|
RADIOPAQUE PVC MARKERS-BARIUM SULFATE 24 MARKERS CAPSULE [21381]
|
Facility
|
OP
|
$119.88
|
|
|
Service Code
|
HCPCS A9698
|
| Hospital Charge Code |
901700042
|
|
Hospital Revenue Code
|
254
|
| Min. Negotiated Rate |
$23.98 |
| Max. Negotiated Rate |
$101.90 |
| Rate for Payer: Adventist Health Commercial |
$23.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$89.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.62
|
| Rate for Payer: Cash Price |
$65.93
|
| Rate for Payer: Cigna of CA HMO |
$76.72
|
| Rate for Payer: Cigna of CA PPO |
$88.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$101.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$101.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.95
|
| Rate for Payer: EPIC Health Plan Senior |
$47.95
|
| Rate for Payer: Galaxy Health WC |
$101.90
|
| Rate for Payer: Global Benefits Group Commercial |
$71.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$79.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$83.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.92
|
| Rate for Payer: Multiplan Commercial |
$95.90
|
| Rate for Payer: Networks By Design Commercial |
$77.92
|
| Rate for Payer: Prime Health Services Commercial |
$101.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$71.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$71.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$59.94
|
| Rate for Payer: United Healthcare All Other HMO |
$59.94
|
| Rate for Payer: United Healthcare HMO Rider |
$59.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.90
|
| Rate for Payer: Vantage Medical Group Senior |
$101.90
|
|
|
RADIOPAQUE PVC MARKERS-BARIUM SULFATE 24 MARKERS CAPSULE [21381]
|
Facility
|
IP
|
$119.88
|
|
|
Service Code
|
HCPCS A9698
|
| Hospital Charge Code |
901700042
|
|
Hospital Revenue Code
|
254
|
| Min. Negotiated Rate |
$23.98 |
| Max. Negotiated Rate |
$101.90 |
| Rate for Payer: Adventist Health Commercial |
$23.98
|
| Rate for Payer: Blue Shield of California Commercial |
$88.47
|
| Rate for Payer: Blue Shield of California EPN |
$58.26
|
| Rate for Payer: Cash Price |
$65.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.95
|
| Rate for Payer: EPIC Health Plan Senior |
$47.95
|
| Rate for Payer: Galaxy Health WC |
$101.90
|
| Rate for Payer: Global Benefits Group Commercial |
$71.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$79.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.77
|
| Rate for Payer: Multiplan Commercial |
$95.90
|
| Rate for Payer: Networks By Design Commercial |
$77.92
|
| Rate for Payer: Prime Health Services Commercial |
$101.90
|
|
|
RALOXIFENE 60 MG TABLET [22143]
|
Facility
|
OP
|
$3.73
|
|
|
Service Code
|
NDC 50268-694-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$3.17 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.29
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cigna of CA HMO |
$2.61
|
| Rate for Payer: Cigna of CA PPO |
$2.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.49
|
| Rate for Payer: EPIC Health Plan Senior |
$1.49
|
| Rate for Payer: Galaxy Health WC |
$3.17
|
| Rate for Payer: Global Benefits Group Commercial |
$2.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.61
|
| Rate for Payer: Multiplan Commercial |
$2.98
|
| Rate for Payer: Networks By Design Commercial |
$2.42
|
| Rate for Payer: Prime Health Services Commercial |
$3.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1.86
|
| Rate for Payer: United Healthcare HMO Rider |
$1.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.17
|
| Rate for Payer: Vantage Medical Group Senior |
$3.17
|
|
|
RALOXIFENE 60 MG TABLET [22143]
|
Facility
|
IP
|
$0.78
|
|
|
Service Code
|
NDC 43598-505-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.58
|
| Rate for Payer: Blue Shield of California EPN |
$0.38
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: Cigna of CA HMO |
$0.55
|
| Rate for Payer: Cigna of CA PPO |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: EPIC Health Plan Senior |
$0.31
|
| Rate for Payer: Galaxy Health WC |
$0.66
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
| Rate for Payer: Networks By Design Commercial |
$0.51
|
| Rate for Payer: Prime Health Services Commercial |
$0.66
|
|
|
RALOXIFENE 60 MG TABLET [22143]
|
Facility
|
IP
|
$3.73
|
|
|
Service Code
|
NDC 50268-694-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$3.17 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Blue Shield of California Commercial |
$2.75
|
| Rate for Payer: Blue Shield of California EPN |
$1.81
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cigna of CA HMO |
$2.61
|
| Rate for Payer: Cigna of CA PPO |
$2.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.49
|
| Rate for Payer: EPIC Health Plan Senior |
$1.49
|
| Rate for Payer: Galaxy Health WC |
$3.17
|
| Rate for Payer: Global Benefits Group Commercial |
$2.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$2.98
|
| Rate for Payer: Networks By Design Commercial |
$2.42
|
| Rate for Payer: Prime Health Services Commercial |
$3.17
|
|
|
RALOXIFENE 60 MG TABLET [22143]
|
Facility
|
OP
|
$0.78
|
|
|
Service Code
|
NDC 43598-505-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.48
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: Cigna of CA HMO |
$0.55
|
| Rate for Payer: Cigna of CA PPO |
$0.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: EPIC Health Plan Senior |
$0.31
|
| Rate for Payer: Galaxy Health WC |
$0.66
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
| Rate for Payer: Networks By Design Commercial |
$0.51
|
| Rate for Payer: Prime Health Services Commercial |
$0.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.39
|
| Rate for Payer: United Healthcare All Other HMO |
$0.39
|
| Rate for Payer: United Healthcare HMO Rider |
$0.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: Vantage Medical Group Senior |
$0.66
|
|
|
RALOXIFENE 60 MG TABLET [22143]
|
Facility
|
OP
|
$3.73
|
|
|
Service Code
|
NDC 50268-694-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$3.17 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.29
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cigna of CA HMO |
$2.61
|
| Rate for Payer: Cigna of CA PPO |
$2.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.49
|
| Rate for Payer: EPIC Health Plan Senior |
$1.49
|
| Rate for Payer: Galaxy Health WC |
$3.17
|
| Rate for Payer: Global Benefits Group Commercial |
$2.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.61
|
| Rate for Payer: Multiplan Commercial |
$2.98
|
| Rate for Payer: Networks By Design Commercial |
$2.42
|
| Rate for Payer: Prime Health Services Commercial |
$3.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1.86
|
| Rate for Payer: United Healthcare HMO Rider |
$1.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.17
|
| Rate for Payer: Vantage Medical Group Senior |
$3.17
|
|
|
RALOXIFENE 60 MG TABLET [22143]
|
Facility
|
IP
|
$3.73
|
|
|
Service Code
|
NDC 50268-694-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$3.17 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Blue Shield of California Commercial |
$2.75
|
| Rate for Payer: Blue Shield of California EPN |
$1.81
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cigna of CA HMO |
$2.61
|
| Rate for Payer: Cigna of CA PPO |
$2.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.49
|
| Rate for Payer: EPIC Health Plan Senior |
$1.49
|
| Rate for Payer: Galaxy Health WC |
$3.17
|
| Rate for Payer: Global Benefits Group Commercial |
$2.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$2.98
|
| Rate for Payer: Networks By Design Commercial |
$2.42
|
| Rate for Payer: Prime Health Services Commercial |
$3.17
|
|
|
RALTEGRAVIR 400 MG TABLET [88608]
|
Facility
|
IP
|
$41.66
|
|
|
Service Code
|
NDC 0006-0227-61
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.33 |
| Max. Negotiated Rate |
$35.41 |
| Rate for Payer: Adventist Health Commercial |
$8.33
|
| Rate for Payer: Blue Shield of California Commercial |
$30.75
|
| Rate for Payer: Blue Shield of California EPN |
$20.25
|
| Rate for Payer: Cash Price |
$22.92
|
| Rate for Payer: Cigna of CA HMO |
$29.16
|
| Rate for Payer: Cigna of CA PPO |
$29.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.66
|
| Rate for Payer: EPIC Health Plan Senior |
$16.66
|
| Rate for Payer: Galaxy Health WC |
$35.41
|
| Rate for Payer: Global Benefits Group Commercial |
$25.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$33.33
|
| Rate for Payer: Networks By Design Commercial |
$27.08
|
| Rate for Payer: Prime Health Services Commercial |
$35.41
|
|
|
RALTEGRAVIR 400 MG TABLET [88608]
|
Facility
|
OP
|
$41.66
|
|
|
Service Code
|
NDC 0006-0227-61
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.33 |
| Max. Negotiated Rate |
$35.41 |
| Rate for Payer: Adventist Health Commercial |
$8.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.58
|
| Rate for Payer: Cash Price |
$22.92
|
| Rate for Payer: Cigna of CA HMO |
$29.16
|
| Rate for Payer: Cigna of CA PPO |
$29.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.66
|
| Rate for Payer: EPIC Health Plan Senior |
$16.66
|
| Rate for Payer: Galaxy Health WC |
$35.41
|
| Rate for Payer: Global Benefits Group Commercial |
$25.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.16
|
| Rate for Payer: Multiplan Commercial |
$33.33
|
| Rate for Payer: Networks By Design Commercial |
$27.08
|
| Rate for Payer: Prime Health Services Commercial |
$35.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.83
|
| Rate for Payer: United Healthcare All Other HMO |
$20.83
|
| Rate for Payer: United Healthcare HMO Rider |
$20.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.41
|
| Rate for Payer: Vantage Medical Group Senior |
$35.41
|
|
|
RAMIPRIL 5 MG CAPSULE [11261]
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
NDC 65862-476-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO |
$0.12
|
| Rate for Payer: United Healthcare HMO Rider |
$0.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
RAMIPRIL 5 MG CAPSULE [11261]
|
Facility
|
IP
|
$0.24
|
|
|
Service Code
|
NDC 65862-476-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
|
|
RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION [205590]
|
Facility
|
OP
|
$180.09
|
|
|
Service Code
|
HCPCS J9308
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.02 |
| Max. Negotiated Rate |
$199.84 |
| Rate for Payer: Blue Shield of California EPN |
$87.41
|
| Rate for Payer: Adventist Health Commercial |
$36.02
|
| Rate for Payer: Adventist Health Commercial |
$36.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$111.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$111.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$81.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$81.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$74.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$74.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$199.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$199.84
|
| Rate for Payer: Blue Shield of California Commercial |
$87.41
|
| Rate for Payer: Blue Shield of California Commercial |
$87.41
|
| Rate for Payer: Blue Shield of California EPN |
$87.41
|
| Rate for Payer: Cash Price |
$99.05
|
| Rate for Payer: Cash Price |
$99.05
|
| Rate for Payer: Cash Price |
$99.05
|
| Rate for Payer: Cash Price |
$99.05
|
| Rate for Payer: Cigna of CA HMO |
$126.07
|
| Rate for Payer: Cigna of CA HMO |
$126.06
|
| Rate for Payer: Cigna of CA PPO |
$126.06
|
| Rate for Payer: Cigna of CA PPO |
$126.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$81.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$81.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.51
|
| Rate for Payer: EPIC Health Plan Senior |
$74.45
|
| Rate for Payer: EPIC Health Plan Senior |
$74.45
|
| Rate for Payer: Galaxy Health WC |
$153.08
|
| Rate for Payer: Galaxy Health WC |
$153.09
|
| Rate for Payer: Global Benefits Group Commercial |
$108.06
|
| Rate for Payer: Global Benefits Group Commercial |
$108.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$122.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$122.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$73.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$73.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$74.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$74.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$138.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$138.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$93.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$93.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$99.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$99.77
|
| Rate for Payer: Multiplan Commercial |
$144.07
|
| Rate for Payer: Multiplan Commercial |
$144.08
|
| Rate for Payer: Networks By Design Commercial |
$90.05
|
| Rate for Payer: Networks By Design Commercial |
$90.05
|
| Rate for Payer: Prime Health Services Commercial |
$153.08
|
| Rate for Payer: Prime Health Services Commercial |
$153.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$108.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$108.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$108.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$108.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.59
|
| Rate for Payer: United Healthcare All Other HMO |
$65.79
|
| Rate for Payer: United Healthcare All Other HMO |
$65.79
|
| Rate for Payer: United Healthcare HMO Rider |
$64.36
|
| Rate for Payer: United Healthcare HMO Rider |
$64.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.98
|
| Rate for Payer: Upland Medical Group Pediatric |
$74.45
|
| Rate for Payer: Upland Medical Group Pediatric |
$74.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.90
|
| Rate for Payer: Vantage Medical Group Senior |
$81.90
|
| Rate for Payer: Vantage Medical Group Senior |
$81.90
|
|
|
RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION [205590]
|
Facility
|
IP
|
$180.10
|
|
|
Service Code
|
HCPCS J9308
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.02 |
| Max. Negotiated Rate |
$153.09 |
| Rate for Payer: Adventist Health Commercial |
$36.02
|
| Rate for Payer: Adventist Health Commercial |
$36.02
|
| Rate for Payer: Blue Shield of California Commercial |
$132.91
|
| Rate for Payer: Blue Shield of California Commercial |
$132.91
|
| Rate for Payer: Blue Shield of California EPN |
$87.52
|
| Rate for Payer: Blue Shield of California EPN |
$87.53
|
| Rate for Payer: Cash Price |
$99.05
|
| Rate for Payer: Cash Price |
$99.05
|
| Rate for Payer: Cigna of CA HMO |
$126.07
|
| Rate for Payer: Cigna of CA HMO |
$126.06
|
| Rate for Payer: Cigna of CA PPO |
$126.06
|
| Rate for Payer: Cigna of CA PPO |
$126.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.04
|
| Rate for Payer: EPIC Health Plan Senior |
$72.04
|
| Rate for Payer: EPIC Health Plan Senior |
$72.04
|
| Rate for Payer: Galaxy Health WC |
$153.08
|
| Rate for Payer: Galaxy Health WC |
$153.09
|
| Rate for Payer: Global Benefits Group Commercial |
$108.05
|
| Rate for Payer: Global Benefits Group Commercial |
$108.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.22
|
| Rate for Payer: Multiplan Commercial |
$144.07
|
| Rate for Payer: Multiplan Commercial |
$144.08
|
| Rate for Payer: Networks By Design Commercial |
$90.05
|
| Rate for Payer: Networks By Design Commercial |
$90.05
|
| Rate for Payer: Prime Health Services Commercial |
$153.09
|
| Rate for Payer: Prime Health Services Commercial |
$153.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.59
|
| Rate for Payer: United Healthcare All Other HMO |
$65.79
|
| Rate for Payer: United Healthcare All Other HMO |
$65.79
|
| Rate for Payer: United Healthcare HMO Rider |
$64.36
|
| Rate for Payer: United Healthcare HMO Rider |
$64.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.98
|
|
|
RANOLAZINE ER 1,000 MG TABLET,EXTENDED RELEASE,12 HR [88007]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 27241-126-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.61
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Senior |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
RANOLAZINE ER 1,000 MG TABLET,EXTENDED RELEASE,12 HR [88007]
|
Facility
|
IP
|
$0.34
|
|
|
Service Code
|
NDC 42291-774-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cigna of CA HMO |
$0.24
|
| Rate for Payer: Cigna of CA PPO |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Networks By Design Commercial |
$0.22
|
| Rate for Payer: Prime Health Services Commercial |
$0.29
|
|
|
RANOLAZINE ER 1,000 MG TABLET,EXTENDED RELEASE,12 HR [88007]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 27241-126-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.74
|
| Rate for Payer: Blue Shield of California EPN |
$0.49
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Senior |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
|
|
RANOLAZINE ER 1,000 MG TABLET,EXTENDED RELEASE,12 HR [88007]
|
Facility
|
OP
|
$0.34
|
|
|
Service Code
|
NDC 42291-774-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.21
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cigna of CA HMO |
$0.24
|
| Rate for Payer: Cigna of CA PPO |
$0.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Networks By Design Commercial |
$0.22
|
| Rate for Payer: Prime Health Services Commercial |
$0.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Vantage Medical Group Senior |
$0.29
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR [70434]
|
Facility
|
IP
|
$0.60
|
|
|
Service Code
|
NDC 27241-125-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR [70434]
|
Facility
|
IP
|
$1.68
|
|
|
Service Code
|
NDC 60687-549-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.82
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: EPIC Health Plan Senior |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR [70434]
|
Facility
|
OP
|
$0.60
|
|
|
Service Code
|
NDC 27241-125-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.37
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR [70434]
|
Facility
|
OP
|
$1.68
|
|
|
Service Code
|
NDC 60687-549-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.03
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: EPIC Health Plan Senior |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.84
|
| Rate for Payer: United Healthcare All Other HMO |
$0.84
|
| Rate for Payer: United Healthcare HMO Rider |
$0.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1.43
|
|
|
RASAGILINE 0.5 MG TABLET [76480]
|
Facility
|
IP
|
$3.44
|
|
|
Service Code
|
NDC 23155-746-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2.54
|
| Rate for Payer: Blue Shield of California EPN |
$1.67
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cigna of CA HMO |
$2.41
|
| Rate for Payer: Cigna of CA PPO |
$2.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: EPIC Health Plan Senior |
$1.38
|
| Rate for Payer: Galaxy Health WC |
$2.92
|
| Rate for Payer: Global Benefits Group Commercial |
$2.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: Multiplan Commercial |
$2.75
|
| Rate for Payer: Networks By Design Commercial |
$2.24
|
| Rate for Payer: Prime Health Services Commercial |
$2.92
|
|
|
RASAGILINE 0.5 MG TABLET [76480]
|
Facility
|
OP
|
$8.25
|
|
|
Service Code
|
NDC 0093-3060-56
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$7.01 |
| Rate for Payer: Adventist Health Commercial |
$1.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.07
|
| Rate for Payer: Cash Price |
$4.54
|
| Rate for Payer: Cigna of CA HMO |
$5.78
|
| Rate for Payer: Cigna of CA PPO |
$5.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.30
|
| Rate for Payer: EPIC Health Plan Senior |
$3.30
|
| Rate for Payer: Galaxy Health WC |
$7.01
|
| Rate for Payer: Global Benefits Group Commercial |
$4.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.78
|
| Rate for Payer: Multiplan Commercial |
$6.60
|
| Rate for Payer: Networks By Design Commercial |
$5.36
|
| Rate for Payer: Prime Health Services Commercial |
$7.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.12
|
| Rate for Payer: United Healthcare All Other HMO |
$4.12
|
| Rate for Payer: United Healthcare HMO Rider |
$4.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.01
|
| Rate for Payer: Vantage Medical Group Senior |
$7.01
|
|
|
RASAGILINE 0.5 MG TABLET [76480]
|
Facility
|
IP
|
$17.80
|
|
|
Service Code
|
NDC 47781-683-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$15.13 |
| Rate for Payer: Adventist Health Commercial |
$3.56
|
| Rate for Payer: Blue Shield of California Commercial |
$13.14
|
| Rate for Payer: Blue Shield of California EPN |
$8.65
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cigna of CA HMO |
$12.46
|
| Rate for Payer: Cigna of CA PPO |
$12.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.12
|
| Rate for Payer: EPIC Health Plan Senior |
$7.12
|
| Rate for Payer: Galaxy Health WC |
$15.13
|
| Rate for Payer: Global Benefits Group Commercial |
$10.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.27
|
| Rate for Payer: Multiplan Commercial |
$14.24
|
| Rate for Payer: Networks By Design Commercial |
$11.57
|
| Rate for Payer: Prime Health Services Commercial |
$15.13
|
|
