|
RANOLAZINE ER 1,000 MG TABLET,EXTENDED RELEASE,12 HR [88007]
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
NDC 27241-126-02
|
| Hospital Charge Code |
1711990
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.60
|
| Rate for Payer: BCBS Transplant Transplant |
$0.60
|
| Rate for Payer: Blue Shield of California Commercial |
$0.74
|
| Rate for Payer: Blue Shield of California EPN |
$0.58
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Media |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
RANOLAZINE ER 1,000 MG TABLET,EXTENDED RELEASE,12 HR [88007]
|
Facility
IP
|
$0.34
|
|
|
Service Code
|
NDC 42291-774-60
|
| Hospital Charge Code |
1711990
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Blue Shield of California Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.24
|
| Rate for Payer: Cigna of CA PPO |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Networks By Design Commercial |
$0.22
|
| Rate for Payer: Prime Health Services Commercial |
$0.29
|
|
|
RANOLAZINE ER 1,000 MG TABLET,EXTENDED RELEASE,12 HR [88007]
|
Facility
OP
|
$0.34
|
|
|
Service Code
|
NDC 42291-774-60
|
| Hospital Charge Code |
1711990
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.29
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.20
|
| Rate for Payer: BCBS Transplant Transplant |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.24
|
| Rate for Payer: Cigna of CA PPO |
$0.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.29
|
| Rate for Payer: Dignity Health Media |
$0.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Networks By Design Commercial |
$0.22
|
| Rate for Payer: Prime Health Services Commercial |
$0.29
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Vantage Medical Group Senior |
$0.29
|
|
|
RANOLAZINE ER 1,000 MG TABLET,EXTENDED RELEASE,12 HR [88007]
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
NDC 27241-126-02
|
| Hospital Charge Code |
1711990
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Blue Shield of California Commercial |
$0.71
|
| Rate for Payer: Blue Shield of California EPN |
$0.51
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR [70434]
|
Facility
IP
|
$0.60
|
|
|
Service Code
|
NDC 27241-125-02
|
| Hospital Charge Code |
1711999
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR [70434]
|
Facility
OP
|
$0.60
|
|
|
Service Code
|
NDC 27241-125-02
|
| Hospital Charge Code |
1711999
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: BCBS Transplant Transplant |
$0.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Media |
$0.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR [70434]
|
Facility
OP
|
$1.68
|
|
|
Service Code
|
NDC 60687-549-11
|
| Hospital Charge Code |
1711999
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.98
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.43
|
| Rate for Payer: Dignity Health Media |
$1.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.84
|
| Rate for Payer: United Healthcare All Other HMO |
$0.84
|
| Rate for Payer: United Healthcare HMO Rider |
$0.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1.43
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR [70434]
|
Facility
IP
|
$8.22
|
|
|
Service Code
|
NDC 61958-1003-1
|
| Hospital Charge Code |
1711999
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$6.99 |
| Rate for Payer: Blue Shield of California Commercial |
$5.85
|
| Rate for Payer: Blue Shield of California EPN |
$4.21
|
| Rate for Payer: Cash Price |
$3.70
|
| Rate for Payer: Cigna of CA HMO |
$5.75
|
| Rate for Payer: Cigna of CA PPO |
$5.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.29
|
| Rate for Payer: Galaxy Health WC |
$6.99
|
| Rate for Payer: Global Benefits Group Commercial |
$4.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.97
|
| Rate for Payer: Multiplan Commercial |
$6.58
|
| Rate for Payer: Networks By Design Commercial |
$5.34
|
| Rate for Payer: Prime Health Services Commercial |
$6.99
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR [70434]
|
Facility
IP
|
$1.68
|
|
|
Service Code
|
NDC 60687-549-11
|
| Hospital Charge Code |
1711999
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Blue Shield of California Commercial |
$1.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.86
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR [70434]
|
Facility
OP
|
$8.22
|
|
|
Service Code
|
NDC 61958-1003-1
|
| Hospital Charge Code |
1711999
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$6.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.99
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.90
|
| Rate for Payer: BCBS Transplant Transplant |
$4.93
|
| Rate for Payer: Blue Shield of California Commercial |
$6.06
|
| Rate for Payer: Blue Shield of California EPN |
$4.80
|
| Rate for Payer: Cash Price |
$3.70
|
| Rate for Payer: Cigna of CA HMO |
$5.75
|
| Rate for Payer: Cigna of CA PPO |
$5.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.99
|
| Rate for Payer: Dignity Health Media |
$6.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.29
|
| Rate for Payer: Galaxy Health WC |
$6.99
|
| Rate for Payer: Global Benefits Group Commercial |
$4.93
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.97
|
| Rate for Payer: Multiplan Commercial |
$6.58
|
| Rate for Payer: Networks By Design Commercial |
$5.34
|
| Rate for Payer: Prime Health Services Commercial |
$6.99
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.11
|
| Rate for Payer: United Healthcare All Other HMO |
$4.11
|
| Rate for Payer: United Healthcare HMO Rider |
$4.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.99
|
| Rate for Payer: Vantage Medical Group Senior |
$6.99
|
|
|
RASAGILINE 0.5 MG TABLET [76480]
|
Facility
OP
|
$3.44
|
|
|
Service Code
|
NDC 23155-746-03
|
| Hospital Charge Code |
1711909
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: BCBS Transplant Transplant |
$2.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.05
|
| Rate for Payer: Blue Shield of California Commercial |
$2.54
|
| Rate for Payer: Blue Shield of California EPN |
$2.01
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Cigna of CA HMO |
$2.41
|
| Rate for Payer: Cigna of CA PPO |
$2.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.92
|
| Rate for Payer: Dignity Health Media |
$2.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.38
|
| Rate for Payer: Galaxy Health WC |
$2.92
|
| Rate for Payer: Global Benefits Group Commercial |
$2.06
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: Multiplan Commercial |
$2.75
|
| Rate for Payer: Networks By Design Commercial |
$2.24
|
| Rate for Payer: Prime Health Services Commercial |
$2.92
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.72
|
| Rate for Payer: United Healthcare All Other HMO |
$1.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.92
|
| Rate for Payer: Vantage Medical Group Senior |
$2.92
|
|
|
RASAGILINE 0.5 MG TABLET [76480]
|
Facility
OP
|
$17.80
|
|
|
Service Code
|
NDC 47781-683-30
|
| Hospital Charge Code |
1711909
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$15.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.61
|
| Rate for Payer: BCBS Transplant Transplant |
$10.68
|
| Rate for Payer: Blue Shield of California Commercial |
$13.12
|
| Rate for Payer: Blue Shield of California EPN |
$10.40
|
| Rate for Payer: Cash Price |
$8.01
|
| Rate for Payer: Cigna of CA HMO |
$12.46
|
| Rate for Payer: Cigna of CA PPO |
$12.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.13
|
| Rate for Payer: Dignity Health Media |
$15.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.12
|
| Rate for Payer: Galaxy Health WC |
$15.13
|
| Rate for Payer: Global Benefits Group Commercial |
$10.68
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.27
|
| Rate for Payer: Multiplan Commercial |
$14.24
|
| Rate for Payer: Networks By Design Commercial |
$11.57
|
| Rate for Payer: Prime Health Services Commercial |
$15.13
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.90
|
| Rate for Payer: United Healthcare All Other HMO |
$8.90
|
| Rate for Payer: United Healthcare HMO Rider |
$8.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.13
|
| Rate for Payer: Vantage Medical Group Senior |
$15.13
|
|
|
RASAGILINE 0.5 MG TABLET [76480]
|
Facility
OP
|
$8.25
|
|
|
Service Code
|
NDC 0093-3060-56
|
| Hospital Charge Code |
1711909
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$7.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.54
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.92
|
| Rate for Payer: BCBS Transplant Transplant |
$4.95
|
| Rate for Payer: Blue Shield of California Commercial |
$6.08
|
| Rate for Payer: Blue Shield of California EPN |
$4.82
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Cigna of CA HMO |
$5.78
|
| Rate for Payer: Cigna of CA PPO |
$5.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.01
|
| Rate for Payer: Dignity Health Media |
$7.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.30
|
| Rate for Payer: Galaxy Health WC |
$7.01
|
| Rate for Payer: Global Benefits Group Commercial |
$4.95
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.98
|
| Rate for Payer: Multiplan Commercial |
$6.60
|
| Rate for Payer: Networks By Design Commercial |
$5.36
|
| Rate for Payer: Prime Health Services Commercial |
$7.01
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.12
|
| Rate for Payer: United Healthcare All Other HMO |
$4.12
|
| Rate for Payer: United Healthcare HMO Rider |
$4.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.01
|
| Rate for Payer: Vantage Medical Group Senior |
$7.01
|
|
|
RASAGILINE 0.5 MG TABLET [76480]
|
Facility
IP
|
$3.44
|
|
|
Service Code
|
NDC 23155-746-03
|
| Hospital Charge Code |
1711909
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Blue Shield of California Commercial |
$2.45
|
| Rate for Payer: Blue Shield of California EPN |
$1.76
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Cigna of CA HMO |
$2.41
|
| Rate for Payer: Cigna of CA PPO |
$2.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: Galaxy Health WC |
$2.92
|
| Rate for Payer: Global Benefits Group Commercial |
$2.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: Multiplan Commercial |
$2.75
|
| Rate for Payer: Networks By Design Commercial |
$2.24
|
| Rate for Payer: Prime Health Services Commercial |
$2.92
|
|
|
RASAGILINE 0.5 MG TABLET [76480]
|
Facility
IP
|
$8.25
|
|
|
Service Code
|
NDC 0093-3060-56
|
| Hospital Charge Code |
1711909
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$7.01 |
| Rate for Payer: Blue Shield of California Commercial |
$5.87
|
| Rate for Payer: Blue Shield of California EPN |
$4.22
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Cigna of CA HMO |
$5.78
|
| Rate for Payer: Cigna of CA PPO |
$5.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.30
|
| Rate for Payer: Galaxy Health WC |
$7.01
|
| Rate for Payer: Global Benefits Group Commercial |
$4.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.98
|
| Rate for Payer: Multiplan Commercial |
$6.60
|
| Rate for Payer: Networks By Design Commercial |
$5.36
|
| Rate for Payer: Prime Health Services Commercial |
$7.01
|
|
|
RASAGILINE 0.5 MG TABLET [76480]
|
Facility
IP
|
$17.80
|
|
|
Service Code
|
NDC 47781-683-30
|
| Hospital Charge Code |
1711909
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$15.13 |
| Rate for Payer: Blue Shield of California Commercial |
$12.67
|
| Rate for Payer: Blue Shield of California EPN |
$9.11
|
| Rate for Payer: Cash Price |
$8.01
|
| Rate for Payer: Cigna of CA HMO |
$12.46
|
| Rate for Payer: Cigna of CA PPO |
$12.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.12
|
| Rate for Payer: Galaxy Health WC |
$15.13
|
| Rate for Payer: Global Benefits Group Commercial |
$10.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.27
|
| Rate for Payer: Multiplan Commercial |
$14.24
|
| Rate for Payer: Networks By Design Commercial |
$11.57
|
| Rate for Payer: Prime Health Services Commercial |
$15.13
|
|
|
RASAGILINE 1 MG TABLET [76481]
|
Facility
OP
|
$17.80
|
|
|
Service Code
|
NDC 47781-690-30
|
| Hospital Charge Code |
1711908
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$15.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.61
|
| Rate for Payer: BCBS Transplant Transplant |
$10.68
|
| Rate for Payer: Blue Shield of California Commercial |
$13.12
|
| Rate for Payer: Blue Shield of California EPN |
$10.40
|
| Rate for Payer: Cash Price |
$8.01
|
| Rate for Payer: Cigna of CA HMO |
$12.46
|
| Rate for Payer: Cigna of CA PPO |
$12.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.13
|
| Rate for Payer: Dignity Health Media |
$15.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.12
|
| Rate for Payer: Galaxy Health WC |
$15.13
|
| Rate for Payer: Global Benefits Group Commercial |
$10.68
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.27
|
| Rate for Payer: Multiplan Commercial |
$14.24
|
| Rate for Payer: Networks By Design Commercial |
$11.57
|
| Rate for Payer: Prime Health Services Commercial |
$15.13
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.90
|
| Rate for Payer: United Healthcare All Other HMO |
$8.90
|
| Rate for Payer: United Healthcare HMO Rider |
$8.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.13
|
| Rate for Payer: Vantage Medical Group Senior |
$15.13
|
|
|
RASAGILINE 1 MG TABLET [76481]
|
Facility
IP
|
$41.81
|
|
|
Service Code
|
NDC 68546-229-56
|
| Hospital Charge Code |
1711908
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.03 |
| Max. Negotiated Rate |
$35.54 |
| Rate for Payer: Blue Shield of California Commercial |
$29.77
|
| Rate for Payer: Blue Shield of California EPN |
$21.41
|
| Rate for Payer: Cash Price |
$18.81
|
| Rate for Payer: Cigna of CA HMO |
$29.27
|
| Rate for Payer: Cigna of CA PPO |
$29.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.72
|
| Rate for Payer: Galaxy Health WC |
$35.54
|
| Rate for Payer: Global Benefits Group Commercial |
$25.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.03
|
| Rate for Payer: Multiplan Commercial |
$33.45
|
| Rate for Payer: Networks By Design Commercial |
$27.18
|
| Rate for Payer: Prime Health Services Commercial |
$35.54
|
|
|
RASAGILINE 1 MG TABLET [76481]
|
Facility
OP
|
$41.81
|
|
|
Service Code
|
NDC 68546-229-56
|
| Hospital Charge Code |
1711908
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.03 |
| Max. Negotiated Rate |
$35.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$35.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$23.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$23.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.91
|
| Rate for Payer: BCBS Transplant Transplant |
$25.09
|
| Rate for Payer: Blue Shield of California Commercial |
$30.81
|
| Rate for Payer: Blue Shield of California EPN |
$24.42
|
| Rate for Payer: Cash Price |
$18.81
|
| Rate for Payer: Cigna of CA HMO |
$29.27
|
| Rate for Payer: Cigna of CA PPO |
$29.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.54
|
| Rate for Payer: Dignity Health Media |
$35.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.72
|
| Rate for Payer: Galaxy Health WC |
$35.54
|
| Rate for Payer: Global Benefits Group Commercial |
$25.09
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$31.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.03
|
| Rate for Payer: Multiplan Commercial |
$33.45
|
| Rate for Payer: Networks By Design Commercial |
$27.18
|
| Rate for Payer: Prime Health Services Commercial |
$35.54
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$25.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.90
|
| Rate for Payer: United Healthcare All Other HMO |
$20.90
|
| Rate for Payer: United Healthcare HMO Rider |
$20.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.54
|
| Rate for Payer: Vantage Medical Group Senior |
$35.54
|
|
|
RASAGILINE 1 MG TABLET [76481]
|
Facility
IP
|
$8.25
|
|
|
Service Code
|
NDC 0093-3061-56
|
| Hospital Charge Code |
1711908
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$7.01 |
| Rate for Payer: Blue Shield of California Commercial |
$5.87
|
| Rate for Payer: Blue Shield of California EPN |
$4.22
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Cigna of CA HMO |
$5.78
|
| Rate for Payer: Cigna of CA PPO |
$5.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.30
|
| Rate for Payer: Galaxy Health WC |
$7.01
|
| Rate for Payer: Global Benefits Group Commercial |
$4.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.98
|
| Rate for Payer: Multiplan Commercial |
$6.60
|
| Rate for Payer: Networks By Design Commercial |
$5.36
|
| Rate for Payer: Prime Health Services Commercial |
$7.01
|
|
|
RASAGILINE 1 MG TABLET [76481]
|
Facility
IP
|
$3.44
|
|
|
Service Code
|
NDC 23155-747-03
|
| Hospital Charge Code |
1711908
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Blue Shield of California Commercial |
$2.45
|
| Rate for Payer: Blue Shield of California EPN |
$1.76
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Cigna of CA HMO |
$2.41
|
| Rate for Payer: Cigna of CA PPO |
$2.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: Galaxy Health WC |
$2.92
|
| Rate for Payer: Global Benefits Group Commercial |
$2.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: Multiplan Commercial |
$2.75
|
| Rate for Payer: Networks By Design Commercial |
$2.24
|
| Rate for Payer: Prime Health Services Commercial |
$2.92
|
|
|
RASAGILINE 1 MG TABLET [76481]
|
Facility
OP
|
$8.25
|
|
|
Service Code
|
NDC 0093-3061-56
|
| Hospital Charge Code |
1711908
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$7.01 |
| Rate for Payer: Galaxy Health WC |
$7.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.54
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.92
|
| Rate for Payer: BCBS Transplant Transplant |
$4.95
|
| Rate for Payer: Blue Shield of California Commercial |
$6.08
|
| Rate for Payer: Blue Shield of California EPN |
$4.82
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Cigna of CA HMO |
$5.78
|
| Rate for Payer: Cigna of CA PPO |
$5.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.01
|
| Rate for Payer: Dignity Health Media |
$7.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4.95
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.98
|
| Rate for Payer: Multiplan Commercial |
$6.60
|
| Rate for Payer: Networks By Design Commercial |
$5.36
|
| Rate for Payer: Prime Health Services Commercial |
$7.01
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.12
|
| Rate for Payer: United Healthcare All Other HMO |
$4.12
|
| Rate for Payer: United Healthcare HMO Rider |
$4.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.01
|
| Rate for Payer: Vantage Medical Group Senior |
$7.01
|
|
|
RASAGILINE 1 MG TABLET [76481]
|
Facility
IP
|
$17.80
|
|
|
Service Code
|
NDC 47781-690-30
|
| Hospital Charge Code |
1711908
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$15.13 |
| Rate for Payer: Blue Shield of California Commercial |
$12.67
|
| Rate for Payer: Blue Shield of California EPN |
$9.11
|
| Rate for Payer: Cash Price |
$8.01
|
| Rate for Payer: Cigna of CA HMO |
$12.46
|
| Rate for Payer: Cigna of CA PPO |
$12.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.12
|
| Rate for Payer: Galaxy Health WC |
$15.13
|
| Rate for Payer: Global Benefits Group Commercial |
$10.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.27
|
| Rate for Payer: Multiplan Commercial |
$14.24
|
| Rate for Payer: Networks By Design Commercial |
$11.57
|
| Rate for Payer: Prime Health Services Commercial |
$15.13
|
|
|
RASAGILINE 1 MG TABLET [76481]
|
Facility
OP
|
$3.44
|
|
|
Service Code
|
NDC 23155-747-03
|
| Hospital Charge Code |
1711908
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.05
|
| Rate for Payer: BCBS Transplant Transplant |
$2.06
|
| Rate for Payer: Blue Shield of California Commercial |
$2.54
|
| Rate for Payer: Blue Shield of California EPN |
$2.01
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Cigna of CA HMO |
$2.41
|
| Rate for Payer: Cigna of CA PPO |
$2.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.92
|
| Rate for Payer: Dignity Health Media |
$2.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.38
|
| Rate for Payer: Galaxy Health WC |
$2.92
|
| Rate for Payer: Global Benefits Group Commercial |
$2.06
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: Multiplan Commercial |
$2.75
|
| Rate for Payer: Networks By Design Commercial |
$2.24
|
| Rate for Payer: Prime Health Services Commercial |
$2.92
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.72
|
| Rate for Payer: United Healthcare All Other HMO |
$1.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.92
|
| Rate for Payer: Vantage Medical Group Senior |
$2.92
|
|
|
RASBURICASE 1.5 MG INTRAVENOUS SOLUTION [33591]
|
Facility
OP
|
$1,276.65
|
|
|
Service Code
|
CPT J2783
|
| Hospital Charge Code |
1722030
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$220.63 |
| Max. Negotiated Rate |
$2,309.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,309.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$403.99
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$403.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$220.63
|
| Rate for Payer: BCBS Transplant Transplant |
$765.99
|
| Rate for Payer: Blue Shield of California Commercial |
$940.89
|
| Rate for Payer: Blue Shield of California EPN |
$362.60
|
| Rate for Payer: Cash Price |
$574.49
|
| Rate for Payer: Cash Price |
$574.49
|
| Rate for Payer: Cigna of CA HMO |
$893.66
|
| Rate for Payer: Cigna of CA PPO |
$893.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$550.90
|
| Rate for Payer: Dignity Health Media |
$367.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$403.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$495.81
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$367.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$367.27
|
| Rate for Payer: Galaxy Health WC |
$1,085.15
|
| Rate for Payer: Global Benefits Group Commercial |
$765.99
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$957.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$602.32
|
| Rate for Payer: Heritage Provider Network Transplant |
$602.32
|
| Rate for Payer: IEHP Medi-Cal |
$594.97
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$594.97
|
| Rate for Payer: IEHP Medicare Advantage |
$367.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$851.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$486.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$367.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$462.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$492.14
|
| Rate for Payer: Multiplan Commercial |
$1,021.32
|
| Rate for Payer: Networks By Design Commercial |
$638.32
|
| Rate for Payer: Prime Health Services Commercial |
$1,085.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$765.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$765.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$638.32
|
| Rate for Payer: United Healthcare All Other HMO |
$638.32
|
| Rate for Payer: United Healthcare HMO Rider |
$638.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$638.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$550.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$403.99
|
| Rate for Payer: Vantage Medical Group Senior |
$367.27
|
|
