|
RITUXIMAB-PVVR 10 MG/ML INTRAVENOUS SOLUTION [226878]
|
Facility
OP
|
$86.02
|
|
|
Service Code
|
CPT Q5119
|
| Hospital Charge Code |
NDG22687A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.45 |
| Max. Negotiated Rate |
$152.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$128.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.49
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.49
|
| 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 |
$86.02
|
| 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 |
$25.56
|
| Rate for Payer: Dignity Health Media |
$22.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.60
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$20.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.45
|
| 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 |
$33.53
|
| Rate for Payer: Heritage Provider Network Transplant |
$33.53
|
| Rate for Payer: IEHP Medi-Cal |
$33.12
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$33.12
|
| Rate for Payer: IEHP Medicare Advantage |
$20.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.40
|
| 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 |
$25.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.49
|
| Rate for Payer: Vantage Medical Group Senior |
$22.49
|
|
|
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
|
|
|
RITUXIMAB-PVVR 10 MG/ML INTRAVENOUS SOLUTION [226878]
|
Facility
IP
|
$86.02
|
|
|
Service Code
|
CPT Q5119
|
| Hospital Charge Code |
NDG22687A
|
|
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
|
|
|
RIVAROXABAN 10 MG TABLET [153876]
|
Facility
IP
|
$21.70
|
|
|
Service Code
|
NDC 50458-580-30
|
| Hospital Charge Code |
1712514
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$18.44 |
| Rate for Payer: Blue Shield of California Commercial |
$15.45
|
| Rate for Payer: Blue Shield of California EPN |
$11.11
|
| Rate for Payer: Cash Price |
$9.77
|
| Rate for Payer: Cigna of CA HMO |
$15.19
|
| Rate for Payer: Cigna of CA PPO |
$15.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.68
|
| Rate for Payer: Galaxy Health WC |
$18.44
|
| Rate for Payer: Global Benefits Group Commercial |
$13.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.21
|
| Rate for Payer: Multiplan Commercial |
$17.36
|
| Rate for Payer: Networks By Design Commercial |
$14.10
|
| Rate for Payer: Prime Health Services Commercial |
$18.44
|
|
|
RIVAROXABAN 10 MG TABLET [153876]
|
Facility
OP
|
$21.70
|
|
|
Service Code
|
NDC 50458-580-30
|
| Hospital Charge Code |
1712514
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$18.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.94
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.93
|
| Rate for Payer: BCBS Transplant Transplant |
$13.02
|
| Rate for Payer: Blue Shield of California Commercial |
$15.99
|
| Rate for Payer: Blue Shield of California EPN |
$12.67
|
| Rate for Payer: Cash Price |
$9.77
|
| Rate for Payer: Cigna of CA HMO |
$15.19
|
| Rate for Payer: Cigna of CA PPO |
$15.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.44
|
| Rate for Payer: Dignity Health Media |
$18.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.68
|
| Rate for Payer: Galaxy Health WC |
$18.44
|
| Rate for Payer: Global Benefits Group Commercial |
$13.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$16.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.21
|
| Rate for Payer: Multiplan Commercial |
$17.36
|
| Rate for Payer: Networks By Design Commercial |
$14.10
|
| Rate for Payer: Prime Health Services Commercial |
$18.44
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$13.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.85
|
| Rate for Payer: United Healthcare All Other HMO |
$10.85
|
| Rate for Payer: United Healthcare HMO Rider |
$10.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.44
|
| Rate for Payer: Vantage Medical Group Senior |
$18.44
|
|
|
RIVAROXABAN 15 MG TABLET [153877]
|
Facility
OP
|
$21.70
|
|
|
Service Code
|
NDC 50458-578-10
|
| Hospital Charge Code |
1712515
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$18.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.94
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.93
|
| Rate for Payer: BCBS Transplant Transplant |
$13.02
|
| Rate for Payer: Blue Shield of California Commercial |
$15.99
|
| Rate for Payer: Blue Shield of California EPN |
$12.67
|
| Rate for Payer: Cash Price |
$9.77
|
| Rate for Payer: Cigna of CA HMO |
$15.19
|
| Rate for Payer: Cigna of CA PPO |
$15.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.44
|
| Rate for Payer: Dignity Health Media |
$18.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.68
|
| Rate for Payer: Galaxy Health WC |
$18.44
|
| Rate for Payer: Global Benefits Group Commercial |
$13.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$16.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.21
|
| Rate for Payer: Multiplan Commercial |
$17.36
|
| Rate for Payer: Networks By Design Commercial |
$14.10
|
| Rate for Payer: Prime Health Services Commercial |
$18.44
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$13.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.85
|
| Rate for Payer: United Healthcare All Other HMO |
$10.85
|
| Rate for Payer: United Healthcare HMO Rider |
$10.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.44
|
| Rate for Payer: Vantage Medical Group Senior |
$18.44
|
|
|
RIVAROXABAN 15 MG TABLET [153877]
|
Facility
IP
|
$21.70
|
|
|
Service Code
|
NDC 50458-578-10
|
| Hospital Charge Code |
1712515
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$18.44 |
| Rate for Payer: Blue Shield of California Commercial |
$15.45
|
| Rate for Payer: Blue Shield of California EPN |
$11.11
|
| Rate for Payer: Cash Price |
$9.77
|
| Rate for Payer: Cigna of CA HMO |
$15.19
|
| Rate for Payer: Cigna of CA PPO |
$15.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.68
|
| Rate for Payer: Galaxy Health WC |
$18.44
|
| Rate for Payer: Global Benefits Group Commercial |
$13.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.21
|
| Rate for Payer: Multiplan Commercial |
$17.36
|
| Rate for Payer: Networks By Design Commercial |
$14.10
|
| Rate for Payer: Prime Health Services Commercial |
$18.44
|
|
|
RIVAROXABAN 15 MG TABLET [153877]
|
Facility
IP
|
$21.70
|
|
|
Service Code
|
NDC 50458-578-01
|
| Hospital Charge Code |
1712515
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$18.44 |
| Rate for Payer: Blue Shield of California Commercial |
$15.45
|
| Rate for Payer: Blue Shield of California EPN |
$11.11
|
| Rate for Payer: Cash Price |
$9.77
|
| Rate for Payer: Cigna of CA HMO |
$15.19
|
| Rate for Payer: Cigna of CA PPO |
$15.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.68
|
| Rate for Payer: Galaxy Health WC |
$18.44
|
| Rate for Payer: Global Benefits Group Commercial |
$13.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.21
|
| Rate for Payer: Multiplan Commercial |
$17.36
|
| Rate for Payer: Networks By Design Commercial |
$14.10
|
| Rate for Payer: Prime Health Services Commercial |
$18.44
|
|
|
RIVAROXABAN 15 MG TABLET [153877]
|
Facility
OP
|
$21.70
|
|
|
Service Code
|
NDC 50458-578-01
|
| Hospital Charge Code |
1712515
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$18.44 |
| Rate for Payer: BCBS Transplant Transplant |
$13.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.94
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.93
|
| Rate for Payer: Blue Shield of California Commercial |
$15.99
|
| Rate for Payer: Blue Shield of California EPN |
$12.67
|
| Rate for Payer: Cash Price |
$9.77
|
| Rate for Payer: Cigna of CA HMO |
$15.19
|
| Rate for Payer: Cigna of CA PPO |
$15.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.44
|
| Rate for Payer: Dignity Health Media |
$18.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.68
|
| Rate for Payer: Galaxy Health WC |
$18.44
|
| Rate for Payer: Global Benefits Group Commercial |
$13.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$16.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.21
|
| Rate for Payer: Multiplan Commercial |
$17.36
|
| Rate for Payer: Networks By Design Commercial |
$14.10
|
| Rate for Payer: Prime Health Services Commercial |
$18.44
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$13.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.85
|
| Rate for Payer: United Healthcare All Other HMO |
$10.85
|
| Rate for Payer: United Healthcare HMO Rider |
$10.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.44
|
| Rate for Payer: Vantage Medical Group Senior |
$18.44
|
|
|
RIVAROXABAN 20 MG TABLET [153878]
|
Facility
OP
|
$21.70
|
|
|
Service Code
|
NDC 50458-579-30
|
| Hospital Charge Code |
1712516
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$18.44 |
| Rate for Payer: Galaxy Health WC |
$18.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.94
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.93
|
| Rate for Payer: BCBS Transplant Transplant |
$13.02
|
| Rate for Payer: Blue Shield of California Commercial |
$15.99
|
| Rate for Payer: Blue Shield of California EPN |
$12.67
|
| Rate for Payer: Cash Price |
$9.77
|
| Rate for Payer: Cigna of CA HMO |
$15.19
|
| Rate for Payer: Cigna of CA PPO |
$15.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.44
|
| Rate for Payer: Dignity Health Media |
$18.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.68
|
| Rate for Payer: Global Benefits Group Commercial |
$13.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$16.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.21
|
| Rate for Payer: Multiplan Commercial |
$17.36
|
| Rate for Payer: Networks By Design Commercial |
$14.10
|
| Rate for Payer: Prime Health Services Commercial |
$18.44
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$13.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.85
|
| Rate for Payer: United Healthcare All Other HMO |
$10.85
|
| Rate for Payer: United Healthcare HMO Rider |
$10.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.44
|
| Rate for Payer: Vantage Medical Group Senior |
$18.44
|
|
|
RIVAROXABAN 20 MG TABLET [153878]
|
Facility
IP
|
$21.70
|
|
|
Service Code
|
NDC 50458-579-10
|
| Hospital Charge Code |
1712516
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$18.44 |
| Rate for Payer: Blue Shield of California Commercial |
$15.45
|
| Rate for Payer: Blue Shield of California EPN |
$11.11
|
| Rate for Payer: Cash Price |
$9.77
|
| Rate for Payer: Cigna of CA HMO |
$15.19
|
| Rate for Payer: Cigna of CA PPO |
$15.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.68
|
| Rate for Payer: Galaxy Health WC |
$18.44
|
| Rate for Payer: Global Benefits Group Commercial |
$13.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.21
|
| Rate for Payer: Multiplan Commercial |
$17.36
|
| Rate for Payer: Networks By Design Commercial |
$14.10
|
| Rate for Payer: Prime Health Services Commercial |
$18.44
|
|
|
RIVAROXABAN 20 MG TABLET [153878]
|
Facility
IP
|
$21.70
|
|
|
Service Code
|
NDC 50458-579-30
|
| Hospital Charge Code |
1712516
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$18.44 |
| Rate for Payer: Blue Shield of California Commercial |
$15.45
|
| Rate for Payer: Blue Shield of California EPN |
$11.11
|
| Rate for Payer: Cash Price |
$9.77
|
| Rate for Payer: Cigna of CA HMO |
$15.19
|
| Rate for Payer: Cigna of CA PPO |
$15.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.68
|
| Rate for Payer: Galaxy Health WC |
$18.44
|
| Rate for Payer: Global Benefits Group Commercial |
$13.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.21
|
| Rate for Payer: Multiplan Commercial |
$17.36
|
| Rate for Payer: Networks By Design Commercial |
$14.10
|
| Rate for Payer: Prime Health Services Commercial |
$18.44
|
|
|
RIVAROXABAN 20 MG TABLET [153878]
|
Facility
OP
|
$21.70
|
|
|
Service Code
|
NDC 50458-579-10
|
| Hospital Charge Code |
1712516
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$18.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.94
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.93
|
| Rate for Payer: BCBS Transplant Transplant |
$13.02
|
| Rate for Payer: Blue Shield of California Commercial |
$15.99
|
| Rate for Payer: Blue Shield of California EPN |
$12.67
|
| Rate for Payer: Cash Price |
$9.77
|
| Rate for Payer: Cigna of CA HMO |
$15.19
|
| Rate for Payer: Cigna of CA PPO |
$15.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.44
|
| Rate for Payer: Dignity Health Media |
$18.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.68
|
| Rate for Payer: Galaxy Health WC |
$18.44
|
| Rate for Payer: Global Benefits Group Commercial |
$13.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$16.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.21
|
| Rate for Payer: Multiplan Commercial |
$17.36
|
| Rate for Payer: Networks By Design Commercial |
$14.10
|
| Rate for Payer: Prime Health Services Commercial |
$18.44
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$13.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.85
|
| Rate for Payer: United Healthcare All Other HMO |
$10.85
|
| Rate for Payer: United Healthcare HMO Rider |
$10.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.44
|
| Rate for Payer: Vantage Medical Group Senior |
$18.44
|
|
|
RIVAROXABAN 2.5 MG TABLET [222768]
|
Facility
OP
|
$10.85
|
|
|
Service Code
|
NDC 50458-577-60
|
| Hospital Charge Code |
ERX222768
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$9.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.97
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.46
|
| Rate for Payer: BCBS Transplant Transplant |
$6.51
|
| Rate for Payer: Blue Shield of California Commercial |
$8.00
|
| Rate for Payer: Blue Shield of California EPN |
$6.34
|
| Rate for Payer: Cash Price |
$4.88
|
| Rate for Payer: Cigna of CA HMO |
$7.60
|
| Rate for Payer: Cigna of CA PPO |
$7.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.22
|
| Rate for Payer: Dignity Health Media |
$9.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.34
|
| Rate for Payer: Galaxy Health WC |
$9.22
|
| Rate for Payer: Global Benefits Group Commercial |
$6.51
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.60
|
| Rate for Payer: Multiplan Commercial |
$8.68
|
| Rate for Payer: Networks By Design Commercial |
$7.05
|
| Rate for Payer: Prime Health Services Commercial |
$9.22
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.42
|
| Rate for Payer: United Healthcare All Other HMO |
$5.42
|
| Rate for Payer: United Healthcare HMO Rider |
$5.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.22
|
| Rate for Payer: Vantage Medical Group Senior |
$9.22
|
|
|
RIVAROXABAN 2.5 MG TABLET [222768]
|
Facility
IP
|
$10.85
|
|
|
Service Code
|
NDC 50458-577-60
|
| Hospital Charge Code |
ERX222768
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$9.22 |
| Rate for Payer: Blue Shield of California Commercial |
$7.73
|
| Rate for Payer: Blue Shield of California EPN |
$5.56
|
| Rate for Payer: Cash Price |
$4.88
|
| Rate for Payer: Cigna of CA HMO |
$7.60
|
| Rate for Payer: Cigna of CA PPO |
$7.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.34
|
| Rate for Payer: Galaxy Health WC |
$9.22
|
| Rate for Payer: Global Benefits Group Commercial |
$6.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.60
|
| Rate for Payer: Multiplan Commercial |
$8.68
|
| Rate for Payer: Networks By Design Commercial |
$7.05
|
| Rate for Payer: Prime Health Services Commercial |
$9.22
|
|
|
RIVASTIGMINE 1.5 MG CAPSULE [28278]
|
Facility
IP
|
$1.25
|
|
|
Service Code
|
NDC 51991-793-06
|
| Hospital Charge Code |
1711861
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.06 |
| Rate for Payer: Blue Shield of California Commercial |
$0.89
|
| Rate for Payer: Blue Shield of California EPN |
$0.64
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: Cigna of CA HMO |
$0.88
|
| Rate for Payer: Cigna of CA PPO |
$0.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
| Rate for Payer: Galaxy Health WC |
$1.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$1.00
|
| Rate for Payer: Networks By Design Commercial |
$0.81
|
| Rate for Payer: Prime Health Services Commercial |
$1.06
|
|
|
RIVASTIGMINE 1.5 MG CAPSULE [28278]
|
Facility
OP
|
$1.25
|
|
|
Service Code
|
NDC 51991-793-06
|
| Hospital Charge Code |
1711861
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.74
|
| Rate for Payer: BCBS Transplant Transplant |
$0.75
|
| Rate for Payer: Blue Shield of California Commercial |
$0.92
|
| Rate for Payer: Blue Shield of California EPN |
$0.73
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: Cigna of CA HMO |
$0.88
|
| Rate for Payer: Cigna of CA PPO |
$0.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.06
|
| Rate for Payer: Dignity Health Media |
$1.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.50
|
| Rate for Payer: Galaxy Health WC |
$1.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.75
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$1.00
|
| Rate for Payer: Networks By Design Commercial |
$0.81
|
| Rate for Payer: Prime Health Services Commercial |
$1.06
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.63
|
| Rate for Payer: United Healthcare All Other HMO |
$0.63
|
| Rate for Payer: United Healthcare HMO Rider |
$0.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.06
|
| Rate for Payer: Vantage Medical Group Senior |
$1.06
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
OP
|
$5.10
|
|
|
Service Code
|
NDC 70710-1196-7
|
| Hospital Charge Code |
1712347
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$4.34 |
| Rate for Payer: Galaxy Health WC |
$4.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.04
|
| Rate for Payer: BCBS Transplant Transplant |
$3.06
|
| Rate for Payer: Blue Shield of California Commercial |
$3.76
|
| Rate for Payer: Blue Shield of California EPN |
$2.98
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna of CA HMO |
$3.57
|
| Rate for Payer: Cigna of CA PPO |
$3.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.34
|
| Rate for Payer: Dignity Health Media |
$4.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.04
|
| Rate for Payer: Global Benefits Group Commercial |
$3.06
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.22
|
| Rate for Payer: Multiplan Commercial |
$4.08
|
| Rate for Payer: Networks By Design Commercial |
$3.32
|
| Rate for Payer: Prime Health Services Commercial |
$4.34
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.55
|
| Rate for Payer: United Healthcare All Other HMO |
$2.55
|
| Rate for Payer: United Healthcare HMO Rider |
$2.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Vantage Medical Group Senior |
$4.34
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
OP
|
$5.10
|
|
|
Service Code
|
NDC 70710-1196-1
|
| Hospital Charge Code |
1712347
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$4.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.04
|
| Rate for Payer: BCBS Transplant Transplant |
$3.06
|
| Rate for Payer: Blue Shield of California Commercial |
$3.76
|
| Rate for Payer: Blue Shield of California EPN |
$2.98
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna of CA HMO |
$3.57
|
| Rate for Payer: Cigna of CA PPO |
$3.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.34
|
| Rate for Payer: Dignity Health Media |
$4.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.04
|
| Rate for Payer: Galaxy Health WC |
$4.34
|
| Rate for Payer: Global Benefits Group Commercial |
$3.06
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.22
|
| Rate for Payer: Multiplan Commercial |
$4.08
|
| Rate for Payer: Networks By Design Commercial |
$3.32
|
| Rate for Payer: Prime Health Services Commercial |
$4.34
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.55
|
| Rate for Payer: United Healthcare All Other HMO |
$2.55
|
| Rate for Payer: United Healthcare HMO Rider |
$2.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Vantage Medical Group Senior |
$4.34
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
OP
|
$16.22
|
|
|
Service Code
|
NDC 0781-7304-58
|
| Hospital Charge Code |
1712347
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$13.79 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.79
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.66
|
| Rate for Payer: BCBS Transplant Transplant |
$9.73
|
| Rate for Payer: Blue Shield of California Commercial |
$11.95
|
| Rate for Payer: Blue Shield of California EPN |
$9.47
|
| Rate for Payer: Cash Price |
$7.30
|
| Rate for Payer: Cigna of CA HMO |
$11.35
|
| Rate for Payer: Cigna of CA PPO |
$11.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.79
|
| Rate for Payer: Dignity Health Media |
$13.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.49
|
| Rate for Payer: Galaxy Health WC |
$13.79
|
| Rate for Payer: Global Benefits Group Commercial |
$9.73
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.89
|
| Rate for Payer: Multiplan Commercial |
$12.98
|
| Rate for Payer: Networks By Design Commercial |
$10.54
|
| Rate for Payer: Prime Health Services Commercial |
$13.79
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.11
|
| Rate for Payer: United Healthcare All Other HMO |
$8.11
|
| Rate for Payer: United Healthcare HMO Rider |
$8.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.79
|
| Rate for Payer: Vantage Medical Group Senior |
$13.79
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
IP
|
$16.22
|
|
|
Service Code
|
NDC 0781-7304-31
|
| Hospital Charge Code |
1712347
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$13.79 |
| Rate for Payer: Blue Shield of California Commercial |
$11.55
|
| Rate for Payer: Blue Shield of California EPN |
$8.30
|
| Rate for Payer: Cash Price |
$7.30
|
| Rate for Payer: Cigna of CA HMO |
$11.35
|
| Rate for Payer: Cigna of CA PPO |
$11.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.49
|
| Rate for Payer: Galaxy Health WC |
$13.79
|
| Rate for Payer: Global Benefits Group Commercial |
$9.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.89
|
| Rate for Payer: Multiplan Commercial |
$12.98
|
| Rate for Payer: Networks By Design Commercial |
$10.54
|
| Rate for Payer: Prime Health Services Commercial |
$13.79
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
OP
|
$16.22
|
|
|
Service Code
|
NDC 0781-7304-31
|
| Hospital Charge Code |
1712347
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$13.79 |
| Rate for Payer: BCBS Transplant Transplant |
$9.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.79
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.66
|
| Rate for Payer: Blue Shield of California Commercial |
$11.95
|
| Rate for Payer: Blue Shield of California EPN |
$9.47
|
| Rate for Payer: Cash Price |
$7.30
|
| Rate for Payer: Cigna of CA HMO |
$11.35
|
| Rate for Payer: Cigna of CA PPO |
$11.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.79
|
| Rate for Payer: Dignity Health Media |
$13.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.49
|
| Rate for Payer: Galaxy Health WC |
$13.79
|
| Rate for Payer: Global Benefits Group Commercial |
$9.73
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.89
|
| Rate for Payer: Multiplan Commercial |
$12.98
|
| Rate for Payer: Networks By Design Commercial |
$10.54
|
| Rate for Payer: Prime Health Services Commercial |
$13.79
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.11
|
| Rate for Payer: United Healthcare All Other HMO |
$8.11
|
| Rate for Payer: United Healthcare HMO Rider |
$8.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.79
|
| Rate for Payer: Vantage Medical Group Senior |
$13.79
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
OP
|
$2.00
|
|
|
Service Code
|
NDC 0378-9070-93
|
| Hospital Charge Code |
1712347
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.19
|
| Rate for Payer: BCBS Transplant Transplant |
$1.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1.47
|
| Rate for Payer: Blue Shield of California EPN |
$1.17
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.70
|
| Rate for Payer: Dignity Health Media |
$1.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.30
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1.70
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
IP
|
$2.00
|
|
|
Service Code
|
NDC 0378-9070-16
|
| Hospital Charge Code |
1712347
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Blue Shield of California Commercial |
$1.42
|
| Rate for Payer: Blue Shield of California EPN |
$1.02
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.30
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
IP
|
$16.22
|
|
|
Service Code
|
NDC 0781-7304-58
|
| Hospital Charge Code |
1712347
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$13.79 |
| Rate for Payer: Blue Shield of California Commercial |
$11.55
|
| Rate for Payer: Blue Shield of California EPN |
$8.30
|
| Rate for Payer: Cash Price |
$7.30
|
| Rate for Payer: Cigna of CA HMO |
$11.35
|
| Rate for Payer: Cigna of CA PPO |
$11.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.49
|
| Rate for Payer: Galaxy Health WC |
$13.79
|
| Rate for Payer: Global Benefits Group Commercial |
$9.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.89
|
| Rate for Payer: Multiplan Commercial |
$12.98
|
| Rate for Payer: Networks By Design Commercial |
$10.54
|
| Rate for Payer: Prime Health Services Commercial |
$13.79
|
|
