|
EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION [23124]
|
Facility
|
IP
|
$5.40
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Adventist Health Commercial |
$1.08
|
| Rate for Payer: Adventist Health Commercial |
$2.26
|
| Rate for Payer: Cash Price |
$6.20
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.22
|
| Rate for Payer: Heritage Provider Network Senior |
$5.22
|
| Rate for Payer: Heritage Provider Network Senior |
$2.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.82
|
| Rate for Payer: Multiplan Commercial |
$4.05
|
| Rate for Payer: Multiplan Commercial |
$8.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.79
|
|
|
EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION [23124]
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$27.52 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.52
|
| Rate for Payer: Blue Shield of California Commercial |
$10.84
|
| Rate for Payer: Blue Shield of California EPN |
$10.84
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.10
|
| Rate for Payer: Dignity Health Senior |
$5.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.78
|
| Rate for Payer: Heritage Provider Network Senior |
$2.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.20
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.40
|
| Rate for Payer: TriValley Medical Group Senior |
$2.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$5.10
|
|
|
EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION [23124]
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.78
|
| Rate for Payer: Heritage Provider Network Senior |
$2.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.99
|
|
|
EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION [23124]
|
Facility
|
OP
|
$5.40
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Adventist Health Commercial |
$1.08
|
| Rate for Payer: Adventist Health Commercial |
$2.26
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.89
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.46
|
| Rate for Payer: Blue Shield of California Commercial |
$6.88
|
| Rate for Payer: Blue Shield of California Commercial |
$3.29
|
| Rate for Payer: Blue Shield of California EPN |
$2.64
|
| Rate for Payer: Blue Shield of California EPN |
$5.50
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cash Price |
$6.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.59
|
| Rate for Payer: Dignity Health Senior |
$4.59
|
| Rate for Payer: Dignity Health Senior |
$9.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.50
|
| Rate for Payer: Heritage Provider Network Senior |
$5.22
|
| Rate for Payer: Heritage Provider Network Senior |
$2.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.78
|
| Rate for Payer: Multiplan Commercial |
$8.46
|
| Rate for Payer: Multiplan Commercial |
$4.05
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.16
|
| Rate for Payer: TriValley Medical Group Senior |
$2.16
|
| Rate for Payer: TriValley Medical Group Senior |
$4.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.59
|
| Rate for Payer: Vantage Medical Group Senior |
$9.59
|
| Rate for Payer: Vantage Medical Group Senior |
$4.59
|
|
|
ERAVACYCLINE 50 MG INTRAVENOUS SOLUTION [222798]
|
Facility
|
IP
|
$80.50
|
|
|
Service Code
|
HCPCS J0122
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$60.38 |
| Rate for Payer: Adventist Health Commercial |
$16.10
|
| Rate for Payer: Cash Price |
$44.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$37.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.27
|
| Rate for Payer: Heritage Provider Network Senior |
$37.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.12
|
| Rate for Payer: Multiplan Commercial |
$60.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.65
|
|
|
ERAVACYCLINE 50 MG INTRAVENOUS SOLUTION [222798]
|
Facility
|
OP
|
$80.50
|
|
|
Service Code
|
HCPCS J0122
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$68.42 |
| Rate for Payer: Adventist Health Commercial |
$16.10
|
| Rate for Payer: Aetna of CA Gatekeeper |
$43.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$55.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.02
|
| Rate for Payer: Blue Shield of California Commercial |
$1.12
|
| Rate for Payer: Blue Shield of California EPN |
$1.12
|
| Rate for Payer: Cash Price |
$44.28
|
| Rate for Payer: Cash Price |
$44.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$37.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.42
|
| Rate for Payer: Dignity Health Senior |
$68.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.27
|
| Rate for Payer: Heritage Provider Network Senior |
$37.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$38.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$56.35
|
| Rate for Payer: Multiplan Commercial |
$60.38
|
| Rate for Payer: TriValley Medical Group Commercial |
$32.20
|
| Rate for Payer: TriValley Medical Group Senior |
$32.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.42
|
| Rate for Payer: Vantage Medical Group Senior |
$68.42
|
|
|
ERDAFITINIB 3 MG TABLET [224623]
|
Facility
|
OP
|
$455.28
|
|
|
Service Code
|
NDC 59676-030-56
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$82.41 |
| Max. Negotiated Rate |
$386.99 |
| Rate for Payer: Adventist Health Commercial |
$91.06
|
| Rate for Payer: Aetna of CA Gatekeeper |
$243.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$312.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$386.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$250.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$341.46
|
| Rate for Payer: Blue Shield of California Commercial |
$277.72
|
| Rate for Payer: Blue Shield of California EPN |
$222.18
|
| Rate for Payer: Cash Price |
$250.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$295.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$386.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$386.99
|
| Rate for Payer: Dignity Health Senior |
$386.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$291.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$281.82
|
| Rate for Payer: Heritage Provider Network Senior |
$281.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$217.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$318.70
|
| Rate for Payer: Multiplan Commercial |
$341.46
|
| Rate for Payer: TriValley Medical Group Commercial |
$182.11
|
| Rate for Payer: TriValley Medical Group Senior |
$182.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$227.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$227.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$386.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$386.99
|
| Rate for Payer: Vantage Medical Group Senior |
$386.99
|
|
|
ERDAFITINIB 3 MG TABLET [224623]
|
Facility
|
IP
|
$455.28
|
|
|
Service Code
|
NDC 59676-030-56
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$82.41 |
| Max. Negotiated Rate |
$341.46 |
| Rate for Payer: Adventist Health Commercial |
$91.06
|
| Rate for Payer: Cash Price |
$250.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$308.22
|
| Rate for Payer: Heritage Provider Network Senior |
$308.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.82
|
| Rate for Payer: Multiplan Commercial |
$341.46
|
|
|
ERDAFITINIB 4 MG TABLET [224624]
|
Facility
|
OP
|
$607.04
|
|
|
Service Code
|
NDC 59676-040-28
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$109.87 |
| Max. Negotiated Rate |
$515.98 |
| Rate for Payer: Adventist Health Commercial |
$121.41
|
| Rate for Payer: Aetna of CA Gatekeeper |
$324.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$417.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$515.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$333.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$455.28
|
| Rate for Payer: Blue Shield of California Commercial |
$370.29
|
| Rate for Payer: Blue Shield of California EPN |
$296.24
|
| Rate for Payer: Cash Price |
$333.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$394.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$515.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$515.98
|
| Rate for Payer: Dignity Health Senior |
$515.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$388.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$375.76
|
| Rate for Payer: Heritage Provider Network Senior |
$375.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$289.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$424.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$424.93
|
| Rate for Payer: Multiplan Commercial |
$455.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$242.82
|
| Rate for Payer: TriValley Medical Group Senior |
$242.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$303.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$303.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$515.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$515.98
|
| Rate for Payer: Vantage Medical Group Senior |
$515.98
|
|
|
ERDAFITINIB 4 MG TABLET [224624]
|
Facility
|
IP
|
$607.04
|
|
|
Service Code
|
NDC 59676-040-28
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$109.87 |
| Max. Negotiated Rate |
$455.28 |
| Rate for Payer: Adventist Health Commercial |
$121.41
|
| Rate for Payer: Cash Price |
$333.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$327.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$410.97
|
| Rate for Payer: Heritage Provider Network Senior |
$410.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.76
|
| Rate for Payer: Multiplan Commercial |
$455.28
|
|
|
ERDAFITINIB 5 MG TABLET [224625]
|
Facility
|
IP
|
$758.80
|
|
|
Service Code
|
NDC 59676-050-28
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$137.34 |
| Max. Negotiated Rate |
$569.10 |
| Rate for Payer: Adventist Health Commercial |
$151.76
|
| Rate for Payer: Cash Price |
$417.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$409.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$513.71
|
| Rate for Payer: Heritage Provider Network Senior |
$513.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.70
|
| Rate for Payer: Multiplan Commercial |
$569.10
|
|
|
ERDAFITINIB 5 MG TABLET [224625]
|
Facility
|
OP
|
$758.80
|
|
|
Service Code
|
NDC 59676-050-28
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$137.34 |
| Max. Negotiated Rate |
$644.98 |
| Rate for Payer: Adventist Health Commercial |
$151.76
|
| Rate for Payer: Aetna of CA Gatekeeper |
$405.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$521.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$644.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$417.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$569.10
|
| Rate for Payer: Blue Shield of California Commercial |
$462.87
|
| Rate for Payer: Blue Shield of California EPN |
$370.29
|
| Rate for Payer: Cash Price |
$417.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$493.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$644.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$644.98
|
| Rate for Payer: Dignity Health Senior |
$644.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$485.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$469.70
|
| Rate for Payer: Heritage Provider Network Senior |
$469.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$361.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$531.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$531.16
|
| Rate for Payer: Multiplan Commercial |
$569.10
|
| Rate for Payer: TriValley Medical Group Commercial |
$303.52
|
| Rate for Payer: TriValley Medical Group Senior |
$303.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$379.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$379.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$644.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$644.98
|
| Rate for Payer: Vantage Medical Group Senior |
$644.98
|
|
|
ERENUMAB-AOOE 70 MG/ML SUBCUTANEOUS AUTO-INJECTOR [221765]
|
Facility
|
OP
|
$921.20
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$166.74 |
| Max. Negotiated Rate |
$783.02 |
| Rate for Payer: Adventist Health Commercial |
$184.24
|
| Rate for Payer: Aetna of CA Gatekeeper |
$492.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$632.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$783.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$506.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$690.90
|
| Rate for Payer: Blue Shield of California Commercial |
$561.93
|
| Rate for Payer: Blue Shield of California EPN |
$449.55
|
| Rate for Payer: Cash Price |
$506.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$423.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$783.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$783.02
|
| Rate for Payer: Dignity Health Senior |
$783.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$589.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$426.52
|
| Rate for Payer: Heritage Provider Network Senior |
$426.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$439.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$644.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$644.84
|
| Rate for Payer: Multiplan Commercial |
$690.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$368.48
|
| Rate for Payer: TriValley Medical Group Senior |
$368.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$332.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$305.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$783.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$783.02
|
| Rate for Payer: Vantage Medical Group Senior |
$783.02
|
|
|
ERENUMAB-AOOE 70 MG/ML SUBCUTANEOUS AUTO-INJECTOR [221765]
|
Facility
|
IP
|
$921.20
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$166.74 |
| Max. Negotiated Rate |
$690.90 |
| Rate for Payer: Adventist Health Commercial |
$184.24
|
| Rate for Payer: Cash Price |
$506.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$423.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$497.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$426.52
|
| Rate for Payer: Heritage Provider Network Senior |
$426.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.30
|
| Rate for Payer: Multiplan Commercial |
$690.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$332.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$305.01
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE [2863]
|
Facility
|
OP
|
$1.68
|
|
|
Service Code
|
NDC 50268-297-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.82
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.43
|
| Rate for Payer: Dignity Health Senior |
$1.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.67
|
| Rate for Payer: TriValley Medical Group Senior |
$0.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1.43
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE [2863]
|
Facility
|
OP
|
$0.27
|
|
|
Service Code
|
NDC 69452-151-20
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.23
|
| Rate for Payer: Dignity Health Senior |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Senior |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Vantage Medical Group Senior |
$0.23
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE [2863]
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
NDC 69452-151-20
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Senior |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE [2863]
|
Facility
|
IP
|
$1.68
|
|
|
Service Code
|
NDC 50268-297-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.14
|
| Rate for Payer: Heritage Provider Network Senior |
$1.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE [2863]
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
NDC 42806-547-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.12
|
| Rate for Payer: Dignity Health Senior |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Senior |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.12
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE [2863]
|
Facility
|
IP
|
$0.14
|
|
|
Service Code
|
NDC 42806-547-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Senior |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE [2863]
|
Facility
|
IP
|
$1.68
|
|
|
Service Code
|
NDC 50268-297-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.14
|
| Rate for Payer: Heritage Provider Network Senior |
$1.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE [2863]
|
Facility
|
OP
|
$1.68
|
|
|
Service Code
|
NDC 50268-297-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.82
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.43
|
| Rate for Payer: Dignity Health Senior |
$1.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.67
|
| Rate for Payer: TriValley Medical Group Senior |
$0.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1.43
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS [9943]
|
Facility
|
OP
|
$1.66
|
|
|
Service Code
|
NDC 3932835760
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.41 |
| Rate for Payer: Adventist Health Commercial |
$0.33
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.81
|
| Rate for Payer: Cash Price |
$0.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.41
|
| Rate for Payer: Dignity Health Senior |
$1.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.03
|
| Rate for Payer: Heritage Provider Network Senior |
$1.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.16
|
| Rate for Payer: Multiplan Commercial |
$1.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.66
|
| Rate for Payer: TriValley Medical Group Senior |
$0.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.41
|
| Rate for Payer: Vantage Medical Group Senior |
$1.41
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS [9943]
|
Facility
|
IP
|
$1.66
|
|
|
Service Code
|
NDC 3932835760
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.25 |
| Rate for Payer: Adventist Health Commercial |
$0.33
|
| Rate for Payer: Cash Price |
$0.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.12
|
| Rate for Payer: Heritage Provider Network Senior |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$1.25
|
|
|
ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION [106773]
|
Facility
|
OP
|
$846.00
|
|
|
Service Code
|
HCPCS J9179
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.58 |
| Max. Negotiated Rate |
$634.50 |
| Rate for Payer: Adventist Health Commercial |
$169.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$452.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$581.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$156.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$115.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$308.18
|
| Rate for Payer: Blue Shield of California Commercial |
$131.07
|
| Rate for Payer: Blue Shield of California EPN |
$131.07
|
| Rate for Payer: Cash Price |
$465.30
|
| Rate for Payer: Cash Price |
$465.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$389.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$130.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$115.04
|
| Rate for Payer: Dignity Health Senior |
$115.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.44
|
| Rate for Payer: EPIC Health Plan Medicare |
$104.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$391.70
|
| Rate for Payer: Heritage Provider Network Senior |
$391.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$118.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$104.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$403.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$120.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$131.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$131.78
|
| Rate for Payer: Multiplan Commercial |
$634.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$338.40
|
| Rate for Payer: TriValley Medical Group Senior |
$338.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$305.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$280.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$130.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$115.04
|
| Rate for Payer: Vantage Medical Group Senior |
$115.04
|
|
