|
FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE [108029]
|
Facility
|
IP
|
$87.15
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.77 |
| Max. Negotiated Rate |
$65.36 |
| Rate for Payer: Adventist Health Commercial |
$17.43
|
| Rate for Payer: Cash Price |
$47.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.35
|
| Rate for Payer: Heritage Provider Network Senior |
$40.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.79
|
| Rate for Payer: Multiplan Commercial |
$65.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.86
|
|
|
FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE [32215]
|
Facility
|
IP
|
$59.66
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$44.74 |
| Rate for Payer: Adventist Health Commercial |
$11.93
|
| Rate for Payer: Cash Price |
$32.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.62
|
| Rate for Payer: Heritage Provider Network Senior |
$27.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.91
|
| Rate for Payer: Multiplan Commercial |
$44.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.75
|
|
|
FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE [32215]
|
Facility
|
OP
|
$59.66
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$50.71 |
| Rate for Payer: Adventist Health Commercial |
$11.93
|
| Rate for Payer: Aetna of CA Gatekeeper |
$31.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.43
|
| Rate for Payer: Blue Shield of California Commercial |
$4.90
|
| Rate for Payer: Blue Shield of California EPN |
$4.90
|
| Rate for Payer: Cash Price |
$32.81
|
| Rate for Payer: Cash Price |
$32.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.71
|
| Rate for Payer: Dignity Health Senior |
$50.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.62
|
| Rate for Payer: Heritage Provider Network Senior |
$27.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$28.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.76
|
| Rate for Payer: Multiplan Commercial |
$44.74
|
| Rate for Payer: TriValley Medical Group Commercial |
$23.86
|
| Rate for Payer: TriValley Medical Group Senior |
$23.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.71
|
| Rate for Payer: Vantage Medical Group Senior |
$50.71
|
|
|
FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE [108028]
|
Facility
|
OP
|
$110.60
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$94.01 |
| Rate for Payer: Adventist Health Commercial |
$22.12
|
| Rate for Payer: Adventist Health Commercial |
$21.73
|
| Rate for Payer: Aetna of CA Gatekeeper |
$58.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$59.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$75.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$74.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$94.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$92.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$59.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$81.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.43
|
| Rate for Payer: Blue Shield of California Commercial |
$4.90
|
| Rate for Payer: Blue Shield of California Commercial |
$4.90
|
| Rate for Payer: Blue Shield of California EPN |
$4.90
|
| Rate for Payer: Blue Shield of California EPN |
$4.90
|
| Rate for Payer: Cash Price |
$60.83
|
| Rate for Payer: Cash Price |
$59.75
|
| Rate for Payer: Cash Price |
$59.75
|
| Rate for Payer: Cash Price |
$60.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$49.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$92.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$94.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$92.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$94.01
|
| Rate for Payer: Dignity Health Senior |
$92.34
|
| Rate for Payer: Dignity Health Senior |
$94.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$51.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.30
|
| Rate for Payer: Heritage Provider Network Senior |
$50.30
|
| Rate for Payer: Heritage Provider Network Senior |
$51.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$52.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$51.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$77.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$76.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$76.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77.42
|
| Rate for Payer: Multiplan Commercial |
$82.95
|
| Rate for Payer: Multiplan Commercial |
$81.48
|
| Rate for Payer: TriValley Medical Group Commercial |
$44.24
|
| Rate for Payer: TriValley Medical Group Commercial |
$43.46
|
| Rate for Payer: TriValley Medical Group Senior |
$43.46
|
| Rate for Payer: TriValley Medical Group Senior |
$44.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$39.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$39.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$35.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$94.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$92.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$92.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$94.01
|
| Rate for Payer: Vantage Medical Group Senior |
$92.34
|
| Rate for Payer: Vantage Medical Group Senior |
$94.01
|
|
|
FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE [108028]
|
Facility
|
IP
|
$108.64
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.66 |
| Max. Negotiated Rate |
$81.48 |
| Rate for Payer: Adventist Health Commercial |
$21.73
|
| Rate for Payer: Adventist Health Commercial |
$22.12
|
| Rate for Payer: Cash Price |
$60.83
|
| Rate for Payer: Cash Price |
$59.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$49.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$51.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.30
|
| Rate for Payer: Heritage Provider Network Senior |
$50.30
|
| Rate for Payer: Heritage Provider Network Senior |
$51.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.16
|
| Rate for Payer: Multiplan Commercial |
$82.95
|
| Rate for Payer: Multiplan Commercial |
$81.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$39.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$39.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$35.97
|
|
|
FOOD SUPPLEMNT,LACTO-REDUCE 0.05 GRAM-1.2 KCAL/ML LIQUID FOR TUBE FEED [216461]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 4390018480
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
FOOD SUPPLEMNT,LACTO-REDUCE 0.05 GRAM-1.2 KCAL/ML LIQUID FOR TUBE FEED [216461]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 4390018480
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION [88225]
|
Facility
|
IP
|
$12.30
|
|
|
Service Code
|
NDC 49502-605-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$9.22 |
| Rate for Payer: Adventist Health Commercial |
$2.46
|
| Rate for Payer: Cash Price |
$6.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.33
|
| Rate for Payer: Heritage Provider Network Senior |
$8.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.08
|
| Rate for Payer: Multiplan Commercial |
$9.22
|
|
|
FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION [88225]
|
Facility
|
IP
|
$12.30
|
|
|
Service Code
|
NDC 49502-605-95
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$9.22 |
| Rate for Payer: Adventist Health Commercial |
$2.46
|
| Rate for Payer: Cash Price |
$6.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.33
|
| Rate for Payer: Heritage Provider Network Senior |
$8.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.08
|
| Rate for Payer: Multiplan Commercial |
$9.22
|
|
|
FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION [88225]
|
Facility
|
OP
|
$12.30
|
|
|
Service Code
|
NDC 49502-605-95
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Adventist Health Commercial |
$2.46
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.22
|
| Rate for Payer: Blue Shield of California Commercial |
$7.50
|
| Rate for Payer: Blue Shield of California EPN |
$6.00
|
| Rate for Payer: Cash Price |
$6.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.46
|
| Rate for Payer: Dignity Health Senior |
$10.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.61
|
| Rate for Payer: Heritage Provider Network Senior |
$7.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.61
|
| Rate for Payer: Multiplan Commercial |
$9.22
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.92
|
| Rate for Payer: TriValley Medical Group Senior |
$4.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.46
|
| Rate for Payer: Vantage Medical Group Senior |
$10.46
|
|
|
FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION [88225]
|
Facility
|
OP
|
$12.30
|
|
|
Service Code
|
NDC 49502-605-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Adventist Health Commercial |
$2.46
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.22
|
| Rate for Payer: Blue Shield of California Commercial |
$7.50
|
| Rate for Payer: Blue Shield of California EPN |
$6.00
|
| Rate for Payer: Cash Price |
$6.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.46
|
| Rate for Payer: Dignity Health Senior |
$10.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.61
|
| Rate for Payer: Heritage Provider Network Senior |
$7.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.61
|
| Rate for Payer: Multiplan Commercial |
$9.22
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.92
|
| Rate for Payer: TriValley Medical Group Senior |
$4.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.46
|
| Rate for Payer: Vantage Medical Group Senior |
$10.46
|
|
|
FOSAPREPITANT 150 MG INTRAVENOUS POWDER FOR SOLUTION [106783]
|
Facility
|
IP
|
$98.62
|
|
|
Service Code
|
HCPCS J1453
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.85 |
| Max. Negotiated Rate |
$73.97 |
| Rate for Payer: Adventist Health Commercial |
$19.72
|
| Rate for Payer: Adventist Health Commercial |
$6.72
|
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Adventist Health Commercial |
$10.08
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$27.72
|
| Rate for Payer: Cash Price |
$18.48
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$54.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$45.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.89
|
| Rate for Payer: Heritage Provider Network Senior |
$22.22
|
| Rate for Payer: Heritage Provider Network Senior |
$13.89
|
| Rate for Payer: Heritage Provider Network Senior |
$15.56
|
| Rate for Payer: Heritage Provider Network Senior |
$23.34
|
| Rate for Payer: Heritage Provider Network Senior |
$45.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$37.80
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Multiplan Commercial |
$73.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$35.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$32.65
|
|
|
FOSAPREPITANT 150 MG INTRAVENOUS POWDER FOR SOLUTION [106783]
|
Facility
|
OP
|
$98.62
|
|
|
Service Code
|
HCPCS J1453
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$83.83 |
| Rate for Payer: Adventist Health Commercial |
$19.72
|
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Adventist Health Commercial |
$6.72
|
| Rate for Payer: Adventist Health Commercial |
$10.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$26.94
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.96
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.71
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$25.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$67.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$83.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.44
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$18.48
|
| Rate for Payer: Cash Price |
$18.48
|
| Rate for Payer: Cash Price |
$27.72
|
| Rate for Payer: Cash Price |
$54.24
|
| Rate for Payer: Cash Price |
$54.24
|
| Rate for Payer: Cash Price |
$27.72
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$45.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$83.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.83
|
| Rate for Payer: Dignity Health Senior |
$83.83
|
| Rate for Payer: Dignity Health Senior |
$42.84
|
| Rate for Payer: Dignity Health Senior |
$28.56
|
| Rate for Payer: Dignity Health Senior |
$40.80
|
| Rate for Payer: Dignity Health Senior |
$25.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.34
|
| Rate for Payer: Heritage Provider Network Senior |
$15.56
|
| Rate for Payer: Heritage Provider Network Senior |
$23.34
|
| Rate for Payer: Heritage Provider Network Senior |
$13.89
|
| Rate for Payer: Heritage Provider Network Senior |
$22.22
|
| Rate for Payer: Heritage Provider Network Senior |
$45.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$47.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$69.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$69.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.28
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$37.80
|
| Rate for Payer: Multiplan Commercial |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$73.97
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.16
|
| Rate for Payer: TriValley Medical Group Commercial |
$19.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$39.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.44
|
| Rate for Payer: TriValley Medical Group Senior |
$13.44
|
| Rate for Payer: TriValley Medical Group Senior |
$39.45
|
| Rate for Payer: TriValley Medical Group Senior |
$20.16
|
| Rate for Payer: TriValley Medical Group Senior |
$19.20
|
| Rate for Payer: TriValley Medical Group Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$35.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$32.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$83.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.56
|
| Rate for Payer: Vantage Medical Group Senior |
$25.50
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
| Rate for Payer: Vantage Medical Group Senior |
$40.80
|
| Rate for Payer: Vantage Medical Group Senior |
$83.83
|
| Rate for Payer: Vantage Medical Group Senior |
$28.56
|
|
|
FOSCARNET 24 MG/ML INTRAVENOUS SOLUTION [10093]
|
Facility
|
IP
|
$2.04
|
|
|
Service Code
|
HCPCS J1455
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.53 |
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Adventist Health Commercial |
$0.35
|
| Rate for Payer: Adventist Health Commercial |
$0.45
|
| Rate for Payer: Cash Price |
$1.12
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.94
|
| Rate for Payer: Heritage Provider Network Senior |
$0.94
|
| Rate for Payer: Heritage Provider Network Senior |
$0.80
|
| Rate for Payer: Heritage Provider Network Senior |
$1.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$1.70
|
| Rate for Payer: Multiplan Commercial |
$1.30
|
| Rate for Payer: Multiplan Commercial |
$1.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.68
|
|
|
FOSCARNET 24 MG/ML INTRAVENOUS SOLUTION [10093]
|
Facility
|
OP
|
$2.27
|
|
|
Service Code
|
HCPCS J1455
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$169.53 |
| Rate for Payer: Adventist Health Commercial |
$0.45
|
| Rate for Payer: Adventist Health Commercial |
$0.35
|
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.21
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.92
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$169.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$169.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$169.53
|
| Rate for Payer: Blue Shield of California Commercial |
$66.77
|
| Rate for Payer: Blue Shield of California Commercial |
$66.77
|
| Rate for Payer: Blue Shield of California Commercial |
$66.77
|
| Rate for Payer: Blue Shield of California EPN |
$66.77
|
| Rate for Payer: Blue Shield of California EPN |
$66.77
|
| Rate for Payer: Blue Shield of California EPN |
$66.77
|
| Rate for Payer: Cash Price |
$1.12
|
| Rate for Payer: Cash Price |
$1.12
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.14
|
| Rate for Payer: Dignity Health Senior |
$17.14
|
| Rate for Payer: Dignity Health Senior |
$17.14
|
| Rate for Payer: Dignity Health Senior |
$17.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.58
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.58
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.80
|
| Rate for Payer: Heritage Provider Network Senior |
$0.94
|
| Rate for Payer: Heritage Provider Network Senior |
$1.05
|
| Rate for Payer: Heritage Provider Network Senior |
$0.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.64
|
| Rate for Payer: Multiplan Commercial |
$1.53
|
| Rate for Payer: Multiplan Commercial |
$1.30
|
| Rate for Payer: Multiplan Commercial |
$1.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.82
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.91
|
| Rate for Payer: TriValley Medical Group Senior |
$0.69
|
| Rate for Payer: TriValley Medical Group Senior |
$0.82
|
| Rate for Payer: TriValley Medical Group Senior |
$0.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.14
|
| Rate for Payer: Vantage Medical Group Senior |
$17.14
|
| Rate for Payer: Vantage Medical Group Senior |
$17.14
|
| Rate for Payer: Vantage Medical Group Senior |
$17.14
|
|
|
FOSCARNET INTRAVITREAL INJECTION 2400 MCG/0.1 ML [4081568]
|
Facility
|
OP
|
$2.30
|
|
|
Service Code
|
HCPCS J1455
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$169.53 |
| Rate for Payer: Adventist Health Commercial |
$0.46
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$169.53
|
| Rate for Payer: Blue Shield of California Commercial |
$66.77
|
| Rate for Payer: Blue Shield of California EPN |
$66.77
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.14
|
| Rate for Payer: Dignity Health Senior |
$17.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.47
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.06
|
| Rate for Payer: Heritage Provider Network Senior |
$1.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.64
|
| Rate for Payer: Multiplan Commercial |
$1.73
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.92
|
| Rate for Payer: TriValley Medical Group Senior |
$0.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.14
|
| Rate for Payer: Vantage Medical Group Senior |
$17.14
|
|
|
FOSCARNET INTRAVITREAL INJECTION 2400 MCG/0.1 ML [4081568]
|
Facility
|
IP
|
$2.30
|
|
|
Service Code
|
HCPCS J1455
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$1.73 |
| Rate for Payer: Adventist Health Commercial |
$0.46
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.06
|
| Rate for Payer: Heritage Provider Network Senior |
$1.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Multiplan Commercial |
$1.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.76
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET [14825]
|
Facility
|
OP
|
$96.38
|
|
|
Service Code
|
NDC 70700-268-99
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.44 |
| Max. Negotiated Rate |
$81.92 |
| Rate for Payer: Adventist Health Commercial |
$19.28
|
| Rate for Payer: Aetna of CA Gatekeeper |
$51.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$66.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$81.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$72.28
|
| Rate for Payer: Blue Shield of California Commercial |
$58.79
|
| Rate for Payer: Blue Shield of California EPN |
$47.03
|
| Rate for Payer: Cash Price |
$53.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$62.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.92
|
| Rate for Payer: Dignity Health Senior |
$81.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.66
|
| Rate for Payer: Heritage Provider Network Senior |
$59.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$45.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$67.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67.47
|
| Rate for Payer: Multiplan Commercial |
$72.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$38.55
|
| Rate for Payer: TriValley Medical Group Senior |
$38.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$48.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$48.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.92
|
| Rate for Payer: Vantage Medical Group Senior |
$81.92
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET [14825]
|
Facility
|
OP
|
$83.76
|
|
|
Service Code
|
NDC 67877-749-57
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$15.16 |
| Max. Negotiated Rate |
$71.20 |
| Rate for Payer: Adventist Health Commercial |
$16.75
|
| Rate for Payer: Aetna of CA Gatekeeper |
$44.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$57.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.82
|
| Rate for Payer: Blue Shield of California Commercial |
$51.09
|
| Rate for Payer: Blue Shield of California EPN |
$40.87
|
| Rate for Payer: Cash Price |
$46.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$54.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$71.20
|
| Rate for Payer: Dignity Health Senior |
$71.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$51.85
|
| Rate for Payer: Heritage Provider Network Senior |
$51.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$39.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$58.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$58.63
|
| Rate for Payer: Multiplan Commercial |
$62.82
|
| Rate for Payer: TriValley Medical Group Commercial |
$33.50
|
| Rate for Payer: TriValley Medical Group Senior |
$33.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$41.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$41.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$71.20
|
| Rate for Payer: Vantage Medical Group Senior |
$71.20
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET [14825]
|
Facility
|
OP
|
$96.38
|
|
|
Service Code
|
NDC 70700-268-94
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.44 |
| Max. Negotiated Rate |
$81.92 |
| Rate for Payer: Adventist Health Commercial |
$19.28
|
| Rate for Payer: Aetna of CA Gatekeeper |
$51.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$66.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$81.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$72.28
|
| Rate for Payer: Blue Shield of California Commercial |
$58.79
|
| Rate for Payer: Blue Shield of California EPN |
$47.03
|
| Rate for Payer: Cash Price |
$53.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$62.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.92
|
| Rate for Payer: Dignity Health Senior |
$81.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.66
|
| Rate for Payer: Heritage Provider Network Senior |
$59.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$45.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$67.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67.47
|
| Rate for Payer: Multiplan Commercial |
$72.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$38.55
|
| Rate for Payer: TriValley Medical Group Senior |
$38.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$48.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$48.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.92
|
| Rate for Payer: Vantage Medical Group Senior |
$81.92
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET [14825]
|
Facility
|
IP
|
$96.38
|
|
|
Service Code
|
NDC 70700-268-94
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.44 |
| Max. Negotiated Rate |
$72.28 |
| Rate for Payer: Adventist Health Commercial |
$19.28
|
| Rate for Payer: Cash Price |
$53.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.25
|
| Rate for Payer: Heritage Provider Network Senior |
$65.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.09
|
| Rate for Payer: Multiplan Commercial |
$72.28
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET [14825]
|
Facility
|
IP
|
$96.38
|
|
|
Service Code
|
NDC 70700-268-99
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.44 |
| Max. Negotiated Rate |
$72.28 |
| Rate for Payer: Adventist Health Commercial |
$19.28
|
| Rate for Payer: Cash Price |
$53.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.25
|
| Rate for Payer: Heritage Provider Network Senior |
$65.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.09
|
| Rate for Payer: Multiplan Commercial |
$72.28
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET [14825]
|
Facility
|
IP
|
$83.76
|
|
|
Service Code
|
NDC 67877-749-57
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$15.16 |
| Max. Negotiated Rate |
$62.82 |
| Rate for Payer: Adventist Health Commercial |
$16.75
|
| Rate for Payer: Cash Price |
$46.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$56.71
|
| Rate for Payer: Heritage Provider Network Senior |
$56.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.94
|
| Rate for Payer: Multiplan Commercial |
$62.82
|
|
|
FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION [88011]
|
Facility
|
OP
|
$24.26
|
|
|
Service Code
|
HCPCS Q2009
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.65 |
| Max. Negotiated Rate |
$20.62 |
| Rate for Payer: Adventist Health Commercial |
$4.85
|
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.75
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.08
|
| Rate for Payer: Blue Shield of California Commercial |
$3.65
|
| Rate for Payer: Blue Shield of California Commercial |
$3.65
|
| Rate for Payer: Blue Shield of California EPN |
$3.65
|
| Rate for Payer: Blue Shield of California EPN |
$3.65
|
| Rate for Payer: Cash Price |
$13.34
|
| Rate for Payer: Cash Price |
$13.34
|
| Rate for Payer: Cash Price |
$1.81
|
| Rate for Payer: Cash Price |
$1.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.79
|
| Rate for Payer: Dignity Health Senior |
$20.62
|
| Rate for Payer: Dignity Health Senior |
$2.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.23
|
| Rate for Payer: Heritage Provider Network Senior |
$11.23
|
| Rate for Payer: Heritage Provider Network Senior |
$1.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.98
|
| Rate for Payer: Multiplan Commercial |
$18.20
|
| Rate for Payer: Multiplan Commercial |
$2.46
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.31
|
| Rate for Payer: TriValley Medical Group Senior |
$9.70
|
| Rate for Payer: TriValley Medical Group Senior |
$1.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Vantage Medical Group Senior |
$20.62
|
| Rate for Payer: Vantage Medical Group Senior |
$2.79
|
|
|
FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION [88011]
|
Facility
|
IP
|
$3.28
|
|
|
Service Code
|
HCPCS Q2009
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Adventist Health Commercial |
$4.85
|
| Rate for Payer: Cash Price |
$1.81
|
| Rate for Payer: Cash Price |
$13.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.51
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.52
|
| Rate for Payer: Heritage Provider Network Senior |
$1.52
|
| Rate for Payer: Heritage Provider Network Senior |
$11.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.82
|
| Rate for Payer: Multiplan Commercial |
$18.20
|
| Rate for Payer: Multiplan Commercial |
$2.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.09
|
|
