|
RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION [221392]
|
Facility
|
IP
|
$816.60
|
|
|
Service Code
|
CPT 90375
|
| Hospital Charge Code |
NDG221392
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$195.98 |
| Max. Negotiated Rate |
$694.11 |
| Rate for Payer: Blue Shield of California Commercial |
$581.42
|
| Rate for Payer: Blue Shield of California EPN |
$418.10
|
| Rate for Payer: Cash Price |
$367.47
|
| Rate for Payer: Cigna of CA HMO |
$571.62
|
| Rate for Payer: Cigna of CA PPO |
$571.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$326.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$326.64
|
| Rate for Payer: Galaxy Health WC |
$694.11
|
| Rate for Payer: Global Benefits Group Commercial |
$489.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$544.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$311.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.98
|
| Rate for Payer: Multiplan Commercial |
$653.28
|
| Rate for Payer: Networks By Design Commercial |
$408.30
|
| Rate for Payer: Prime Health Services Commercial |
$694.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$308.35
|
| Rate for Payer: United Healthcare All Other HMO |
$301.16
|
| Rate for Payer: United Healthcare HMO Rider |
$294.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$269.48
|
|
|
RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION [221392]
|
Facility
|
OP
|
$816.60
|
|
|
Service Code
|
CPT 90375
|
| Hospital Charge Code |
NDG221392
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$156.13 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,016.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$362.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$318.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$318.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.13
|
| Rate for Payer: Blue Distinction Transplant |
$489.96
|
| Rate for Payer: Blue Shield of California Commercial |
$601.83
|
| Rate for Payer: Blue Shield of California EPN |
$402.26
|
| Rate for Payer: Cash Price |
$367.47
|
| Rate for Payer: Cash Price |
$367.47
|
| Rate for Payer: Cigna of CA HMO |
$571.62
|
| Rate for Payer: Cigna of CA PPO |
$571.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$434.97
|
| Rate for Payer: Dignity Health Media |
$289.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$318.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$391.47
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$289.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$289.98
|
| Rate for Payer: Galaxy Health WC |
$694.11
|
| Rate for Payer: Global Benefits Group Commercial |
$489.96
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$612.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$475.57
|
| Rate for Payer: Heritage Provider Network Transplant |
$475.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$469.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$469.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$289.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$544.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$559.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$289.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$365.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$388.57
|
| Rate for Payer: Multiplan Commercial |
$653.28
|
| Rate for Payer: Networks By Design Commercial |
$408.30
|
| Rate for Payer: Prime Health Services Commercial |
$694.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$489.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$489.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$408.30
|
| Rate for Payer: United Healthcare All Other HMO |
$408.30
|
| Rate for Payer: United Healthcare HMO Rider |
$408.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$408.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$434.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$318.98
|
| Rate for Payer: Vantage Medical Group Senior |
$289.98
|
|
|
RABIES VACCINE,HUMAN DIPLOID (PF) 2.5 UNIT INTRAMUSCULAR SOLUTION [11257]
|
Facility
|
OP
|
$486.20
|
|
|
Service Code
|
CPT 90675
|
| Hospital Charge Code |
ERX11257
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$116.69 |
| Max. Negotiated Rate |
$2,257.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,257.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$405.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$357.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$357.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$310.86
|
| Rate for Payer: Blue Distinction Transplant |
$291.72
|
| Rate for Payer: Blue Shield of California Commercial |
$358.33
|
| Rate for Payer: Blue Shield of California EPN |
$416.53
|
| Rate for Payer: Cash Price |
$218.79
|
| Rate for Payer: Cash Price |
$218.79
|
| Rate for Payer: Cigna of CA HMO |
$340.34
|
| Rate for Payer: Cigna of CA PPO |
$340.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$487.12
|
| Rate for Payer: Dignity Health Media |
$324.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$357.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$324.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$324.74
|
| Rate for Payer: Galaxy Health WC |
$413.27
|
| Rate for Payer: Global Benefits Group Commercial |
$291.72
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$364.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$532.58
|
| Rate for Payer: Heritage Provider Network Transplant |
$532.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$526.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$526.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$324.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$324.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$625.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$324.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$409.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$435.16
|
| Rate for Payer: Multiplan Commercial |
$388.96
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: Prime Health Services Commercial |
$413.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$291.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$291.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$243.10
|
| Rate for Payer: United Healthcare All Other HMO |
$243.10
|
| Rate for Payer: United Healthcare HMO Rider |
$243.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$243.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$487.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$357.22
|
| Rate for Payer: Vantage Medical Group Senior |
$324.74
|
|
|
RABIES VACCINE,HUMAN DIPLOID (PF) 2.5 UNIT INTRAMUSCULAR SOLUTION [11257]
|
Facility
|
IP
|
$486.20
|
|
|
Service Code
|
CPT 90675
|
| Hospital Charge Code |
ERX11257
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$116.69 |
| Max. Negotiated Rate |
$413.27 |
| Rate for Payer: Blue Shield of California Commercial |
$346.17
|
| Rate for Payer: Blue Shield of California EPN |
$248.93
|
| Rate for Payer: Cash Price |
$218.79
|
| Rate for Payer: Cigna of CA HMO |
$340.34
|
| Rate for Payer: Cigna of CA PPO |
$340.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$194.48
|
| Rate for Payer: Galaxy Health WC |
$413.27
|
| Rate for Payer: Global Benefits Group Commercial |
$291.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$324.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.69
|
| Rate for Payer: Multiplan Commercial |
$388.96
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: Prime Health Services Commercial |
$413.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.59
|
| Rate for Payer: United Healthcare All Other HMO |
$179.31
|
| Rate for Payer: United Healthcare HMO Rider |
$175.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$160.45
|
|
|
RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP [22120]
|
Facility
|
IP
|
$477.59
|
|
|
Service Code
|
CPT 90675
|
| Hospital Charge Code |
1720343
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$114.62 |
| Max. Negotiated Rate |
$405.95 |
| Rate for Payer: Blue Shield of California Commercial |
$340.04
|
| Rate for Payer: Blue Shield of California EPN |
$244.53
|
| Rate for Payer: Cash Price |
$214.92
|
| Rate for Payer: Cigna of CA HMO |
$334.31
|
| Rate for Payer: Cigna of CA PPO |
$334.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$191.04
|
| Rate for Payer: Galaxy Health WC |
$405.95
|
| Rate for Payer: Global Benefits Group Commercial |
$286.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$318.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$181.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.62
|
| Rate for Payer: Multiplan Commercial |
$382.07
|
| Rate for Payer: Networks By Design Commercial |
$238.80
|
| Rate for Payer: Prime Health Services Commercial |
$405.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$180.34
|
| Rate for Payer: United Healthcare All Other HMO |
$176.14
|
| Rate for Payer: United Healthcare HMO Rider |
$172.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$157.60
|
|
|
RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP [22120]
|
Facility
|
OP
|
$477.59
|
|
|
Service Code
|
CPT 90675
|
| Hospital Charge Code |
1720343
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$114.62 |
| Max. Negotiated Rate |
$2,257.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,257.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$405.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$357.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$357.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$310.86
|
| Rate for Payer: Blue Distinction Transplant |
$286.55
|
| Rate for Payer: Blue Shield of California Commercial |
$351.98
|
| Rate for Payer: Blue Shield of California EPN |
$416.53
|
| Rate for Payer: Cash Price |
$214.92
|
| Rate for Payer: Cash Price |
$214.92
|
| Rate for Payer: Cigna of CA HMO |
$334.31
|
| Rate for Payer: Cigna of CA PPO |
$334.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$487.12
|
| Rate for Payer: Dignity Health Media |
$324.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$357.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$324.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$324.74
|
| Rate for Payer: Galaxy Health WC |
$405.95
|
| Rate for Payer: Global Benefits Group Commercial |
$286.55
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$358.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$532.58
|
| Rate for Payer: Heritage Provider Network Transplant |
$532.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$526.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$526.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$324.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$318.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$625.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$324.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$409.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$435.16
|
| Rate for Payer: Multiplan Commercial |
$382.07
|
| Rate for Payer: Networks By Design Commercial |
$238.80
|
| Rate for Payer: Prime Health Services Commercial |
$405.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$286.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$286.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$238.80
|
| Rate for Payer: United Healthcare All Other HMO |
$238.80
|
| Rate for Payer: United Healthcare HMO Rider |
$238.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$238.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$487.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$357.22
|
| Rate for Payer: Vantage Medical Group Senior |
$324.74
|
|
|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION [2851]
|
Facility
|
IP
|
$1.68
|
|
|
Service Code
|
NDC 0487-5901-99
|
| Hospital Charge Code |
1781099
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Blue Shield of California Commercial |
$1.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.86
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
|
|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION [2851]
|
Facility
|
OP
|
$1.68
|
|
|
Service Code
|
NDC 0487-5901-99
|
| Hospital Charge Code |
1781099
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.00
|
| Rate for Payer: Blue Distinction Transplant |
$1.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.98
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.43
|
| Rate for Payer: Dignity Health Media |
$1.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.84
|
| Rate for Payer: United Healthcare All Other HMO |
$0.84
|
| Rate for Payer: United Healthcare HMO Rider |
$0.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1.43
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$29,382.68
|
|
|
Service Code
|
APR-DRG 6923
|
| Min. Negotiated Rate |
$22,539.61 |
| Max. Negotiated Rate |
$29,382.68 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22,539.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29,382.68
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$9,551.85
|
|
|
Service Code
|
APR-DRG 6921
|
| Min. Negotiated Rate |
$7,327.28 |
| Max. Negotiated Rate |
$9,551.85 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,327.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,551.85
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$52,219.52
|
|
|
Service Code
|
APR-DRG 6924
|
| Min. Negotiated Rate |
$40,057.87 |
| Max. Negotiated Rate |
$52,219.52 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40,057.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52,219.52
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$16,197.01
|
|
|
Service Code
|
APR-DRG 6922
|
| Min. Negotiated Rate |
$12,424.81 |
| Max. Negotiated Rate |
$16,197.01 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12,424.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,197.01
|
|
|
RADIUM RA 223 DICHLOR 1,100 KBQ/ML (30 MICROCURIE/ML) INTRAVENOUS SOLN [202157]
|
Facility
|
IP
|
$60,372.00
|
|
|
Service Code
|
CPT A9606
|
| Hospital Charge Code |
ERX202157
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$14,489.28 |
| Max. Negotiated Rate |
$51,316.20 |
| Rate for Payer: Blue Shield of California Commercial |
$42,984.86
|
| Rate for Payer: Blue Shield of California EPN |
$30,910.46
|
| Rate for Payer: Cash Price |
$27,167.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,148.80
|
| Rate for Payer: Galaxy Health WC |
$51,316.20
|
| Rate for Payer: Global Benefits Group Commercial |
$36,223.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40,268.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23,001.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,489.28
|
| Rate for Payer: Multiplan Commercial |
$48,297.60
|
| Rate for Payer: Networks By Design Commercial |
$39,241.80
|
| Rate for Payer: Prime Health Services Commercial |
$51,316.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$22,796.47
|
| Rate for Payer: United Healthcare All Other HMO |
$22,265.19
|
| Rate for Payer: United Healthcare HMO Rider |
$21,782.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19,922.76
|
|
|
RADIUM RA 223 DICHLOR 1,100 KBQ/ML (30 MICROCURIE/ML) INTRAVENOUS SOLN [202157]
|
Facility
|
OP
|
$60,372.00
|
|
|
Service Code
|
CPT A9606
|
| Hospital Charge Code |
ERX202157
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$161.16 |
| Max. Negotiated Rate |
$51,316.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,081.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$241.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$177.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$161.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$242.61
|
| Rate for Payer: Blue Distinction Transplant |
$36,223.20
|
| Rate for Payer: Blue Shield of California Commercial |
$35,679.85
|
| Rate for Payer: Blue Shield of California EPN |
$28,314.47
|
| Rate for Payer: Cash Price |
$27,167.40
|
| Rate for Payer: Cash Price |
$27,167.40
|
| Rate for Payer: Cigna of CA HMO |
$38,638.08
|
| Rate for Payer: Cigna of CA PPO |
$44,675.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$241.74
|
| Rate for Payer: Dignity Health Media |
$161.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$177.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$217.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$161.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$161.16
|
| Rate for Payer: Galaxy Health WC |
$51,316.20
|
| Rate for Payer: Global Benefits Group Commercial |
$36,223.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$45,279.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$264.31
|
| Rate for Payer: Heritage Provider Network Transplant |
$264.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$261.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$261.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$161.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40,268.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$305.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$161.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,489.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$203.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$215.96
|
| Rate for Payer: Multiplan Commercial |
$48,297.60
|
| Rate for Payer: Networks By Design Commercial |
$39,241.80
|
| Rate for Payer: Prime Health Services Commercial |
$51,316.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36,223.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36,223.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$30,186.00
|
| Rate for Payer: United Healthcare All Other HMO |
$30,186.00
|
| Rate for Payer: United Healthcare HMO Rider |
$30,186.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,186.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$241.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$177.28
|
| Rate for Payer: Vantage Medical Group Senior |
$161.16
|
|
|
RALOXIFENE 60 MG TABLET [22143]
|
Facility
|
OP
|
$2.77
|
|
|
Service Code
|
NDC 43598-505-30
|
| Hospital Charge Code |
1710918
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.65
|
| Rate for Payer: Blue Distinction Transplant |
$1.66
|
| Rate for Payer: Blue Shield of California Commercial |
$2.04
|
| Rate for Payer: Blue Shield of California EPN |
$1.62
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cigna of CA HMO |
$1.94
|
| Rate for Payer: Cigna of CA PPO |
$1.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.35
|
| Rate for Payer: Dignity Health Media |
$2.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.11
|
| Rate for Payer: Galaxy Health WC |
$2.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1.66
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$2.22
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Prime Health Services Commercial |
$2.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.38
|
| Rate for Payer: United Healthcare All Other HMO |
$1.38
|
| Rate for Payer: United Healthcare HMO Rider |
$1.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2.35
|
|
|
RALOXIFENE 60 MG TABLET [22143]
|
Facility
|
IP
|
$2.77
|
|
|
Service Code
|
NDC 43598-505-30
|
| Hospital Charge Code |
1710918
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.35 |
| Rate for Payer: Blue Shield of California Commercial |
$1.97
|
| Rate for Payer: Blue Shield of California EPN |
$1.42
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cigna of CA HMO |
$1.94
|
| Rate for Payer: Cigna of CA PPO |
$1.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.11
|
| Rate for Payer: Galaxy Health WC |
$2.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$2.22
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Prime Health Services Commercial |
$2.35
|
|
|
RALTEGRAVIR 400 MG TABLET [88608]
|
Facility
|
OP
|
$38.21
|
|
|
Service Code
|
NDC 0006-0227-61
|
| Hospital Charge Code |
1711979
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.17 |
| Max. Negotiated Rate |
$32.48 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.77
|
| Rate for Payer: Blue Distinction Transplant |
$22.93
|
| Rate for Payer: Blue Shield of California Commercial |
$28.16
|
| Rate for Payer: Blue Shield of California EPN |
$22.31
|
| Rate for Payer: Cash Price |
$17.19
|
| Rate for Payer: Cigna of CA HMO |
$26.75
|
| Rate for Payer: Cigna of CA PPO |
$26.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.48
|
| Rate for Payer: Dignity Health Media |
$32.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.28
|
| Rate for Payer: Galaxy Health WC |
$32.48
|
| Rate for Payer: Global Benefits Group Commercial |
$22.93
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$28.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.17
|
| Rate for Payer: Multiplan Commercial |
$30.57
|
| Rate for Payer: Networks By Design Commercial |
$24.84
|
| Rate for Payer: Prime Health Services Commercial |
$32.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.10
|
| Rate for Payer: United Healthcare All Other HMO |
$19.10
|
| Rate for Payer: United Healthcare HMO Rider |
$19.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.48
|
| Rate for Payer: Vantage Medical Group Senior |
$32.48
|
|
|
RALTEGRAVIR 400 MG TABLET [88608]
|
Facility
|
IP
|
$38.21
|
|
|
Service Code
|
NDC 0006-0227-61
|
| Hospital Charge Code |
1711979
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.17 |
| Max. Negotiated Rate |
$32.48 |
| Rate for Payer: Blue Shield of California Commercial |
$27.21
|
| Rate for Payer: Blue Shield of California EPN |
$19.56
|
| Rate for Payer: Cash Price |
$17.19
|
| Rate for Payer: Cigna of CA HMO |
$26.75
|
| Rate for Payer: Cigna of CA PPO |
$26.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.28
|
| Rate for Payer: Galaxy Health WC |
$32.48
|
| Rate for Payer: Global Benefits Group Commercial |
$22.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.17
|
| Rate for Payer: Multiplan Commercial |
$30.57
|
| Rate for Payer: Networks By Design Commercial |
$24.84
|
| Rate for Payer: Prime Health Services Commercial |
$32.48
|
|
|
RAMIPRIL 5 MG CAPSULE [11261]
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
NDC 65862-476-01
|
| Hospital Charge Code |
1712231
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
| Rate for Payer: Blue Distinction Transplant |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Media |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO |
$0.12
|
| Rate for Payer: United Healthcare HMO Rider |
$0.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
RAMIPRIL 5 MG CAPSULE [11261]
|
Facility
|
IP
|
$0.24
|
|
|
Service Code
|
NDC 65862-476-01
|
| Hospital Charge Code |
1712231
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Blue Shield of California Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
|
|
RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION [205590]
|
Facility
|
OP
|
$166.40
|
|
|
Service Code
|
NDC 0002-7678-01
|
| Hospital Charge Code |
NDG2206
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.94 |
| Max. Negotiated Rate |
$141.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$109.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$141.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$91.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$91.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$99.14
|
| Rate for Payer: Blue Distinction Transplant |
$99.84
|
| Rate for Payer: Blue Shield of California Commercial |
$122.64
|
| Rate for Payer: Blue Shield of California EPN |
$97.18
|
| Rate for Payer: Cash Price |
$74.88
|
| Rate for Payer: Cigna of CA HMO |
$116.48
|
| Rate for Payer: Cigna of CA PPO |
$116.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$141.44
|
| Rate for Payer: Dignity Health Media |
$141.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$141.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$66.56
|
| Rate for Payer: Galaxy Health WC |
$141.44
|
| Rate for Payer: Global Benefits Group Commercial |
$99.84
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$124.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.94
|
| Rate for Payer: Multiplan Commercial |
$133.12
|
| Rate for Payer: Networks By Design Commercial |
$83.20
|
| Rate for Payer: Prime Health Services Commercial |
$141.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$99.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$99.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$83.20
|
| Rate for Payer: United Healthcare All Other HMO |
$83.20
|
| Rate for Payer: United Healthcare HMO Rider |
$83.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$83.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$141.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$141.44
|
| Rate for Payer: Vantage Medical Group Senior |
$141.44
|
|
|
RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION [205590]
|
Facility
|
IP
|
$166.40
|
|
|
Service Code
|
NDC 0002-7669-01
|
| Hospital Charge Code |
NDG2205
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.94 |
| Max. Negotiated Rate |
$141.44 |
| Rate for Payer: Blue Shield of California Commercial |
$118.48
|
| Rate for Payer: Blue Shield of California EPN |
$85.20
|
| Rate for Payer: Cash Price |
$74.88
|
| Rate for Payer: Cigna of CA HMO |
$116.48
|
| Rate for Payer: Cigna of CA PPO |
$116.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$66.56
|
| Rate for Payer: Galaxy Health WC |
$141.44
|
| Rate for Payer: Global Benefits Group Commercial |
$99.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.94
|
| Rate for Payer: Multiplan Commercial |
$133.12
|
| Rate for Payer: Networks By Design Commercial |
$83.20
|
| Rate for Payer: Prime Health Services Commercial |
$141.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$62.83
|
| Rate for Payer: United Healthcare All Other HMO |
$61.37
|
| Rate for Payer: United Healthcare HMO Rider |
$60.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$54.91
|
|
|
RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION [205590]
|
Facility
|
OP
|
$166.40
|
|
|
Service Code
|
NDC 0002-7669-01
|
| Hospital Charge Code |
NDG2205
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.94 |
| Max. Negotiated Rate |
$141.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$109.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$141.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$91.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$91.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$99.14
|
| Rate for Payer: Blue Distinction Transplant |
$99.84
|
| Rate for Payer: Blue Shield of California Commercial |
$122.64
|
| Rate for Payer: Blue Shield of California EPN |
$97.18
|
| Rate for Payer: Cash Price |
$74.88
|
| Rate for Payer: Cigna of CA HMO |
$116.48
|
| Rate for Payer: Cigna of CA PPO |
$116.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$141.44
|
| Rate for Payer: Dignity Health Media |
$141.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$141.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$66.56
|
| Rate for Payer: Galaxy Health WC |
$141.44
|
| Rate for Payer: Global Benefits Group Commercial |
$99.84
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$124.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.94
|
| Rate for Payer: Multiplan Commercial |
$133.12
|
| Rate for Payer: Networks By Design Commercial |
$83.20
|
| Rate for Payer: Prime Health Services Commercial |
$141.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$99.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$99.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$83.20
|
| Rate for Payer: United Healthcare All Other HMO |
$83.20
|
| Rate for Payer: United Healthcare HMO Rider |
$83.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$83.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$141.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$141.44
|
| Rate for Payer: Vantage Medical Group Senior |
$141.44
|
|
|
RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION [205590]
|
Facility
|
IP
|
$166.40
|
|
|
Service Code
|
NDC 0002-7678-01
|
| Hospital Charge Code |
NDG2206
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.94 |
| Max. Negotiated Rate |
$141.44 |
| Rate for Payer: Blue Shield of California Commercial |
$118.48
|
| Rate for Payer: Blue Shield of California EPN |
$85.20
|
| Rate for Payer: Cash Price |
$74.88
|
| Rate for Payer: Cigna of CA HMO |
$116.48
|
| Rate for Payer: Cigna of CA PPO |
$116.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$66.56
|
| Rate for Payer: Galaxy Health WC |
$141.44
|
| Rate for Payer: Global Benefits Group Commercial |
$99.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.94
|
| Rate for Payer: Multiplan Commercial |
$133.12
|
| Rate for Payer: Networks By Design Commercial |
$83.20
|
| Rate for Payer: Prime Health Services Commercial |
$141.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$62.83
|
| Rate for Payer: United Healthcare All Other HMO |
$61.37
|
| Rate for Payer: United Healthcare HMO Rider |
$60.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$54.91
|
|
|
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SOLUTION FOR INJECTION [197046]
|
Facility
|
IP
|
$28,080.00
|
|
|
Service Code
|
NDC 50242-082-02
|
| Hospital Charge Code |
NDG197046
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,739.20 |
| Max. Negotiated Rate |
$23,868.00 |
| Rate for Payer: Blue Shield of California Commercial |
$19,992.96
|
| Rate for Payer: Blue Shield of California EPN |
$14,376.96
|
| Rate for Payer: Cash Price |
$12,636.00
|
| Rate for Payer: Cigna of CA HMO |
$19,656.00
|
| Rate for Payer: Cigna of CA PPO |
$19,656.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,232.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$11,232.00
|
| Rate for Payer: Galaxy Health WC |
$23,868.00
|
| Rate for Payer: Global Benefits Group Commercial |
$16,848.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,729.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,698.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,739.20
|
| Rate for Payer: Multiplan Commercial |
$22,464.00
|
| Rate for Payer: Networks By Design Commercial |
$14,040.00
|
| Rate for Payer: Prime Health Services Commercial |
$23,868.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,603.01
|
| Rate for Payer: United Healthcare All Other HMO |
$10,355.90
|
| Rate for Payer: United Healthcare HMO Rider |
$10,131.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,266.40
|
|
