|
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION [18192]
|
Facility
|
OP
|
$0.58
|
|
|
Service Code
|
CPT J2795
|
| Hospital Charge Code |
1720981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.41
|
| Rate for Payer: Blue Distinction Transplant |
$0.35
|
| Rate for Payer: Blue Distinction Transplant |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.49
|
| Rate for Payer: Dignity Health Media |
$0.49
|
| Rate for Payer: Dignity Health Media |
$0.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.49
|
| Rate for Payer: Galaxy Health WC |
$0.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.16
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.49
|
| Rate for Payer: Prime Health Services Commercial |
$0.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.29
|
| Rate for Payer: United Healthcare All Other HMO |
$0.29
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare HMO Rider |
$0.29
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.49
|
| Rate for Payer: Vantage Medical Group Senior |
$0.49
|
| Rate for Payer: Vantage Medical Group Senior |
$0.18
|
|
|
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION [18192]
|
Facility
|
IP
|
$0.21
|
|
|
Service Code
|
CPT J2795
|
| Hospital Charge Code |
1720981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.21
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.19
|
|
|
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION [18192]
|
Facility
|
IP
|
$0.49
|
|
|
Service Code
|
CPT J2795
|
| Hospital Charge Code |
1771273
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Blue Shield of California Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.25
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.39
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.19
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
|
|
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION [18192]
|
Facility
|
OP
|
$0.49
|
|
|
Service Code
|
CPT J2795
|
| Hospital Charge Code |
1771273
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.41
|
| Rate for Payer: Blue Distinction Transplant |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.42
|
| Rate for Payer: Dignity Health Media |
$0.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.39
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.25
|
| Rate for Payer: United Healthcare All Other HMO |
$0.25
|
| Rate for Payer: United Healthcare HMO Rider |
$0.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.42
|
| Rate for Payer: Vantage Medical Group Senior |
$0.42
|
|
|
ROSUVASTATIN 10 MG TABLET [35134]
|
Facility
|
IP
|
$11.06
|
|
|
Service Code
|
NDC 0310-0751-90
|
| Hospital Charge Code |
1712304
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$9.40 |
| Rate for Payer: Blue Shield of California Commercial |
$7.87
|
| Rate for Payer: Blue Shield of California EPN |
$5.66
|
| Rate for Payer: Cash Price |
$4.98
|
| Rate for Payer: Cigna of CA HMO |
$7.74
|
| Rate for Payer: Cigna of CA PPO |
$7.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.42
|
| Rate for Payer: Galaxy Health WC |
$9.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.65
|
| Rate for Payer: Multiplan Commercial |
$8.85
|
| Rate for Payer: Networks By Design Commercial |
$7.19
|
| Rate for Payer: Prime Health Services Commercial |
$9.40
|
|
|
ROSUVASTATIN 10 MG TABLET [35134]
|
Facility
|
OP
|
$11.06
|
|
|
Service Code
|
NDC 0310-0751-90
|
| Hospital Charge Code |
1712304
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$9.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.59
|
| Rate for Payer: Blue Distinction Transplant |
$6.64
|
| Rate for Payer: Blue Shield of California Commercial |
$8.15
|
| Rate for Payer: Blue Shield of California EPN |
$6.46
|
| Rate for Payer: Cash Price |
$4.98
|
| Rate for Payer: Cigna of CA HMO |
$7.74
|
| Rate for Payer: Cigna of CA PPO |
$7.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.40
|
| Rate for Payer: Dignity Health Media |
$9.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.42
|
| Rate for Payer: Galaxy Health WC |
$9.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6.64
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.65
|
| Rate for Payer: Multiplan Commercial |
$8.85
|
| Rate for Payer: Networks By Design Commercial |
$7.19
|
| Rate for Payer: Prime Health Services Commercial |
$9.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.53
|
| Rate for Payer: United Healthcare All Other HMO |
$5.53
|
| Rate for Payer: United Healthcare HMO Rider |
$5.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.40
|
| Rate for Payer: Vantage Medical Group Senior |
$9.40
|
|
|
ROSUVASTATIN 20 MG TABLET [35135]
|
Facility
|
IP
|
$11.06
|
|
|
Service Code
|
NDC 0310-0752-90
|
| Hospital Charge Code |
1712305
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$9.40 |
| Rate for Payer: Blue Shield of California Commercial |
$7.87
|
| Rate for Payer: Blue Shield of California EPN |
$5.66
|
| Rate for Payer: Cash Price |
$4.98
|
| Rate for Payer: Cigna of CA HMO |
$7.74
|
| Rate for Payer: Cigna of CA PPO |
$7.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.42
|
| Rate for Payer: Galaxy Health WC |
$9.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.65
|
| Rate for Payer: Multiplan Commercial |
$8.85
|
| Rate for Payer: Networks By Design Commercial |
$7.19
|
| Rate for Payer: Prime Health Services Commercial |
$9.40
|
|
|
ROSUVASTATIN 20 MG TABLET [35135]
|
Facility
|
OP
|
$11.06
|
|
|
Service Code
|
NDC 0310-0752-90
|
| Hospital Charge Code |
1712305
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$9.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.59
|
| Rate for Payer: Blue Distinction Transplant |
$6.64
|
| Rate for Payer: Blue Shield of California Commercial |
$8.15
|
| Rate for Payer: Blue Shield of California EPN |
$6.46
|
| Rate for Payer: Cash Price |
$4.98
|
| Rate for Payer: Cigna of CA HMO |
$7.74
|
| Rate for Payer: Cigna of CA PPO |
$7.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.40
|
| Rate for Payer: Dignity Health Media |
$9.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.42
|
| Rate for Payer: Galaxy Health WC |
$9.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6.64
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.65
|
| Rate for Payer: Multiplan Commercial |
$8.85
|
| Rate for Payer: Networks By Design Commercial |
$7.19
|
| Rate for Payer: Prime Health Services Commercial |
$9.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.53
|
| Rate for Payer: United Healthcare All Other HMO |
$5.53
|
| Rate for Payer: United Healthcare HMO Rider |
$5.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.40
|
| Rate for Payer: Vantage Medical Group Senior |
$9.40
|
|
|
ROSUVASTATIN 40 MG TABLET [35136]
|
Facility
|
IP
|
$17.90
|
|
|
Service Code
|
NDC 71205-078-30
|
| Hospital Charge Code |
1712306
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$15.22 |
| Rate for Payer: Blue Shield of California Commercial |
$12.74
|
| Rate for Payer: Blue Shield of California EPN |
$9.16
|
| Rate for Payer: Cash Price |
$8.06
|
| Rate for Payer: Cigna of CA HMO |
$12.53
|
| Rate for Payer: Cigna of CA PPO |
$12.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.16
|
| Rate for Payer: Galaxy Health WC |
$15.22
|
| Rate for Payer: Global Benefits Group Commercial |
$10.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.30
|
| Rate for Payer: Multiplan Commercial |
$14.32
|
| Rate for Payer: Networks By Design Commercial |
$11.64
|
| Rate for Payer: Prime Health Services Commercial |
$15.22
|
|
|
ROSUVASTATIN 40 MG TABLET [35136]
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
NDC 68462-264-30
|
| Hospital Charge Code |
1712306
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.15
|
| 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 |
$0.17
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.16
|
| Rate for Payer: Cigna of CA PPO |
$0.16
|
| 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 |
$0.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.09
|
| 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 |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
| 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 |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.15
|
| 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
|
|
|
ROSUVASTATIN 40 MG TABLET [35136]
|
Facility
|
OP
|
$17.90
|
|
|
Service Code
|
NDC 71205-078-30
|
| Hospital Charge Code |
1712306
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$15.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.66
|
| Rate for Payer: Blue Distinction Transplant |
$10.74
|
| Rate for Payer: Blue Shield of California Commercial |
$13.19
|
| Rate for Payer: Blue Shield of California EPN |
$10.45
|
| Rate for Payer: Cash Price |
$8.06
|
| Rate for Payer: Cigna of CA HMO |
$12.53
|
| Rate for Payer: Cigna of CA PPO |
$12.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.22
|
| Rate for Payer: Dignity Health Media |
$15.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.16
|
| Rate for Payer: Galaxy Health WC |
$15.22
|
| Rate for Payer: Global Benefits Group Commercial |
$10.74
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$13.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.30
|
| Rate for Payer: Multiplan Commercial |
$14.32
|
| Rate for Payer: Networks By Design Commercial |
$11.64
|
| Rate for Payer: Prime Health Services Commercial |
$15.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.95
|
| Rate for Payer: United Healthcare All Other HMO |
$8.95
|
| Rate for Payer: United Healthcare HMO Rider |
$8.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.22
|
| Rate for Payer: Vantage Medical Group Senior |
$15.22
|
|
|
ROSUVASTATIN 40 MG TABLET [35136]
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
NDC 68462-264-30
|
| Hospital Charge Code |
1712306
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.16
|
| Rate for Payer: Cigna of CA PPO |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| 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 |
$0.15
|
| 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 |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.15
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
|
|
ROTAVIRUS VACCINE LIVE, PENTAVALENT 2 ML ORAL SOLUTION [70476]
|
Facility
|
OP
|
$55.46
|
|
|
Service Code
|
CPT 90680
|
| Hospital Charge Code |
1716082
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.31 |
| Max. Negotiated Rate |
$679.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$679.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$47.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$143.03
|
| Rate for Payer: Blue Distinction Transplant |
$33.28
|
| Rate for Payer: Blue Shield of California Commercial |
$40.87
|
| Rate for Payer: Blue Shield of California EPN |
$105.31
|
| Rate for Payer: Cash Price |
$24.96
|
| Rate for Payer: Cash Price |
$24.96
|
| Rate for Payer: Cigna of CA HMO |
$38.82
|
| Rate for Payer: Cigna of CA PPO |
$38.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$47.14
|
| Rate for Payer: Dignity Health Media |
$47.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$22.18
|
| Rate for Payer: Galaxy Health WC |
$47.14
|
| Rate for Payer: Global Benefits Group Commercial |
$33.28
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$41.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.31
|
| Rate for Payer: Multiplan Commercial |
$44.37
|
| Rate for Payer: Networks By Design Commercial |
$27.73
|
| Rate for Payer: Prime Health Services Commercial |
$47.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.73
|
| Rate for Payer: United Healthcare All Other HMO |
$27.73
|
| Rate for Payer: United Healthcare HMO Rider |
$27.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$47.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.14
|
| Rate for Payer: Vantage Medical Group Senior |
$47.14
|
|
|
ROTAVIRUS VACCINE LIVE, PENTAVALENT 2 ML ORAL SOLUTION [70476]
|
Facility
|
IP
|
$55.46
|
|
|
Service Code
|
CPT 90680
|
| Hospital Charge Code |
1716082
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.31 |
| Max. Negotiated Rate |
$47.14 |
| Rate for Payer: Blue Shield of California Commercial |
$39.49
|
| Rate for Payer: Blue Shield of California EPN |
$28.40
|
| Rate for Payer: Cash Price |
$24.96
|
| Rate for Payer: Cigna of CA HMO |
$38.82
|
| Rate for Payer: Cigna of CA PPO |
$38.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$22.18
|
| Rate for Payer: Galaxy Health WC |
$47.14
|
| Rate for Payer: Global Benefits Group Commercial |
$33.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.31
|
| Rate for Payer: Multiplan Commercial |
$44.37
|
| Rate for Payer: Networks By Design Commercial |
$27.73
|
| Rate for Payer: Prime Health Services Commercial |
$47.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.94
|
| Rate for Payer: United Healthcare All Other HMO |
$20.45
|
| Rate for Payer: United Healthcare HMO Rider |
$20.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.30
|
|
|
ROTIGOTINE 2 MG/24 HOUR TRANSDERMAL 24 HOUR PATCH [82100]
|
Facility
|
IP
|
$32.26
|
|
|
Service Code
|
NDC 50474-802-03
|
| Hospital Charge Code |
ERX82100
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.74 |
| Max. Negotiated Rate |
$27.42 |
| Rate for Payer: Blue Shield of California Commercial |
$22.97
|
| Rate for Payer: Blue Shield of California EPN |
$16.52
|
| Rate for Payer: Cash Price |
$14.52
|
| Rate for Payer: Cigna of CA HMO |
$22.58
|
| Rate for Payer: Cigna of CA PPO |
$22.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.90
|
| Rate for Payer: Galaxy Health WC |
$27.42
|
| Rate for Payer: Global Benefits Group Commercial |
$19.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.74
|
| Rate for Payer: Multiplan Commercial |
$25.81
|
| Rate for Payer: Networks By Design Commercial |
$20.97
|
| Rate for Payer: Prime Health Services Commercial |
$27.42
|
|
|
ROTIGOTINE 2 MG/24 HOUR TRANSDERMAL 24 HOUR PATCH [82100]
|
Facility
|
OP
|
$32.26
|
|
|
Service Code
|
NDC 50474-802-03
|
| Hospital Charge Code |
ERX82100
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.74 |
| Max. Negotiated Rate |
$27.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$21.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.22
|
| Rate for Payer: Blue Distinction Transplant |
$19.36
|
| Rate for Payer: Blue Shield of California Commercial |
$23.78
|
| Rate for Payer: Blue Shield of California EPN |
$18.84
|
| Rate for Payer: Cash Price |
$14.52
|
| Rate for Payer: Cigna of CA HMO |
$22.58
|
| Rate for Payer: Cigna of CA PPO |
$22.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.42
|
| Rate for Payer: Dignity Health Media |
$27.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.90
|
| Rate for Payer: Galaxy Health WC |
$27.42
|
| Rate for Payer: Global Benefits Group Commercial |
$19.36
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$24.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.74
|
| Rate for Payer: Multiplan Commercial |
$25.81
|
| Rate for Payer: Networks By Design Commercial |
$20.97
|
| Rate for Payer: Prime Health Services Commercial |
$27.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.13
|
| Rate for Payer: United Healthcare All Other HMO |
$16.13
|
| Rate for Payer: United Healthcare HMO Rider |
$16.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.42
|
| Rate for Payer: Vantage Medical Group Senior |
$27.42
|
|
|
ROTIGOTINE 4 MG/24 HOUR TRANSDERMAL 24 HOUR PATCH [82101]
|
Facility
|
OP
|
$32.26
|
|
|
Service Code
|
NDC 50474-804-03
|
| Hospital Charge Code |
ERX82101
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.74 |
| Max. Negotiated Rate |
$27.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$21.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.22
|
| Rate for Payer: Blue Distinction Transplant |
$19.36
|
| Rate for Payer: Blue Shield of California Commercial |
$23.78
|
| Rate for Payer: Blue Shield of California EPN |
$18.84
|
| Rate for Payer: Cash Price |
$14.52
|
| Rate for Payer: Cigna of CA HMO |
$22.58
|
| Rate for Payer: Cigna of CA PPO |
$22.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.42
|
| Rate for Payer: Dignity Health Media |
$27.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.90
|
| Rate for Payer: Galaxy Health WC |
$27.42
|
| Rate for Payer: Global Benefits Group Commercial |
$19.36
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$24.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.74
|
| Rate for Payer: Multiplan Commercial |
$25.81
|
| Rate for Payer: Networks By Design Commercial |
$20.97
|
| Rate for Payer: Prime Health Services Commercial |
$27.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.13
|
| Rate for Payer: United Healthcare All Other HMO |
$16.13
|
| Rate for Payer: United Healthcare HMO Rider |
$16.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.42
|
| Rate for Payer: Vantage Medical Group Senior |
$27.42
|
|
|
ROTIGOTINE 4 MG/24 HOUR TRANSDERMAL 24 HOUR PATCH [82101]
|
Facility
|
IP
|
$32.26
|
|
|
Service Code
|
NDC 50474-804-03
|
| Hospital Charge Code |
ERX82101
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.74 |
| Max. Negotiated Rate |
$27.42 |
| Rate for Payer: Blue Shield of California Commercial |
$22.97
|
| Rate for Payer: Blue Shield of California EPN |
$16.52
|
| Rate for Payer: Cash Price |
$14.52
|
| Rate for Payer: Cigna of CA HMO |
$22.58
|
| Rate for Payer: Cigna of CA PPO |
$22.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.90
|
| Rate for Payer: Galaxy Health WC |
$27.42
|
| Rate for Payer: Global Benefits Group Commercial |
$19.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.74
|
| Rate for Payer: Multiplan Commercial |
$25.81
|
| Rate for Payer: Networks By Design Commercial |
$20.97
|
| Rate for Payer: Prime Health Services Commercial |
$27.42
|
|
|
RUFINAMIDE 200 MG TABLET [95691]
|
Facility
|
IP
|
$3.69
|
|
|
Service Code
|
NDC 68462-713-08
|
| Hospital Charge Code |
1712406
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$3.14 |
| Rate for Payer: Blue Shield of California Commercial |
$2.63
|
| Rate for Payer: Blue Shield of California EPN |
$1.89
|
| 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: EPIC Health Plan Commercial |
$1.48
|
| Rate for Payer: Galaxy Health WC |
$3.14
|
| Rate for Payer: Global Benefits Group Commercial |
$2.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.89
|
| Rate for Payer: Multiplan Commercial |
$2.95
|
| Rate for Payer: Networks By Design Commercial |
$2.40
|
| Rate for Payer: Prime Health Services Commercial |
$3.14
|
|
|
RUFINAMIDE 200 MG TABLET [95691]
|
Facility
|
OP
|
$3.69
|
|
|
Service Code
|
NDC 68462-713-08
|
| Hospital Charge Code |
1712406
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$3.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.20
|
| Rate for Payer: Blue Distinction Transplant |
$2.21
|
| Rate for Payer: Blue Shield of California Commercial |
$2.72
|
| Rate for Payer: Blue Shield of California EPN |
$2.15
|
| 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 |
$3.14
|
| Rate for Payer: Dignity Health Media |
$3.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.48
|
| Rate for Payer: Galaxy Health WC |
$3.14
|
| Rate for Payer: Global Benefits Group Commercial |
$2.21
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.89
|
| Rate for Payer: Multiplan Commercial |
$2.95
|
| Rate for Payer: Networks By Design Commercial |
$2.40
|
| Rate for Payer: Prime Health Services Commercial |
$3.14
|
| 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 |
$3.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.14
|
| Rate for Payer: Vantage Medical Group Senior |
$3.14
|
|
|
RUFINAMIDE 200 MG TABLET [95691]
|
Facility
|
IP
|
$3.69
|
|
|
Service Code
|
NDC 0054-0425-23
|
| Hospital Charge Code |
1712406
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$3.14 |
| Rate for Payer: Blue Shield of California Commercial |
$2.63
|
| Rate for Payer: Blue Shield of California EPN |
$1.89
|
| 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: EPIC Health Plan Commercial |
$1.48
|
| Rate for Payer: Galaxy Health WC |
$3.14
|
| Rate for Payer: Global Benefits Group Commercial |
$2.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.89
|
| Rate for Payer: Multiplan Commercial |
$2.95
|
| Rate for Payer: Networks By Design Commercial |
$2.40
|
| Rate for Payer: Prime Health Services Commercial |
$3.14
|
|
|
RUFINAMIDE 200 MG TABLET [95691]
|
Facility
|
OP
|
$3.69
|
|
|
Service Code
|
NDC 0054-0425-23
|
| Hospital Charge Code |
1712406
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$3.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.20
|
| Rate for Payer: Blue Distinction Transplant |
$2.21
|
| Rate for Payer: Blue Shield of California Commercial |
$2.72
|
| Rate for Payer: Blue Shield of California EPN |
$2.15
|
| 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 |
$3.14
|
| Rate for Payer: Dignity Health Media |
$3.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.48
|
| Rate for Payer: Galaxy Health WC |
$3.14
|
| Rate for Payer: Global Benefits Group Commercial |
$2.21
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.89
|
| Rate for Payer: Multiplan Commercial |
$2.95
|
| Rate for Payer: Networks By Design Commercial |
$2.40
|
| Rate for Payer: Prime Health Services Commercial |
$3.14
|
| 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 |
$3.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.14
|
| Rate for Payer: Vantage Medical Group Senior |
$3.14
|
|
|
RUFINAMIDE 400 MG TABLET [95692]
|
Facility
|
OP
|
$7.37
|
|
|
Service Code
|
NDC 0054-0426-23
|
| Hospital Charge Code |
1712407
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$6.26 |
| 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 |
$4.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.39
|
| Rate for Payer: Blue Distinction Transplant |
$4.42
|
| Rate for Payer: Blue Shield of California Commercial |
$5.43
|
| Rate for Payer: Blue Shield of California EPN |
$4.30
|
| 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 Media |
$6.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.95
|
| Rate for Payer: Galaxy Health WC |
$6.26
|
| Rate for Payer: Global Benefits Group Commercial |
$4.42
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.81
|
| 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
|
| 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 |
$3.68
|
| Rate for Payer: United Healthcare All Other HMO |
$3.68
|
| Rate for Payer: United Healthcare HMO Rider |
$3.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.68
|
| 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 400 MG TABLET [95692]
|
Facility
|
IP
|
$7.37
|
|
|
Service Code
|
NDC 0054-0426-23
|
| Hospital Charge Code |
1712407
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$6.26 |
| Rate for Payer: Blue Shield of California Commercial |
$5.25
|
| Rate for Payer: Blue Shield of California EPN |
$3.77
|
| 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: EPIC Health Plan Commercial |
$2.95
|
| Rate for Payer: Galaxy Health WC |
$6.26
|
| Rate for Payer: Global Benefits Group Commercial |
$4.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.81
|
| 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 40 MG/ML ORAL SUSPENSION [108804]
|
Facility
|
IP
|
$4.59
|
|
|
Service Code
|
NDC 62856-584-46
|
| Hospital Charge Code |
1715258
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Blue Shield of California Commercial |
$3.27
|
| Rate for Payer: Blue Shield of California EPN |
$2.35
|
| 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: EPIC Health Plan Commercial |
$1.84
|
| Rate for Payer: Galaxy Health WC |
$3.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.75
|
| 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
|
|
