|
DAPAGLIFLOZIN 10 MG TABLET [204693]
|
Facility
|
OP
|
$15.11
|
|
|
Service Code
|
NDC 0310621030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$12.84 |
| Rate for Payer: Adventist Health Commercial |
$3.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.56
|
| Rate for Payer: Blue Shield of California Commercial |
$9.22
|
| Rate for Payer: Blue Shield of California EPN |
$7.37
|
| Rate for Payer: Cash Price |
$6.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.35
|
| Rate for Payer: Heritage Provider Network Senior |
$9.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.58
|
| Rate for Payer: Multiplan Commercial |
$11.33
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.04
|
| Rate for Payer: TriValley Medical Group Senior |
$6.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.84
|
| Rate for Payer: Vantage Medical Group Senior |
$12.84
|
|
|
DAPAGLIFLOZIN 10 MG TABLET [204693]
|
Facility
|
IP
|
$15.14
|
|
|
Service Code
|
NDC 6699345730
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$11.36 |
| Rate for Payer: Adventist Health Commercial |
$3.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.75
|
| Rate for Payer: Cash Price |
$6.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.25
|
| Rate for Payer: Heritage Provider Network Senior |
$10.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.79
|
| Rate for Payer: Multiplan Commercial |
$11.36
|
|
|
DAPAGLIFLOZIN 10 MG TABLET [204693]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 0781599031
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.64
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.68
|
| Rate for Payer: Heritage Provider Network Senior |
$0.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
|
|
DAPAGLIFLOZIN 10 MG TABLET [204693]
|
Facility
|
IP
|
$15.11
|
|
|
Service Code
|
NDC 0310621030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$11.33 |
| Rate for Payer: Adventist Health Commercial |
$3.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.73
|
| Rate for Payer: Cash Price |
$6.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.23
|
| Rate for Payer: Heritage Provider Network Senior |
$10.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.78
|
| Rate for Payer: Multiplan Commercial |
$11.33
|
|
|
DAPAGLIFLOZIN 10 MG TABLET [204693]
|
Facility
|
OP
|
$0.60
|
|
|
Service Code
|
NDC 2724115201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.30
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.37
|
| Rate for Payer: Heritage Provider Network Senior |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.24
|
| Rate for Payer: TriValley Medical Group Senior |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
|
DAPAGLIFLOZIN 10 MG TABLET [204693]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 0781599031
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.50
|
| Rate for Payer: Blue Shield of California Commercial |
$0.61
|
| Rate for Payer: Blue Shield of California EPN |
$0.49
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.62
|
| Rate for Payer: Heritage Provider Network Senior |
$0.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| 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 |
$0.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
DAPAGLIFLOZIN 10 MG TABLET [204693]
|
Facility
|
IP
|
$15.11
|
|
|
Service Code
|
NDC 0310621039
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$11.33 |
| Rate for Payer: Adventist Health Commercial |
$3.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.73
|
| Rate for Payer: Cash Price |
$6.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.23
|
| Rate for Payer: Heritage Provider Network Senior |
$10.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.78
|
| Rate for Payer: Multiplan Commercial |
$11.33
|
|
|
DAPAGLIFLOZIN 10 MG TABLET [204693]
|
Facility
|
IP
|
$0.60
|
|
|
Service Code
|
NDC 2724115201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.39
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.41
|
| Rate for Payer: Heritage Provider Network Senior |
$0.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
|
|
DAPSONE 100 MG TABLET [2131]
|
Facility
|
OP
|
$1.86
|
|
|
Service Code
|
NDC 6498056603
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.58 |
| Rate for Payer: Adventist Health Commercial |
$0.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.93
|
| Rate for Payer: Blue Shield of California Commercial |
$1.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.91
|
| Rate for Payer: Cash Price |
$0.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.15
|
| Rate for Payer: Heritage Provider Network Senior |
$1.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.30
|
| Rate for Payer: Multiplan Commercial |
$1.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.74
|
| Rate for Payer: TriValley Medical Group Senior |
$0.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.58
|
| Rate for Payer: Vantage Medical Group Senior |
$1.58
|
|
|
DAPSONE 100 MG TABLET [2131]
|
Facility
|
OP
|
$1.45
|
|
|
Service Code
|
NDC 7095413610
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.90
|
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.73
|
| Rate for Payer: Blue Shield of California Commercial |
$0.88
|
| Rate for Payer: Blue Shield of California EPN |
$0.71
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.90
|
| Rate for Payer: Heritage Provider Network Senior |
$0.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.01
|
| Rate for Payer: Multiplan Commercial |
$1.09
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.58
|
| Rate for Payer: TriValley Medical Group Senior |
$0.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.23
|
| Rate for Payer: Vantage Medical Group Senior |
$1.23
|
|
|
DAPSONE 100 MG TABLET [2131]
|
Facility
|
IP
|
$1.86
|
|
|
Service Code
|
NDC 6498056603
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Adventist Health Commercial |
$0.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.20
|
| Rate for Payer: Cash Price |
$0.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.26
|
| Rate for Payer: Heritage Provider Network Senior |
$1.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.47
|
| Rate for Payer: Multiplan Commercial |
$1.40
|
|
|
DAPSONE 100 MG TABLET [2131]
|
Facility
|
IP
|
$1.45
|
|
|
Service Code
|
NDC 7095413610
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.09 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.93
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.98
|
| Rate for Payer: Heritage Provider Network Senior |
$0.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.09
|
|
|
DAPSONE ORAL SUSPENSION COMPOUND 2 MG/ML [4080263]
|
Facility
|
OP
|
$2.37
|
|
|
Service Code
|
NDC 9994080263
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$2.01 |
| Rate for Payer: Adventist Health Commercial |
$0.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1.45
|
| Rate for Payer: Blue Shield of California EPN |
$1.16
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.47
|
| Rate for Payer: Heritage Provider Network Senior |
$1.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.66
|
| Rate for Payer: Multiplan Commercial |
$1.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.95
|
| Rate for Payer: TriValley Medical Group Senior |
$0.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.01
|
| Rate for Payer: Vantage Medical Group Senior |
$2.01
|
|
|
DAPSONE ORAL SUSPENSION COMPOUND 2 MG/ML [4080263]
|
Facility
|
IP
|
$2.37
|
|
|
Service Code
|
NDC 9994080263
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.78 |
| Rate for Payer: Adventist Health Commercial |
$0.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.53
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.60
|
| Rate for Payer: Heritage Provider Network Senior |
$1.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: Multiplan Commercial |
$1.78
|
|
|
DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION [36989]
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.82
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$44.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.45
|
| Rate for Payer: Heritage Provider Network Senior |
$44.45
|
| Rate for Payer: Heritage Provider Network Senior |
$16.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$34.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.92
|
|
|
DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION [36989]
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$81.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$72.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.79
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$44.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$81.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.67
|
| Rate for Payer: Heritage Provider Network Senior |
$44.45
|
| Rate for Payer: Heritage Provider Network Senior |
$16.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$45.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$67.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$38.40
|
| Rate for Payer: TriValley Medical Group Senior |
$14.40
|
| Rate for Payer: TriValley Medical Group Senior |
$38.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$34.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.60
|
| Rate for Payer: Vantage Medical Group Senior |
$81.60
|
| Rate for Payer: Vantage Medical Group Senior |
$30.60
|
|
|
DARATUMUMAB 1,800 MG-HYALURONIDASE-FIHJ 30,000 UNIT/15 ML SUBCUT SOLN [228045]
|
Facility
|
OP
|
$899.03
|
|
|
Service Code
|
HCPCS J9144
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.80 |
| Max. Negotiated Rate |
$674.27 |
| Rate for Payer: Adventist Health Commercial |
$179.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$555.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.97
|
| Rate for Payer: Blue Shield of California Commercial |
$56.80
|
| Rate for Payer: Blue Shield of California EPN |
$56.80
|
| Rate for Payer: Cash Price |
$404.56
|
| Rate for Payer: Cash Price |
$404.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$413.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$575.38
|
| Rate for Payer: EPIC Health Plan Medicare |
$57.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$416.25
|
| Rate for Payer: Heritage Provider Network Senior |
$416.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$57.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$428.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$162.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$65.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$76.45
|
| Rate for Payer: Multiplan Commercial |
$674.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$359.61
|
| Rate for Payer: TriValley Medical Group Senior |
$359.61
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$324.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$297.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.76
|
| Rate for Payer: Vantage Medical Group Senior |
$62.76
|
|
|
DARATUMUMAB 1,800 MG-HYALURONIDASE-FIHJ 30,000 UNIT/15 ML SUBCUT SOLN [228045]
|
Facility
|
IP
|
$899.03
|
|
|
Service Code
|
HCPCS J9144
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$162.72 |
| Max. Negotiated Rate |
$674.27 |
| Rate for Payer: Adventist Health Commercial |
$179.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$578.98
|
| Rate for Payer: Cash Price |
$404.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$413.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$485.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$416.25
|
| Rate for Payer: Heritage Provider Network Senior |
$416.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$162.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.76
|
| Rate for Payer: Multiplan Commercial |
$674.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$324.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$297.67
|
|
|
DARATUMUMAB-HYALURONIDASE-FIHJ (DARZALEX FASPRO) 1800 MG/30000 UNIT SQ INJECTION [40820601]
|
Facility
|
IP
|
$899.03
|
|
|
Service Code
|
HCPCS J9144
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$162.72 |
| Max. Negotiated Rate |
$674.27 |
| Rate for Payer: Adventist Health Commercial |
$179.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$578.98
|
| Rate for Payer: Cash Price |
$404.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$413.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$485.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$416.25
|
| Rate for Payer: Heritage Provider Network Senior |
$416.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$162.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.76
|
| Rate for Payer: Multiplan Commercial |
$674.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$324.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$297.67
|
|
|
DARATUMUMAB-HYALURONIDASE-FIHJ (DARZALEX FASPRO) 1800 MG/30000 UNIT SQ INJECTION [40820601]
|
Facility
|
OP
|
$899.03
|
|
|
Service Code
|
HCPCS J9144
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.80 |
| Max. Negotiated Rate |
$674.27 |
| Rate for Payer: Vantage Medical Group Senior |
$62.76
|
| Rate for Payer: Adventist Health Commercial |
$179.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$555.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.97
|
| Rate for Payer: Blue Shield of California Commercial |
$56.80
|
| Rate for Payer: Blue Shield of California EPN |
$56.80
|
| Rate for Payer: Cash Price |
$404.56
|
| Rate for Payer: Cash Price |
$404.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$413.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$575.38
|
| Rate for Payer: EPIC Health Plan Medicare |
$57.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$416.25
|
| Rate for Payer: Heritage Provider Network Senior |
$416.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$57.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$428.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$162.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$65.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$76.45
|
| Rate for Payer: Multiplan Commercial |
$674.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$359.61
|
| Rate for Payer: TriValley Medical Group Senior |
$359.61
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$324.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$297.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.76
|
|
|
DARBEPOETIN ALFA 100 MCG/0.5 ML IN POLYSORBATE INJECTION SYRINGE [108044]
|
Facility
|
IP
|
$1,857.60
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$336.23 |
| Max. Negotiated Rate |
$1,393.20 |
| Rate for Payer: Adventist Health Commercial |
$371.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,196.29
|
| Rate for Payer: Cash Price |
$835.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$854.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,003.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$860.07
|
| Rate for Payer: Heritage Provider Network Senior |
$860.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$336.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$464.40
|
| Rate for Payer: Multiplan Commercial |
$1,393.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$671.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$615.05
|
|
|
DARBEPOETIN ALFA 100 MCG/0.5 ML IN POLYSORBATE INJECTION SYRINGE [108044]
|
Facility
|
OP
|
$1,857.60
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$1,393.20 |
| Rate for Payer: Adventist Health Commercial |
$371.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,148.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.70
|
| Rate for Payer: Blue Shield of California Commercial |
$7.90
|
| Rate for Payer: Blue Shield of California EPN |
$7.90
|
| Rate for Payer: Cash Price |
$835.92
|
| Rate for Payer: Cash Price |
$835.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$854.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,188.86
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$860.07
|
| Rate for Payer: Heritage Provider Network Senior |
$860.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$886.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$336.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$464.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.91
|
| Rate for Payer: Multiplan Commercial |
$1,393.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$743.04
|
| Rate for Payer: TriValley Medical Group Senior |
$743.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$671.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$615.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.21
|
| Rate for Payer: Vantage Medical Group Senior |
$3.21
|
|
|
DARBEPOETIN ALFA 150 MCG/0.3 ML IN POLYSORBATE INJECTION SYRINGE [108046]
|
Facility
|
OP
|
$4,644.00
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$3,483.00 |
| Rate for Payer: Adventist Health Commercial |
$928.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,869.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.70
|
| Rate for Payer: Blue Shield of California Commercial |
$7.90
|
| Rate for Payer: Blue Shield of California EPN |
$7.90
|
| Rate for Payer: Cash Price |
$2,089.80
|
| Rate for Payer: Cash Price |
$2,089.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,136.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,972.16
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,150.17
|
| Rate for Payer: Heritage Provider Network Senior |
$2,150.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,215.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$840.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,161.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.91
|
| Rate for Payer: Multiplan Commercial |
$3,483.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,857.60
|
| Rate for Payer: TriValley Medical Group Senior |
$1,857.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,677.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,537.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.21
|
| Rate for Payer: Vantage Medical Group Senior |
$3.21
|
|
|
DARBEPOETIN ALFA 150 MCG/0.3 ML IN POLYSORBATE INJECTION SYRINGE [108046]
|
Facility
|
IP
|
$4,644.00
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$840.56 |
| Max. Negotiated Rate |
$3,483.00 |
| Rate for Payer: Adventist Health Commercial |
$928.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,990.74
|
| Rate for Payer: Cash Price |
$2,089.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,136.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,507.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,150.17
|
| Rate for Payer: Heritage Provider Network Senior |
$2,150.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$840.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,161.00
|
| Rate for Payer: Multiplan Commercial |
$3,483.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,677.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,537.63
|
|
|
DARBEPOETIN ALFA 200 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE [108047]
|
Facility
|
OP
|
$4,644.00
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$3,483.00 |
| Rate for Payer: Adventist Health Commercial |
$928.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,869.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.70
|
| Rate for Payer: Blue Shield of California Commercial |
$7.90
|
| Rate for Payer: Blue Shield of California EPN |
$7.90
|
| Rate for Payer: Cash Price |
$2,089.80
|
| Rate for Payer: Cash Price |
$2,089.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,136.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,972.16
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,150.17
|
| Rate for Payer: Heritage Provider Network Senior |
$2,150.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,215.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$840.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,161.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.91
|
| Rate for Payer: Multiplan Commercial |
$3,483.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,857.60
|
| Rate for Payer: TriValley Medical Group Senior |
$1,857.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,677.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,537.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.21
|
| Rate for Payer: Vantage Medical Group Senior |
$3.21
|
|
