|
RITONAVIR 100 MG TABLET [100995]
|
Facility
|
IP
|
$6.40
|
|
|
Service Code
|
NDC 0054040713
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$5.44 |
| Rate for Payer: Adventist Health Commercial |
$1.28
|
| Rate for Payer: Blue Shield of California Commercial |
$3.24
|
| Rate for Payer: Blue Shield of California Commercial |
$4.92
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: Cigna of CA HMO |
$4.48
|
| Rate for Payer: Cigna of CA PPO |
$4.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.56
|
| Rate for Payer: EPIC Health Plan Senior |
$2.56
|
| Rate for Payer: Galaxy Health WC |
$5.44
|
| Rate for Payer: Global Benefits Group Commercial |
$3.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.54
|
| Rate for Payer: Multiplan Commercial |
$5.12
|
| Rate for Payer: Networks By Design Commercial |
$4.16
|
| Rate for Payer: Prime Health Services Commercial |
$5.44
|
|
|
RITONAVIR 100 MG TABLET [100995]
|
Facility
|
IP
|
$3.20
|
|
|
Service Code
|
NDC 3172259730
|
| 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 |
$1.62
|
| Rate for Payer: Blue Shield of California Commercial |
$2.46
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Cigna of CA HMO |
$2.24
|
| Rate for Payer: Cigna of CA PPO |
$2.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.89
|
| 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
|
$6.40
|
|
|
Service Code
|
NDC 0054040713
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$5.44 |
| Rate for Payer: Adventist Health Commercial |
$1.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.11
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: Cigna of CA HMO |
$4.48
|
| Rate for Payer: Cigna of CA PPO |
$4.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.56
|
| Rate for Payer: EPIC Health Plan Senior |
$2.56
|
| Rate for Payer: Galaxy Health WC |
$5.44
|
| Rate for Payer: Global Benefits Group Commercial |
$3.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.48
|
| Rate for Payer: Multiplan Commercial |
$5.12
|
| Rate for Payer: Networks By Design Commercial |
$4.16
|
| Rate for Payer: Prime Health Services Commercial |
$5.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.20
|
| Rate for Payer: United Healthcare All Other HMO |
$3.20
|
| Rate for Payer: United Healthcare HMO Rider |
$3.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.44
|
| Rate for Payer: Vantage Medical Group Senior |
$5.44
|
|
|
RITONAVIR 100 MG TABLET [100995]
|
Facility
|
IP
|
$3.20
|
|
|
Service Code
|
NDC 6586268730
|
| 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 |
$1.62
|
| Rate for Payer: Blue Shield of California Commercial |
$2.46
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Cigna of CA HMO |
$2.24
|
| Rate for Payer: Cigna of CA PPO |
$2.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.89
|
| 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
|
|
|
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 |
$57.16
|
| Rate for Payer: Blue Shield of California Commercial |
$86.70
|
| Rate for Payer: Cash Price |
$50.73
|
| Rate for Payer: Cigna of CA HMO |
$78.92
|
| Rate for Payer: Cigna of CA PPO |
$78.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$71.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.52
|
| 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 |
$240.11 |
| Rate for Payer: Adventist Health Commercial |
$22.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$150.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$109.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$240.11
|
| Rate for Payer: Blue Shield of California Commercial |
$112.74
|
| Rate for Payer: Cash Price |
$50.73
|
| Rate for Payer: Cash Price |
$50.73
|
| 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 |
$91.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$80.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$80.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$78.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.91
|
| Rate for Payer: EPIC Health Plan Senior |
$80.61
|
| Rate for Payer: Galaxy Health WC |
$95.83
|
| Rate for Payer: Global Benefits Group Commercial |
$67.64
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$120.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$73.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$73.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$142.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$102.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$92.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$98.20
|
| 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 |
$73.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$91.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$80.61
|
| Rate for Payer: Vantage Medical Group Senior |
$80.61
|
|
|
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 |
$240.11 |
| Rate for Payer: Adventist Health Commercial |
$22.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$150.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$109.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$240.11
|
| Rate for Payer: Blue Shield of California Commercial |
$112.74
|
| Rate for Payer: Cash Price |
$50.73
|
| Rate for Payer: Cash Price |
$50.73
|
| 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 |
$91.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$80.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$80.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$78.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.91
|
| Rate for Payer: EPIC Health Plan Senior |
$80.61
|
| Rate for Payer: Galaxy Health WC |
$95.83
|
| Rate for Payer: Global Benefits Group Commercial |
$67.64
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$120.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$73.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$73.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$142.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$102.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$92.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$98.20
|
| 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 |
$73.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$91.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$80.61
|
| Rate for Payer: Vantage Medical Group Senior |
$80.61
|
|
|
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 |
$57.16
|
| Rate for Payer: Blue Shield of California Commercial |
$86.70
|
| Rate for Payer: Cash Price |
$50.73
|
| Rate for Payer: Cigna of CA HMO |
$78.92
|
| Rate for Payer: Cigna of CA PPO |
$78.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$71.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.52
|
| 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 |
$36.39 |
| Max. Negotiated Rate |
$573.34 |
| Rate for Payer: Adventist Health Commercial |
$134.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.05
|
| Rate for Payer: Blue Shield of California Commercial |
$56.37
|
| Rate for Payer: Cash Price |
$303.53
|
| Rate for Payer: Cash Price |
$303.53
|
| 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 |
$45.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$472.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.04
|
| Rate for Payer: EPIC Health Plan Senior |
$40.03
|
| Rate for Payer: Galaxy Health WC |
$573.34
|
| Rate for Payer: Global Benefits Group Commercial |
$404.71
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$59.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$36.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$36.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$428.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$78.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48.76
|
| 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 |
$36.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.03
|
| Rate for Payer: Vantage Medical Group Senior |
$40.03
|
|
|
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 |
$341.98
|
| Rate for Payer: Blue Shield of California Commercial |
$518.71
|
| Rate for Payer: Cash Price |
$303.53
|
| Rate for Payer: Cigna of CA HMO |
$472.16
|
| Rate for Payer: Cigna of CA PPO |
$472.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$428.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$397.97
|
| 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 |
$341.25
|
| Rate for Payer: Blue Shield of California Commercial |
$517.60
|
| Rate for Payer: Cash Price |
$302.89
|
| Rate for Payer: Cigna of CA HMO |
$471.16
|
| Rate for Payer: Cigna of CA PPO |
$471.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$427.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$397.12
|
| 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 |
$36.39 |
| Max. Negotiated Rate |
$572.12 |
| Rate for Payer: Adventist Health Commercial |
$134.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.05
|
| Rate for Payer: Blue Shield of California Commercial |
$56.37
|
| Rate for Payer: Cash Price |
$302.89
|
| Rate for Payer: Cash Price |
$302.89
|
| 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 |
$45.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$471.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.04
|
| Rate for Payer: EPIC Health Plan Senior |
$40.03
|
| Rate for Payer: Galaxy Health WC |
$572.12
|
| Rate for Payer: Global Benefits Group Commercial |
$403.85
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$59.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$36.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$36.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$427.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$78.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48.76
|
| 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 |
$36.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.03
|
| Rate for Payer: Vantage Medical Group Senior |
$40.03
|
|
|
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 |
$232.34 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$232.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$183.14
|
| Rate for Payer: Blue Shield of California Commercial |
$86.02
|
| Rate for Payer: Cash Price |
$38.71
|
| Rate for Payer: Cash Price |
$38.71
|
| Rate for Payer: Cigna of CA HMO |
$60.21
|
| Rate for Payer: Cigna of CA PPO |
$60.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.57
|
| Rate for Payer: EPIC Health Plan Senior |
$20.38
|
| Rate for Payer: Galaxy Health WC |
$73.12
|
| Rate for Payer: Global Benefits Group Commercial |
$51.61
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$54.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.83
|
| 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 |
$18.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.38
|
| Rate for Payer: Vantage Medical Group Senior |
$20.38
|
|
|
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 |
$43.61
|
| Rate for Payer: Blue Shield of California Commercial |
$66.15
|
| Rate for Payer: Cash Price |
$38.71
|
| Rate for Payer: Cigna of CA HMO |
$60.21
|
| Rate for Payer: Cigna of CA PPO |
$60.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$54.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.75
|
| 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 |
$16.16 |
| Max. Negotiated Rate |
$183.14 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$156.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$183.14
|
| Rate for Payer: Blue Shield of California Commercial |
$86.02
|
| Rate for Payer: Cash Price |
$38.71
|
| Rate for Payer: Cash Price |
$38.71
|
| Rate for Payer: Cigna of CA HMO |
$60.21
|
| Rate for Payer: Cigna of CA PPO |
$60.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.66
|
| Rate for Payer: EPIC Health Plan Senior |
$17.78
|
| Rate for Payer: Galaxy Health WC |
$73.12
|
| Rate for Payer: Global Benefits Group Commercial |
$51.61
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$54.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.65
|
| 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 |
$16.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.78
|
| Rate for Payer: Vantage Medical Group Senior |
$17.78
|
|
|
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: Cigna of CA HMO |
$60.21
|
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Blue Shield of California Commercial |
$43.61
|
| Rate for Payer: Blue Shield of California Commercial |
$66.15
|
| Rate for Payer: Cash Price |
$38.71
|
| Rate for Payer: Cigna of CA PPO |
$60.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$54.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.75
|
| 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
|
|
|
RIVAROXABAN 10 MG TABLET [153876]
|
Facility
|
IP
|
$24.47
|
|
|
Service Code
|
NDC 5045858030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$20.80 |
| Rate for Payer: Adventist Health Commercial |
$4.89
|
| Rate for Payer: Blue Shield of California Commercial |
$12.41
|
| Rate for Payer: Blue Shield of California Commercial |
$18.82
|
| Rate for Payer: Cash Price |
$11.01
|
| Rate for Payer: Cigna of CA HMO |
$17.13
|
| Rate for Payer: Cigna of CA PPO |
$17.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.79
|
| Rate for Payer: EPIC Health Plan Senior |
$9.79
|
| Rate for Payer: Galaxy Health WC |
$20.80
|
| Rate for Payer: Global Benefits Group Commercial |
$14.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.87
|
| Rate for Payer: Multiplan Commercial |
$19.58
|
| Rate for Payer: Networks By Design Commercial |
$15.91
|
| Rate for Payer: Prime Health Services Commercial |
$20.80
|
|
|
RIVAROXABAN 10 MG TABLET [153876]
|
Facility
|
OP
|
$24.47
|
|
|
Service Code
|
NDC 5045858030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$20.80 |
| Rate for Payer: Adventist Health Commercial |
$4.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.70
|
| Rate for Payer: Cash Price |
$11.01
|
| Rate for Payer: Cigna of CA HMO |
$17.13
|
| Rate for Payer: Cigna of CA PPO |
$17.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.79
|
| Rate for Payer: EPIC Health Plan Senior |
$9.79
|
| Rate for Payer: Galaxy Health WC |
$20.80
|
| Rate for Payer: Global Benefits Group Commercial |
$14.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.13
|
| Rate for Payer: Multiplan Commercial |
$19.58
|
| Rate for Payer: Networks By Design Commercial |
$15.91
|
| Rate for Payer: Prime Health Services Commercial |
$20.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.23
|
| Rate for Payer: United Healthcare All Other HMO |
$12.23
|
| Rate for Payer: United Healthcare HMO Rider |
$12.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.80
|
| Rate for Payer: Vantage Medical Group Senior |
$20.80
|
|
|
RIVAROXABAN 15 MG TABLET [153877]
|
Facility
|
IP
|
$24.47
|
|
|
Service Code
|
NDC 5045857810
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$20.80 |
| Rate for Payer: Adventist Health Commercial |
$4.89
|
| Rate for Payer: Blue Shield of California Commercial |
$12.41
|
| Rate for Payer: Blue Shield of California Commercial |
$18.82
|
| Rate for Payer: Cash Price |
$11.01
|
| Rate for Payer: Cigna of CA HMO |
$17.13
|
| Rate for Payer: Cigna of CA PPO |
$17.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.79
|
| Rate for Payer: EPIC Health Plan Senior |
$9.79
|
| Rate for Payer: Galaxy Health WC |
$20.80
|
| Rate for Payer: Global Benefits Group Commercial |
$14.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.87
|
| Rate for Payer: Multiplan Commercial |
$19.58
|
| Rate for Payer: Networks By Design Commercial |
$15.91
|
| Rate for Payer: Prime Health Services Commercial |
$20.80
|
|
|
RIVAROXABAN 15 MG TABLET [153877]
|
Facility
|
OP
|
$24.47
|
|
|
Service Code
|
NDC 5045857801
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$20.80 |
| Rate for Payer: Adventist Health Commercial |
$4.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.70
|
| Rate for Payer: Cash Price |
$11.01
|
| Rate for Payer: Cigna of CA HMO |
$17.13
|
| Rate for Payer: Cigna of CA PPO |
$17.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.79
|
| Rate for Payer: EPIC Health Plan Senior |
$9.79
|
| Rate for Payer: Galaxy Health WC |
$20.80
|
| Rate for Payer: Global Benefits Group Commercial |
$14.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.13
|
| Rate for Payer: Multiplan Commercial |
$19.58
|
| Rate for Payer: Networks By Design Commercial |
$15.91
|
| Rate for Payer: Prime Health Services Commercial |
$20.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.23
|
| Rate for Payer: United Healthcare All Other HMO |
$12.23
|
| Rate for Payer: United Healthcare HMO Rider |
$12.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.80
|
| Rate for Payer: Vantage Medical Group Senior |
$20.80
|
|
|
RIVAROXABAN 15 MG TABLET [153877]
|
Facility
|
IP
|
$24.47
|
|
|
Service Code
|
NDC 5045857801
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$20.80 |
| Rate for Payer: Adventist Health Commercial |
$4.89
|
| Rate for Payer: Blue Shield of California Commercial |
$12.41
|
| Rate for Payer: Blue Shield of California Commercial |
$18.82
|
| Rate for Payer: Cash Price |
$11.01
|
| Rate for Payer: Cigna of CA HMO |
$17.13
|
| Rate for Payer: Cigna of CA PPO |
$17.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.79
|
| Rate for Payer: EPIC Health Plan Senior |
$9.79
|
| Rate for Payer: Galaxy Health WC |
$20.80
|
| Rate for Payer: Global Benefits Group Commercial |
$14.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.87
|
| Rate for Payer: Multiplan Commercial |
$19.58
|
| Rate for Payer: Networks By Design Commercial |
$15.91
|
| Rate for Payer: Prime Health Services Commercial |
$20.80
|
|
|
RIVAROXABAN 15 MG TABLET [153877]
|
Facility
|
OP
|
$24.47
|
|
|
Service Code
|
NDC 5045857810
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$20.80 |
| Rate for Payer: Adventist Health Commercial |
$4.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.70
|
| Rate for Payer: Cash Price |
$11.01
|
| Rate for Payer: Cigna of CA HMO |
$17.13
|
| Rate for Payer: Cigna of CA PPO |
$17.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.79
|
| Rate for Payer: EPIC Health Plan Senior |
$9.79
|
| Rate for Payer: Galaxy Health WC |
$20.80
|
| Rate for Payer: Global Benefits Group Commercial |
$14.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.13
|
| Rate for Payer: Multiplan Commercial |
$19.58
|
| Rate for Payer: Networks By Design Commercial |
$15.91
|
| Rate for Payer: Prime Health Services Commercial |
$20.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.23
|
| Rate for Payer: United Healthcare All Other HMO |
$12.23
|
| Rate for Payer: United Healthcare HMO Rider |
$12.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.80
|
| Rate for Payer: Vantage Medical Group Senior |
$20.80
|
|
|
RIVAROXABAN 20 MG TABLET [153878]
|
Facility
|
OP
|
$24.47
|
|
|
Service Code
|
NDC 5045857930
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$20.80 |
| Rate for Payer: Adventist Health Commercial |
$4.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.70
|
| Rate for Payer: Cash Price |
$11.01
|
| Rate for Payer: Cigna of CA HMO |
$17.13
|
| Rate for Payer: Cigna of CA PPO |
$17.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.79
|
| Rate for Payer: EPIC Health Plan Senior |
$9.79
|
| Rate for Payer: Galaxy Health WC |
$20.80
|
| Rate for Payer: Global Benefits Group Commercial |
$14.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.13
|
| Rate for Payer: Multiplan Commercial |
$19.58
|
| Rate for Payer: Networks By Design Commercial |
$15.91
|
| Rate for Payer: Prime Health Services Commercial |
$20.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.23
|
| Rate for Payer: United Healthcare All Other HMO |
$12.23
|
| Rate for Payer: United Healthcare HMO Rider |
$12.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.80
|
| Rate for Payer: Vantage Medical Group Senior |
$20.80
|
|
|
RIVAROXABAN 20 MG TABLET [153878]
|
Facility
|
IP
|
$24.47
|
|
|
Service Code
|
NDC 5045857930
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$20.80 |
| Rate for Payer: Adventist Health Commercial |
$4.89
|
| Rate for Payer: Blue Shield of California Commercial |
$12.41
|
| Rate for Payer: Blue Shield of California Commercial |
$18.82
|
| Rate for Payer: Cash Price |
$11.01
|
| Rate for Payer: Cigna of CA HMO |
$17.13
|
| Rate for Payer: Cigna of CA PPO |
$17.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.79
|
| Rate for Payer: EPIC Health Plan Senior |
$9.79
|
| Rate for Payer: Galaxy Health WC |
$20.80
|
| Rate for Payer: Global Benefits Group Commercial |
$14.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.87
|
| Rate for Payer: Multiplan Commercial |
$19.58
|
| Rate for Payer: Networks By Design Commercial |
$15.91
|
| Rate for Payer: Prime Health Services Commercial |
$20.80
|
|
|
RIVAROXABAN 20 MG TABLET [153878]
|
Facility
|
IP
|
$24.47
|
|
|
Service Code
|
NDC 5045857910
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$20.80 |
| Rate for Payer: Adventist Health Commercial |
$4.89
|
| Rate for Payer: Blue Shield of California Commercial |
$12.41
|
| Rate for Payer: Blue Shield of California Commercial |
$18.82
|
| Rate for Payer: Cash Price |
$11.01
|
| Rate for Payer: Cigna of CA HMO |
$17.13
|
| Rate for Payer: Cigna of CA PPO |
$17.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.79
|
| Rate for Payer: EPIC Health Plan Senior |
$9.79
|
| Rate for Payer: Galaxy Health WC |
$20.80
|
| Rate for Payer: Global Benefits Group Commercial |
$14.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.87
|
| Rate for Payer: Multiplan Commercial |
$19.58
|
| Rate for Payer: Networks By Design Commercial |
$15.91
|
| Rate for Payer: Prime Health Services Commercial |
$20.80
|
|
