|
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
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
IP
|
$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: 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
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
|
|
|
RIZATRIPTAN 10 MG DISINTEGRATING TABLET [27630]
|
Facility
OP
|
$1.95
|
|
|
Service Code
|
NDC 68462-468-06
|
| Hospital Charge Code |
ERX27630
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$1.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: BCBS Transplant Transplant |
$1.17
|
| Rate for Payer: Blue Shield of California Commercial |
$1.44
|
| Rate for Payer: Blue Shield of California EPN |
$1.14
|
| Rate for Payer: Cash Price |
$0.88
|
| Rate for Payer: Cigna of CA HMO |
$1.36
|
| Rate for Payer: Cigna of CA PPO |
$1.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.66
|
| Rate for Payer: Dignity Health Media |
$1.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.78
|
| Rate for Payer: Galaxy Health WC |
$1.66
|
| Rate for Payer: Global Benefits Group Commercial |
$1.17
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.47
|
| Rate for Payer: Multiplan Commercial |
$1.56
|
| Rate for Payer: Networks By Design Commercial |
$1.27
|
| Rate for Payer: Prime Health Services Commercial |
$1.66
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.98
|
| Rate for Payer: United Healthcare All Other HMO |
$0.98
|
| Rate for Payer: United Healthcare HMO Rider |
$0.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.66
|
| Rate for Payer: Vantage Medical Group Senior |
$1.66
|
|
|
RIZATRIPTAN 10 MG DISINTEGRATING TABLET [27630]
|
Facility
IP
|
$1.95
|
|
|
Service Code
|
NDC 68462-468-06
|
| Hospital Charge Code |
ERX27630
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$1.66 |
| Rate for Payer: Blue Shield of California Commercial |
$1.39
|
| Rate for Payer: Blue Shield of California EPN |
$1.00
|
| Rate for Payer: Cash Price |
$0.88
|
| Rate for Payer: Cigna of CA HMO |
$1.36
|
| Rate for Payer: Cigna of CA PPO |
$1.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.78
|
| Rate for Payer: Galaxy Health WC |
$1.66
|
| Rate for Payer: Global Benefits Group Commercial |
$1.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.47
|
| Rate for Payer: Multiplan Commercial |
$1.56
|
| Rate for Payer: Networks By Design Commercial |
$1.27
|
| Rate for Payer: Prime Health Services Commercial |
$1.66
|
|
|
RIZATRIPTAN 10 MG TABLET [23377]
|
Facility
IP
|
$1.80
|
|
|
Service Code
|
NDC 0093-7472-19
|
| Hospital Charge Code |
1712228
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.53 |
| Rate for Payer: Blue Shield of California Commercial |
$1.28
|
| Rate for Payer: Blue Shield of California EPN |
$0.92
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cigna of CA HMO |
$1.26
|
| Rate for Payer: Cigna of CA PPO |
$1.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$1.53
|
| Rate for Payer: Global Benefits Group Commercial |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$1.44
|
| Rate for Payer: Networks By Design Commercial |
$1.17
|
| Rate for Payer: Prime Health Services Commercial |
$1.53
|
|
|
RIZATRIPTAN 10 MG TABLET [23377]
|
Facility
IP
|
$1.19
|
|
|
Service Code
|
NDC 57237-088-63
|
| Hospital Charge Code |
1712228
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.01 |
| Rate for Payer: Blue Shield of California Commercial |
$0.85
|
| Rate for Payer: Blue Shield of California EPN |
$0.61
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cigna of CA HMO |
$0.83
|
| Rate for Payer: Cigna of CA PPO |
$0.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.95
|
| Rate for Payer: Networks By Design Commercial |
$0.77
|
| Rate for Payer: Prime Health Services Commercial |
$1.01
|
|
|
RIZATRIPTAN 10 MG TABLET [23377]
|
Facility
OP
|
$1.80
|
|
|
Service Code
|
NDC 0093-7472-19
|
| Hospital Charge Code |
1712228
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.07
|
| Rate for Payer: BCBS Transplant Transplant |
$1.08
|
| Rate for Payer: Blue Shield of California Commercial |
$1.33
|
| Rate for Payer: Blue Shield of California EPN |
$1.05
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cigna of CA HMO |
$1.26
|
| Rate for Payer: Cigna of CA PPO |
$1.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.53
|
| Rate for Payer: Dignity Health Media |
$1.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$1.53
|
| Rate for Payer: Global Benefits Group Commercial |
$1.08
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$1.44
|
| Rate for Payer: Networks By Design Commercial |
$1.17
|
| Rate for Payer: Prime Health Services Commercial |
$1.53
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.90
|
| Rate for Payer: United Healthcare All Other HMO |
$0.90
|
| Rate for Payer: United Healthcare HMO Rider |
$0.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1.53
|
|
|
RIZATRIPTAN 10 MG TABLET [23377]
|
Facility
OP
|
$1.19
|
|
|
Service Code
|
NDC 57237-088-63
|
| Hospital Charge Code |
1712228
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.71
|
| Rate for Payer: BCBS Transplant Transplant |
$0.71
|
| Rate for Payer: Blue Shield of California Commercial |
$0.88
|
| Rate for Payer: Blue Shield of California EPN |
$0.69
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cigna of CA HMO |
$0.83
|
| Rate for Payer: Cigna of CA PPO |
$0.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.01
|
| Rate for Payer: Dignity Health Media |
$1.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.71
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.95
|
| Rate for Payer: Networks By Design Commercial |
$0.77
|
| Rate for Payer: Prime Health Services Commercial |
$1.01
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.60
|
| Rate for Payer: United Healthcare All Other HMO |
$0.60
|
| Rate for Payer: United Healthcare HMO Rider |
$0.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.01
|
| Rate for Payer: Vantage Medical Group Senior |
$1.01
|
|
|
RIZATRIPTAN 5 MG TABLET [23376]
|
Facility
OP
|
$1.44
|
|
|
Service Code
|
NDC 68462-465-99
|
| Hospital Charge Code |
1712622
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.86
|
| Rate for Payer: BCBS Transplant Transplant |
$0.86
|
| Rate for Payer: Blue Shield of California Commercial |
$1.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.84
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Cigna of CA HMO |
$1.01
|
| Rate for Payer: Cigna of CA PPO |
$1.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.22
|
| Rate for Payer: Dignity Health Media |
$1.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.15
|
| Rate for Payer: Networks By Design Commercial |
$0.94
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.72
|
| Rate for Payer: United Healthcare All Other HMO |
$0.72
|
| Rate for Payer: United Healthcare HMO Rider |
$0.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.22
|
| Rate for Payer: Vantage Medical Group Senior |
$1.22
|
|
|
RIZATRIPTAN 5 MG TABLET [23376]
|
Facility
IP
|
$1.44
|
|
|
Service Code
|
NDC 68462-465-40
|
| Hospital Charge Code |
1712622
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Blue Shield of California Commercial |
$1.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.74
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Cigna of CA HMO |
$1.01
|
| Rate for Payer: Cigna of CA PPO |
$1.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.15
|
| Rate for Payer: Networks By Design Commercial |
$0.94
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
|
|
RIZATRIPTAN 5 MG TABLET [23376]
|
Facility
IP
|
$1.44
|
|
|
Service Code
|
NDC 68462-465-99
|
| Hospital Charge Code |
1712622
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Blue Shield of California Commercial |
$1.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.74
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Cigna of CA HMO |
$1.01
|
| Rate for Payer: Cigna of CA PPO |
$1.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.15
|
| Rate for Payer: Networks By Design Commercial |
$0.94
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
|
|
RIZATRIPTAN 5 MG TABLET [23376]
|
Facility
OP
|
$1.44
|
|
|
Service Code
|
NDC 68462-465-40
|
| Hospital Charge Code |
1712622
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.86
|
| Rate for Payer: BCBS Transplant Transplant |
$0.86
|
| Rate for Payer: Blue Shield of California Commercial |
$1.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.84
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Cigna of CA HMO |
$1.01
|
| Rate for Payer: Cigna of CA PPO |
$1.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.22
|
| Rate for Payer: Dignity Health Media |
$1.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.15
|
| Rate for Payer: Networks By Design Commercial |
$0.94
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.72
|
| Rate for Payer: United Healthcare All Other HMO |
$0.72
|
| Rate for Payer: United Healthcare HMO Rider |
$0.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.22
|
| Rate for Payer: Vantage Medical Group Senior |
$1.22
|
|
|
ROCURONIUM 50 MG/5 ML VIAL- CODE [40895812]
|
Facility
IP
|
$1.16
|
|
|
Service Code
|
NDC 67457-228-05
|
| Hospital Charge Code |
1722005
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Blue Shield of California Commercial |
$0.83
|
| Rate for Payer: Blue Shield of California EPN |
$0.59
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: Galaxy Health WC |
$0.99
|
| Rate for Payer: Global Benefits Group Commercial |
$0.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: Networks By Design Commercial |
$0.75
|
| Rate for Payer: Prime Health Services Commercial |
$0.99
|
|
|
ROCURONIUM 50 MG/5 ML VIAL- CODE [40895812]
|
Facility
OP
|
$1.16
|
|
|
Service Code
|
NDC 67457-228-05
|
| Hospital Charge Code |
1722005
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Cigna of CA HMO |
$0.74
|
| Rate for Payer: Cigna of CA PPO |
$0.86
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.99
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.69
|
| Rate for Payer: BCBS Transplant Transplant |
$0.70
|
| Rate for Payer: Blue Shield of California Commercial |
$0.85
|
| Rate for Payer: Blue Shield of California EPN |
$0.68
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.99
|
| Rate for Payer: Dignity Health Media |
$0.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.46
|
| Rate for Payer: Galaxy Health WC |
$0.99
|
| Rate for Payer: Global Benefits Group Commercial |
$0.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: Networks By Design Commercial |
$0.75
|
| Rate for Payer: Prime Health Services Commercial |
$0.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.58
|
| Rate for Payer: United Healthcare All Other HMO |
$0.58
|
| Rate for Payer: United Healthcare HMO Rider |
$0.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: Vantage Medical Group Senior |
$0.99
|
|
|
ROFLUMILAST 500 MCG TABLET [109401]
|
Facility
OP
|
$17.24
|
|
|
Service Code
|
NDC 0310-0095-30
|
| Hospital Charge Code |
ERX109401
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$14.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.27
|
| Rate for Payer: BCBS Transplant Transplant |
$10.34
|
| Rate for Payer: Blue Shield of California Commercial |
$12.71
|
| Rate for Payer: Blue Shield of California EPN |
$10.07
|
| Rate for Payer: Cash Price |
$7.76
|
| Rate for Payer: Cigna of CA HMO |
$12.07
|
| Rate for Payer: Cigna of CA PPO |
$12.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.65
|
| Rate for Payer: Dignity Health Media |
$14.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.90
|
| Rate for Payer: Galaxy Health WC |
$14.65
|
| Rate for Payer: Global Benefits Group Commercial |
$10.34
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.14
|
| Rate for Payer: Multiplan Commercial |
$13.79
|
| Rate for Payer: Networks By Design Commercial |
$11.21
|
| Rate for Payer: Prime Health Services Commercial |
$14.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.62
|
| Rate for Payer: United Healthcare All Other HMO |
$8.62
|
| Rate for Payer: United Healthcare HMO Rider |
$8.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.65
|
| Rate for Payer: Vantage Medical Group Senior |
$14.65
|
|
|
ROFLUMILAST 500 MCG TABLET [109401]
|
Facility
IP
|
$0.72
|
|
|
Service Code
|
NDC 72205-200-30
|
| Hospital Charge Code |
ERX109401
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Blue Shield of California Commercial |
$0.51
|
| Rate for Payer: Blue Shield of California EPN |
$0.37
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.61
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.58
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.61
|
|
|
ROFLUMILAST 500 MCG TABLET [109401]
|
Facility
OP
|
$0.72
|
|
|
Service Code
|
NDC 72205-200-30
|
| Hospital Charge Code |
ERX109401
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.61
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.43
|
| Rate for Payer: BCBS Transplant Transplant |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$0.53
|
| Rate for Payer: Blue Shield of California EPN |
$0.42
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.61
|
| Rate for Payer: Dignity Health Media |
$0.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.61
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.58
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.61
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.36
|
| Rate for Payer: United Healthcare All Other HMO |
$0.36
|
| Rate for Payer: United Healthcare HMO Rider |
$0.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.61
|
| Rate for Payer: Vantage Medical Group Senior |
$0.61
|
|
|
ROFLUMILAST 500 MCG TABLET [109401]
|
Facility
IP
|
$17.24
|
|
|
Service Code
|
NDC 0310-0095-30
|
| Hospital Charge Code |
ERX109401
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$14.65 |
| Rate for Payer: Blue Shield of California Commercial |
$12.27
|
| Rate for Payer: Blue Shield of California EPN |
$8.83
|
| Rate for Payer: Cash Price |
$7.76
|
| Rate for Payer: Cigna of CA HMO |
$12.07
|
| Rate for Payer: Cigna of CA PPO |
$12.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.90
|
| Rate for Payer: Galaxy Health WC |
$14.65
|
| Rate for Payer: Global Benefits Group Commercial |
$10.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.14
|
| Rate for Payer: Multiplan Commercial |
$13.79
|
| Rate for Payer: Networks By Design Commercial |
$11.21
|
| Rate for Payer: Prime Health Services Commercial |
$14.65
|
|
|
ROMIDEPSIN 10 MG/2 ML INTRAVENOUS POWDER FOR SOLUTION [100344]
|
Facility
IP
|
$3,838.38
|
|
|
Service Code
|
CPT J9319
|
| Hospital Charge Code |
ERX100344
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$921.21 |
| Max. Negotiated Rate |
$3,262.62 |
| Rate for Payer: Blue Shield of California Commercial |
$2,732.93
|
| Rate for Payer: Blue Shield of California EPN |
$1,965.25
|
| Rate for Payer: Cash Price |
$1,727.27
|
| Rate for Payer: Cigna of CA HMO |
$2,686.87
|
| Rate for Payer: Cigna of CA PPO |
$2,686.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,535.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,535.35
|
| Rate for Payer: Galaxy Health WC |
$3,262.62
|
| Rate for Payer: Global Benefits Group Commercial |
$2,303.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,560.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,462.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$921.21
|
| Rate for Payer: Multiplan Commercial |
$3,070.70
|
| Rate for Payer: Networks By Design Commercial |
$1,919.19
|
| Rate for Payer: Prime Health Services Commercial |
$3,262.62
|
|
|
ROMIDEPSIN 10 MG/2 ML INTRAVENOUS POWDER FOR SOLUTION [100344]
|
Facility
OP
|
$3,838.38
|
|
|
Service Code
|
CPT J9319
|
| Hospital Charge Code |
ERX100344
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.96 |
| Max. Negotiated Rate |
$3,262.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$201.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$39.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$35.16
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$35.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.11
|
| Rate for Payer: BCBS Transplant Transplant |
$2,303.03
|
| Rate for Payer: Blue Shield of California Commercial |
$2,828.89
|
| Rate for Payer: Blue Shield of California EPN |
$2,241.61
|
| Rate for Payer: Cash Price |
$1,727.27
|
| Rate for Payer: Cash Price |
$1,727.27
|
| Rate for Payer: Cigna of CA HMO |
$2,686.87
|
| Rate for Payer: Cigna of CA PPO |
$2,686.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$47.94
|
| Rate for Payer: Dignity Health Media |
$31.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.15
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$31.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$31.96
|
| Rate for Payer: Galaxy Health WC |
$3,262.62
|
| Rate for Payer: Global Benefits Group Commercial |
$2,303.03
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,878.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.42
|
| Rate for Payer: Heritage Provider Network Transplant |
$52.42
|
| Rate for Payer: IEHP Medi-Cal |
$51.78
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$51.78
|
| Rate for Payer: IEHP Medicare Advantage |
$31.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,560.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$921.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$40.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.83
|
| Rate for Payer: Multiplan Commercial |
$3,070.70
|
| Rate for Payer: Networks By Design Commercial |
$1,919.19
|
| Rate for Payer: Prime Health Services Commercial |
$3,262.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,303.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,303.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,919.19
|
| Rate for Payer: United Healthcare All Other HMO |
$1,919.19
|
| Rate for Payer: United Healthcare HMO Rider |
$1,919.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,919.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$47.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.16
|
| Rate for Payer: Vantage Medical Group Senior |
$31.96
|
|
|
ROMIPLOSTIM 125 MCG SUBCUTANEOUS SOLUTION [226462]
|
Facility
OP
|
$1,431.00
|
|
|
Service Code
|
CPT J2796
|
| Hospital Charge Code |
ERX226462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.42 |
| Max. Negotiated Rate |
$1,216.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$603.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$120.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$105.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$105.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.42
|
| Rate for Payer: BCBS Transplant Transplant |
$858.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,054.65
|
| Rate for Payer: Blue Shield of California EPN |
$93.58
|
| Rate for Payer: Cash Price |
$643.95
|
| Rate for Payer: Cash Price |
$643.95
|
| Rate for Payer: Cigna of CA HMO |
$1,001.70
|
| Rate for Payer: Cigna of CA PPO |
$1,001.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$144.04
|
| Rate for Payer: Dignity Health Media |
$96.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$105.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.64
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$96.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$96.03
|
| Rate for Payer: Galaxy Health WC |
$1,216.35
|
| Rate for Payer: Global Benefits Group Commercial |
$858.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,073.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$157.48
|
| Rate for Payer: IEHP Medi-Cal |
$155.56
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$155.56
|
| Rate for Payer: IEHP Medicare Advantage |
$96.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$954.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$96.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$343.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$120.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$128.68
|
| Rate for Payer: Multiplan Commercial |
$1,144.80
|
| Rate for Payer: Networks By Design Commercial |
$715.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,216.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$858.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$858.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$715.50
|
| Rate for Payer: United Healthcare All Other HMO |
$715.50
|
| Rate for Payer: United Healthcare HMO Rider |
$715.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$715.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$144.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$105.63
|
| Rate for Payer: Vantage Medical Group Senior |
$96.03
|
|
|
ROMIPLOSTIM 125 MCG SUBCUTANEOUS SOLUTION [226462]
|
Facility
IP
|
$1,431.00
|
|
|
Service Code
|
CPT J2796
|
| Hospital Charge Code |
ERX226462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$343.44 |
| Max. Negotiated Rate |
$1,216.35 |
| Rate for Payer: Blue Shield of California Commercial |
$1,018.87
|
| Rate for Payer: Blue Shield of California EPN |
$732.67
|
| Rate for Payer: Cash Price |
$643.95
|
| Rate for Payer: Cigna of CA HMO |
$1,001.70
|
| Rate for Payer: Cigna of CA PPO |
$1,001.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$572.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$572.40
|
| Rate for Payer: Galaxy Health WC |
$1,216.35
|
| Rate for Payer: Global Benefits Group Commercial |
$858.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$954.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$545.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$343.44
|
| Rate for Payer: Multiplan Commercial |
$1,144.80
|
| Rate for Payer: Networks By Design Commercial |
$715.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,216.35
|
|
|
ROMIPLOSTIM 250 MCG SUBCUTANEOUS SOLUTION [93566]
|
Facility
OP
|
$2,861.96
|
|
|
Service Code
|
CPT J2796
|
| Hospital Charge Code |
1721175
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.42 |
| Max. Negotiated Rate |
$2,432.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$603.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$120.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$105.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$105.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.42
|
| Rate for Payer: BCBS Transplant Transplant |
$1,717.18
|
| Rate for Payer: Blue Shield of California Commercial |
$2,109.26
|
| Rate for Payer: Blue Shield of California EPN |
$93.58
|
| Rate for Payer: Cash Price |
$1,287.88
|
| Rate for Payer: Cash Price |
$1,287.88
|
| Rate for Payer: Cigna of CA HMO |
$2,003.37
|
| Rate for Payer: Cigna of CA PPO |
$2,003.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$144.04
|
| Rate for Payer: Dignity Health Media |
$96.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$105.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.64
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$96.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$96.03
|
| Rate for Payer: Galaxy Health WC |
$2,432.67
|
| Rate for Payer: Global Benefits Group Commercial |
$1,717.18
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,146.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$157.48
|
| Rate for Payer: IEHP Medi-Cal |
$155.56
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$155.56
|
| Rate for Payer: IEHP Medicare Advantage |
$96.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,908.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$96.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$686.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$120.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$128.68
|
| Rate for Payer: Multiplan Commercial |
$2,289.57
|
| Rate for Payer: Networks By Design Commercial |
$1,430.98
|
| Rate for Payer: Prime Health Services Commercial |
$2,432.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,717.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,717.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,430.98
|
| Rate for Payer: United Healthcare All Other HMO |
$1,430.98
|
| Rate for Payer: United Healthcare HMO Rider |
$1,430.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,430.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$144.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$105.63
|
| Rate for Payer: Vantage Medical Group Senior |
$96.03
|
|
