|
RASAGILINE 1 MG TABLET [76481]
|
Facility
|
IP
|
$17.80
|
|
|
Service Code
|
NDC 47781-690-30
|
| Hospital Charge Code |
1711908
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$15.13 |
| Rate for Payer: Blue Shield of California Commercial |
$12.67
|
| Rate for Payer: Blue Shield of California EPN |
$9.11
|
| Rate for Payer: Cash Price |
$8.01
|
| Rate for Payer: Cigna of CA HMO |
$12.46
|
| Rate for Payer: Cigna of CA PPO |
$12.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.12
|
| Rate for Payer: Galaxy Health WC |
$15.13
|
| Rate for Payer: Global Benefits Group Commercial |
$10.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.27
|
| Rate for Payer: Multiplan Commercial |
$14.24
|
| Rate for Payer: Networks By Design Commercial |
$11.57
|
| Rate for Payer: Prime Health Services Commercial |
$15.13
|
|
|
RASAGILINE 1 MG TABLET [76481]
|
Facility
|
IP
|
$8.25
|
|
|
Service Code
|
NDC 0093-3061-56
|
| Hospital Charge Code |
1711908
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$7.01 |
| Rate for Payer: Blue Shield of California Commercial |
$5.87
|
| Rate for Payer: Blue Shield of California EPN |
$4.22
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Cigna of CA HMO |
$5.78
|
| Rate for Payer: Cigna of CA PPO |
$5.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.30
|
| Rate for Payer: Galaxy Health WC |
$7.01
|
| Rate for Payer: Global Benefits Group Commercial |
$4.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.98
|
| Rate for Payer: Multiplan Commercial |
$6.60
|
| Rate for Payer: Networks By Design Commercial |
$5.36
|
| Rate for Payer: Prime Health Services Commercial |
$7.01
|
|
|
RASBURICASE 1.5 MG INTRAVENOUS SOLUTION [33591]
|
Facility
|
IP
|
$1,276.65
|
|
|
Service Code
|
CPT J2783
|
| Hospital Charge Code |
1722030
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$306.40 |
| Max. Negotiated Rate |
$1,085.15 |
| Rate for Payer: Blue Shield of California Commercial |
$908.97
|
| Rate for Payer: Blue Shield of California EPN |
$653.64
|
| Rate for Payer: Cash Price |
$574.49
|
| Rate for Payer: Cigna of CA HMO |
$893.66
|
| Rate for Payer: Cigna of CA PPO |
$893.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$510.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$510.66
|
| Rate for Payer: Galaxy Health WC |
$1,085.15
|
| Rate for Payer: Global Benefits Group Commercial |
$765.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$851.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$486.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.40
|
| Rate for Payer: Multiplan Commercial |
$1,021.32
|
| Rate for Payer: Networks By Design Commercial |
$638.32
|
| Rate for Payer: Prime Health Services Commercial |
$1,085.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$482.06
|
| Rate for Payer: United Healthcare All Other HMO |
$470.83
|
| Rate for Payer: United Healthcare HMO Rider |
$460.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$421.29
|
|
|
RASBURICASE 1.5 MG INTRAVENOUS SOLUTION [33591]
|
Facility
|
OP
|
$1,276.65
|
|
|
Service Code
|
CPT J2783
|
| Hospital Charge Code |
1722030
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$220.63 |
| Max. Negotiated Rate |
$2,309.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,309.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$403.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$403.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$220.63
|
| Rate for Payer: Blue Distinction Transplant |
$765.99
|
| Rate for Payer: Blue Shield of California Commercial |
$940.89
|
| Rate for Payer: Blue Shield of California EPN |
$362.60
|
| Rate for Payer: Cash Price |
$574.49
|
| Rate for Payer: Cash Price |
$574.49
|
| Rate for Payer: Cigna of CA HMO |
$893.66
|
| Rate for Payer: Cigna of CA PPO |
$893.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$550.90
|
| Rate for Payer: Dignity Health Media |
$367.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$403.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$495.81
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$367.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$367.27
|
| Rate for Payer: Galaxy Health WC |
$1,085.15
|
| Rate for Payer: Global Benefits Group Commercial |
$765.99
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$957.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$602.32
|
| Rate for Payer: Heritage Provider Network Transplant |
$602.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$594.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$594.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$367.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$851.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$486.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$367.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$462.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$492.14
|
| Rate for Payer: Multiplan Commercial |
$1,021.32
|
| Rate for Payer: Networks By Design Commercial |
$638.32
|
| Rate for Payer: Prime Health Services Commercial |
$1,085.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$765.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$765.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$638.32
|
| Rate for Payer: United Healthcare All Other HMO |
$638.32
|
| Rate for Payer: United Healthcare HMO Rider |
$638.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$638.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$550.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$403.99
|
| Rate for Payer: Vantage Medical Group Senior |
$367.27
|
|
|
RAVULIZUMAB-CWVZ 100 MG/ML INTRAVENOUS SOLUTION [229668]
|
Facility
|
OP
|
$2,561.60
|
|
|
Service Code
|
CPT J1303
|
| Hospital Charge Code |
NDG229668A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$221.77 |
| Max. Negotiated Rate |
$2,177.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,394.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$277.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$243.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$243.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$454.99
|
| Rate for Payer: Blue Distinction Transplant |
$1,536.96
|
| Rate for Payer: Blue Shield of California Commercial |
$1,887.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,495.97
|
| Rate for Payer: Cash Price |
$1,152.72
|
| Rate for Payer: Cash Price |
$1,152.72
|
| Rate for Payer: Cigna of CA HMO |
$1,793.12
|
| Rate for Payer: Cigna of CA PPO |
$1,793.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.22
|
| Rate for Payer: Dignity Health Media |
$243.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$243.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$299.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$221.77
|
| Rate for Payer: EPIC Health Plan Transplant |
$221.77
|
| Rate for Payer: Galaxy Health WC |
$2,177.36
|
| Rate for Payer: Global Benefits Group Commercial |
$1,536.96
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,921.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$363.71
|
| Rate for Payer: Heritage Provider Network Transplant |
$363.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$359.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$359.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$221.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,708.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$429.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$221.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$614.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$279.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$297.18
|
| Rate for Payer: Multiplan Commercial |
$2,049.28
|
| Rate for Payer: Networks By Design Commercial |
$1,280.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,177.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,536.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,536.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,280.80
|
| Rate for Payer: United Healthcare All Other HMO |
$1,280.80
|
| Rate for Payer: United Healthcare HMO Rider |
$1,280.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,280.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$277.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$243.95
|
| Rate for Payer: Vantage Medical Group Senior |
$243.95
|
|
|
RAVULIZUMAB-CWVZ 100 MG/ML INTRAVENOUS SOLUTION [229668]
|
Facility
|
IP
|
$2,561.60
|
|
|
Service Code
|
CPT J1303
|
| Hospital Charge Code |
NDG229668A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$614.78 |
| Max. Negotiated Rate |
$2,177.36 |
| Rate for Payer: Blue Shield of California Commercial |
$1,823.86
|
| Rate for Payer: Blue Shield of California EPN |
$1,311.54
|
| Rate for Payer: Cash Price |
$1,152.72
|
| Rate for Payer: Cigna of CA HMO |
$1,793.12
|
| Rate for Payer: Cigna of CA PPO |
$1,793.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,024.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,024.64
|
| Rate for Payer: Galaxy Health WC |
$2,177.36
|
| Rate for Payer: Global Benefits Group Commercial |
$1,536.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,708.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$975.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$614.78
|
| Rate for Payer: Multiplan Commercial |
$2,049.28
|
| Rate for Payer: Networks By Design Commercial |
$1,280.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,177.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$967.26
|
| Rate for Payer: United Healthcare All Other HMO |
$944.72
|
| Rate for Payer: United Healthcare HMO Rider |
$924.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$845.33
|
|
|
Reconstruction midface, LeFort I; 3 or more pieces, segment movement in any direction, requiring bone grafts (includes obtaining autografts) (eg, ungrafted bilateral alveolar cleft or multiple osteotomies)
|
Facility
|
OP
|
$12,491.00
|
|
|
Service Code
|
CPT 21147
|
| Min. Negotiated Rate |
$424.42 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,628.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$424.42
|
|
|
Reconstruction midface, LeFort I; 3 or more pieces, segment movement in any direction, without bone graft
|
Facility
|
OP
|
$12,491.00
|
|
|
Service Code
|
CPT 21143
|
| Min. Negotiated Rate |
$2,129.18 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,539.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Dignity Health Media |
$7,316.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,048.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,877.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,316.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,999.72
|
| Rate for Payer: Heritage Provider Network Transplant |
$11,999.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,853.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$11,853.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,316.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,129.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,316.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,219.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,804.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
Reconstruction of mandibular rami and/or body, sagittal split; with internal rigid fixation
|
Facility
|
OP
|
$12,491.00
|
|
|
Service Code
|
CPT 21196
|
| Min. Negotiated Rate |
$1,980.64 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,241.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Dignity Health Media |
$7,316.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,048.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,877.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,316.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,999.72
|
| Rate for Payer: Heritage Provider Network Transplant |
$11,999.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,853.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$11,853.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,316.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,980.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,316.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,219.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,804.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE [91408]
|
Facility
|
IP
|
$61.86
|
|
|
Service Code
|
CPT J2785
|
| Hospital Charge Code |
1796133
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.85 |
| Max. Negotiated Rate |
$52.58 |
| Rate for Payer: Blue Shield of California Commercial |
$44.04
|
| Rate for Payer: Blue Shield of California Commercial |
$5.13
|
| Rate for Payer: Blue Shield of California EPN |
$31.67
|
| Rate for Payer: Blue Shield of California EPN |
$3.69
|
| Rate for Payer: Cash Price |
$27.84
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cigna of CA HMO |
$43.30
|
| Rate for Payer: Cigna of CA HMO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$43.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.88
|
| Rate for Payer: Galaxy Health WC |
$52.58
|
| Rate for Payer: Galaxy Health WC |
$6.12
|
| Rate for Payer: Global Benefits Group Commercial |
$4.32
|
| Rate for Payer: Global Benefits Group Commercial |
$37.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: Multiplan Commercial |
$49.49
|
| Rate for Payer: Multiplan Commercial |
$5.76
|
| Rate for Payer: Networks By Design Commercial |
$30.93
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Prime Health Services Commercial |
$52.58
|
| Rate for Payer: Prime Health Services Commercial |
$6.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.72
|
| Rate for Payer: United Healthcare All Other HMO |
$22.81
|
| Rate for Payer: United Healthcare All Other HMO |
$2.66
|
| Rate for Payer: United Healthcare HMO Rider |
$22.32
|
| Rate for Payer: United Healthcare HMO Rider |
$2.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.38
|
|
|
REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE [91408]
|
Facility
|
OP
|
$61.86
|
|
|
Service Code
|
CPT J2785
|
| Hospital Charge Code |
1796133
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.85 |
| Max. Negotiated Rate |
$124.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$89.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$89.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.46
|
| Rate for Payer: Blue Distinction Transplant |
$37.12
|
| Rate for Payer: Blue Distinction Transplant |
$4.32
|
| Rate for Payer: Blue Shield of California Commercial |
$45.59
|
| Rate for Payer: Blue Shield of California Commercial |
$5.31
|
| Rate for Payer: Blue Shield of California EPN |
$72.89
|
| Rate for Payer: Blue Shield of California EPN |
$72.89
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$27.84
|
| Rate for Payer: Cash Price |
$27.84
|
| Rate for Payer: Cigna of CA HMO |
$43.30
|
| Rate for Payer: Cigna of CA HMO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$43.30
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.58
|
| Rate for Payer: Dignity Health Media |
$6.12
|
| Rate for Payer: Dignity Health Media |
$52.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.88
|
| Rate for Payer: Galaxy Health WC |
$52.58
|
| Rate for Payer: Galaxy Health WC |
$6.12
|
| Rate for Payer: Global Benefits Group Commercial |
$4.32
|
| Rate for Payer: Global Benefits Group Commercial |
$37.12
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$46.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.85
|
| Rate for Payer: Multiplan Commercial |
$5.76
|
| Rate for Payer: Multiplan Commercial |
$49.49
|
| Rate for Payer: Networks By Design Commercial |
$30.93
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Prime Health Services Commercial |
$6.12
|
| Rate for Payer: Prime Health Services Commercial |
$52.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.60
|
| Rate for Payer: United Healthcare All Other HMO |
$3.60
|
| Rate for Payer: United Healthcare All Other HMO |
$30.93
|
| Rate for Payer: United Healthcare HMO Rider |
$3.60
|
| Rate for Payer: United Healthcare HMO Rider |
$30.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$52.58
|
|
|
REHABILITATION
|
Facility
|
IP
|
$29,349.00
|
|
|
Service Code
|
APR-DRG 8604
|
| Min. Negotiated Rate |
$22,513.77 |
| Max. Negotiated Rate |
$29,349.00 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22,513.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29,349.00
|
|
|
REHABILITATION
|
Facility
|
IP
|
$18,809.32
|
|
|
Service Code
|
APR-DRG 8602
|
| Min. Negotiated Rate |
$14,428.73 |
| Max. Negotiated Rate |
$18,809.32 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14,428.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,809.32
|
|
|
REHABILITATION
|
Facility
|
IP
|
$15,345.75
|
|
|
Service Code
|
APR-DRG 8601
|
| Min. Negotiated Rate |
$11,771.80 |
| Max. Negotiated Rate |
$15,345.75 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,771.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15,345.75
|
|
|
REHABILITATION
|
Facility
|
IP
|
$23,957.67
|
|
|
Service Code
|
APR-DRG 8603
|
| Min. Negotiated Rate |
$18,378.05 |
| Max. Negotiated Rate |
$23,957.67 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18,378.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23,957.67
|
|
|
RELUGOLIX 120 MG TABLET [229912]
|
Facility
|
IP
|
$104.15
|
|
|
Service Code
|
NDC 72974-120-01
|
| Hospital Charge Code |
ERX229912
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$88.53 |
| Rate for Payer: Blue Shield of California Commercial |
$74.15
|
| Rate for Payer: Blue Shield of California EPN |
$53.32
|
| Rate for Payer: Cash Price |
$46.87
|
| Rate for Payer: Cigna of CA HMO |
$72.90
|
| Rate for Payer: Cigna of CA PPO |
$72.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.66
|
| Rate for Payer: Galaxy Health WC |
$88.53
|
| Rate for Payer: Global Benefits Group Commercial |
$62.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Multiplan Commercial |
$83.32
|
| Rate for Payer: Networks By Design Commercial |
$67.70
|
| Rate for Payer: Prime Health Services Commercial |
$88.53
|
|
|
RELUGOLIX 120 MG TABLET [229912]
|
Facility
|
OP
|
$104.15
|
|
|
Service Code
|
NDC 72974-120-01
|
| Hospital Charge Code |
ERX229912
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$88.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$68.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$88.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$57.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.05
|
| Rate for Payer: Blue Distinction Transplant |
$62.49
|
| Rate for Payer: Blue Shield of California Commercial |
$76.76
|
| Rate for Payer: Blue Shield of California EPN |
$60.82
|
| Rate for Payer: Cash Price |
$46.87
|
| Rate for Payer: Cigna of CA HMO |
$72.90
|
| Rate for Payer: Cigna of CA PPO |
$72.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$88.53
|
| Rate for Payer: Dignity Health Media |
$88.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$88.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$41.66
|
| Rate for Payer: Galaxy Health WC |
$88.53
|
| Rate for Payer: Global Benefits Group Commercial |
$62.49
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$78.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Multiplan Commercial |
$83.32
|
| Rate for Payer: Networks By Design Commercial |
$67.70
|
| Rate for Payer: Prime Health Services Commercial |
$88.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$62.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$62.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.08
|
| Rate for Payer: United Healthcare All Other HMO |
$52.08
|
| Rate for Payer: United Healthcare HMO Rider |
$52.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$88.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$88.53
|
| Rate for Payer: Vantage Medical Group Senior |
$88.53
|
|
|
REMDESIVIR 100 MG/20 ML (5 MG/ML) IV SOLN (FOR PTS 40 KG OR MORE) [228088]
|
Facility
|
OP
|
$31.20
|
|
|
Service Code
|
CPT J0248
|
| Hospital Charge Code |
NDG228088
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$34.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$34.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.05
|
| Rate for Payer: Blue Distinction Transplant |
$18.72
|
| Rate for Payer: Blue Shield of California Commercial |
$22.99
|
| Rate for Payer: Blue Shield of California EPN |
$18.22
|
| Rate for Payer: Cash Price |
$14.04
|
| Rate for Payer: Cash Price |
$14.04
|
| Rate for Payer: Cigna of CA HMO |
$21.84
|
| Rate for Payer: Cigna of CA PPO |
$21.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.57
|
| Rate for Payer: Dignity Health Media |
$6.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.18
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.06
|
| Rate for Payer: Galaxy Health WC |
$26.52
|
| Rate for Payer: Global Benefits Group Commercial |
$18.72
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$23.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.94
|
| Rate for Payer: Heritage Provider Network Transplant |
$9.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$9.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.12
|
| Rate for Payer: Multiplan Commercial |
$24.96
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$26.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.60
|
| Rate for Payer: United Healthcare All Other HMO |
$15.60
|
| Rate for Payer: United Healthcare HMO Rider |
$15.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.66
|
| Rate for Payer: Vantage Medical Group Senior |
$6.66
|
|
|
REMDESIVIR 100 MG/20 ML (5 MG/ML) IV SOLN (FOR PTS 40 KG OR MORE) [228088]
|
Facility
|
IP
|
$31.20
|
|
|
Service Code
|
CPT J0248
|
| Hospital Charge Code |
NDG228088
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$26.52 |
| Rate for Payer: Blue Shield of California Commercial |
$22.21
|
| Rate for Payer: Blue Shield of California EPN |
$15.97
|
| Rate for Payer: Cash Price |
$14.04
|
| Rate for Payer: Cigna of CA HMO |
$21.84
|
| Rate for Payer: Cigna of CA PPO |
$21.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.48
|
| Rate for Payer: Galaxy Health WC |
$26.52
|
| Rate for Payer: Global Benefits Group Commercial |
$18.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.49
|
| Rate for Payer: Multiplan Commercial |
$24.96
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$26.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.78
|
| Rate for Payer: United Healthcare All Other HMO |
$11.51
|
| Rate for Payer: United Healthcare HMO Rider |
$11.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.30
|
|
|
REMDESIVIR 100 MG/20 ML VIAL - COMMERCIAL PRODUCT [4082058624]
|
Facility
|
IP
|
$31.20
|
|
|
Service Code
|
CPT J0248
|
| Hospital Charge Code |
NDG228088
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$26.52 |
| Rate for Payer: Blue Shield of California Commercial |
$22.21
|
| Rate for Payer: Blue Shield of California EPN |
$15.97
|
| Rate for Payer: Cash Price |
$14.04
|
| Rate for Payer: Cigna of CA HMO |
$21.84
|
| Rate for Payer: Cigna of CA PPO |
$21.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.48
|
| Rate for Payer: Galaxy Health WC |
$26.52
|
| Rate for Payer: Global Benefits Group Commercial |
$18.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.49
|
| Rate for Payer: Multiplan Commercial |
$24.96
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$26.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.78
|
| Rate for Payer: United Healthcare All Other HMO |
$11.51
|
| Rate for Payer: United Healthcare HMO Rider |
$11.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.30
|
|
|
REMDESIVIR 100 MG/20 ML VIAL - COMMERCIAL PRODUCT [4082058624]
|
Facility
|
OP
|
$31.20
|
|
|
Service Code
|
CPT J0248
|
| Hospital Charge Code |
NDG228088
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$34.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$34.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.05
|
| Rate for Payer: Blue Distinction Transplant |
$18.72
|
| Rate for Payer: Blue Shield of California Commercial |
$22.99
|
| Rate for Payer: Blue Shield of California EPN |
$18.22
|
| Rate for Payer: Cash Price |
$14.04
|
| Rate for Payer: Cash Price |
$14.04
|
| Rate for Payer: Cigna of CA HMO |
$21.84
|
| Rate for Payer: Cigna of CA PPO |
$21.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.57
|
| Rate for Payer: Dignity Health Media |
$6.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.18
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.06
|
| Rate for Payer: Galaxy Health WC |
$26.52
|
| Rate for Payer: Global Benefits Group Commercial |
$18.72
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$23.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.94
|
| Rate for Payer: Heritage Provider Network Transplant |
$9.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$9.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.12
|
| Rate for Payer: Multiplan Commercial |
$24.96
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$26.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.60
|
| Rate for Payer: United Healthcare All Other HMO |
$15.60
|
| Rate for Payer: United Healthcare HMO Rider |
$15.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.66
|
| Rate for Payer: Vantage Medical Group Senior |
$6.66
|
|
|
REMDESIVIR 100 MG LYOPHILIZED POWDER FOR INJECTION - COMMERCIAL PRODUCT [4082058626]
|
Facility
|
IP
|
$685.78
|
|
|
Service Code
|
CPT J0248
|
| Hospital Charge Code |
ERX4082058626
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$164.59 |
| Max. Negotiated Rate |
$582.91 |
| Rate for Payer: Blue Shield of California Commercial |
$488.28
|
| Rate for Payer: Blue Shield of California EPN |
$351.12
|
| Rate for Payer: Cash Price |
$308.60
|
| Rate for Payer: Cigna of CA HMO |
$480.05
|
| Rate for Payer: Cigna of CA PPO |
$480.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$274.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$274.31
|
| Rate for Payer: Galaxy Health WC |
$582.91
|
| Rate for Payer: Global Benefits Group Commercial |
$411.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$457.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$261.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.59
|
| Rate for Payer: Multiplan Commercial |
$548.62
|
| Rate for Payer: Networks By Design Commercial |
$342.89
|
| Rate for Payer: Prime Health Services Commercial |
$582.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$258.95
|
| Rate for Payer: United Healthcare All Other HMO |
$252.92
|
| Rate for Payer: United Healthcare HMO Rider |
$247.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$226.31
|
|
|
REMDESIVIR 100 MG LYOPHILIZED POWDER FOR INJECTION - COMMERCIAL PRODUCT [4082058626]
|
Facility
|
OP
|
$685.78
|
|
|
Service Code
|
CPT J0248
|
| Hospital Charge Code |
ERX4082058626
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$582.91 |
| Rate for Payer: Aetna of CA HMO/PPO |
$34.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.05
|
| Rate for Payer: Blue Distinction Transplant |
$411.47
|
| Rate for Payer: Blue Shield of California Commercial |
$505.42
|
| Rate for Payer: Blue Shield of California EPN |
$400.50
|
| Rate for Payer: Cash Price |
$308.60
|
| Rate for Payer: Cash Price |
$308.60
|
| Rate for Payer: Cigna of CA HMO |
$480.05
|
| Rate for Payer: Cigna of CA PPO |
$480.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.57
|
| Rate for Payer: Dignity Health Media |
$6.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.18
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.06
|
| Rate for Payer: Galaxy Health WC |
$582.91
|
| Rate for Payer: Global Benefits Group Commercial |
$411.47
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$514.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.94
|
| Rate for Payer: Heritage Provider Network Transplant |
$9.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$9.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$457.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.12
|
| Rate for Payer: Multiplan Commercial |
$548.62
|
| Rate for Payer: Networks By Design Commercial |
$342.89
|
| Rate for Payer: Prime Health Services Commercial |
$582.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$411.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$411.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$342.89
|
| Rate for Payer: United Healthcare All Other HMO |
$342.89
|
| Rate for Payer: United Healthcare HMO Rider |
$342.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$342.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.66
|
| Rate for Payer: Vantage Medical Group Senior |
$6.66
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
|
OP
|
$73.55
|
|
|
Service Code
|
NDC 67457-198-00
|
| Hospital Charge Code |
1737066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.65 |
| Max. Negotiated Rate |
$62.52 |
| Rate for Payer: Aetna of CA HMO/PPO |
$48.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$62.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.82
|
| Rate for Payer: Blue Distinction Transplant |
$44.13
|
| Rate for Payer: Blue Shield of California Commercial |
$54.21
|
| Rate for Payer: Blue Shield of California EPN |
$42.95
|
| Rate for Payer: Cash Price |
$33.10
|
| Rate for Payer: Cigna of CA HMO |
$47.07
|
| Rate for Payer: Cigna of CA PPO |
$54.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.52
|
| Rate for Payer: Dignity Health Media |
$62.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$29.42
|
| Rate for Payer: Galaxy Health WC |
$62.52
|
| Rate for Payer: Global Benefits Group Commercial |
$44.13
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$55.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.65
|
| Rate for Payer: Multiplan Commercial |
$58.84
|
| Rate for Payer: Networks By Design Commercial |
$47.81
|
| Rate for Payer: Prime Health Services Commercial |
$62.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.78
|
| Rate for Payer: United Healthcare All Other HMO |
$36.78
|
| Rate for Payer: United Healthcare HMO Rider |
$36.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$62.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.52
|
| Rate for Payer: Vantage Medical Group Senior |
$62.52
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
|
OP
|
$73.50
|
|
|
Service Code
|
NDC 0143-9391-10
|
| Hospital Charge Code |
1737066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.64 |
| Max. Negotiated Rate |
$62.48 |
| Rate for Payer: Aetna of CA HMO/PPO |
$48.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$62.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.79
|
| Rate for Payer: Blue Distinction Transplant |
$44.10
|
| Rate for Payer: Blue Shield of California Commercial |
$54.17
|
| Rate for Payer: Blue Shield of California EPN |
$42.92
|
| Rate for Payer: Cash Price |
$33.08
|
| Rate for Payer: Cigna of CA HMO |
$47.04
|
| Rate for Payer: Cigna of CA PPO |
$54.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.48
|
| Rate for Payer: Dignity Health Media |
$62.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$29.40
|
| Rate for Payer: Galaxy Health WC |
$62.48
|
| Rate for Payer: Global Benefits Group Commercial |
$44.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$55.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.64
|
| Rate for Payer: Multiplan Commercial |
$58.80
|
| Rate for Payer: Networks By Design Commercial |
$47.78
|
| Rate for Payer: Prime Health Services Commercial |
$62.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.75
|
| Rate for Payer: United Healthcare All Other HMO |
$36.75
|
| Rate for Payer: United Healthcare HMO Rider |
$36.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$62.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.48
|
| Rate for Payer: Vantage Medical Group Senior |
$62.48
|
|
