|
IMIPRAMINE 10 MG TABLET [3860]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 69315-133-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
| Rate for Payer: Dignity Health Senior |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Senior |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Senior |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
|
|
IMIPRAMINE 10 MG TABLET [3860]
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
NDC 69584-425-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Senior |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
|
|
IMIPRAMINE 10 MG TABLET [3860]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 69315-133-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Senior |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
|
|
IMIPRAMINE 25 MG TABLET [3861]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 69584-426-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: Dignity Health Senior |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Senior |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Senior |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
IMIPRAMINE 25 MG TABLET [3861]
|
Facility
|
IP
|
$0.29
|
|
|
Service Code
|
NDC 69315-134-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.20
|
| Rate for Payer: Heritage Provider Network Senior |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
|
|
IMIPRAMINE 25 MG TABLET [3861]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 69584-426-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Senior |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
|
|
IMIPRAMINE 25 MG TABLET [3861]
|
Facility
|
OP
|
$0.29
|
|
|
Service Code
|
NDC 69315-134-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.25
|
| Rate for Payer: Dignity Health Senior |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Senior |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.12
|
| Rate for Payer: TriValley Medical Group Senior |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: Vantage Medical Group Senior |
$0.25
|
|
|
IMIQUIMOD 5 % TOPICAL CREAM PACKET [20718]
|
Facility
|
IP
|
$2.50
|
|
|
Service Code
|
NDC 45802-368-00
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: Adventist Health Commercial |
$0.50
|
| Rate for Payer: Cash Price |
$1.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.69
|
| Rate for Payer: Heritage Provider Network Senior |
$1.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.63
|
| Rate for Payer: Multiplan Commercial |
$1.88
|
|
|
IMIQUIMOD 5 % TOPICAL CREAM PACKET [20718]
|
Facility
|
OP
|
$2.50
|
|
|
Service Code
|
NDC 45802-368-00
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Adventist Health Commercial |
$0.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.52
|
| Rate for Payer: Blue Shield of California EPN |
$1.22
|
| Rate for Payer: Cash Price |
$1.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.12
|
| Rate for Payer: Dignity Health Senior |
$2.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.55
|
| Rate for Payer: Heritage Provider Network Senior |
$1.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.75
|
| Rate for Payer: Multiplan Commercial |
$1.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.00
|
| Rate for Payer: TriValley Medical Group Senior |
$1.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2.12
|
|
|
IMIQUIMOD 5 % TOPICAL CREAM PACKET [20718]
|
Facility
|
IP
|
$2.50
|
|
|
Service Code
|
NDC 45802-368-62
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: Adventist Health Commercial |
$0.50
|
| Rate for Payer: Cash Price |
$1.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.69
|
| Rate for Payer: Heritage Provider Network Senior |
$1.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.63
|
| Rate for Payer: Multiplan Commercial |
$1.88
|
|
|
IMIQUIMOD 5 % TOPICAL CREAM PACKET [20718]
|
Facility
|
OP
|
$2.50
|
|
|
Service Code
|
NDC 45802-368-62
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Adventist Health Commercial |
$0.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.52
|
| Rate for Payer: Blue Shield of California EPN |
$1.22
|
| Rate for Payer: Cash Price |
$1.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.12
|
| Rate for Payer: Dignity Health Senior |
$2.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.55
|
| Rate for Payer: Heritage Provider Network Senior |
$1.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.75
|
| Rate for Payer: Multiplan Commercial |
$1.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.00
|
| Rate for Payer: TriValley Medical Group Senior |
$1.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2.12
|
|
|
IMMUNE GLOB G 1 GRAM/5 ML(20 %)-PROL-IGA 0-50 MCG/ML SUBCUTANEOUS SOLN [108090]
|
Facility
|
OP
|
$57.84
|
|
|
Service Code
|
HCPCS J1559
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.47 |
| Max. Negotiated Rate |
$61.25 |
| Rate for Payer: Adventist Health Commercial |
$11.57
|
| Rate for Payer: Aetna of CA Gatekeeper |
$30.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.25
|
| Rate for Payer: Blue Shield of California Commercial |
$23.20
|
| Rate for Payer: Blue Shield of California EPN |
$23.20
|
| Rate for Payer: Cash Price |
$31.81
|
| Rate for Payer: Cash Price |
$31.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.54
|
| Rate for Payer: Dignity Health Senior |
$15.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.02
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.78
|
| Rate for Payer: Heritage Provider Network Senior |
$26.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.79
|
| Rate for Payer: Multiplan Commercial |
$43.38
|
| Rate for Payer: TriValley Medical Group Commercial |
$23.14
|
| Rate for Payer: TriValley Medical Group Senior |
$23.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.54
|
| Rate for Payer: Vantage Medical Group Senior |
$15.54
|
|
|
IMMUNE GLOB G 1 GRAM/5 ML(20 %)-PROL-IGA 0-50 MCG/ML SUBCUTANEOUS SOLN [108090]
|
Facility
|
IP
|
$57.84
|
|
|
Service Code
|
HCPCS J1559
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.47 |
| Max. Negotiated Rate |
$43.38 |
| Rate for Payer: Adventist Health Commercial |
$11.57
|
| Rate for Payer: Cash Price |
$31.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.78
|
| Rate for Payer: Heritage Provider Network Senior |
$26.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.46
|
| Rate for Payer: Multiplan Commercial |
$43.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.15
|
|
|
IMMUNE GLOB G 20 GRAM/200 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN [107754]
|
Facility
|
OP
|
$17.85
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$189.07 |
| Rate for Payer: Adventist Health Commercial |
$3.57
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$189.07
|
| Rate for Payer: Blue Shield of California Commercial |
$72.29
|
| Rate for Payer: Blue Shield of California EPN |
$72.29
|
| Rate for Payer: Cash Price |
$9.82
|
| Rate for Payer: Cash Price |
$9.82
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.83
|
| Rate for Payer: Dignity Health Senior |
$52.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.42
|
| Rate for Payer: EPIC Health Plan Medicare |
$48.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.26
|
| Rate for Payer: Heritage Provider Network Senior |
$8.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$60.52
|
| Rate for Payer: Multiplan Commercial |
$13.39
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.14
|
| Rate for Payer: TriValley Medical Group Senior |
$7.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$60.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.83
|
| Rate for Payer: Vantage Medical Group Senior |
$52.83
|
|
|
IMMUNE GLOB G 20 GRAM/200 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN [107754]
|
Facility
|
IP
|
$17.85
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$13.39 |
| Rate for Payer: Adventist Health Commercial |
$3.57
|
| Rate for Payer: Cash Price |
$9.82
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.26
|
| Rate for Payer: Heritage Provider Network Senior |
$8.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.46
|
| Rate for Payer: Multiplan Commercial |
$13.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.91
|
|
|
IMMUNE GLOB G 40 GRAM/400 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN [207906]
|
Facility
|
IP
|
$17.85
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$13.39 |
| Rate for Payer: Adventist Health Commercial |
$3.57
|
| Rate for Payer: Cash Price |
$9.82
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.26
|
| Rate for Payer: Heritage Provider Network Senior |
$8.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.46
|
| Rate for Payer: Multiplan Commercial |
$13.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.91
|
|
|
IMMUNE GLOB G 40 GRAM/400 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN [207906]
|
Facility
|
OP
|
$17.85
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$189.07 |
| Rate for Payer: Adventist Health Commercial |
$3.57
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$189.07
|
| Rate for Payer: Blue Shield of California Commercial |
$72.29
|
| Rate for Payer: Blue Shield of California EPN |
$72.29
|
| Rate for Payer: Cash Price |
$9.82
|
| Rate for Payer: Cash Price |
$9.82
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.83
|
| Rate for Payer: Dignity Health Senior |
$52.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.42
|
| Rate for Payer: EPIC Health Plan Medicare |
$48.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.26
|
| Rate for Payer: Heritage Provider Network Senior |
$8.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$60.52
|
| Rate for Payer: Multiplan Commercial |
$13.39
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.14
|
| Rate for Payer: TriValley Medical Group Senior |
$7.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$60.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.83
|
| Rate for Payer: Vantage Medical Group Senior |
$52.83
|
|
|
IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION [209934]
|
Facility
|
OP
|
$20.95
|
|
|
Service Code
|
HCPCS J1569
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.79 |
| Max. Negotiated Rate |
$226.10 |
| Rate for Payer: Adventist Health Commercial |
$4.19
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$226.10
|
| Rate for Payer: Blue Shield of California Commercial |
$86.45
|
| Rate for Payer: Blue Shield of California EPN |
$86.45
|
| Rate for Payer: Cash Price |
$11.52
|
| Rate for Payer: Cash Price |
$11.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.58
|
| Rate for Payer: Dignity Health Senior |
$52.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.41
|
| Rate for Payer: EPIC Health Plan Medicare |
$47.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.70
|
| Rate for Payer: Heritage Provider Network Senior |
$9.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$45.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$47.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$60.22
|
| Rate for Payer: Multiplan Commercial |
$15.71
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.38
|
| Rate for Payer: TriValley Medical Group Senior |
$8.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.58
|
| Rate for Payer: Vantage Medical Group Senior |
$52.58
|
|
|
IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION [209934]
|
Facility
|
IP
|
$20.95
|
|
|
Service Code
|
HCPCS J1569
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.79 |
| Max. Negotiated Rate |
$15.71 |
| Rate for Payer: Adventist Health Commercial |
$4.19
|
| Rate for Payer: Cash Price |
$11.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.70
|
| Rate for Payer: Heritage Provider Network Senior |
$9.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.24
|
| Rate for Payer: Multiplan Commercial |
$15.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.94
|
|
|
IMMUNE GLOB,GAMM(IGG)10 %-MALT-IGA OVER 50 MCG/ML INTRAVENOUS SOLUTION [207352]
|
Facility
|
IP
|
$23.31
|
|
|
Service Code
|
HCPCS J1568
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$17.48 |
| Rate for Payer: Adventist Health Commercial |
$4.66
|
| Rate for Payer: Cash Price |
$12.82
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.79
|
| Rate for Payer: Heritage Provider Network Senior |
$10.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.83
|
| Rate for Payer: Multiplan Commercial |
$17.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.72
|
|
|
IMMUNE GLOB,GAMM(IGG)10 %-MALT-IGA OVER 50 MCG/ML INTRAVENOUS SOLUTION [207352]
|
Facility
|
OP
|
$23.31
|
|
|
Service Code
|
HCPCS J1568
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$251.55 |
| Rate for Payer: Adventist Health Commercial |
$4.66
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$251.55
|
| Rate for Payer: Blue Shield of California Commercial |
$99.07
|
| Rate for Payer: Blue Shield of California EPN |
$99.07
|
| Rate for Payer: Cash Price |
$12.82
|
| Rate for Payer: Cash Price |
$12.82
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.21
|
| Rate for Payer: Dignity Health Senior |
$53.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.92
|
| Rate for Payer: EPIC Health Plan Medicare |
$48.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.79
|
| Rate for Payer: Heritage Provider Network Senior |
$10.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$60.95
|
| Rate for Payer: Multiplan Commercial |
$17.48
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.32
|
| Rate for Payer: TriValley Medical Group Senior |
$9.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$60.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.21
|
| Rate for Payer: Vantage Medical Group Senior |
$53.21
|
|
|
IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION [209935]
|
Facility
|
OP
|
$23.02
|
|
|
Service Code
|
HCPCS J1459
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.17 |
| Max. Negotiated Rate |
$243.82 |
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$55.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$243.82
|
| Rate for Payer: Blue Shield of California Commercial |
$92.33
|
| Rate for Payer: Blue Shield of California EPN |
$92.33
|
| Rate for Payer: Cash Price |
$12.66
|
| Rate for Payer: Cash Price |
$12.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.48
|
| Rate for Payer: Dignity Health Senior |
$55.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.73
|
| Rate for Payer: EPIC Health Plan Medicare |
$50.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.66
|
| Rate for Payer: Heritage Provider Network Senior |
$10.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$49.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$50.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.54
|
| Rate for Payer: Multiplan Commercial |
$17.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.21
|
| Rate for Payer: TriValley Medical Group Senior |
$9.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$63.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.48
|
| Rate for Payer: Vantage Medical Group Senior |
$55.48
|
|
|
IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION [209935]
|
Facility
|
IP
|
$23.02
|
|
|
Service Code
|
HCPCS J1459
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.17 |
| Max. Negotiated Rate |
$17.27 |
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Cash Price |
$12.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.66
|
| Rate for Payer: Heritage Provider Network Senior |
$10.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.75
|
| Rate for Payer: Multiplan Commercial |
$17.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.62
|
|
|
IMMUNE GLOB,GAMM(IGG) 5 %-MALT-IGA OVER 50 MCG/ML INTRAVENOUS SOLUTION [210297]
|
Facility
|
IP
|
$11.65
|
|
|
Service Code
|
HCPCS J1568
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$8.74 |
| Rate for Payer: Adventist Health Commercial |
$2.33
|
| Rate for Payer: Cash Price |
$6.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.39
|
| Rate for Payer: Heritage Provider Network Senior |
$5.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.91
|
| Rate for Payer: Multiplan Commercial |
$8.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.86
|
|
|
IMMUNE GLOB,GAMM(IGG) 5 %-MALT-IGA OVER 50 MCG/ML INTRAVENOUS SOLUTION [210297]
|
Facility
|
OP
|
$11.65
|
|
|
Service Code
|
HCPCS J1568
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$251.55 |
| Rate for Payer: Adventist Health Commercial |
$2.33
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$251.55
|
| Rate for Payer: Blue Shield of California Commercial |
$99.07
|
| Rate for Payer: Blue Shield of California EPN |
$99.07
|
| Rate for Payer: Cash Price |
$6.41
|
| Rate for Payer: Cash Price |
$6.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.21
|
| Rate for Payer: Dignity Health Senior |
$53.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.46
|
| Rate for Payer: EPIC Health Plan Medicare |
$48.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.39
|
| Rate for Payer: Heritage Provider Network Senior |
$5.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$60.95
|
| Rate for Payer: Multiplan Commercial |
$8.74
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.66
|
| Rate for Payer: TriValley Medical Group Senior |
$4.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$60.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.21
|
| Rate for Payer: Vantage Medical Group Senior |
$53.21
|
|
