|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE [39277]
|
Facility
|
IP
|
$0.36
|
|
|
Service Code
|
NDC 68001-415-04
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.24
|
| Rate for Payer: Heritage Provider Network Senior |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE [39277]
|
Facility
|
IP
|
$1.92
|
|
|
Service Code
|
NDC 60687-745-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.44 |
| Rate for Payer: Adventist Health Commercial |
$0.38
|
| Rate for Payer: Cash Price |
$1.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.30
|
| Rate for Payer: Heritage Provider Network Senior |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.44
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE [39277]
|
Facility
|
OP
|
$0.59
|
|
|
Service Code
|
NDC 43547-381-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Blue Shield of California Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.50
|
| Rate for Payer: Dignity Health Senior |
$0.50
|
| 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 Permanente of CA Commercial |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| 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 |
$0.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: Vantage Medical Group Senior |
$0.50
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE [39277]
|
Facility
|
IP
|
$0.40
|
|
|
Service Code
|
NDC 57237-019-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.27
|
| Rate for Payer: Heritage Provider Network Senior |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.30
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE [39277]
|
Facility
|
IP
|
$0.59
|
|
|
Service Code
|
NDC 43547-381-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.40
|
| Rate for Payer: Heritage Provider Network Senior |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE SPRINKLE [225947]
|
Facility
|
OP
|
$8.95
|
|
|
Service Code
|
NDC 47335-619-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$7.61 |
| Rate for Payer: Adventist Health Commercial |
$1.79
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.71
|
| Rate for Payer: Blue Shield of California Commercial |
$5.46
|
| Rate for Payer: Blue Shield of California EPN |
$4.37
|
| Rate for Payer: Cash Price |
$4.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.61
|
| Rate for Payer: Dignity Health Senior |
$7.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.54
|
| Rate for Payer: Heritage Provider Network Senior |
$5.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.26
|
| Rate for Payer: Multiplan Commercial |
$6.71
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.58
|
| Rate for Payer: TriValley Medical Group Senior |
$3.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.61
|
| Rate for Payer: Vantage Medical Group Senior |
$7.61
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE SPRINKLE [225947]
|
Facility
|
IP
|
$8.95
|
|
|
Service Code
|
NDC 47335-619-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$6.71 |
| Rate for Payer: Adventist Health Commercial |
$1.79
|
| Rate for Payer: Cash Price |
$4.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.06
|
| Rate for Payer: Heritage Provider Network Senior |
$6.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.24
|
| Rate for Payer: Multiplan Commercial |
$6.71
|
|
|
DURLOBACTAM 0.5 GRAM INTRAVENOUS SOLUTION [241588]
|
Facility
|
OP
|
$199.60
|
|
|
Service Code
|
NDC 68547-311-30
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.13 |
| Max. Negotiated Rate |
$169.66 |
| Rate for Payer: Adventist Health Commercial |
$39.92
|
| Rate for Payer: Aetna of CA Gatekeeper |
$106.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$137.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$169.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$109.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$149.70
|
| Rate for Payer: Blue Shield of California Commercial |
$121.76
|
| Rate for Payer: Blue Shield of California EPN |
$97.40
|
| Rate for Payer: Cash Price |
$109.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$129.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$169.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$169.66
|
| Rate for Payer: Dignity Health Senior |
$169.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.55
|
| Rate for Payer: Heritage Provider Network Senior |
$123.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$95.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$139.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$139.72
|
| Rate for Payer: Multiplan Commercial |
$149.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$79.84
|
| Rate for Payer: TriValley Medical Group Senior |
$79.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$99.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$99.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$169.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$169.66
|
| Rate for Payer: Vantage Medical Group Senior |
$169.66
|
|
|
DURLOBACTAM 0.5 GRAM INTRAVENOUS SOLUTION [241588]
|
Facility
|
IP
|
$199.60
|
|
|
Service Code
|
NDC 68547-311-30
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.13 |
| Max. Negotiated Rate |
$149.70 |
| Rate for Payer: Adventist Health Commercial |
$39.92
|
| Rate for Payer: Cash Price |
$109.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$135.13
|
| Rate for Payer: Heritage Provider Network Senior |
$135.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.90
|
| Rate for Payer: Multiplan Commercial |
$149.70
|
|
|
DURVALUMAB 50 MG/ML INTRAVENOUS SOLUTION [217071]
|
Facility
|
OP
|
$515.36
|
|
|
Service Code
|
HCPCS J9173
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$83.87 |
| Max. Negotiated Rate |
$386.52 |
| Rate for Payer: Adventist Health Commercial |
$103.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$275.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$354.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$127.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$93.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$93.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$218.10
|
| Rate for Payer: Blue Shield of California Commercial |
$84.21
|
| Rate for Payer: Blue Shield of California EPN |
$84.21
|
| Rate for Payer: Cash Price |
$283.45
|
| Rate for Payer: Cash Price |
$283.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$237.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$106.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.78
|
| Rate for Payer: Dignity Health Senior |
$93.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$329.83
|
| Rate for Payer: EPIC Health Plan Medicare |
$85.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$238.61
|
| Rate for Payer: Heritage Provider Network Senior |
$238.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$85.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$245.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$98.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$107.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$107.42
|
| Rate for Payer: Multiplan Commercial |
$386.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$206.14
|
| Rate for Payer: TriValley Medical Group Senior |
$206.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$186.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$170.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$106.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.78
|
| Rate for Payer: Vantage Medical Group Senior |
$93.78
|
|
|
DURVALUMAB 50 MG/ML INTRAVENOUS SOLUTION [217071]
|
Facility
|
IP
|
$515.36
|
|
|
Service Code
|
HCPCS J9173
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$93.28 |
| Max. Negotiated Rate |
$386.52 |
| Rate for Payer: Adventist Health Commercial |
$103.07
|
| Rate for Payer: Cash Price |
$283.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$237.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$238.61
|
| Rate for Payer: Heritage Provider Network Senior |
$238.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.84
|
| Rate for Payer: Multiplan Commercial |
$386.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$186.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$170.64
|
|
|
DUTASTERIDE 0.5 MG CAPSULE [34089]
|
Facility
|
IP
|
$0.38
|
|
|
Service Code
|
NDC 42806-549-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.26
|
| Rate for Payer: Heritage Provider Network Senior |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
|
|
DUTASTERIDE 0.5 MG CAPSULE [34089]
|
Facility
|
IP
|
$0.44
|
|
|
Service Code
|
NDC 31722-131-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.33 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.30
|
| Rate for Payer: Heritage Provider Network Senior |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.33
|
|
|
DUTASTERIDE 0.5 MG CAPSULE [34089]
|
Facility
|
OP
|
$0.38
|
|
|
Service Code
|
NDC 42806-549-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.19
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.32
|
| Rate for Payer: Dignity Health Senior |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.24
|
| Rate for Payer: Heritage Provider Network Senior |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.15
|
| Rate for Payer: TriValley Medical Group Senior |
$0.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Vantage Medical Group Senior |
$0.32
|
|
|
DUTASTERIDE 0.5 MG CAPSULE [34089]
|
Facility
|
OP
|
$0.44
|
|
|
Service Code
|
NDC 31722-131-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.33
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.37
|
| Rate for Payer: Dignity Health Senior |
$0.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.27
|
| Rate for Payer: Heritage Provider Network Senior |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$0.33
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.18
|
| Rate for Payer: TriValley Medical Group Senior |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Vantage Medical Group Senior |
$0.37
|
|
|
DV10BB1
|
Facility
|
IP
|
$8,769.00
|
|
| Hospital Charge Code |
5562
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
DV11B6Z
|
Facility
|
IP
|
$8,769.00
|
|
| Hospital Charge Code |
5563
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
DV11BB1
|
Facility
|
IP
|
$8,769.00
|
|
| Hospital Charge Code |
5564
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
DW10BB1
|
Facility
|
IP
|
$8,769.00
|
|
| Hospital Charge Code |
5565
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
DW10BBZ
|
Facility
|
IP
|
$8,769.00
|
|
| Hospital Charge Code |
5566
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
DW11B6Z
|
Facility
|
IP
|
$8,769.00
|
|
| Hospital Charge Code |
5567
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
DW11BB1
|
Facility
|
IP
|
$8,769.00
|
|
| Hospital Charge Code |
5568
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
DW12B6Z
|
Facility
|
IP
|
$8,769.00
|
|
| Hospital Charge Code |
5569
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
DW12BB1
|
Facility
|
IP
|
$8,769.00
|
|
| Hospital Charge Code |
5570
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
DW13B6Z
|
Facility
|
IP
|
$8,769.00
|
|
| Hospital Charge Code |
5571
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
