|
RITONAVIR 100 MG TABLET [100995]
|
Facility
|
IP
|
$3.20
|
|
|
Service Code
|
NDC 65862-687-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: Adventist Health Commercial |
$0.64
|
| Rate for Payer: Blue Shield of California Commercial |
$2.36
|
| Rate for Payer: Blue Shield of California EPN |
$1.56
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cigna of CA HMO |
$2.24
|
| Rate for Payer: Cigna of CA PPO |
$2.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: EPIC Health Plan Senior |
$1.28
|
| Rate for Payer: Galaxy Health WC |
$2.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: Multiplan Commercial |
$2.56
|
| Rate for Payer: Networks By Design Commercial |
$2.08
|
| Rate for Payer: Prime Health Services Commercial |
$2.72
|
|
|
RITONAVIR 100 MG TABLET [100995]
|
Facility
|
OP
|
$3.20
|
|
|
Service Code
|
NDC 65862-687-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: Adventist Health Commercial |
$0.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.97
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cigna of CA HMO |
$2.24
|
| Rate for Payer: Cigna of CA PPO |
$2.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: EPIC Health Plan Senior |
$1.28
|
| Rate for Payer: Galaxy Health WC |
$2.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.24
|
| Rate for Payer: Multiplan Commercial |
$2.56
|
| Rate for Payer: Networks By Design Commercial |
$2.08
|
| Rate for Payer: Prime Health Services Commercial |
$2.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1.60
|
| Rate for Payer: United Healthcare HMO Rider |
$1.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.72
|
| Rate for Payer: Vantage Medical Group Senior |
$2.72
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS [22149]
|
Facility
|
IP
|
$112.74
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.55 |
| Max. Negotiated Rate |
$95.83 |
| Rate for Payer: Adventist Health Commercial |
$22.55
|
| Rate for Payer: Blue Shield of California Commercial |
$83.20
|
| Rate for Payer: Blue Shield of California EPN |
$54.79
|
| Rate for Payer: Cash Price |
$62.01
|
| Rate for Payer: Cigna of CA HMO |
$78.92
|
| Rate for Payer: Cigna of CA PPO |
$78.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.10
|
| Rate for Payer: EPIC Health Plan Senior |
$45.10
|
| Rate for Payer: Galaxy Health WC |
$95.83
|
| Rate for Payer: Global Benefits Group Commercial |
$67.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.06
|
| Rate for Payer: Multiplan Commercial |
$90.19
|
| Rate for Payer: Networks By Design Commercial |
$56.37
|
| Rate for Payer: Prime Health Services Commercial |
$95.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.31
|
| Rate for Payer: United Healthcare All Other HMO |
$41.18
|
| Rate for Payer: United Healthcare HMO Rider |
$40.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.92
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS [22149]
|
Facility
|
OP
|
$112.74
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.55 |
| Max. Negotiated Rate |
$255.21 |
| Rate for Payer: Adventist Health Commercial |
$22.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$255.21
|
| Rate for Payer: Blue Shield of California Commercial |
$112.74
|
| Rate for Payer: Blue Shield of California EPN |
$112.74
|
| Rate for Payer: Cash Price |
$62.01
|
| Rate for Payer: Cash Price |
$62.01
|
| Rate for Payer: Cigna of CA HMO |
$78.92
|
| Rate for Payer: Cigna of CA PPO |
$78.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$94.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$83.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.51
|
| Rate for Payer: EPIC Health Plan Senior |
$75.93
|
| Rate for Payer: Galaxy Health WC |
$95.83
|
| Rate for Payer: Global Benefits Group Commercial |
$67.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$124.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$76.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.75
|
| Rate for Payer: Multiplan Commercial |
$90.19
|
| Rate for Payer: Networks By Design Commercial |
$56.37
|
| Rate for Payer: Prime Health Services Commercial |
$95.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.31
|
| Rate for Payer: United Healthcare All Other HMO |
$41.18
|
| Rate for Payer: United Healthcare HMO Rider |
$40.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.92
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$94.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.52
|
| Rate for Payer: Vantage Medical Group Senior |
$83.52
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS NON-ONCOLOGY [4081336]
|
Facility
|
OP
|
$112.74
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.55 |
| Max. Negotiated Rate |
$255.21 |
| Rate for Payer: Adventist Health Commercial |
$22.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$255.21
|
| Rate for Payer: Blue Shield of California Commercial |
$112.74
|
| Rate for Payer: Blue Shield of California EPN |
$112.74
|
| Rate for Payer: Cash Price |
$62.01
|
| Rate for Payer: Cash Price |
$62.01
|
| Rate for Payer: Cigna of CA HMO |
$78.92
|
| Rate for Payer: Cigna of CA PPO |
$78.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$94.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$83.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.51
|
| Rate for Payer: EPIC Health Plan Senior |
$75.93
|
| Rate for Payer: Galaxy Health WC |
$95.83
|
| Rate for Payer: Global Benefits Group Commercial |
$67.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$124.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$76.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.75
|
| Rate for Payer: Multiplan Commercial |
$90.19
|
| Rate for Payer: Networks By Design Commercial |
$56.37
|
| Rate for Payer: Prime Health Services Commercial |
$95.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.31
|
| Rate for Payer: United Healthcare All Other HMO |
$41.18
|
| Rate for Payer: United Healthcare HMO Rider |
$40.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.92
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$94.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.52
|
| Rate for Payer: Vantage Medical Group Senior |
$83.52
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS NON-ONCOLOGY [4081336]
|
Facility
|
IP
|
$112.74
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.55 |
| Max. Negotiated Rate |
$95.83 |
| Rate for Payer: Adventist Health Commercial |
$22.55
|
| Rate for Payer: Blue Shield of California Commercial |
$83.20
|
| Rate for Payer: Blue Shield of California EPN |
$54.79
|
| Rate for Payer: Cash Price |
$62.01
|
| Rate for Payer: Cigna of CA HMO |
$78.92
|
| Rate for Payer: Cigna of CA PPO |
$78.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.10
|
| Rate for Payer: EPIC Health Plan Senior |
$45.10
|
| Rate for Payer: Galaxy Health WC |
$95.83
|
| Rate for Payer: Global Benefits Group Commercial |
$67.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.06
|
| Rate for Payer: Multiplan Commercial |
$90.19
|
| Rate for Payer: Networks By Design Commercial |
$56.37
|
| Rate for Payer: Prime Health Services Commercial |
$95.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.31
|
| Rate for Payer: United Healthcare All Other HMO |
$41.18
|
| Rate for Payer: United Healthcare HMO Rider |
$40.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.92
|
|
|
RITUXIMAB 1,400 MG/11.7 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN [218742]
|
Facility
|
OP
|
$674.52
|
|
|
Service Code
|
HCPCS J9311
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.96 |
| Max. Negotiated Rate |
$573.34 |
| Rate for Payer: Adventist Health Commercial |
$134.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$442.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.60
|
| Rate for Payer: Blue Shield of California Commercial |
$56.37
|
| Rate for Payer: Blue Shield of California EPN |
$56.37
|
| Rate for Payer: Cash Price |
$370.99
|
| Rate for Payer: Cash Price |
$370.99
|
| Rate for Payer: Cigna of CA HMO |
$472.16
|
| Rate for Payer: Cigna of CA PPO |
$472.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.90
|
| Rate for Payer: EPIC Health Plan Senior |
$36.96
|
| Rate for Payer: Galaxy Health WC |
$573.34
|
| Rate for Payer: Global Benefits Group Commercial |
$404.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$36.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$449.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.53
|
| Rate for Payer: Multiplan Commercial |
$539.62
|
| Rate for Payer: Networks By Design Commercial |
$337.26
|
| Rate for Payer: Prime Health Services Commercial |
$573.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$404.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$404.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$253.15
|
| Rate for Payer: United Healthcare All Other HMO |
$246.40
|
| Rate for Payer: United Healthcare HMO Rider |
$241.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$220.91
|
| Rate for Payer: Upland Medical Group Pediatric |
$36.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.66
|
| Rate for Payer: Vantage Medical Group Senior |
$40.66
|
|
|
RITUXIMAB 1,400 MG/11.7 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN [218742]
|
Facility
|
IP
|
$674.52
|
|
|
Service Code
|
HCPCS J9311
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$134.90 |
| Max. Negotiated Rate |
$573.34 |
| Rate for Payer: Adventist Health Commercial |
$134.90
|
| Rate for Payer: Blue Shield of California Commercial |
$497.80
|
| Rate for Payer: Blue Shield of California EPN |
$327.82
|
| Rate for Payer: Cash Price |
$370.99
|
| Rate for Payer: Cigna of CA HMO |
$472.16
|
| Rate for Payer: Cigna of CA PPO |
$472.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$269.81
|
| Rate for Payer: EPIC Health Plan Senior |
$269.81
|
| Rate for Payer: Galaxy Health WC |
$573.34
|
| Rate for Payer: Global Benefits Group Commercial |
$404.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$449.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$256.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$417.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.88
|
| Rate for Payer: Multiplan Commercial |
$539.62
|
| Rate for Payer: Networks By Design Commercial |
$337.26
|
| Rate for Payer: Prime Health Services Commercial |
$573.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$253.15
|
| Rate for Payer: United Healthcare All Other HMO |
$246.40
|
| Rate for Payer: United Healthcare HMO Rider |
$241.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$220.91
|
|
|
RITUXIMAB 1,600 MG/13.4 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN [218821]
|
Facility
|
IP
|
$673.08
|
|
|
Service Code
|
HCPCS J9311
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$134.62 |
| Max. Negotiated Rate |
$572.12 |
| Rate for Payer: Adventist Health Commercial |
$134.62
|
| Rate for Payer: Blue Shield of California Commercial |
$496.73
|
| Rate for Payer: Blue Shield of California EPN |
$327.12
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cigna of CA HMO |
$471.16
|
| Rate for Payer: Cigna of CA PPO |
$471.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$269.23
|
| Rate for Payer: EPIC Health Plan Senior |
$269.23
|
| Rate for Payer: Galaxy Health WC |
$572.12
|
| Rate for Payer: Global Benefits Group Commercial |
$403.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$448.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$256.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$416.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.54
|
| Rate for Payer: Multiplan Commercial |
$538.46
|
| Rate for Payer: Networks By Design Commercial |
$336.54
|
| Rate for Payer: Prime Health Services Commercial |
$572.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$252.61
|
| Rate for Payer: United Healthcare All Other HMO |
$245.88
|
| Rate for Payer: United Healthcare HMO Rider |
$240.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$220.43
|
|
|
RITUXIMAB 1,600 MG/13.4 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN [218821]
|
Facility
|
OP
|
$673.08
|
|
|
Service Code
|
HCPCS J9311
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.96 |
| Max. Negotiated Rate |
$572.12 |
| Rate for Payer: Adventist Health Commercial |
$134.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$441.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.60
|
| Rate for Payer: Blue Shield of California Commercial |
$56.37
|
| Rate for Payer: Blue Shield of California EPN |
$56.37
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cigna of CA HMO |
$471.16
|
| Rate for Payer: Cigna of CA PPO |
$471.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.90
|
| Rate for Payer: EPIC Health Plan Senior |
$36.96
|
| Rate for Payer: Galaxy Health WC |
$572.12
|
| Rate for Payer: Global Benefits Group Commercial |
$403.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$36.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$448.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.53
|
| Rate for Payer: Multiplan Commercial |
$538.46
|
| Rate for Payer: Networks By Design Commercial |
$336.54
|
| Rate for Payer: Prime Health Services Commercial |
$572.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$403.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$403.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$252.61
|
| Rate for Payer: United Healthcare All Other HMO |
$245.88
|
| Rate for Payer: United Healthcare HMO Rider |
$240.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$220.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$36.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.66
|
| Rate for Payer: Vantage Medical Group Senior |
$40.66
|
|
|
RITUXIMAB-ARRX 10 MG/ML INTRAVENOUS SOLUTION [229898]
|
Facility
|
IP
|
$86.02
|
|
|
Service Code
|
HCPCS Q5123
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$73.12 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Blue Shield of California Commercial |
$63.48
|
| Rate for Payer: Blue Shield of California EPN |
$41.81
|
| Rate for Payer: Cash Price |
$47.31
|
| Rate for Payer: Cigna of CA HMO |
$60.21
|
| Rate for Payer: Cigna of CA PPO |
$60.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.41
|
| Rate for Payer: EPIC Health Plan Senior |
$34.41
|
| Rate for Payer: Galaxy Health WC |
$73.12
|
| Rate for Payer: Global Benefits Group Commercial |
$51.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.64
|
| Rate for Payer: Multiplan Commercial |
$68.82
|
| Rate for Payer: Networks By Design Commercial |
$43.01
|
| Rate for Payer: Prime Health Services Commercial |
$73.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.28
|
| Rate for Payer: United Healthcare All Other HMO |
$31.42
|
| Rate for Payer: United Healthcare HMO Rider |
$30.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.17
|
|
|
RITUXIMAB-ARRX 10 MG/ML INTRAVENOUS SOLUTION [229898]
|
Facility
|
OP
|
$86.02
|
|
|
Service Code
|
HCPCS Q5123
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$194.72 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$56.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$194.72
|
| Rate for Payer: Blue Shield of California Commercial |
$86.02
|
| Rate for Payer: Blue Shield of California EPN |
$86.02
|
| Rate for Payer: Cash Price |
$47.31
|
| Rate for Payer: Cash Price |
$47.31
|
| Rate for Payer: Cigna of CA HMO |
$60.21
|
| Rate for Payer: Cigna of CA PPO |
$60.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.39
|
| Rate for Payer: EPIC Health Plan Senior |
$29.92
|
| Rate for Payer: Galaxy Health WC |
$73.12
|
| Rate for Payer: Global Benefits Group Commercial |
$51.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$49.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$40.09
|
| Rate for Payer: Multiplan Commercial |
$68.82
|
| Rate for Payer: Networks By Design Commercial |
$43.01
|
| Rate for Payer: Prime Health Services Commercial |
$73.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.28
|
| Rate for Payer: United Healthcare All Other HMO |
$31.42
|
| Rate for Payer: United Healthcare HMO Rider |
$30.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.17
|
| Rate for Payer: Upland Medical Group Pediatric |
$29.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.91
|
| Rate for Payer: Vantage Medical Group Senior |
$32.91
|
|
|
RITUXIMAB-PVVR 10 MG/ML INTRAVENOUS SOLUTION [226878]
|
Facility
|
IP
|
$86.02
|
|
|
Service Code
|
HCPCS Q5119
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$73.12 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Blue Shield of California Commercial |
$63.48
|
| Rate for Payer: Blue Shield of California EPN |
$41.81
|
| Rate for Payer: Cash Price |
$47.31
|
| Rate for Payer: Cigna of CA HMO |
$60.21
|
| Rate for Payer: Cigna of CA PPO |
$60.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.41
|
| Rate for Payer: EPIC Health Plan Senior |
$34.41
|
| Rate for Payer: Galaxy Health WC |
$73.12
|
| Rate for Payer: Global Benefits Group Commercial |
$51.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.64
|
| Rate for Payer: Multiplan Commercial |
$68.82
|
| Rate for Payer: Networks By Design Commercial |
$43.01
|
| Rate for Payer: Prime Health Services Commercial |
$73.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.28
|
| Rate for Payer: United Healthcare All Other HMO |
$31.42
|
| Rate for Payer: United Healthcare HMO Rider |
$30.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.17
|
|
|
RITUXIMAB-PVVR 10 MG/ML INTRAVENOUS SOLUTION [226878]
|
Facility
|
OP
|
$86.02
|
|
|
Service Code
|
HCPCS Q5119
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$194.72 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$56.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$194.72
|
| Rate for Payer: Blue Shield of California Commercial |
$86.02
|
| Rate for Payer: Blue Shield of California EPN |
$86.02
|
| Rate for Payer: Cash Price |
$47.31
|
| Rate for Payer: Cash Price |
$47.31
|
| Rate for Payer: Cigna of CA HMO |
$60.21
|
| Rate for Payer: Cigna of CA PPO |
$60.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.78
|
| Rate for Payer: EPIC Health Plan Senior |
$26.50
|
| Rate for Payer: Galaxy Health WC |
$73.12
|
| Rate for Payer: Global Benefits Group Commercial |
$51.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.51
|
| Rate for Payer: Multiplan Commercial |
$68.82
|
| Rate for Payer: Networks By Design Commercial |
$43.01
|
| Rate for Payer: Prime Health Services Commercial |
$73.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.28
|
| Rate for Payer: United Healthcare All Other HMO |
$31.42
|
| Rate for Payer: United Healthcare HMO Rider |
$30.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.17
|
| Rate for Payer: Upland Medical Group Pediatric |
$26.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.15
|
| Rate for Payer: Vantage Medical Group Senior |
$29.15
|
|
|
RIVAROXABAN 10 MG TABLET [153876]
|
Facility
|
IP
|
$23.92
|
|
|
Service Code
|
NDC 50458-580-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.78 |
| Max. Negotiated Rate |
$20.33 |
| Rate for Payer: Adventist Health Commercial |
$4.78
|
| Rate for Payer: Blue Shield of California Commercial |
$17.65
|
| Rate for Payer: Blue Shield of California EPN |
$11.63
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cigna of CA HMO |
$16.74
|
| Rate for Payer: Cigna of CA PPO |
$16.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.57
|
| Rate for Payer: EPIC Health Plan Senior |
$9.57
|
| Rate for Payer: Galaxy Health WC |
$20.33
|
| Rate for Payer: Global Benefits Group Commercial |
$14.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.74
|
| Rate for Payer: Multiplan Commercial |
$19.14
|
| Rate for Payer: Networks By Design Commercial |
$15.55
|
| Rate for Payer: Prime Health Services Commercial |
$20.33
|
|
|
RIVAROXABAN 10 MG TABLET [153876]
|
Facility
|
OP
|
$23.92
|
|
|
Service Code
|
NDC 50458-580-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.78 |
| Max. Negotiated Rate |
$20.33 |
| Rate for Payer: Adventist Health Commercial |
$4.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.69
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cigna of CA HMO |
$16.74
|
| Rate for Payer: Cigna of CA PPO |
$16.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.57
|
| Rate for Payer: EPIC Health Plan Senior |
$9.57
|
| Rate for Payer: Galaxy Health WC |
$20.33
|
| Rate for Payer: Global Benefits Group Commercial |
$14.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.74
|
| Rate for Payer: Multiplan Commercial |
$19.14
|
| Rate for Payer: Networks By Design Commercial |
$15.55
|
| Rate for Payer: Prime Health Services Commercial |
$20.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.96
|
| Rate for Payer: United Healthcare All Other HMO |
$11.96
|
| Rate for Payer: United Healthcare HMO Rider |
$11.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.33
|
| Rate for Payer: Vantage Medical Group Senior |
$20.33
|
|
|
RIVAROXABAN 15 MG TABLET [153877]
|
Facility
|
OP
|
$23.92
|
|
|
Service Code
|
NDC 50458-578-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.78 |
| Max. Negotiated Rate |
$20.33 |
| Rate for Payer: Adventist Health Commercial |
$4.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.69
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cigna of CA HMO |
$16.74
|
| Rate for Payer: Cigna of CA PPO |
$16.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.57
|
| Rate for Payer: EPIC Health Plan Senior |
$9.57
|
| Rate for Payer: Galaxy Health WC |
$20.33
|
| Rate for Payer: Global Benefits Group Commercial |
$14.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.74
|
| Rate for Payer: Multiplan Commercial |
$19.14
|
| Rate for Payer: Networks By Design Commercial |
$15.55
|
| Rate for Payer: Prime Health Services Commercial |
$20.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.96
|
| Rate for Payer: United Healthcare All Other HMO |
$11.96
|
| Rate for Payer: United Healthcare HMO Rider |
$11.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.33
|
| Rate for Payer: Vantage Medical Group Senior |
$20.33
|
|
|
RIVAROXABAN 15 MG TABLET [153877]
|
Facility
|
IP
|
$23.92
|
|
|
Service Code
|
NDC 50458-578-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.78 |
| Max. Negotiated Rate |
$20.33 |
| Rate for Payer: Adventist Health Commercial |
$4.78
|
| Rate for Payer: Blue Shield of California Commercial |
$17.65
|
| Rate for Payer: Blue Shield of California EPN |
$11.63
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cigna of CA HMO |
$16.74
|
| Rate for Payer: Cigna of CA PPO |
$16.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.57
|
| Rate for Payer: EPIC Health Plan Senior |
$9.57
|
| Rate for Payer: Galaxy Health WC |
$20.33
|
| Rate for Payer: Global Benefits Group Commercial |
$14.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.74
|
| Rate for Payer: Multiplan Commercial |
$19.14
|
| Rate for Payer: Networks By Design Commercial |
$15.55
|
| Rate for Payer: Prime Health Services Commercial |
$20.33
|
|
|
RIVAROXABAN 15 MG TABLET [153877]
|
Facility
|
IP
|
$23.92
|
|
|
Service Code
|
NDC 50458-578-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.78 |
| Max. Negotiated Rate |
$20.33 |
| Rate for Payer: Adventist Health Commercial |
$4.78
|
| Rate for Payer: Blue Shield of California Commercial |
$17.65
|
| Rate for Payer: Blue Shield of California EPN |
$11.63
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cigna of CA HMO |
$16.74
|
| Rate for Payer: Cigna of CA PPO |
$16.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.57
|
| Rate for Payer: EPIC Health Plan Senior |
$9.57
|
| Rate for Payer: Galaxy Health WC |
$20.33
|
| Rate for Payer: Global Benefits Group Commercial |
$14.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.74
|
| Rate for Payer: Multiplan Commercial |
$19.14
|
| Rate for Payer: Networks By Design Commercial |
$15.55
|
| Rate for Payer: Prime Health Services Commercial |
$20.33
|
|
|
RIVAROXABAN 15 MG TABLET [153877]
|
Facility
|
OP
|
$23.92
|
|
|
Service Code
|
NDC 50458-578-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.78 |
| Max. Negotiated Rate |
$20.33 |
| Rate for Payer: Adventist Health Commercial |
$4.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.69
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cigna of CA HMO |
$16.74
|
| Rate for Payer: Cigna of CA PPO |
$16.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.57
|
| Rate for Payer: EPIC Health Plan Senior |
$9.57
|
| Rate for Payer: Galaxy Health WC |
$20.33
|
| Rate for Payer: Global Benefits Group Commercial |
$14.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.74
|
| Rate for Payer: Multiplan Commercial |
$19.14
|
| Rate for Payer: Networks By Design Commercial |
$15.55
|
| Rate for Payer: Prime Health Services Commercial |
$20.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.96
|
| Rate for Payer: United Healthcare All Other HMO |
$11.96
|
| Rate for Payer: United Healthcare HMO Rider |
$11.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.33
|
| Rate for Payer: Vantage Medical Group Senior |
$20.33
|
|
|
RIVAROXABAN 20 MG TABLET [153878]
|
Facility
|
IP
|
$23.92
|
|
|
Service Code
|
NDC 50458-579-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.78 |
| Max. Negotiated Rate |
$20.33 |
| Rate for Payer: Adventist Health Commercial |
$4.78
|
| Rate for Payer: Blue Shield of California Commercial |
$17.65
|
| Rate for Payer: Blue Shield of California EPN |
$11.63
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cigna of CA HMO |
$16.74
|
| Rate for Payer: Cigna of CA PPO |
$16.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.57
|
| Rate for Payer: EPIC Health Plan Senior |
$9.57
|
| Rate for Payer: Galaxy Health WC |
$20.33
|
| Rate for Payer: Global Benefits Group Commercial |
$14.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.74
|
| Rate for Payer: Multiplan Commercial |
$19.14
|
| Rate for Payer: Networks By Design Commercial |
$15.55
|
| Rate for Payer: Prime Health Services Commercial |
$20.33
|
|
|
RIVAROXABAN 20 MG TABLET [153878]
|
Facility
|
IP
|
$23.92
|
|
|
Service Code
|
NDC 50458-579-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.78 |
| Max. Negotiated Rate |
$20.33 |
| Rate for Payer: Adventist Health Commercial |
$4.78
|
| Rate for Payer: Blue Shield of California Commercial |
$17.65
|
| Rate for Payer: Blue Shield of California EPN |
$11.63
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cigna of CA HMO |
$16.74
|
| Rate for Payer: Cigna of CA PPO |
$16.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.57
|
| Rate for Payer: EPIC Health Plan Senior |
$9.57
|
| Rate for Payer: Galaxy Health WC |
$20.33
|
| Rate for Payer: Global Benefits Group Commercial |
$14.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.74
|
| Rate for Payer: Multiplan Commercial |
$19.14
|
| Rate for Payer: Networks By Design Commercial |
$15.55
|
| Rate for Payer: Prime Health Services Commercial |
$20.33
|
|
|
RIVAROXABAN 20 MG TABLET [153878]
|
Facility
|
OP
|
$23.92
|
|
|
Service Code
|
NDC 50458-579-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.78 |
| Max. Negotiated Rate |
$20.33 |
| Rate for Payer: Adventist Health Commercial |
$4.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.69
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cigna of CA HMO |
$16.74
|
| Rate for Payer: Cigna of CA PPO |
$16.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.57
|
| Rate for Payer: EPIC Health Plan Senior |
$9.57
|
| Rate for Payer: Galaxy Health WC |
$20.33
|
| Rate for Payer: Global Benefits Group Commercial |
$14.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.74
|
| Rate for Payer: Multiplan Commercial |
$19.14
|
| Rate for Payer: Networks By Design Commercial |
$15.55
|
| Rate for Payer: Prime Health Services Commercial |
$20.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.96
|
| Rate for Payer: United Healthcare All Other HMO |
$11.96
|
| Rate for Payer: United Healthcare HMO Rider |
$11.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.33
|
| Rate for Payer: Vantage Medical Group Senior |
$20.33
|
|
|
RIVAROXABAN 20 MG TABLET [153878]
|
Facility
|
OP
|
$23.92
|
|
|
Service Code
|
NDC 50458-579-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.78 |
| Max. Negotiated Rate |
$20.33 |
| Rate for Payer: Adventist Health Commercial |
$4.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.69
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cigna of CA HMO |
$16.74
|
| Rate for Payer: Cigna of CA PPO |
$16.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.57
|
| Rate for Payer: EPIC Health Plan Senior |
$9.57
|
| Rate for Payer: Galaxy Health WC |
$20.33
|
| Rate for Payer: Global Benefits Group Commercial |
$14.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.74
|
| Rate for Payer: Multiplan Commercial |
$19.14
|
| Rate for Payer: Networks By Design Commercial |
$15.55
|
| Rate for Payer: Prime Health Services Commercial |
$20.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.96
|
| Rate for Payer: United Healthcare All Other HMO |
$11.96
|
| Rate for Payer: United Healthcare HMO Rider |
$11.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.33
|
| Rate for Payer: Vantage Medical Group Senior |
$20.33
|
|
|
RIVAROXABAN 2.5 MG TABLET [222768]
|
Facility
|
IP
|
$11.96
|
|
|
Service Code
|
NDC 50458-577-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$10.17 |
| Rate for Payer: Adventist Health Commercial |
$2.39
|
| Rate for Payer: Blue Shield of California Commercial |
$8.83
|
| Rate for Payer: Blue Shield of California EPN |
$5.81
|
| Rate for Payer: Cash Price |
$6.58
|
| Rate for Payer: Cigna of CA HMO |
$8.37
|
| Rate for Payer: Cigna of CA PPO |
$8.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.78
|
| Rate for Payer: EPIC Health Plan Senior |
$4.78
|
| Rate for Payer: Galaxy Health WC |
$10.17
|
| Rate for Payer: Global Benefits Group Commercial |
$7.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.87
|
| Rate for Payer: Multiplan Commercial |
$9.57
|
| Rate for Payer: Networks By Design Commercial |
$7.77
|
| Rate for Payer: Prime Health Services Commercial |
$10.17
|
|
