|
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
|
OP
|
$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: Aetna of CA HMO/PPO |
$2.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.11
|
| 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: Dignity Health Commercial/Exchange |
$2.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.92
|
| 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: Molina Healthcare of CA Medi-Cal |
$2.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.41
|
| Rate for Payer: Multiplan Commercial |
$2.75
|
| Rate for Payer: Networks By Design Commercial |
$2.24
|
| Rate for Payer: Prime Health Services Commercial |
$2.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.72
|
| Rate for Payer: United Healthcare All Other HMO |
$1.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.92
|
| Rate for Payer: Vantage Medical Group Senior |
$2.92
|
|
|
RASAGILINE 0.5 MG TABLET [76480]
|
Facility
|
IP
|
$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: Blue Shield of California Commercial |
$6.09
|
| Rate for Payer: Blue Shield of California EPN |
$4.01
|
| 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: 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: Multiplan Commercial |
$6.60
|
| Rate for Payer: Networks By Design Commercial |
$5.36
|
| Rate for Payer: Prime Health Services Commercial |
$7.01
|
|
|
RASAGILINE 1 MG TABLET [76481]
|
Facility
|
OP
|
$3.44
|
|
|
Service Code
|
NDC 23155-747-03
|
| 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: Aetna of CA HMO/PPO |
$2.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.11
|
| 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: Dignity Health Commercial/Exchange |
$2.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.92
|
| 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: Molina Healthcare of CA Medi-Cal |
$2.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.41
|
| Rate for Payer: Multiplan Commercial |
$2.75
|
| Rate for Payer: Networks By Design Commercial |
$2.24
|
| Rate for Payer: Prime Health Services Commercial |
$2.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.72
|
| Rate for Payer: United Healthcare All Other HMO |
$1.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.92
|
| Rate for Payer: Vantage Medical Group Senior |
$2.92
|
|
|
RASAGILINE 1 MG TABLET [76481]
|
Facility
|
IP
|
$50.04
|
|
|
Service Code
|
NDC 68546-229-56
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$42.53 |
| Rate for Payer: Adventist Health Commercial |
$10.01
|
| Rate for Payer: Blue Shield of California Commercial |
$36.93
|
| Rate for Payer: Blue Shield of California EPN |
$24.32
|
| Rate for Payer: Cash Price |
$27.52
|
| Rate for Payer: Cigna of CA HMO |
$35.03
|
| Rate for Payer: Cigna of CA PPO |
$35.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.02
|
| Rate for Payer: EPIC Health Plan Senior |
$20.02
|
| Rate for Payer: Galaxy Health WC |
$42.53
|
| Rate for Payer: Global Benefits Group Commercial |
$30.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.01
|
| Rate for Payer: Multiplan Commercial |
$40.03
|
| Rate for Payer: Networks By Design Commercial |
$32.53
|
| Rate for Payer: Prime Health Services Commercial |
$42.53
|
|
|
RASAGILINE 1 MG TABLET [76481]
|
Facility
|
IP
|
$17.80
|
|
|
Service Code
|
NDC 47781-690-30
|
| 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
|
|
|
RASAGILINE 1 MG TABLET [76481]
|
Facility
|
OP
|
$50.04
|
|
|
Service Code
|
NDC 68546-229-56
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$42.53 |
| Rate for Payer: Cigna of CA HMO |
$35.03
|
| Rate for Payer: Adventist Health Commercial |
$10.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.73
|
| Rate for Payer: Cash Price |
$27.52
|
| Rate for Payer: Cigna of CA PPO |
$35.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.02
|
| Rate for Payer: EPIC Health Plan Senior |
$20.02
|
| Rate for Payer: Galaxy Health WC |
$42.53
|
| Rate for Payer: Global Benefits Group Commercial |
$30.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.03
|
| Rate for Payer: Multiplan Commercial |
$40.03
|
| Rate for Payer: Networks By Design Commercial |
$32.53
|
| Rate for Payer: Prime Health Services Commercial |
$42.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.02
|
| Rate for Payer: United Healthcare All Other HMO |
$25.02
|
| Rate for Payer: United Healthcare HMO Rider |
$25.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.53
|
| Rate for Payer: Vantage Medical Group Senior |
$42.53
|
|
|
RASAGILINE 1 MG TABLET [76481]
|
Facility
|
OP
|
$8.25
|
|
|
Service Code
|
NDC 0093-3061-56
|
| 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 1 MG TABLET [76481]
|
Facility
|
IP
|
$3.44
|
|
|
Service Code
|
NDC 23155-747-03
|
| 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 1 MG TABLET [76481]
|
Facility
|
OP
|
$17.80
|
|
|
Service Code
|
NDC 47781-690-30
|
| 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: Aetna of CA HMO/PPO |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.93
|
| 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: Dignity Health Commercial/Exchange |
$15.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.13
|
| 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: Molina Healthcare of CA Medi-Cal |
$12.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$14.24
|
| Rate for Payer: Networks By Design Commercial |
$11.57
|
| Rate for Payer: Prime Health Services Commercial |
$15.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.90
|
| Rate for Payer: United Healthcare All Other HMO |
$8.90
|
| Rate for Payer: United Healthcare HMO Rider |
$8.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.13
|
| Rate for Payer: Vantage Medical Group Senior |
$15.13
|
|
|
RASAGILINE 1 MG TABLET [76481]
|
Facility
|
IP
|
$8.25
|
|
|
Service Code
|
NDC 0093-3061-56
|
| 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: Blue Shield of California Commercial |
$6.09
|
| Rate for Payer: Blue Shield of California EPN |
$4.01
|
| 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: 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: Multiplan Commercial |
$6.60
|
| Rate for Payer: Networks By Design Commercial |
$5.36
|
| Rate for Payer: Prime Health Services Commercial |
$7.01
|
|
|
REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE [91408]
|
Facility
|
IP
|
$7.20
|
|
|
Service Code
|
HCPCS J2785
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$6.12 |
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Adventist Health Commercial |
$0.96
|
| Rate for Payer: Blue Shield of California Commercial |
$5.31
|
| Rate for Payer: Blue Shield of California Commercial |
$3.54
|
| Rate for Payer: Blue Shield of California EPN |
$2.33
|
| Rate for Payer: Blue Shield of California EPN |
$3.50
|
| Rate for Payer: Cash Price |
$3.96
|
| Rate for Payer: Cash Price |
$2.64
|
| Rate for Payer: Cigna of CA HMO |
$5.04
|
| Rate for Payer: Cigna of CA HMO |
$3.36
|
| Rate for Payer: Cigna of CA PPO |
$3.36
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Senior |
$1.92
|
| Rate for Payer: EPIC Health Plan Senior |
$2.88
|
| Rate for Payer: Galaxy Health WC |
$4.08
|
| Rate for Payer: Galaxy Health WC |
$6.12
|
| Rate for Payer: Global Benefits Group Commercial |
$2.88
|
| Rate for Payer: Global Benefits Group Commercial |
$4.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
| Rate for Payer: Multiplan Commercial |
$5.76
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Networks By Design Commercial |
$2.40
|
| Rate for Payer: Prime Health Services Commercial |
$6.12
|
| Rate for Payer: Prime Health Services Commercial |
$4.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2.63
|
| Rate for Payer: United Healthcare All Other HMO |
$1.75
|
| Rate for Payer: United Healthcare HMO Rider |
$1.72
|
| Rate for Payer: United Healthcare HMO Rider |
$2.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.36
|
|
|
REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE [91408]
|
Facility
|
OP
|
$4.80
|
|
|
Service Code
|
HCPCS J2785
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$124.66 |
| Rate for Payer: Adventist Health Commercial |
$0.96
|
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.37
|
| Rate for Payer: Blue Shield of California Commercial |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.00
|
| Rate for Payer: Blue Shield of California EPN |
$9.00
|
| Rate for Payer: Blue Shield of California EPN |
$9.00
|
| Rate for Payer: Cash Price |
$2.64
|
| Rate for Payer: Cash Price |
$3.96
|
| Rate for Payer: Cash Price |
$2.64
|
| Rate for Payer: Cash Price |
$3.96
|
| Rate for Payer: Cigna of CA HMO |
$5.04
|
| Rate for Payer: Cigna of CA HMO |
$3.36
|
| Rate for Payer: Cigna of CA PPO |
$3.36
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Senior |
$2.88
|
| Rate for Payer: EPIC Health Plan Senior |
$1.92
|
| Rate for Payer: Galaxy Health WC |
$6.12
|
| Rate for Payer: Galaxy Health WC |
$4.08
|
| Rate for Payer: Global Benefits Group Commercial |
$4.32
|
| Rate for Payer: Global Benefits Group Commercial |
$2.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.04
|
| Rate for Payer: Multiplan Commercial |
$5.76
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Networks By Design Commercial |
$2.40
|
| Rate for Payer: Prime Health Services Commercial |
$4.08
|
| Rate for Payer: Prime Health Services Commercial |
$6.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.70
|
| Rate for Payer: United Healthcare All Other HMO |
$1.75
|
| Rate for Payer: United Healthcare All Other HMO |
$2.63
|
| Rate for Payer: United Healthcare HMO Rider |
$2.57
|
| Rate for Payer: United Healthcare HMO Rider |
$1.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$4.08
|
| Rate for Payer: Vantage Medical Group Senior |
$6.12
|
|
|
RELUGOLIX 120 MG TABLET [229912]
|
Facility
|
OP
|
$110.49
|
|
|
Service Code
|
NDC 72974-120-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.10 |
| Max. Negotiated Rate |
$93.92 |
| Rate for Payer: Adventist Health Commercial |
$22.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$72.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.85
|
| Rate for Payer: Cash Price |
$60.77
|
| Rate for Payer: Cigna of CA HMO |
$77.34
|
| Rate for Payer: Cigna of CA PPO |
$77.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$93.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.20
|
| Rate for Payer: EPIC Health Plan Senior |
$44.20
|
| Rate for Payer: Galaxy Health WC |
$93.92
|
| Rate for Payer: Global Benefits Group Commercial |
$66.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$77.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77.34
|
| Rate for Payer: Multiplan Commercial |
$88.39
|
| Rate for Payer: Networks By Design Commercial |
$71.82
|
| Rate for Payer: Prime Health Services Commercial |
$93.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.24
|
| Rate for Payer: United Healthcare All Other HMO |
$55.24
|
| Rate for Payer: United Healthcare HMO Rider |
$55.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.92
|
| Rate for Payer: Vantage Medical Group Senior |
$93.92
|
|
|
RELUGOLIX 120 MG TABLET [229912]
|
Facility
|
IP
|
$110.49
|
|
|
Service Code
|
NDC 72974-120-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.10 |
| Max. Negotiated Rate |
$93.92 |
| Rate for Payer: Adventist Health Commercial |
$22.10
|
| Rate for Payer: Blue Shield of California Commercial |
$81.54
|
| Rate for Payer: Blue Shield of California EPN |
$53.70
|
| Rate for Payer: Cash Price |
$60.77
|
| Rate for Payer: Cigna of CA HMO |
$77.34
|
| Rate for Payer: Cigna of CA PPO |
$77.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.20
|
| Rate for Payer: EPIC Health Plan Senior |
$44.20
|
| Rate for Payer: Galaxy Health WC |
$93.92
|
| Rate for Payer: Global Benefits Group Commercial |
$66.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.52
|
| Rate for Payer: Multiplan Commercial |
$88.39
|
| Rate for Payer: Networks By Design Commercial |
$71.82
|
| Rate for Payer: Prime Health Services Commercial |
$93.92
|
|
|
REMDESIVIR 100 MG INTRAVENOUS POWDER FOR SOLUTION [227996]
|
Facility
|
IP
|
$780.86
|
|
|
Service Code
|
HCPCS J0248
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$156.17 |
| Max. Negotiated Rate |
$663.73 |
| Rate for Payer: Adventist Health Commercial |
$156.17
|
| Rate for Payer: Blue Shield of California Commercial |
$576.27
|
| Rate for Payer: Blue Shield of California EPN |
$379.50
|
| Rate for Payer: Cash Price |
$429.48
|
| Rate for Payer: Cigna of CA HMO |
$546.60
|
| Rate for Payer: Cigna of CA PPO |
$546.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.34
|
| Rate for Payer: EPIC Health Plan Senior |
$312.34
|
| Rate for Payer: Galaxy Health WC |
$663.73
|
| Rate for Payer: Global Benefits Group Commercial |
$468.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$520.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$483.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.41
|
| Rate for Payer: Multiplan Commercial |
$624.69
|
| Rate for Payer: Networks By Design Commercial |
$390.43
|
| Rate for Payer: Prime Health Services Commercial |
$663.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$293.06
|
| Rate for Payer: United Healthcare All Other HMO |
$285.25
|
| Rate for Payer: United Healthcare HMO Rider |
$279.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$255.73
|
|
|
REMDESIVIR 100 MG INTRAVENOUS POWDER FOR SOLUTION [227996]
|
Facility
|
OP
|
$780.86
|
|
|
Service Code
|
HCPCS J0248
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.35 |
| Max. Negotiated Rate |
$663.73 |
| Rate for Payer: Adventist Health Commercial |
$156.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$512.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.25
|
| Rate for Payer: Blue Shield of California Commercial |
$7.19
|
| Rate for Payer: Blue Shield of California EPN |
$7.19
|
| Rate for Payer: Cash Price |
$429.48
|
| Rate for Payer: Cash Price |
$429.48
|
| Rate for Payer: Cigna of CA HMO |
$546.60
|
| Rate for Payer: Cigna of CA PPO |
$546.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.08
|
| Rate for Payer: EPIC Health Plan Senior |
$6.73
|
| Rate for Payer: Galaxy Health WC |
$663.73
|
| Rate for Payer: Global Benefits Group Commercial |
$468.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$520.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.02
|
| Rate for Payer: Multiplan Commercial |
$624.69
|
| Rate for Payer: Networks By Design Commercial |
$390.43
|
| Rate for Payer: Prime Health Services Commercial |
$663.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$468.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$468.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$293.06
|
| Rate for Payer: United Healthcare All Other HMO |
$285.25
|
| Rate for Payer: United Healthcare HMO Rider |
$279.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$255.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.40
|
| Rate for Payer: Vantage Medical Group Senior |
$7.40
|
|
|
REMDESIVIR 100 MG LYOPHILIZED POWDER FOR INJECTION - COMMERCIAL PRODUCT [4082058626]
|
Facility
|
OP
|
$780.86
|
|
|
Service Code
|
HCPCS J0248
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.35 |
| Max. Negotiated Rate |
$663.73 |
| Rate for Payer: Adventist Health Commercial |
$156.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$512.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.25
|
| Rate for Payer: Blue Shield of California Commercial |
$7.19
|
| Rate for Payer: Blue Shield of California EPN |
$7.19
|
| Rate for Payer: Cash Price |
$429.48
|
| Rate for Payer: Cash Price |
$429.48
|
| Rate for Payer: Cigna of CA HMO |
$546.60
|
| Rate for Payer: Cigna of CA PPO |
$546.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.08
|
| Rate for Payer: EPIC Health Plan Senior |
$6.73
|
| Rate for Payer: Galaxy Health WC |
$663.73
|
| Rate for Payer: Global Benefits Group Commercial |
$468.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$520.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.02
|
| Rate for Payer: Multiplan Commercial |
$624.69
|
| Rate for Payer: Networks By Design Commercial |
$390.43
|
| Rate for Payer: Prime Health Services Commercial |
$663.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$468.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$468.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$293.06
|
| Rate for Payer: United Healthcare All Other HMO |
$285.25
|
| Rate for Payer: United Healthcare HMO Rider |
$279.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$255.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.40
|
| Rate for Payer: Vantage Medical Group Senior |
$7.40
|
|
|
REMDESIVIR 100 MG LYOPHILIZED POWDER FOR INJECTION - COMMERCIAL PRODUCT [4082058626]
|
Facility
|
IP
|
$780.86
|
|
|
Service Code
|
HCPCS J0248
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$156.17 |
| Max. Negotiated Rate |
$663.73 |
| Rate for Payer: Adventist Health Commercial |
$156.17
|
| Rate for Payer: Blue Shield of California Commercial |
$576.27
|
| Rate for Payer: Blue Shield of California EPN |
$379.50
|
| Rate for Payer: Cash Price |
$429.48
|
| Rate for Payer: Cigna of CA HMO |
$546.60
|
| Rate for Payer: Cigna of CA PPO |
$546.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.34
|
| Rate for Payer: EPIC Health Plan Senior |
$312.34
|
| Rate for Payer: Galaxy Health WC |
$663.73
|
| Rate for Payer: Global Benefits Group Commercial |
$468.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$520.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$483.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.41
|
| Rate for Payer: Multiplan Commercial |
$624.69
|
| Rate for Payer: Networks By Design Commercial |
$390.43
|
| Rate for Payer: Prime Health Services Commercial |
$663.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$293.06
|
| Rate for Payer: United Healthcare All Other HMO |
$285.25
|
| Rate for Payer: United Healthcare HMO Rider |
$279.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$255.73
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
|
IP
|
$87.97
|
|
|
Service Code
|
NDC 63323-723-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.59 |
| Max. Negotiated Rate |
$74.77 |
| Rate for Payer: Adventist Health Commercial |
$17.59
|
| Rate for Payer: Blue Shield of California Commercial |
$64.92
|
| Rate for Payer: Blue Shield of California EPN |
$42.75
|
| Rate for Payer: Cash Price |
$48.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.19
|
| Rate for Payer: EPIC Health Plan Senior |
$35.19
|
| Rate for Payer: Galaxy Health WC |
$74.77
|
| Rate for Payer: Global Benefits Group Commercial |
$52.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.11
|
| Rate for Payer: Multiplan Commercial |
$70.38
|
| Rate for Payer: Networks By Design Commercial |
$57.18
|
| Rate for Payer: Prime Health Services Commercial |
$74.77
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
|
IP
|
$87.97
|
|
|
Service Code
|
NDC 63323-723-03
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.59 |
| Max. Negotiated Rate |
$74.77 |
| Rate for Payer: Adventist Health Commercial |
$17.59
|
| Rate for Payer: Blue Shield of California Commercial |
$64.92
|
| Rate for Payer: Blue Shield of California EPN |
$42.75
|
| Rate for Payer: Cash Price |
$48.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.19
|
| Rate for Payer: EPIC Health Plan Senior |
$35.19
|
| Rate for Payer: Galaxy Health WC |
$74.77
|
| Rate for Payer: Global Benefits Group Commercial |
$52.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.11
|
| Rate for Payer: Multiplan Commercial |
$70.38
|
| Rate for Payer: Networks By Design Commercial |
$57.18
|
| Rate for Payer: Prime Health Services Commercial |
$74.77
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
|
OP
|
$80.83
|
|
|
Service Code
|
NDC 72078-034-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.17 |
| Max. Negotiated Rate |
$68.71 |
| Rate for Payer: Adventist Health Commercial |
$16.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.64
|
| Rate for Payer: Cash Price |
$44.46
|
| Rate for Payer: Cigna of CA HMO |
$51.73
|
| Rate for Payer: Cigna of CA PPO |
$59.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$68.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.33
|
| Rate for Payer: EPIC Health Plan Senior |
$32.33
|
| Rate for Payer: Galaxy Health WC |
$68.71
|
| Rate for Payer: Global Benefits Group Commercial |
$48.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$56.58
|
| Rate for Payer: Multiplan Commercial |
$64.66
|
| Rate for Payer: Networks By Design Commercial |
$52.54
|
| Rate for Payer: Prime Health Services Commercial |
$68.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.41
|
| Rate for Payer: United Healthcare All Other HMO |
$40.41
|
| Rate for Payer: United Healthcare HMO Rider |
$40.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$40.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.71
|
| Rate for Payer: Vantage Medical Group Senior |
$68.71
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
|
IP
|
$80.83
|
|
|
Service Code
|
NDC 72078-034-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.17 |
| Max. Negotiated Rate |
$68.71 |
| Rate for Payer: Adventist Health Commercial |
$16.17
|
| Rate for Payer: Blue Shield of California Commercial |
$59.65
|
| Rate for Payer: Blue Shield of California EPN |
$39.28
|
| Rate for Payer: Cash Price |
$44.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.33
|
| Rate for Payer: EPIC Health Plan Senior |
$32.33
|
| Rate for Payer: Galaxy Health WC |
$68.71
|
| Rate for Payer: Global Benefits Group Commercial |
$48.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.40
|
| Rate for Payer: Multiplan Commercial |
$64.66
|
| Rate for Payer: Networks By Design Commercial |
$52.54
|
| Rate for Payer: Prime Health Services Commercial |
$68.71
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
|
OP
|
$87.97
|
|
|
Service Code
|
NDC 63323-723-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.59 |
| Max. Negotiated Rate |
$74.77 |
| Rate for Payer: Adventist Health Commercial |
$17.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$57.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.02
|
| Rate for Payer: Cash Price |
$48.38
|
| Rate for Payer: Cigna of CA HMO |
$56.30
|
| Rate for Payer: Cigna of CA PPO |
$65.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$74.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.19
|
| Rate for Payer: EPIC Health Plan Senior |
$35.19
|
| Rate for Payer: Galaxy Health WC |
$74.77
|
| Rate for Payer: Global Benefits Group Commercial |
$52.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$61.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$61.58
|
| Rate for Payer: Multiplan Commercial |
$70.38
|
| Rate for Payer: Networks By Design Commercial |
$57.18
|
| Rate for Payer: Prime Health Services Commercial |
$74.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.98
|
| Rate for Payer: United Healthcare All Other HMO |
$43.98
|
| Rate for Payer: United Healthcare HMO Rider |
$43.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.77
|
| Rate for Payer: Vantage Medical Group Senior |
$74.77
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
|
IP
|
$80.83
|
|
|
Service Code
|
NDC 72078-034-00
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.17 |
| Max. Negotiated Rate |
$68.71 |
| Rate for Payer: Adventist Health Commercial |
$16.17
|
| Rate for Payer: Blue Shield of California Commercial |
$59.65
|
| Rate for Payer: Blue Shield of California EPN |
$39.28
|
| Rate for Payer: Cash Price |
$44.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.33
|
| Rate for Payer: EPIC Health Plan Senior |
$32.33
|
| Rate for Payer: Galaxy Health WC |
$68.71
|
| Rate for Payer: Global Benefits Group Commercial |
$48.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.40
|
| Rate for Payer: Multiplan Commercial |
$64.66
|
| Rate for Payer: Networks By Design Commercial |
$52.54
|
| Rate for Payer: Prime Health Services Commercial |
$68.71
|
|
