|
RUFINAMIDE 200 MG TABLET [95691]
|
Facility
|
OP
|
$0.90
|
|
|
Service Code
|
NDC 4257139112
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.58
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Cigna of CA HMO |
$0.63
|
| Rate for Payer: Cigna of CA PPO |
$0.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: EPIC Health Plan Senior |
$0.36
|
| Rate for Payer: Galaxy Health WC |
$0.77
|
| Rate for Payer: Global Benefits Group Commercial |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.63
|
| Rate for Payer: Multiplan Commercial |
$0.72
|
| Rate for Payer: Networks By Design Commercial |
$0.59
|
| Rate for Payer: Prime Health Services Commercial |
$0.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.45
|
| Rate for Payer: United Healthcare All Other HMO |
$0.45
|
| Rate for Payer: United Healthcare HMO Rider |
$0.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.77
|
| Rate for Payer: Vantage Medical Group Senior |
$0.77
|
|
|
RUFINAMIDE 200 MG TABLET [95691]
|
Facility
|
OP
|
$1.80
|
|
|
Service Code
|
NDC 3172259812
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.53 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cigna of CA HMO |
$1.26
|
| Rate for Payer: Cigna of CA PPO |
$1.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Senior |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$1.53
|
| Rate for Payer: Global Benefits Group Commercial |
$1.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$1.44
|
| Rate for Payer: Networks By Design Commercial |
$1.17
|
| Rate for Payer: Prime Health Services Commercial |
$1.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.90
|
| Rate for Payer: United Healthcare All Other HMO |
$0.90
|
| Rate for Payer: United Healthcare HMO Rider |
$0.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1.53
|
|
|
RUFINAMIDE 200 MG TABLET [95691]
|
Facility
|
OP
|
$3.68
|
|
|
Service Code
|
NDC 0054042523
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$3.13 |
| Rate for Payer: Adventist Health Commercial |
$0.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.36
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cigna of CA HMO |
$2.58
|
| Rate for Payer: Cigna of CA PPO |
$2.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.47
|
| Rate for Payer: EPIC Health Plan Senior |
$1.47
|
| Rate for Payer: Galaxy Health WC |
$3.13
|
| Rate for Payer: Global Benefits Group Commercial |
$2.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.58
|
| Rate for Payer: Multiplan Commercial |
$2.94
|
| Rate for Payer: Networks By Design Commercial |
$2.39
|
| Rate for Payer: Prime Health Services Commercial |
$3.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.84
|
| Rate for Payer: United Healthcare All Other HMO |
$1.84
|
| Rate for Payer: United Healthcare HMO Rider |
$1.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3.13
|
|
|
RUFINAMIDE 200 MG TABLET [95691]
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
NDC 3172259812
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.53 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$0.91
|
| Rate for Payer: Blue Shield of California Commercial |
$1.38
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cigna of CA HMO |
$1.26
|
| Rate for Payer: Cigna of CA PPO |
$1.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Senior |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$1.53
|
| Rate for Payer: Global Benefits Group Commercial |
$1.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$1.44
|
| Rate for Payer: Networks By Design Commercial |
$1.17
|
| Rate for Payer: Prime Health Services Commercial |
$1.53
|
|
|
RUFINAMIDE 200 MG TABLET [95691]
|
Facility
|
OP
|
$1.50
|
|
|
Service Code
|
NDC 6846271308
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.27 |
| Rate for Payer: Adventist Health Commercial |
$0.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.96
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cigna of CA HMO |
$1.05
|
| Rate for Payer: Cigna of CA PPO |
$1.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.60
|
| Rate for Payer: EPIC Health Plan Senior |
$0.60
|
| Rate for Payer: Galaxy Health WC |
$1.27
|
| Rate for Payer: Global Benefits Group Commercial |
$0.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.05
|
| Rate for Payer: Multiplan Commercial |
$1.20
|
| Rate for Payer: Networks By Design Commercial |
$0.98
|
| Rate for Payer: Prime Health Services Commercial |
$1.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.75
|
| Rate for Payer: United Healthcare All Other HMO |
$0.75
|
| Rate for Payer: United Healthcare HMO Rider |
$0.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.27
|
| Rate for Payer: Vantage Medical Group Senior |
$1.27
|
|
|
RUFINAMIDE 200 MG TABLET [95691]
|
Facility
|
IP
|
$0.90
|
|
|
Service Code
|
NDC 4257139112
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California Commercial |
$0.69
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Cigna of CA HMO |
$0.63
|
| Rate for Payer: Cigna of CA PPO |
$0.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: EPIC Health Plan Senior |
$0.36
|
| Rate for Payer: Galaxy Health WC |
$0.77
|
| Rate for Payer: Global Benefits Group Commercial |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.72
|
| Rate for Payer: Networks By Design Commercial |
$0.59
|
| Rate for Payer: Prime Health Services Commercial |
$0.77
|
|
|
RUFINAMIDE 200 MG TABLET [95691]
|
Facility
|
IP
|
$1.50
|
|
|
Service Code
|
NDC 6846271308
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.27 |
| Rate for Payer: Adventist Health Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California Commercial |
$0.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1.15
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cigna of CA HMO |
$1.05
|
| Rate for Payer: Cigna of CA PPO |
$1.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.60
|
| Rate for Payer: EPIC Health Plan Senior |
$0.60
|
| Rate for Payer: Galaxy Health WC |
$1.27
|
| Rate for Payer: Global Benefits Group Commercial |
$0.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.20
|
| Rate for Payer: Networks By Design Commercial |
$0.98
|
| Rate for Payer: Prime Health Services Commercial |
$1.27
|
|
|
RUFINAMIDE 200 MG TABLET [95691]
|
Facility
|
IP
|
$3.68
|
|
|
Service Code
|
NDC 0054042523
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$3.13 |
| Rate for Payer: Adventist Health Commercial |
$0.74
|
| Rate for Payer: Blue Shield of California Commercial |
$1.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2.83
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cigna of CA HMO |
$2.58
|
| Rate for Payer: Cigna of CA PPO |
$2.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.47
|
| Rate for Payer: EPIC Health Plan Senior |
$1.47
|
| Rate for Payer: Galaxy Health WC |
$3.13
|
| Rate for Payer: Global Benefits Group Commercial |
$2.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.88
|
| Rate for Payer: Multiplan Commercial |
$2.94
|
| Rate for Payer: Networks By Design Commercial |
$2.39
|
| Rate for Payer: Prime Health Services Commercial |
$3.13
|
|
|
RUFINAMIDE 400 MG TABLET [95692]
|
Facility
|
IP
|
$3.60
|
|
|
Service Code
|
NDC 3172259912
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Blue Shield of California Commercial |
$1.83
|
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Networks By Design Commercial |
$2.34
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
|
|
RUFINAMIDE 400 MG TABLET [95692]
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
NDC 4257139212
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.53 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$0.91
|
| Rate for Payer: Blue Shield of California Commercial |
$1.38
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cigna of CA HMO |
$1.26
|
| Rate for Payer: Cigna of CA PPO |
$1.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Senior |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$1.53
|
| Rate for Payer: Global Benefits Group Commercial |
$1.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$1.44
|
| Rate for Payer: Networks By Design Commercial |
$1.17
|
| Rate for Payer: Prime Health Services Commercial |
$1.53
|
|
|
RUFINAMIDE 400 MG TABLET [95692]
|
Facility
|
OP
|
$1.80
|
|
|
Service Code
|
NDC 4257139212
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.53 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cigna of CA HMO |
$1.26
|
| Rate for Payer: Cigna of CA PPO |
$1.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Senior |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$1.53
|
| Rate for Payer: Global Benefits Group Commercial |
$1.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$1.44
|
| Rate for Payer: Networks By Design Commercial |
$1.17
|
| Rate for Payer: Prime Health Services Commercial |
$1.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.90
|
| Rate for Payer: United Healthcare All Other HMO |
$0.90
|
| Rate for Payer: United Healthcare HMO Rider |
$0.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1.53
|
|
|
RUFINAMIDE 400 MG TABLET [95692]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 6846271408
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1.52
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cigna of CA HMO |
$2.10
|
| Rate for Payer: Cigna of CA PPO |
$2.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1.20
|
| Rate for Payer: Galaxy Health WC |
$2.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$1.95
|
| Rate for Payer: Prime Health Services Commercial |
$2.55
|
|
|
RUFINAMIDE 400 MG TABLET [95692]
|
Facility
|
IP
|
$7.37
|
|
|
Service Code
|
NDC 0054042623
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$6.26 |
| Rate for Payer: Adventist Health Commercial |
$1.47
|
| Rate for Payer: Blue Shield of California Commercial |
$3.74
|
| Rate for Payer: Blue Shield of California Commercial |
$5.67
|
| Rate for Payer: Cash Price |
$3.32
|
| Rate for Payer: Cigna of CA HMO |
$5.16
|
| Rate for Payer: Cigna of CA PPO |
$5.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.95
|
| Rate for Payer: EPIC Health Plan Senior |
$2.95
|
| Rate for Payer: Galaxy Health WC |
$6.26
|
| Rate for Payer: Global Benefits Group Commercial |
$4.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.77
|
| Rate for Payer: Multiplan Commercial |
$5.90
|
| Rate for Payer: Networks By Design Commercial |
$4.79
|
| Rate for Payer: Prime Health Services Commercial |
$6.26
|
|
|
RUFINAMIDE 400 MG TABLET [95692]
|
Facility
|
OP
|
$3.60
|
|
|
Service Code
|
NDC 3172259912
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.31
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.52
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Networks By Design Commercial |
$2.34
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other HMO |
$1.80
|
| Rate for Payer: United Healthcare HMO Rider |
$1.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
|
|
RUFINAMIDE 400 MG TABLET [95692]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 6846271408
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.93
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cigna of CA HMO |
$2.10
|
| Rate for Payer: Cigna of CA PPO |
$2.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1.20
|
| Rate for Payer: Galaxy Health WC |
$2.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$1.95
|
| Rate for Payer: Prime Health Services Commercial |
$2.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2.55
|
|
|
RUFINAMIDE 400 MG TABLET [95692]
|
Facility
|
OP
|
$7.37
|
|
|
Service Code
|
NDC 0054042623
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$6.26 |
| Rate for Payer: Adventist Health Commercial |
$1.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.73
|
| Rate for Payer: Cash Price |
$3.32
|
| Rate for Payer: Cigna of CA HMO |
$5.16
|
| Rate for Payer: Cigna of CA PPO |
$5.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.95
|
| Rate for Payer: EPIC Health Plan Senior |
$2.95
|
| Rate for Payer: Galaxy Health WC |
$6.26
|
| Rate for Payer: Global Benefits Group Commercial |
$4.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.16
|
| Rate for Payer: Multiplan Commercial |
$5.90
|
| Rate for Payer: Networks By Design Commercial |
$4.79
|
| Rate for Payer: Prime Health Services Commercial |
$6.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.69
|
| Rate for Payer: United Healthcare All Other HMO |
$3.69
|
| Rate for Payer: United Healthcare HMO Rider |
$3.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.26
|
| Rate for Payer: Vantage Medical Group Senior |
$6.26
|
|
|
RUFINAMIDE 40 MG/ML ORAL SUSPENSION [108804]
|
Facility
|
OP
|
$4.59
|
|
|
Service Code
|
NDC 6285658446
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Adventist Health Commercial |
$0.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.95
|
| Rate for Payer: Cash Price |
$2.07
|
| Rate for Payer: Cigna of CA HMO |
$3.21
|
| Rate for Payer: Cigna of CA PPO |
$3.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.84
|
| Rate for Payer: EPIC Health Plan Senior |
$1.84
|
| Rate for Payer: Galaxy Health WC |
$3.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.21
|
| Rate for Payer: Multiplan Commercial |
$3.67
|
| Rate for Payer: Networks By Design Commercial |
$2.98
|
| Rate for Payer: Prime Health Services Commercial |
$3.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.29
|
| Rate for Payer: United Healthcare All Other HMO |
$2.29
|
| Rate for Payer: United Healthcare HMO Rider |
$2.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.90
|
| Rate for Payer: Vantage Medical Group Senior |
$3.90
|
|
|
RUFINAMIDE 40 MG/ML ORAL SUSPENSION [108804]
|
Facility
|
IP
|
$4.59
|
|
|
Service Code
|
NDC 6285658446
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Adventist Health Commercial |
$0.92
|
| Rate for Payer: Blue Shield of California Commercial |
$2.33
|
| Rate for Payer: Blue Shield of California Commercial |
$3.53
|
| Rate for Payer: Cash Price |
$2.07
|
| Rate for Payer: Cigna of CA HMO |
$3.21
|
| Rate for Payer: Cigna of CA PPO |
$3.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.84
|
| Rate for Payer: EPIC Health Plan Senior |
$1.84
|
| Rate for Payer: Galaxy Health WC |
$3.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.10
|
| Rate for Payer: Multiplan Commercial |
$3.67
|
| Rate for Payer: Networks By Design Commercial |
$2.98
|
| Rate for Payer: Prime Health Services Commercial |
$3.90
|
|
|
RUXOLITINIB 10 MG TABLET [153887]
|
Facility
|
IP
|
$363.80
|
|
|
Service Code
|
NDC 5088101060
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$72.76 |
| Max. Negotiated Rate |
$309.23 |
| Rate for Payer: Adventist Health Commercial |
$72.76
|
| Rate for Payer: Blue Shield of California Commercial |
$184.45
|
| Rate for Payer: Blue Shield of California Commercial |
$279.76
|
| Rate for Payer: Cash Price |
$163.71
|
| Rate for Payer: Cigna of CA HMO |
$254.66
|
| Rate for Payer: Cigna of CA PPO |
$254.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$254.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$145.52
|
| Rate for Payer: EPIC Health Plan Senior |
$145.52
|
| Rate for Payer: Galaxy Health WC |
$309.23
|
| Rate for Payer: Global Benefits Group Commercial |
$218.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$231.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$214.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.31
|
| Rate for Payer: Multiplan Commercial |
$291.04
|
| Rate for Payer: Networks By Design Commercial |
$236.47
|
| Rate for Payer: Prime Health Services Commercial |
$309.23
|
|
|
RUXOLITINIB 10 MG TABLET [153887]
|
Facility
|
OP
|
$363.80
|
|
|
Service Code
|
NDC 5088101060
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$72.76 |
| Max. Negotiated Rate |
$309.23 |
| Rate for Payer: Adventist Health Commercial |
$72.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$238.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$309.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$200.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$272.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$233.45
|
| Rate for Payer: Cash Price |
$163.71
|
| Rate for Payer: Cigna of CA HMO |
$254.66
|
| Rate for Payer: Cigna of CA PPO |
$254.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$309.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$309.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$309.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$254.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$145.52
|
| Rate for Payer: EPIC Health Plan Senior |
$145.52
|
| Rate for Payer: Galaxy Health WC |
$309.23
|
| Rate for Payer: Global Benefits Group Commercial |
$218.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$231.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$132.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$214.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$254.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$254.66
|
| Rate for Payer: Multiplan Commercial |
$291.04
|
| Rate for Payer: Networks By Design Commercial |
$236.47
|
| Rate for Payer: Prime Health Services Commercial |
$309.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$218.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$218.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$181.90
|
| Rate for Payer: United Healthcare All Other HMO |
$181.90
|
| Rate for Payer: United Healthcare HMO Rider |
$181.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$181.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$309.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$309.23
|
| Rate for Payer: Vantage Medical Group Senior |
$309.23
|
|
|
RUXOLITINIB 15 MG TABLET [153888]
|
Facility
|
OP
|
$363.80
|
|
|
Service Code
|
NDC 5088101560
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$72.76 |
| Max. Negotiated Rate |
$309.23 |
| Rate for Payer: Adventist Health Commercial |
$72.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$238.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$309.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$200.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$272.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$233.45
|
| Rate for Payer: Cash Price |
$163.71
|
| Rate for Payer: Cigna of CA HMO |
$254.66
|
| Rate for Payer: Cigna of CA PPO |
$254.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$309.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$309.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$309.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$254.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$145.52
|
| Rate for Payer: EPIC Health Plan Senior |
$145.52
|
| Rate for Payer: Galaxy Health WC |
$309.23
|
| Rate for Payer: Global Benefits Group Commercial |
$218.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$231.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$132.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$214.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$254.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$254.66
|
| Rate for Payer: Multiplan Commercial |
$291.04
|
| Rate for Payer: Networks By Design Commercial |
$236.47
|
| Rate for Payer: Prime Health Services Commercial |
$309.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$218.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$218.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$181.90
|
| Rate for Payer: United Healthcare All Other HMO |
$181.90
|
| Rate for Payer: United Healthcare HMO Rider |
$181.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$181.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$309.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$309.23
|
| Rate for Payer: Vantage Medical Group Senior |
$309.23
|
|
|
RUXOLITINIB 15 MG TABLET [153888]
|
Facility
|
IP
|
$363.80
|
|
|
Service Code
|
NDC 5088101560
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$72.76 |
| Max. Negotiated Rate |
$309.23 |
| Rate for Payer: Adventist Health Commercial |
$72.76
|
| Rate for Payer: Blue Shield of California Commercial |
$184.45
|
| Rate for Payer: Blue Shield of California Commercial |
$279.76
|
| Rate for Payer: Cash Price |
$163.71
|
| Rate for Payer: Cigna of CA HMO |
$254.66
|
| Rate for Payer: Cigna of CA PPO |
$254.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$254.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$145.52
|
| Rate for Payer: EPIC Health Plan Senior |
$145.52
|
| Rate for Payer: Galaxy Health WC |
$309.23
|
| Rate for Payer: Global Benefits Group Commercial |
$218.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$231.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$214.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.31
|
| Rate for Payer: Multiplan Commercial |
$291.04
|
| Rate for Payer: Networks By Design Commercial |
$236.47
|
| Rate for Payer: Prime Health Services Commercial |
$309.23
|
|
|
RUXOLITINIB 20 MG TABLET [153889]
|
Facility
|
IP
|
$363.80
|
|
|
Service Code
|
NDC 5088102060
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$72.76 |
| Max. Negotiated Rate |
$309.23 |
| Rate for Payer: Adventist Health Commercial |
$72.76
|
| Rate for Payer: Blue Shield of California Commercial |
$184.45
|
| Rate for Payer: Blue Shield of California Commercial |
$279.76
|
| Rate for Payer: Cash Price |
$163.71
|
| Rate for Payer: Cigna of CA HMO |
$254.66
|
| Rate for Payer: Cigna of CA PPO |
$254.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$254.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$145.52
|
| Rate for Payer: EPIC Health Plan Senior |
$145.52
|
| Rate for Payer: Galaxy Health WC |
$309.23
|
| Rate for Payer: Global Benefits Group Commercial |
$218.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$231.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$214.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.31
|
| Rate for Payer: Multiplan Commercial |
$291.04
|
| Rate for Payer: Networks By Design Commercial |
$236.47
|
| Rate for Payer: Prime Health Services Commercial |
$309.23
|
|
|
RUXOLITINIB 20 MG TABLET [153889]
|
Facility
|
OP
|
$363.80
|
|
|
Service Code
|
NDC 5088102060
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$72.76 |
| Max. Negotiated Rate |
$309.23 |
| Rate for Payer: Adventist Health Commercial |
$72.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$238.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$309.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$200.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$272.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$233.45
|
| Rate for Payer: Cash Price |
$163.71
|
| Rate for Payer: Cigna of CA HMO |
$254.66
|
| Rate for Payer: Cigna of CA PPO |
$254.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$309.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$309.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$309.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$254.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$145.52
|
| Rate for Payer: EPIC Health Plan Senior |
$145.52
|
| Rate for Payer: Galaxy Health WC |
$309.23
|
| Rate for Payer: Global Benefits Group Commercial |
$218.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$231.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$132.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$214.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$254.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$254.66
|
| Rate for Payer: Multiplan Commercial |
$291.04
|
| Rate for Payer: Networks By Design Commercial |
$236.47
|
| Rate for Payer: Prime Health Services Commercial |
$309.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$218.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$218.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$181.90
|
| Rate for Payer: United Healthcare All Other HMO |
$181.90
|
| Rate for Payer: United Healthcare HMO Rider |
$181.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$181.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$309.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$309.23
|
| Rate for Payer: Vantage Medical Group Senior |
$309.23
|
|
|
RUXOLITINIB 25 MG TABLET [153890]
|
Facility
|
IP
|
$363.80
|
|
|
Service Code
|
NDC 5088102560
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$72.76 |
| Max. Negotiated Rate |
$309.23 |
| Rate for Payer: Adventist Health Commercial |
$72.76
|
| Rate for Payer: Blue Shield of California Commercial |
$184.45
|
| Rate for Payer: Blue Shield of California Commercial |
$279.76
|
| Rate for Payer: Cash Price |
$163.71
|
| Rate for Payer: Cigna of CA HMO |
$254.66
|
| Rate for Payer: Cigna of CA PPO |
$254.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$254.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$145.52
|
| Rate for Payer: EPIC Health Plan Senior |
$145.52
|
| Rate for Payer: Galaxy Health WC |
$309.23
|
| Rate for Payer: Global Benefits Group Commercial |
$218.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$231.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$214.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.31
|
| Rate for Payer: Multiplan Commercial |
$291.04
|
| Rate for Payer: Networks By Design Commercial |
$236.47
|
| Rate for Payer: Prime Health Services Commercial |
$309.23
|
|
