|
|
DOCETAXEL 20 MG/2 ML (10 MG/ML) INTRAVENOUS SOLUTION [108910]
|
Facility
OP
|
$43.09
|
|
|
Service Code
|
CPT J9171
|
| Hospital Charge Code |
NDG108910
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$41.42 |
| Rate for Payer: Adventist Health Commercial |
$8.62
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$36.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$23.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$32.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.42
|
| Rate for Payer: Blue Shield of California Commercial |
$2.43
|
| Rate for Payer: Blue Shield of California EPN |
$2.43
|
| Rate for Payer: Cash Price |
$19.39
|
| Rate for Payer: Cash Price |
$19.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.63
|
| Rate for Payer: Dignity Health Senior |
$36.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.95
|
| Rate for Payer: Heritage Provider Network Senior |
$19.95
|
| Rate for Payer: IEHP Medi-Cal |
$8.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.77
|
| Rate for Payer: Multiplan Commercial |
$32.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.63
|
| Rate for Payer: Vantage Medical Group Senior |
$36.63
|
|
|
DOCETAXEL 20 MG/2 ML (10 MG/ML) INTRAVENOUS SOLUTION [108910]
|
Facility
IP
|
$43.09
|
|
|
Service Code
|
CPT J9171
|
| Hospital Charge Code |
NDG108910
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$32.32 |
| Rate for Payer: Adventist Health Commercial |
$8.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.60
|
| Rate for Payer: Cash Price |
$19.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.17
|
| Rate for Payer: Heritage Provider Network Senior |
$29.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.77
|
| Rate for Payer: Multiplan Commercial |
$32.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.40
|
|
|
DOCETAXEL 20 MG/ML (1 ML) INTRAVENOUS SOLUTION [106443]
|
Facility
OP
|
$30.00
|
|
|
Service Code
|
CPT J9171
|
| Hospital Charge Code |
1755764
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$41.42 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.42
|
| Rate for Payer: Blue Shield of California Commercial |
$2.43
|
| Rate for Payer: Blue Shield of California EPN |
$2.43
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.50
|
| Rate for Payer: Dignity Health Senior |
$25.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.89
|
| Rate for Payer: Heritage Provider Network Senior |
$13.89
|
| Rate for Payer: IEHP Medi-Cal |
$8.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.50
|
| Rate for Payer: Vantage Medical Group Senior |
$25.50
|
|
|
DOCETAXEL 20 MG/ML (1 ML) INTRAVENOUS SOLUTION [106443]
|
Facility
IP
|
$30.00
|
|
|
Service Code
|
CPT J9171
|
| Hospital Charge Code |
1755764
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.61
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.31
|
| Rate for Payer: Heritage Provider Network Senior |
$20.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.02
|
|
|
DOCETAXEL 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION [108122]
|
Facility
OP
|
$25.50
|
|
|
Service Code
|
CPT J9171
|
| Hospital Charge Code |
1755766
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$41.42 |
| Rate for Payer: Adventist Health Commercial |
$5.10
|
| Rate for Payer: Adventist Health Commercial |
$26.10
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.43
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$89.65
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$110.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$71.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$97.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.42
|
| Rate for Payer: Blue Shield of California Commercial |
$2.43
|
| Rate for Payer: Blue Shield of California Commercial |
$2.43
|
| Rate for Payer: Blue Shield of California EPN |
$2.43
|
| Rate for Payer: Blue Shield of California EPN |
$2.43
|
| Rate for Payer: Cash Price |
$11.48
|
| Rate for Payer: Cash Price |
$11.48
|
| Rate for Payer: Cash Price |
$58.73
|
| Rate for Payer: Cash Price |
$58.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$60.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$110.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$110.92
|
| Rate for Payer: Dignity Health Senior |
$21.68
|
| Rate for Payer: Dignity Health Senior |
$110.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.81
|
| Rate for Payer: Heritage Provider Network Senior |
$60.42
|
| Rate for Payer: Heritage Provider Network Senior |
$11.81
|
| Rate for Payer: IEHP Medi-Cal |
$8.52
|
| Rate for Payer: IEHP Medi-Cal |
$8.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$62.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.38
|
| Rate for Payer: Multiplan Commercial |
$19.12
|
| Rate for Payer: Multiplan Commercial |
$97.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$47.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$43.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$110.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.68
|
| Rate for Payer: Vantage Medical Group Senior |
$110.92
|
| Rate for Payer: Vantage Medical Group Senior |
$21.68
|
|
|
DOCETAXEL 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION [108122]
|
Facility
IP
|
$130.50
|
|
|
Service Code
|
CPT J9171
|
| Hospital Charge Code |
1755766
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.62 |
| Max. Negotiated Rate |
$97.88 |
| Rate for Payer: Adventist Health Commercial |
$26.10
|
| Rate for Payer: Adventist Health Commercial |
$5.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$89.65
|
| Rate for Payer: Cash Price |
$58.73
|
| Rate for Payer: Cash Price |
$11.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$60.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$88.35
|
| Rate for Payer: Heritage Provider Network Senior |
$88.35
|
| Rate for Payer: Heritage Provider Network Senior |
$17.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.62
|
| Rate for Payer: Multiplan Commercial |
$19.12
|
| Rate for Payer: Multiplan Commercial |
$97.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$47.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$43.60
|
|
|
DOCETAXEL 80 MG/8 ML (10 MG/ML) INTRAVENOUS SOLUTION [108907]
|
Facility
IP
|
$24.00
|
|
|
Service Code
|
CPT J9171
|
| Hospital Charge Code |
NDG108907
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Adventist Health Commercial |
$8.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.49
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$19.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.25
|
| Rate for Payer: Heritage Provider Network Senior |
$29.17
|
| Rate for Payer: Heritage Provider Network Senior |
$16.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$32.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.40
|
|
|
DOCETAXEL 80 MG/8 ML (10 MG/ML) INTRAVENOUS SOLUTION [108907]
|
Facility
OP
|
$24.00
|
|
|
Service Code
|
CPT J9171
|
| Hospital Charge Code |
NDG108907
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$41.42 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Adventist Health Commercial |
$8.62
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.43
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$36.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$23.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$32.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.42
|
| Rate for Payer: Blue Shield of California Commercial |
$2.43
|
| Rate for Payer: Blue Shield of California Commercial |
$2.43
|
| Rate for Payer: Blue Shield of California EPN |
$2.43
|
| Rate for Payer: Blue Shield of California EPN |
$2.43
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$19.39
|
| Rate for Payer: Cash Price |
$19.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Senior |
$36.63
|
| Rate for Payer: Dignity Health Senior |
$20.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.11
|
| Rate for Payer: Heritage Provider Network Senior |
$11.11
|
| Rate for Payer: Heritage Provider Network Senior |
$19.95
|
| Rate for Payer: IEHP Medi-Cal |
$8.52
|
| Rate for Payer: IEHP Medi-Cal |
$8.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$32.32
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.63
|
| Rate for Payer: Vantage Medical Group Senior |
$36.63
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
IP
|
$8.02
|
|
|
Service Code
|
NDC 61269-981-35
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$6.02 |
| Rate for Payer: Adventist Health Commercial |
$1.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.51
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.43
|
| Rate for Payer: Heritage Provider Network Senior |
$5.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$6.02
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
OP
|
$8.39
|
|
|
Service Code
|
NDC 46122-681-07
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$7.13 |
| Rate for Payer: Adventist Health Commercial |
$1.68
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.29
|
| Rate for Payer: Blue Shield of California Commercial |
$5.21
|
| Rate for Payer: Blue Shield of California EPN |
$4.92
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: Dignity Health Senior |
$7.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.19
|
| Rate for Payer: Heritage Provider Network Senior |
$5.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$6.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Senior |
$7.13
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
IP
|
$9.28
|
|
|
Service Code
|
NDC 766080155
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$6.96 |
| Rate for Payer: Adventist Health Commercial |
$1.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.38
|
| Rate for Payer: Cash Price |
$4.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.28
|
| Rate for Payer: Heritage Provider Network Senior |
$6.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.32
|
| Rate for Payer: Multiplan Commercial |
$6.96
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
OP
|
$8.02
|
|
|
Service Code
|
NDC 61269-981-35
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$6.82 |
| Rate for Payer: Adventist Health Commercial |
$1.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.41
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.02
|
| Rate for Payer: Blue Shield of California Commercial |
$4.98
|
| Rate for Payer: Blue Shield of California EPN |
$4.71
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.82
|
| Rate for Payer: Dignity Health Senior |
$6.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.96
|
| Rate for Payer: Heritage Provider Network Senior |
$4.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$6.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.82
|
| Rate for Payer: Vantage Medical Group Senior |
$6.82
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
OP
|
$9.28
|
|
|
Service Code
|
NDC 0135-0200-01
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$7.89 |
| Rate for Payer: Adventist Health Commercial |
$1.86
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.89
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.96
|
| Rate for Payer: Blue Shield of California Commercial |
$5.76
|
| Rate for Payer: Blue Shield of California EPN |
$5.45
|
| Rate for Payer: Cash Price |
$4.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.89
|
| Rate for Payer: Dignity Health Senior |
$7.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.74
|
| Rate for Payer: Heritage Provider Network Senior |
$5.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.32
|
| Rate for Payer: Multiplan Commercial |
$6.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.89
|
| Rate for Payer: Vantage Medical Group Senior |
$7.89
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
IP
|
$9.28
|
|
|
Service Code
|
NDC 0135-0200-01
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$6.96 |
| Rate for Payer: Adventist Health Commercial |
$1.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.38
|
| Rate for Payer: Cash Price |
$4.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.28
|
| Rate for Payer: Heritage Provider Network Senior |
$6.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.32
|
| Rate for Payer: Multiplan Commercial |
$6.96
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
OP
|
$9.28
|
|
|
Service Code
|
NDC 766080155
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$7.89 |
| Rate for Payer: Adventist Health Commercial |
$1.86
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.89
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.96
|
| Rate for Payer: Blue Shield of California Commercial |
$5.76
|
| Rate for Payer: Blue Shield of California EPN |
$5.45
|
| Rate for Payer: Cash Price |
$4.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.89
|
| Rate for Payer: Dignity Health Senior |
$7.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.74
|
| Rate for Payer: Heritage Provider Network Senior |
$5.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.32
|
| Rate for Payer: Multiplan Commercial |
$6.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.89
|
| Rate for Payer: Vantage Medical Group Senior |
$7.89
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
IP
|
$8.39
|
|
|
Service Code
|
NDC 46122-681-07
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$6.29 |
| Rate for Payer: Adventist Health Commercial |
$1.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.76
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.68
|
| Rate for Payer: Heritage Provider Network Senior |
$5.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$6.29
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
OP
|
$8.39
|
|
|
Service Code
|
NDC 46122-624-07
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$7.13 |
| Rate for Payer: Adventist Health Commercial |
$1.68
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.29
|
| Rate for Payer: Blue Shield of California Commercial |
$5.21
|
| Rate for Payer: Blue Shield of California EPN |
$4.92
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: Dignity Health Senior |
$7.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.19
|
| Rate for Payer: Heritage Provider Network Senior |
$5.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$6.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Senior |
$7.13
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
IP
|
$8.39
|
|
|
Service Code
|
NDC 46122-624-07
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$6.29 |
| Rate for Payer: Adventist Health Commercial |
$1.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.76
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.68
|
| Rate for Payer: Heritage Provider Network Senior |
$5.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$6.29
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
OP
|
$9.28
|
|
|
Service Code
|
NDC 0766-0801-00
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$7.89 |
| Rate for Payer: Adventist Health Commercial |
$1.86
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.89
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.96
|
| Rate for Payer: Blue Shield of California Commercial |
$5.76
|
| Rate for Payer: Blue Shield of California EPN |
$5.45
|
| Rate for Payer: Cash Price |
$4.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.89
|
| Rate for Payer: Dignity Health Senior |
$7.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.74
|
| Rate for Payer: Heritage Provider Network Senior |
$5.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.32
|
| Rate for Payer: Multiplan Commercial |
$6.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.89
|
| Rate for Payer: Vantage Medical Group Senior |
$7.89
|
|
|
DOCOSANOL 10 % TOPICAL CREAM [29287]
|
Facility
IP
|
$9.28
|
|
|
Service Code
|
NDC 0766-0801-00
|
| Hospital Charge Code |
1743703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$6.96 |
| Rate for Payer: Adventist Health Commercial |
$1.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.38
|
| Rate for Payer: Cash Price |
$4.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.28
|
| Rate for Payer: Heritage Provider Network Senior |
$6.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.32
|
| Rate for Payer: Multiplan Commercial |
$6.96
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE [2566]
|
Facility
IP
|
$0.22
|
|
|
Service Code
|
NDC 60687-129-01
|
| Hospital Charge Code |
1710247
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.15
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Senior |
$0.15
|
| 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
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE [2566]
|
Facility
OP
|
$0.22
|
|
|
Service Code
|
NDC 60687-129-01
|
| Hospital Charge Code |
1710247
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: AlphaCare 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 |
$0.13
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
| Rate for Payer: Dignity Health Senior |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| 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: Multiplan Commercial |
$0.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE [2566]
|
Facility
OP
|
$0.02
|
|
|
Service Code
|
NDC 6961804410
|
| Hospital Charge Code |
1710247
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.02
|
| Rate for Payer: Dignity Health Senior |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Vantage Medical Group Senior |
$0.02
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE [2566]
|
Facility
OP
|
$0.06
|
|
|
Service Code
|
NDC 0904-7183-61
|
| Hospital Charge Code |
1710247
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.05
|
| Rate for Payer: Dignity Health Senior |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Senior |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
