|
DOXORUBICIN BEADS (QUADRASPHERE) [4081287]
|
Facility
|
IP
|
$1.18
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.89 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.76
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.55
|
| Rate for Payer: Heritage Provider Network Senior |
$0.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$0.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.39
|
|
|
DOXORUBICIN BEADS (QUADRASPHERE) [4081287]
|
Facility
|
OP
|
$1.18
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$120.51 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.51
|
| Rate for Payer: Blue Shield of California Commercial |
$7.25
|
| Rate for Payer: Blue Shield of California EPN |
$7.25
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.55
|
| Rate for Payer: Heritage Provider Network Senior |
$0.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.83
|
| Rate for Payer: Multiplan Commercial |
$0.89
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.47
|
| Rate for Payer: TriValley Medical Group Senior |
$0.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1.00
|
|
|
DOXORUBICIN, PEGYLATED LIPOSOMAL 2 MG/ML INTRAVENOUS SUSPENSION [27431]
|
Facility
|
OP
|
$80.83
|
|
|
Service Code
|
HCPCS Q2050
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.63 |
| Max. Negotiated Rate |
$1,174.49 |
| Rate for Payer: Adventist Health Commercial |
$16.17
|
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Adventist Health Commercial |
$8.43
|
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$174.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$174.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$174.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$174.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$128.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$128.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$128.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$128.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$116.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$116.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$116.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$116.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,174.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,174.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,174.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,174.49
|
| Rate for Payer: Blue Shield of California Commercial |
$163.28
|
| Rate for Payer: Blue Shield of California Commercial |
$163.28
|
| Rate for Payer: Blue Shield of California Commercial |
$163.28
|
| Rate for Payer: Blue Shield of California Commercial |
$163.28
|
| Rate for Payer: Blue Shield of California EPN |
$163.28
|
| Rate for Payer: Blue Shield of California EPN |
$163.28
|
| Rate for Payer: Blue Shield of California EPN |
$163.28
|
| Rate for Payer: Blue Shield of California EPN |
$163.28
|
| Rate for Payer: Cash Price |
$36.37
|
| Rate for Payer: Cash Price |
$18.97
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$18.97
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$36.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$37.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$145.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$145.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$145.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$145.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$128.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$128.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$128.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$128.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$128.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$128.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$128.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$128.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.73
|
| Rate for Payer: EPIC Health Plan Medicare |
$116.61
|
| Rate for Payer: EPIC Health Plan Medicare |
$116.61
|
| Rate for Payer: EPIC Health Plan Medicare |
$116.61
|
| Rate for Payer: EPIC Health Plan Medicare |
$116.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.78
|
| Rate for Payer: Heritage Provider Network Senior |
$37.42
|
| Rate for Payer: Heritage Provider Network Senior |
$27.78
|
| Rate for Payer: Heritage Provider Network Senior |
$19.52
|
| Rate for Payer: Heritage Provider Network Senior |
$25.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$116.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$116.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$116.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$116.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$25.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$38.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$28.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$20.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$134.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$134.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$134.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$134.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$156.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$156.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$156.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$156.26
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Multiplan Commercial |
$31.62
|
| Rate for Payer: Multiplan Commercial |
$60.62
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$32.33
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.86
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Senior |
$16.86
|
| Rate for Payer: TriValley Medical Group Senior |
$21.60
|
| Rate for Payer: TriValley Medical Group Senior |
$32.33
|
| Rate for Payer: TriValley Medical Group Senior |
$24.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.23
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$145.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$145.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$145.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$145.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$128.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$128.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$128.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$128.27
|
| Rate for Payer: Vantage Medical Group Senior |
$128.27
|
| Rate for Payer: Vantage Medical Group Senior |
$128.27
|
| Rate for Payer: Vantage Medical Group Senior |
$128.27
|
| Rate for Payer: Vantage Medical Group Senior |
$128.27
|
|
|
DOXORUBICIN, PEGYLATED LIPOSOMAL 2 MG/ML INTRAVENOUS SUSPENSION [27431]
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS Q2050
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Adventist Health Commercial |
$16.17
|
| Rate for Payer: Adventist Health Commercial |
$8.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.05
|
| Rate for Payer: Cash Price |
$18.97
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$36.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$37.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.78
|
| Rate for Payer: Heritage Provider Network Senior |
$27.78
|
| Rate for Payer: Heritage Provider Network Senior |
$19.52
|
| Rate for Payer: Heritage Provider Network Senior |
$25.00
|
| Rate for Payer: Heritage Provider Network Senior |
$37.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.54
|
| Rate for Payer: Multiplan Commercial |
$31.62
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Multiplan Commercial |
$60.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.23
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.76
|
|
|
DOXYCYCLINE 10 MG/ML TOPICAL [4081094]
|
Facility
|
IP
|
$2.90
|
|
|
Service Code
|
NDC 99994081094
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.17 |
| Rate for Payer: Adventist Health Commercial |
$0.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.87
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.96
|
| Rate for Payer: Heritage Provider Network Senior |
$1.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.73
|
| Rate for Payer: Multiplan Commercial |
$2.17
|
|
|
DOXYCYCLINE 10 MG/ML TOPICAL [4081094]
|
Facility
|
OP
|
$2.90
|
|
|
Service Code
|
NDC 99994081094
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Adventist Health Commercial |
$0.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.45
|
| Rate for Payer: Blue Shield of California Commercial |
$1.77
|
| Rate for Payer: Blue Shield of California EPN |
$1.42
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.80
|
| Rate for Payer: Heritage Provider Network Senior |
$1.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.03
|
| Rate for Payer: Multiplan Commercial |
$2.17
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.16
|
| Rate for Payer: TriValley Medical Group Senior |
$1.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.46
|
| Rate for Payer: Vantage Medical Group Senior |
$2.46
|
|
|
DOXYCYCLINE HYCLATE 100 MG CAPSULE [2623]
|
Facility
|
OP
|
$1.62
|
|
|
Service Code
|
NDC 5026827811
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.38 |
| Rate for Payer: Adventist Health Commercial |
$0.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.81
|
| Rate for Payer: Blue Shield of California Commercial |
$0.99
|
| Rate for Payer: Blue Shield of California EPN |
$0.79
|
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.13
|
| Rate for Payer: Multiplan Commercial |
$1.22
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.65
|
| Rate for Payer: TriValley Medical Group Senior |
$0.65
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.38
|
| Rate for Payer: Vantage Medical Group Senior |
$1.38
|
|
|
DOXYCYCLINE HYCLATE 100 MG CAPSULE [2623]
|
Facility
|
OP
|
$0.34
|
|
|
Service Code
|
NDC 0143980350
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.21
|
| Rate for Payer: Heritage Provider Network Senior |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.29
|
| Rate for Payer: Vantage Medical Group Senior |
$0.29
|
|
|
DOXYCYCLINE HYCLATE 100 MG CAPSULE [2623]
|
Facility
|
OP
|
$0.34
|
|
|
Service Code
|
NDC 6923811002
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.21
|
| Rate for Payer: Heritage Provider Network Senior |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Vantage Medical Group Senior |
$0.29
|
|
|
DOXYCYCLINE HYCLATE 100 MG CAPSULE [2623]
|
Facility
|
IP
|
$2.01
|
|
|
Service Code
|
NDC 6068751311
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.51 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.29
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.36
|
| Rate for Payer: Heritage Provider Network Senior |
$1.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$1.51
|
|
|
DOXYCYCLINE HYCLATE 100 MG CAPSULE [2623]
|
Facility
|
OP
|
$2.01
|
|
|
Service Code
|
NDC 6068751311
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.71 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.98
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.24
|
| Rate for Payer: Heritage Provider Network Senior |
$1.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.41
|
| Rate for Payer: Multiplan Commercial |
$1.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.80
|
| Rate for Payer: TriValley Medical Group Senior |
$0.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1.71
|
|
|
DOXYCYCLINE HYCLATE 100 MG CAPSULE [2623]
|
Facility
|
IP
|
$0.34
|
|
|
Service Code
|
NDC 6923811002
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.22
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.23
|
| Rate for Payer: Heritage Provider Network Senior |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
|
|
DOXYCYCLINE HYCLATE 100 MG CAPSULE [2623]
|
Facility
|
OP
|
$2.01
|
|
|
Service Code
|
NDC 6068751365
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.71 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.98
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.24
|
| Rate for Payer: Heritage Provider Network Senior |
$1.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.41
|
| Rate for Payer: Multiplan Commercial |
$1.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.80
|
| Rate for Payer: TriValley Medical Group Senior |
$0.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1.71
|
|
|
DOXYCYCLINE HYCLATE 100 MG CAPSULE [2623]
|
Facility
|
OP
|
$1.62
|
|
|
Service Code
|
NDC 5026827815
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.38 |
| Rate for Payer: Adventist Health Commercial |
$0.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.81
|
| Rate for Payer: Blue Shield of California Commercial |
$0.99
|
| Rate for Payer: Blue Shield of California EPN |
$0.79
|
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.13
|
| Rate for Payer: Multiplan Commercial |
$1.22
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.65
|
| Rate for Payer: TriValley Medical Group Senior |
$0.65
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.38
|
| Rate for Payer: Vantage Medical Group Senior |
$1.38
|
|
|
DOXYCYCLINE HYCLATE 100 MG CAPSULE [2623]
|
Facility
|
IP
|
$1.62
|
|
|
Service Code
|
NDC 5026827811
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Adventist Health Commercial |
$0.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.04
|
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.10
|
| Rate for Payer: Heritage Provider Network Senior |
$1.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$1.22
|
|
|
DOXYCYCLINE HYCLATE 100 MG CAPSULE [2623]
|
Facility
|
IP
|
$1.62
|
|
|
Service Code
|
NDC 5026827815
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Adventist Health Commercial |
$0.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.04
|
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.10
|
| Rate for Payer: Heritage Provider Network Senior |
$1.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$1.22
|
|
|
DOXYCYCLINE HYCLATE 100 MG CAPSULE [2623]
|
Facility
|
OP
|
$1.44
|
|
|
Service Code
|
NDC 0143314250
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.72
|
| Rate for Payer: Blue Shield of California Commercial |
$0.88
|
| Rate for Payer: Blue Shield of California EPN |
$0.70
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.89
|
| Rate for Payer: Heritage Provider Network Senior |
$0.89
|
| 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 |
$1.08
|
| 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 |
$0.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.22
|
| Rate for Payer: Vantage Medical Group Senior |
$1.22
|
|
|
DOXYCYCLINE HYCLATE 100 MG CAPSULE [2623]
|
Facility
|
IP
|
$0.34
|
|
|
Service Code
|
NDC 0143980350
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.22
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.23
|
| Rate for Payer: Heritage Provider Network Senior |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
|
|
DOXYCYCLINE HYCLATE 100 MG CAPSULE [2623]
|
Facility
|
IP
|
$2.45
|
|
|
Service Code
|
NDC 0904042806
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Adventist Health Commercial |
$0.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.58
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.66
|
| Rate for Payer: Heritage Provider Network Senior |
$1.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.61
|
| Rate for Payer: Multiplan Commercial |
$1.84
|
|
|
DOXYCYCLINE HYCLATE 100 MG CAPSULE [2623]
|
Facility
|
IP
|
$2.01
|
|
|
Service Code
|
NDC 6068751365
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.51 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.29
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.36
|
| Rate for Payer: Heritage Provider Network Senior |
$1.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$1.51
|
|
|
DOXYCYCLINE HYCLATE 100 MG CAPSULE [2623]
|
Facility
|
IP
|
$1.44
|
|
|
Service Code
|
NDC 0143314250
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.08 |
| 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 |
$0.97
|
| Rate for Payer: Heritage Provider Network Senior |
$0.97
|
| 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 |
$1.08
|
|
|
DOXYCYCLINE HYCLATE 100 MG CAPSULE [2623]
|
Facility
|
OP
|
$2.45
|
|
|
Service Code
|
NDC 0904042806
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$2.08 |
| Rate for Payer: Adventist Health Commercial |
$0.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.23
|
| Rate for Payer: Blue Shield of California Commercial |
$1.49
|
| Rate for Payer: Blue Shield of California EPN |
$1.20
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.52
|
| Rate for Payer: Heritage Provider Network Senior |
$1.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.72
|
| Rate for Payer: Multiplan Commercial |
$1.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.98
|
| Rate for Payer: TriValley Medical Group Senior |
$0.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.08
|
| Rate for Payer: Vantage Medical Group Senior |
$2.08
|
|
|
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION [2622]
|
Facility
|
OP
|
$31.60
|
|
|
Service Code
|
HCPCS J1271
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$26.86 |
| Rate for Payer: Adventist Health Commercial |
$6.32
|
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Adventist Health Commercial |
$5.05
|
| Rate for Payer: Adventist Health Commercial |
$3.52
|
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.47
|
| Rate for Payer: Blue Shield of California Commercial |
$17.68
|
| Rate for Payer: Blue Shield of California Commercial |
$12.21
|
| Rate for Payer: Blue Shield of California Commercial |
$15.41
|
| Rate for Payer: Blue Shield of California Commercial |
$9.15
|
| Rate for Payer: Blue Shield of California Commercial |
$10.74
|
| Rate for Payer: Blue Shield of California Commercial |
$19.28
|
| Rate for Payer: Blue Shield of California EPN |
$8.59
|
| Rate for Payer: Blue Shield of California EPN |
$7.32
|
| Rate for Payer: Blue Shield of California EPN |
$9.76
|
| Rate for Payer: Blue Shield of California EPN |
$12.33
|
| Rate for Payer: Blue Shield of California EPN |
$14.15
|
| Rate for Payer: Blue Shield of California EPN |
$15.42
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$7.92
|
| Rate for Payer: Cash Price |
$7.92
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$11.37
|
| Rate for Payer: Cash Price |
$11.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.70
|
| Rate for Payer: Heritage Provider Network Senior |
$14.63
|
| Rate for Payer: Heritage Provider Network Senior |
$6.95
|
| Rate for Payer: Heritage Provider Network Senior |
$8.15
|
| Rate for Payer: Heritage Provider Network Senior |
$13.42
|
| Rate for Payer: Heritage Provider Network Senior |
$9.26
|
| Rate for Payer: Heritage Provider Network Senior |
$11.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$15.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.33
|
| Rate for Payer: Multiplan Commercial |
$21.74
|
| Rate for Payer: Multiplan Commercial |
$18.95
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Multiplan Commercial |
$23.70
|
| Rate for Payer: Multiplan Commercial |
$15.01
|
| Rate for Payer: Multiplan Commercial |
$13.21
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.11
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.04
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.64
|
| Rate for Payer: TriValley Medical Group Senior |
$7.04
|
| Rate for Payer: TriValley Medical Group Senior |
$11.60
|
| Rate for Payer: TriValley Medical Group Senior |
$10.11
|
| Rate for Payer: TriValley Medical Group Senior |
$12.64
|
| Rate for Payer: TriValley Medical Group Senior |
$8.00
|
| Rate for Payer: TriValley Medical Group Senior |
$6.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.23
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.75
|
| Rate for Payer: Vantage Medical Group Senior |
$17.01
|
| Rate for Payer: Vantage Medical Group Senior |
$21.48
|
| Rate for Payer: Vantage Medical Group Senior |
$26.86
|
| Rate for Payer: Vantage Medical Group Senior |
$14.97
|
| Rate for Payer: Vantage Medical Group Senior |
$12.75
|
| Rate for Payer: Vantage Medical Group Senior |
$24.64
|
|
|
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION [2622]
|
Facility
|
IP
|
$20.01
|
|
|
Service Code
|
HCPCS J1271
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$15.01 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Adventist Health Commercial |
$6.32
|
| Rate for Payer: Adventist Health Commercial |
$3.52
|
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Adventist Health Commercial |
$5.05
|
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.35
|
| Rate for Payer: Cash Price |
$11.37
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Cash Price |
$7.92
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.15
|
| Rate for Payer: Heritage Provider Network Senior |
$6.95
|
| Rate for Payer: Heritage Provider Network Senior |
$9.26
|
| Rate for Payer: Heritage Provider Network Senior |
$11.70
|
| Rate for Payer: Heritage Provider Network Senior |
$8.15
|
| Rate for Payer: Heritage Provider Network Senior |
$13.42
|
| Rate for Payer: Heritage Provider Network Senior |
$14.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.95
|
| Rate for Payer: Multiplan Commercial |
$23.70
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Multiplan Commercial |
$21.74
|
| Rate for Payer: Multiplan Commercial |
$15.01
|
| Rate for Payer: Multiplan Commercial |
$13.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.23
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.83
|
|
|
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION FOR SCLEROSIS [4082622]
|
Facility
|
OP
|
$31.60
|
|
|
Service Code
|
HCPCS J1271
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$26.86 |
| Rate for Payer: Adventist Health Commercial |
$6.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.47
|
| Rate for Payer: Blue Shield of California Commercial |
$19.28
|
| Rate for Payer: Blue Shield of California EPN |
$15.42
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.63
|
| Rate for Payer: Heritage Provider Network Senior |
$14.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$15.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.12
|
| Rate for Payer: Multiplan Commercial |
$23.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.64
|
| Rate for Payer: TriValley Medical Group Senior |
$12.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.86
|
| Rate for Payer: Vantage Medical Group Senior |
$26.86
|
|
