|
RITLECITINIB 50 MG CAPSULE [238783]
|
Facility
OP
|
$161.54
|
|
|
Service Code
|
NDC 0069-0334-28
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$38.77 |
| Max. Negotiated Rate |
$137.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$105.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$137.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$88.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$88.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.25
|
| Rate for Payer: BCBS Transplant Transplant |
$96.92
|
| Rate for Payer: Blue Shield of California Commercial |
$119.05
|
| Rate for Payer: Blue Shield of California EPN |
$94.34
|
| Rate for Payer: Cash Price |
$72.69
|
| Rate for Payer: Cigna of CA HMO |
$113.08
|
| Rate for Payer: Cigna of CA PPO |
$113.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.31
|
| Rate for Payer: Dignity Health Media |
$137.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$137.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$64.62
|
| Rate for Payer: Galaxy Health WC |
$137.31
|
| Rate for Payer: Global Benefits Group Commercial |
$96.92
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$121.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$107.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.77
|
| Rate for Payer: Multiplan Commercial |
$129.23
|
| Rate for Payer: Networks By Design Commercial |
$105.00
|
| Rate for Payer: Prime Health Services Commercial |
$137.31
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$96.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$96.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$96.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$80.77
|
| Rate for Payer: United Healthcare All Other HMO |
$80.77
|
| Rate for Payer: United Healthcare HMO Rider |
$80.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$80.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$137.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$137.31
|
| Rate for Payer: Vantage Medical Group Senior |
$137.31
|
|
|
RITLECITINIB 50 MG CAPSULE [238783]
|
Facility
IP
|
$161.54
|
|
|
Service Code
|
NDC 0069-0334-28
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$38.77 |
| Max. Negotiated Rate |
$137.31 |
| Rate for Payer: Blue Shield of California Commercial |
$115.02
|
| Rate for Payer: Blue Shield of California EPN |
$82.71
|
| Rate for Payer: Cash Price |
$72.69
|
| Rate for Payer: Cigna of CA HMO |
$113.08
|
| Rate for Payer: Cigna of CA PPO |
$113.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.62
|
| Rate for Payer: Galaxy Health WC |
$137.31
|
| Rate for Payer: Global Benefits Group Commercial |
$96.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$107.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.77
|
| Rate for Payer: Multiplan Commercial |
$129.23
|
| Rate for Payer: Networks By Design Commercial |
$105.00
|
| Rate for Payer: Prime Health Services Commercial |
$137.31
|
|
|
RITONAVIR 100 MG TABLET [100995]
|
Facility
OP
|
$3.20
|
|
|
Service Code
|
NDC 65862-687-30
|
| Hospital Charge Code |
1712621
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.76
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.91
|
| Rate for Payer: BCBS Transplant Transplant |
$1.92
|
| Rate for Payer: Blue Shield of California Commercial |
$2.36
|
| Rate for Payer: Blue Shield of California EPN |
$1.87
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Cigna of CA HMO |
$2.24
|
| Rate for Payer: Cigna of CA PPO |
$2.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.72
|
| Rate for Payer: Dignity Health Media |
$2.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.28
|
| Rate for Payer: Galaxy Health WC |
$2.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.92
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: Multiplan Commercial |
$2.56
|
| Rate for Payer: Networks By Design Commercial |
$2.08
|
| Rate for Payer: Prime Health Services Commercial |
$2.72
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1.60
|
| Rate for Payer: United Healthcare HMO Rider |
$1.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.72
|
| Rate for Payer: Vantage Medical Group Senior |
$2.72
|
|
|
RITONAVIR 100 MG TABLET [100995]
|
Facility
OP
|
$6.40
|
|
|
Service Code
|
NDC 0054-0407-13
|
| Hospital Charge Code |
1712621
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$5.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.81
|
| Rate for Payer: BCBS Transplant Transplant |
$3.84
|
| Rate for Payer: Blue Shield of California Commercial |
$4.72
|
| Rate for Payer: Blue Shield of California EPN |
$3.74
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: Cigna of CA HMO |
$4.48
|
| Rate for Payer: Cigna of CA PPO |
$4.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.44
|
| Rate for Payer: Dignity Health Media |
$5.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.56
|
| Rate for Payer: Galaxy Health WC |
$5.44
|
| Rate for Payer: Global Benefits Group Commercial |
$3.84
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.54
|
| Rate for Payer: Multiplan Commercial |
$5.12
|
| Rate for Payer: Networks By Design Commercial |
$4.16
|
| Rate for Payer: Prime Health Services Commercial |
$5.44
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.20
|
| Rate for Payer: United Healthcare All Other HMO |
$3.20
|
| Rate for Payer: United Healthcare HMO Rider |
$3.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.44
|
| Rate for Payer: Vantage Medical Group Senior |
$5.44
|
|
|
RITONAVIR 100 MG TABLET [100995]
|
Facility
OP
|
$3.20
|
|
|
Service Code
|
NDC 31722-597-30
|
| Hospital Charge Code |
1712621
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: Galaxy Health WC |
$2.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.76
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.91
|
| Rate for Payer: BCBS Transplant Transplant |
$1.92
|
| Rate for Payer: Blue Shield of California Commercial |
$2.36
|
| Rate for Payer: Blue Shield of California EPN |
$1.87
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Cigna of CA HMO |
$2.24
|
| Rate for Payer: Cigna of CA PPO |
$2.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.72
|
| Rate for Payer: Dignity Health Media |
$2.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.28
|
| Rate for Payer: Global Benefits Group Commercial |
$1.92
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: Multiplan Commercial |
$2.56
|
| Rate for Payer: Networks By Design Commercial |
$2.08
|
| Rate for Payer: Prime Health Services Commercial |
$2.72
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1.60
|
| Rate for Payer: United Healthcare HMO Rider |
$1.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.72
|
| Rate for Payer: Vantage Medical Group Senior |
$2.72
|
|
|
RITONAVIR 100 MG TABLET [100995]
|
Facility
IP
|
$3.20
|
|
|
Service Code
|
NDC 31722-597-30
|
| Hospital Charge Code |
1712621
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: Blue Shield of California Commercial |
$2.28
|
| Rate for Payer: Blue Shield of California EPN |
$1.64
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Cigna of CA HMO |
$2.24
|
| Rate for Payer: Cigna of CA PPO |
$2.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: Galaxy Health WC |
$2.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: Multiplan Commercial |
$2.56
|
| Rate for Payer: Networks By Design Commercial |
$2.08
|
| Rate for Payer: Prime Health Services Commercial |
$2.72
|
|
|
RITONAVIR 100 MG TABLET [100995]
|
Facility
IP
|
$3.20
|
|
|
Service Code
|
NDC 65862-687-30
|
| Hospital Charge Code |
1712621
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: Blue Shield of California Commercial |
$2.28
|
| Rate for Payer: Blue Shield of California EPN |
$1.64
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Cigna of CA HMO |
$2.24
|
| Rate for Payer: Cigna of CA PPO |
$2.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: Galaxy Health WC |
$2.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: Multiplan Commercial |
$2.56
|
| Rate for Payer: Networks By Design Commercial |
$2.08
|
| Rate for Payer: Prime Health Services Commercial |
$2.72
|
|
|
RITONAVIR 100 MG TABLET [100995]
|
Facility
IP
|
$6.40
|
|
|
Service Code
|
NDC 0054-0407-13
|
| Hospital Charge Code |
1712621
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$5.44 |
| Rate for Payer: Blue Shield of California Commercial |
$4.56
|
| Rate for Payer: Blue Shield of California EPN |
$3.28
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: Cigna of CA HMO |
$4.48
|
| Rate for Payer: Cigna of CA PPO |
$4.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.56
|
| Rate for Payer: Galaxy Health WC |
$5.44
|
| Rate for Payer: Global Benefits Group Commercial |
$3.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.54
|
| Rate for Payer: Multiplan Commercial |
$5.12
|
| Rate for Payer: Networks By Design Commercial |
$4.16
|
| Rate for Payer: Prime Health Services Commercial |
$5.44
|
|
|
RITONAVIR 80 MG/ML ORAL SOLUTION [16440]
|
Facility
IP
|
$7.20
|
|
|
Service Code
|
NDC 0074-1940-63
|
| Hospital Charge Code |
1715199
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$6.12 |
| Rate for Payer: Blue Shield of California Commercial |
$5.13
|
| Rate for Payer: Blue Shield of California EPN |
$3.69
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cigna of CA HMO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: Galaxy Health WC |
$6.12
|
| Rate for Payer: Global Benefits Group Commercial |
$4.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: Multiplan Commercial |
$5.76
|
| Rate for Payer: Networks By Design Commercial |
$4.68
|
| Rate for Payer: Prime Health Services Commercial |
$6.12
|
|
|
RITONAVIR 80 MG/ML ORAL SOLUTION [16440]
|
Facility
OP
|
$7.20
|
|
|
Service Code
|
NDC 0074-1940-63
|
| Hospital Charge Code |
1715199
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$6.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.29
|
| Rate for Payer: BCBS Transplant Transplant |
$4.32
|
| Rate for Payer: Blue Shield of California Commercial |
$5.31
|
| Rate for Payer: Blue Shield of California EPN |
$4.20
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cigna of CA HMO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.12
|
| Rate for Payer: Dignity Health Media |
$6.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.88
|
| Rate for Payer: Galaxy Health WC |
$6.12
|
| Rate for Payer: Global Benefits Group Commercial |
$4.32
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: Multiplan Commercial |
$5.76
|
| Rate for Payer: Networks By Design Commercial |
$4.68
|
| Rate for Payer: Prime Health Services Commercial |
$6.12
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.60
|
| Rate for Payer: United Healthcare All Other HMO |
$3.60
|
| Rate for Payer: United Healthcare HMO Rider |
$3.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.12
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS [22149]
|
Facility
IP
|
$112.74
|
|
|
Service Code
|
CPT J9312
|
| Hospital Charge Code |
1755782
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.06 |
| Max. Negotiated Rate |
$95.83 |
| Rate for Payer: Multiplan Commercial |
$90.19
|
| Rate for Payer: Blue Shield of California Commercial |
$80.27
|
| Rate for Payer: Blue Shield of California EPN |
$57.72
|
| Rate for Payer: Cash Price |
$50.73
|
| Rate for Payer: Cigna of CA HMO |
$78.92
|
| Rate for Payer: Cigna of CA PPO |
$78.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$45.10
|
| Rate for Payer: Galaxy Health WC |
$95.83
|
| Rate for Payer: Global Benefits Group Commercial |
$67.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.06
|
| Rate for Payer: Networks By Design Commercial |
$56.37
|
| Rate for Payer: Prime Health Services Commercial |
$95.83
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS [22149]
|
Facility
IP
|
$112.74
|
|
|
Service Code
|
CPT J9312
|
| Hospital Charge Code |
1755659
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.06 |
| Max. Negotiated Rate |
$95.83 |
| Rate for Payer: Blue Shield of California Commercial |
$80.27
|
| Rate for Payer: Blue Shield of California EPN |
$57.72
|
| Rate for Payer: Cash Price |
$50.73
|
| Rate for Payer: Cigna of CA HMO |
$78.92
|
| Rate for Payer: Cigna of CA PPO |
$78.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$45.10
|
| Rate for Payer: Galaxy Health WC |
$95.83
|
| Rate for Payer: Global Benefits Group Commercial |
$67.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.06
|
| Rate for Payer: Multiplan Commercial |
$90.19
|
| Rate for Payer: Networks By Design Commercial |
$56.37
|
| Rate for Payer: Prime Health Services Commercial |
$95.83
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS [22149]
|
Facility
OP
|
$112.74
|
|
|
Service Code
|
CPT J9312
|
| Hospital Charge Code |
1755782
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.06 |
| Max. Negotiated Rate |
$200.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$155.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$99.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$87.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$87.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$200.32
|
| Rate for Payer: BCBS Transplant Transplant |
$67.64
|
| Rate for Payer: Blue Shield of California Commercial |
$83.09
|
| Rate for Payer: Blue Shield of California EPN |
$112.74
|
| Rate for Payer: Cash Price |
$50.73
|
| Rate for Payer: Cash Price |
$50.73
|
| Rate for Payer: Cigna of CA HMO |
$78.92
|
| Rate for Payer: Cigna of CA PPO |
$78.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$118.80
|
| Rate for Payer: Dignity Health Media |
$79.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$87.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$79.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$79.20
|
| Rate for Payer: Galaxy Health WC |
$95.83
|
| Rate for Payer: Global Benefits Group Commercial |
$67.64
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$84.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.88
|
| Rate for Payer: Heritage Provider Network Transplant |
$129.88
|
| Rate for Payer: IEHP Medi-Cal |
$128.30
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$128.30
|
| Rate for Payer: IEHP Medicare Advantage |
$79.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$99.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$106.13
|
| Rate for Payer: Multiplan Commercial |
$90.19
|
| Rate for Payer: Networks By Design Commercial |
$56.37
|
| Rate for Payer: Prime Health Services Commercial |
$95.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.37
|
| Rate for Payer: United Healthcare All Other HMO |
$56.37
|
| Rate for Payer: United Healthcare HMO Rider |
$56.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$118.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$87.12
|
| Rate for Payer: Vantage Medical Group Senior |
$79.20
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS [22149]
|
Facility
OP
|
$112.74
|
|
|
Service Code
|
CPT J9312
|
| Hospital Charge Code |
1755659
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.06 |
| Max. Negotiated Rate |
$200.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$155.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$99.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$87.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$87.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$200.32
|
| Rate for Payer: BCBS Transplant Transplant |
$67.64
|
| Rate for Payer: Blue Shield of California Commercial |
$83.09
|
| Rate for Payer: Blue Shield of California EPN |
$112.74
|
| Rate for Payer: Cash Price |
$50.73
|
| Rate for Payer: Cash Price |
$50.73
|
| Rate for Payer: Cigna of CA HMO |
$78.92
|
| Rate for Payer: Cigna of CA PPO |
$78.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$118.80
|
| Rate for Payer: Dignity Health Media |
$79.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$87.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$79.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$79.20
|
| Rate for Payer: Galaxy Health WC |
$95.83
|
| Rate for Payer: Global Benefits Group Commercial |
$67.64
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$84.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.88
|
| Rate for Payer: Heritage Provider Network Transplant |
$129.88
|
| Rate for Payer: IEHP Medi-Cal |
$128.30
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$128.30
|
| Rate for Payer: IEHP Medicare Advantage |
$79.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$99.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$106.13
|
| Rate for Payer: Multiplan Commercial |
$90.19
|
| Rate for Payer: Networks By Design Commercial |
$56.37
|
| Rate for Payer: Prime Health Services Commercial |
$95.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.37
|
| Rate for Payer: United Healthcare All Other HMO |
$56.37
|
| Rate for Payer: United Healthcare HMO Rider |
$56.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$118.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$87.12
|
| Rate for Payer: Vantage Medical Group Senior |
$79.20
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS NON-ONCOLOGY [4081336]
|
Facility
IP
|
$112.74
|
|
|
Service Code
|
NDC 50242-051-21
|
| Hospital Charge Code |
1755659
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.06 |
| Max. Negotiated Rate |
$95.83 |
| Rate for Payer: Blue Shield of California Commercial |
$80.27
|
| Rate for Payer: Blue Shield of California EPN |
$57.72
|
| Rate for Payer: Cash Price |
$50.73
|
| Rate for Payer: Cigna of CA HMO |
$78.92
|
| Rate for Payer: Cigna of CA PPO |
$78.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$45.10
|
| Rate for Payer: Galaxy Health WC |
$95.83
|
| Rate for Payer: Global Benefits Group Commercial |
$67.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.06
|
| Rate for Payer: Multiplan Commercial |
$90.19
|
| Rate for Payer: Networks By Design Commercial |
$56.37
|
| Rate for Payer: Prime Health Services Commercial |
$95.83
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS NON-ONCOLOGY [4081336]
|
Facility
IP
|
$112.74
|
|
|
Service Code
|
NDC 50242-053-06
|
| Hospital Charge Code |
1755782
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.06 |
| Max. Negotiated Rate |
$95.83 |
| Rate for Payer: Blue Shield of California Commercial |
$80.27
|
| Rate for Payer: Blue Shield of California EPN |
$57.72
|
| Rate for Payer: Cash Price |
$50.73
|
| Rate for Payer: Cigna of CA HMO |
$78.92
|
| Rate for Payer: Cigna of CA PPO |
$78.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$45.10
|
| Rate for Payer: Galaxy Health WC |
$95.83
|
| Rate for Payer: Global Benefits Group Commercial |
$67.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.06
|
| Rate for Payer: Multiplan Commercial |
$90.19
|
| Rate for Payer: Networks By Design Commercial |
$56.37
|
| Rate for Payer: Prime Health Services Commercial |
$95.83
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS NON-ONCOLOGY [4081336]
|
Facility
OP
|
$112.74
|
|
|
Service Code
|
NDC 50242-051-21
|
| Hospital Charge Code |
1755659
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.06 |
| Max. Negotiated Rate |
$95.83 |
| Rate for Payer: Aetna of CA HMO/PPO |
$73.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$95.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$62.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$62.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.17
|
| Rate for Payer: BCBS Transplant Transplant |
$67.64
|
| Rate for Payer: Blue Shield of California Commercial |
$83.09
|
| Rate for Payer: Blue Shield of California EPN |
$65.84
|
| Rate for Payer: Cash Price |
$50.73
|
| Rate for Payer: Cash Price |
$50.73
|
| Rate for Payer: Cigna of CA HMO |
$78.92
|
| Rate for Payer: Cigna of CA PPO |
$78.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$95.83
|
| Rate for Payer: Dignity Health Media |
$95.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$95.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$45.10
|
| Rate for Payer: Galaxy Health WC |
$95.83
|
| Rate for Payer: Global Benefits Group Commercial |
$67.64
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$84.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.06
|
| Rate for Payer: Multiplan Commercial |
$90.19
|
| Rate for Payer: Networks By Design Commercial |
$56.37
|
| Rate for Payer: Prime Health Services Commercial |
$95.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.37
|
| Rate for Payer: United Healthcare All Other HMO |
$56.37
|
| Rate for Payer: United Healthcare HMO Rider |
$56.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$95.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$95.83
|
| Rate for Payer: Vantage Medical Group Senior |
$95.83
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS NON-ONCOLOGY [4081336]
|
Facility
OP
|
$112.74
|
|
|
Service Code
|
NDC 50242-053-06
|
| Hospital Charge Code |
1755782
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.06 |
| Max. Negotiated Rate |
$95.83 |
| Rate for Payer: Aetna of CA HMO/PPO |
$73.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$95.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$62.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$62.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.17
|
| Rate for Payer: BCBS Transplant Transplant |
$67.64
|
| Rate for Payer: Blue Shield of California Commercial |
$83.09
|
| Rate for Payer: Blue Shield of California EPN |
$65.84
|
| Rate for Payer: Cash Price |
$50.73
|
| Rate for Payer: Cash Price |
$50.73
|
| Rate for Payer: Cigna of CA HMO |
$78.92
|
| Rate for Payer: Cigna of CA PPO |
$78.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$95.83
|
| Rate for Payer: Dignity Health Media |
$95.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$95.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$45.10
|
| Rate for Payer: Galaxy Health WC |
$95.83
|
| Rate for Payer: Global Benefits Group Commercial |
$67.64
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$84.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.06
|
| Rate for Payer: Multiplan Commercial |
$90.19
|
| Rate for Payer: Networks By Design Commercial |
$56.37
|
| Rate for Payer: Prime Health Services Commercial |
$95.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.37
|
| Rate for Payer: United Healthcare All Other HMO |
$56.37
|
| Rate for Payer: United Healthcare HMO Rider |
$56.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$95.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$95.83
|
| Rate for Payer: Vantage Medical Group Senior |
$95.83
|
|
|
RITUXIMAB 1,400 MG/11.7 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN [218742]
|
Facility
IP
|
$674.52
|
|
|
Service Code
|
CPT J9311
|
| Hospital Charge Code |
NDG218742
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$161.88 |
| Max. Negotiated Rate |
$573.34 |
| Rate for Payer: Blue Shield of California Commercial |
$480.26
|
| Rate for Payer: Blue Shield of California EPN |
$345.35
|
| Rate for Payer: Cash Price |
$303.53
|
| Rate for Payer: Cigna of CA HMO |
$472.16
|
| Rate for Payer: Cigna of CA PPO |
$472.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$269.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$269.81
|
| Rate for Payer: Galaxy Health WC |
$573.34
|
| Rate for Payer: Global Benefits Group Commercial |
$404.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$449.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$256.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.88
|
| Rate for Payer: Multiplan Commercial |
$539.62
|
| Rate for Payer: Networks By Design Commercial |
$337.26
|
| Rate for Payer: Prime Health Services Commercial |
$573.34
|
|
|
RITUXIMAB 1,400 MG/11.7 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN [218742]
|
Facility
OP
|
$674.52
|
|
|
Service Code
|
CPT J9311
|
| Hospital Charge Code |
NDG218742
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$573.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$73.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$46.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$41.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$41.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.16
|
| Rate for Payer: BCBS Transplant Transplant |
$404.71
|
| Rate for Payer: Blue Shield of California Commercial |
$497.12
|
| Rate for Payer: Blue Shield of California EPN |
$56.37
|
| Rate for Payer: Cash Price |
$303.53
|
| Rate for Payer: Cash Price |
$303.53
|
| Rate for Payer: Cigna of CA HMO |
$472.16
|
| Rate for Payer: Cigna of CA PPO |
$472.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.11
|
| Rate for Payer: Dignity Health Media |
$37.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.50
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$37.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$37.40
|
| Rate for Payer: Galaxy Health WC |
$573.34
|
| Rate for Payer: Global Benefits Group Commercial |
$404.71
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$505.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.34
|
| Rate for Payer: Heritage Provider Network Transplant |
$61.34
|
| Rate for Payer: IEHP Medi-Cal |
$60.60
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$60.60
|
| Rate for Payer: IEHP Medicare Advantage |
$37.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$449.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.12
|
| Rate for Payer: Multiplan Commercial |
$539.62
|
| Rate for Payer: Networks By Design Commercial |
$337.26
|
| Rate for Payer: Prime Health Services Commercial |
$573.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$404.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$404.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$337.26
|
| Rate for Payer: United Healthcare All Other HMO |
$337.26
|
| Rate for Payer: United Healthcare HMO Rider |
$337.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$337.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.15
|
| Rate for Payer: Vantage Medical Group Senior |
$37.40
|
|
|
RITUXIMAB 1,600 MG/13.4 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN [218821]
|
Facility
IP
|
$673.08
|
|
|
Service Code
|
CPT J9311
|
| Hospital Charge Code |
NDG218821
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$161.54 |
| Max. Negotiated Rate |
$572.12 |
| Rate for Payer: Blue Shield of California Commercial |
$479.23
|
| Rate for Payer: Blue Shield of California EPN |
$344.62
|
| Rate for Payer: Cash Price |
$302.89
|
| Rate for Payer: Cigna of CA HMO |
$471.16
|
| Rate for Payer: Cigna of CA PPO |
$471.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$269.23
|
| Rate for Payer: EPIC Health Plan Transplant |
$269.23
|
| Rate for Payer: Galaxy Health WC |
$572.12
|
| Rate for Payer: Global Benefits Group Commercial |
$403.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$448.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$256.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.54
|
| Rate for Payer: Multiplan Commercial |
$538.46
|
| Rate for Payer: Networks By Design Commercial |
$336.54
|
| Rate for Payer: Prime Health Services Commercial |
$572.12
|
|
|
RITUXIMAB 1,600 MG/13.4 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN [218821]
|
Facility
OP
|
$673.08
|
|
|
Service Code
|
CPT J9311
|
| Hospital Charge Code |
NDG218821
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$572.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$73.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$46.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$41.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$41.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.16
|
| Rate for Payer: BCBS Transplant Transplant |
$403.85
|
| Rate for Payer: Blue Shield of California Commercial |
$496.06
|
| Rate for Payer: Blue Shield of California EPN |
$56.37
|
| Rate for Payer: Cash Price |
$302.89
|
| Rate for Payer: Cash Price |
$302.89
|
| Rate for Payer: Cigna of CA HMO |
$471.16
|
| Rate for Payer: Cigna of CA PPO |
$471.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.11
|
| Rate for Payer: Dignity Health Media |
$37.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.50
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$37.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$37.40
|
| Rate for Payer: Galaxy Health WC |
$572.12
|
| Rate for Payer: Global Benefits Group Commercial |
$403.85
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$504.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.34
|
| Rate for Payer: Heritage Provider Network Transplant |
$61.34
|
| Rate for Payer: IEHP Medi-Cal |
$60.60
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$60.60
|
| Rate for Payer: IEHP Medicare Advantage |
$37.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$448.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.12
|
| Rate for Payer: Multiplan Commercial |
$538.46
|
| Rate for Payer: Networks By Design Commercial |
$336.54
|
| Rate for Payer: Prime Health Services Commercial |
$572.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$403.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$403.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$336.54
|
| Rate for Payer: United Healthcare All Other HMO |
$336.54
|
| Rate for Payer: United Healthcare HMO Rider |
$336.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$336.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.15
|
| Rate for Payer: Vantage Medical Group Senior |
$37.40
|
|
|
RITUXIMAB-ARRX 10 MG/ML INTRAVENOUS SOLUTION [229898]
|
Facility
OP
|
$86.02
|
|
|
Service Code
|
CPT Q5123
|
| Hospital Charge Code |
NDG229898
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.64 |
| Max. Negotiated Rate |
$290.81 |
| Rate for Payer: Aetna of CA HMO/PPO |
$290.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$51.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$45.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$45.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$152.80
|
| Rate for Payer: BCBS Transplant Transplant |
$51.61
|
| Rate for Payer: Blue Shield of California Commercial |
$63.40
|
| Rate for Payer: Blue Shield of California EPN |
$50.24
|
| Rate for Payer: Cash Price |
$38.71
|
| Rate for Payer: Cash Price |
$38.71
|
| Rate for Payer: Cigna of CA HMO |
$60.21
|
| Rate for Payer: Cigna of CA PPO |
$60.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.77
|
| Rate for Payer: Dignity Health Media |
$45.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$41.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$41.42
|
| Rate for Payer: Galaxy Health WC |
$73.12
|
| Rate for Payer: Global Benefits Group Commercial |
$51.61
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$64.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.93
|
| Rate for Payer: Heritage Provider Network Transplant |
$67.93
|
| Rate for Payer: IEHP Medi-Cal |
$67.10
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$67.10
|
| Rate for Payer: IEHP Medicare Advantage |
$41.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$52.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55.50
|
| Rate for Payer: Multiplan Commercial |
$68.82
|
| Rate for Payer: Networks By Design Commercial |
$43.01
|
| Rate for Payer: Prime Health Services Commercial |
$73.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.01
|
| Rate for Payer: United Healthcare All Other HMO |
$43.01
|
| Rate for Payer: United Healthcare HMO Rider |
$43.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.56
|
| Rate for Payer: Vantage Medical Group Senior |
$45.56
|
|
|
RITUXIMAB-ARRX 10 MG/ML INTRAVENOUS SOLUTION [229898]
|
Facility
IP
|
$86.02
|
|
|
Service Code
|
CPT Q5123
|
| Hospital Charge Code |
NDG229898
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.64 |
| Max. Negotiated Rate |
$73.12 |
| Rate for Payer: Blue Shield of California Commercial |
$61.25
|
| Rate for Payer: Blue Shield of California EPN |
$44.04
|
| Rate for Payer: Cash Price |
$38.71
|
| Rate for Payer: Cigna of CA HMO |
$60.21
|
| Rate for Payer: Cigna of CA PPO |
$60.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$34.41
|
| Rate for Payer: Galaxy Health WC |
$73.12
|
| Rate for Payer: Global Benefits Group Commercial |
$51.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.64
|
| Rate for Payer: Multiplan Commercial |
$68.82
|
| Rate for Payer: Networks By Design Commercial |
$43.01
|
| Rate for Payer: Prime Health Services Commercial |
$73.12
|
|
|
RITUXIMAB-PVVR 10 MG/ML INTRAVENOUS SOLUTION [226878]
|
Facility
IP
|
$86.02
|
|
|
Service Code
|
CPT Q5119
|
| Hospital Charge Code |
NDG226878
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.64 |
| Max. Negotiated Rate |
$73.12 |
| Rate for Payer: Blue Shield of California Commercial |
$61.25
|
| Rate for Payer: Blue Shield of California EPN |
$44.04
|
| Rate for Payer: Cash Price |
$38.71
|
| Rate for Payer: Cigna of CA HMO |
$60.21
|
| Rate for Payer: Cigna of CA PPO |
$60.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$34.41
|
| Rate for Payer: Galaxy Health WC |
$73.12
|
| Rate for Payer: Global Benefits Group Commercial |
$51.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.64
|
| Rate for Payer: Multiplan Commercial |
$68.82
|
| Rate for Payer: Networks By Design Commercial |
$43.01
|
| Rate for Payer: Prime Health Services Commercial |
$73.12
|
|
