|
RITUXIMAB 1,400 MG/11.7 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN [218742]
|
Facility
|
OP
|
$674.52
|
|
|
Service Code
|
HCPCS J9311
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.39 |
| Max. Negotiated Rate |
$607.07 |
| Rate for Payer: Adventist Health Commercial |
$134.90
|
| Rate for Payer: Adventist Health Medi-Cal |
$36.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$116.06
|
| Rate for Payer: Blue Shield of California Commercial |
$62.01
|
| Rate for Payer: Blue Shield of California EPN |
$56.37
|
| Rate for Payer: Cash Price |
$303.53
|
| Rate for Payer: Cash Price |
$303.53
|
| Rate for Payer: Central Health Plan Commercial |
$539.62
|
| Rate for Payer: Cigna of CA HMO |
$472.16
|
| Rate for Payer: Cigna of CA PPO |
$472.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$472.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.04
|
| Rate for Payer: EPIC Health Plan Senior |
$40.03
|
| Rate for Payer: Galaxy Health WC |
$573.34
|
| Rate for Payer: Global Benefits Group Commercial |
$404.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$607.07
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$59.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$36.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$428.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$78.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$48.76
|
| Rate for Payer: Multiplan Commercial |
$505.89
|
| Rate for Payer: Networks By Design Commercial |
$337.26
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$36.39
|
| Rate for Payer: Prime Health Services Commercial |
$573.34
|
| Rate for Payer: Prime Health Services Medicare |
$38.57
|
| Rate for Payer: Riverside University Health System MISP |
$40.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$404.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$404.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$253.15
|
| Rate for Payer: United Healthcare All Other HMO |
$246.40
|
| Rate for Payer: United Healthcare HMO Rider |
$241.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$220.91
|
| Rate for Payer: Upland Medical Group Pediatric |
$36.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.03
|
| Rate for Payer: Vantage Medical Group Senior |
$40.03
|
|
|
RITUXIMAB 1,400 MG/11.7 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN [218742]
|
Facility
|
IP
|
$674.52
|
|
|
Service Code
|
HCPCS J9311
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$134.90 |
| Max. Negotiated Rate |
$607.07 |
| Rate for Payer: Adventist Health Commercial |
$134.90
|
| Rate for Payer: Blue Shield of California Commercial |
$540.97
|
| Rate for Payer: Blue Shield of California EPN |
$339.96
|
| Rate for Payer: Cash Price |
$303.53
|
| Rate for Payer: Central Health Plan Commercial |
$539.62
|
| Rate for Payer: Cigna of CA HMO |
$472.16
|
| Rate for Payer: Cigna of CA PPO |
$472.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$472.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$269.81
|
| Rate for Payer: EPIC Health Plan Senior |
$269.81
|
| Rate for Payer: Galaxy Health WC |
$573.34
|
| Rate for Payer: Global Benefits Group Commercial |
$404.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$607.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$428.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$397.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.90
|
| Rate for Payer: Multiplan Commercial |
$505.89
|
| Rate for Payer: Networks By Design Commercial |
$337.26
|
| Rate for Payer: Prime Health Services Commercial |
$573.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$253.15
|
| Rate for Payer: United Healthcare All Other HMO |
$246.40
|
| Rate for Payer: United Healthcare HMO Rider |
$241.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$220.91
|
|
|
RITUXIMAB 1,600 MG/13.4 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN [218821]
|
Facility
|
OP
|
$673.08
|
|
|
Service Code
|
HCPCS J9311
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.39 |
| Max. Negotiated Rate |
$605.77 |
| Rate for Payer: Adventist Health Commercial |
$134.62
|
| Rate for Payer: Adventist Health Medi-Cal |
$36.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$116.06
|
| Rate for Payer: Blue Shield of California Commercial |
$62.01
|
| Rate for Payer: Blue Shield of California EPN |
$56.37
|
| Rate for Payer: Cash Price |
$302.89
|
| Rate for Payer: Cash Price |
$302.89
|
| Rate for Payer: Central Health Plan Commercial |
$538.46
|
| Rate for Payer: Cigna of CA HMO |
$471.16
|
| Rate for Payer: Cigna of CA PPO |
$471.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$471.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.04
|
| Rate for Payer: EPIC Health Plan Senior |
$40.03
|
| Rate for Payer: Galaxy Health WC |
$572.12
|
| Rate for Payer: Global Benefits Group Commercial |
$403.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$605.77
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$59.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$36.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$427.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$78.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$48.76
|
| Rate for Payer: Multiplan Commercial |
$504.81
|
| Rate for Payer: Networks By Design Commercial |
$336.54
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$36.39
|
| Rate for Payer: Prime Health Services Commercial |
$572.12
|
| Rate for Payer: Prime Health Services Medicare |
$38.57
|
| Rate for Payer: Riverside University Health System MISP |
$40.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$403.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$403.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$252.61
|
| Rate for Payer: United Healthcare All Other HMO |
$245.88
|
| Rate for Payer: United Healthcare HMO Rider |
$240.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$220.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$36.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.03
|
| Rate for Payer: Vantage Medical Group Senior |
$40.03
|
|
|
RITUXIMAB 1,600 MG/13.4 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN [218821]
|
Facility
|
IP
|
$673.08
|
|
|
Service Code
|
HCPCS J9311
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$134.62 |
| Max. Negotiated Rate |
$605.77 |
| Rate for Payer: Adventist Health Commercial |
$134.62
|
| Rate for Payer: Blue Shield of California Commercial |
$539.81
|
| Rate for Payer: Blue Shield of California EPN |
$339.23
|
| Rate for Payer: Cash Price |
$302.89
|
| Rate for Payer: Central Health Plan Commercial |
$538.46
|
| Rate for Payer: Cigna of CA HMO |
$471.16
|
| Rate for Payer: Cigna of CA PPO |
$471.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$471.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$269.23
|
| Rate for Payer: EPIC Health Plan Senior |
$269.23
|
| Rate for Payer: Galaxy Health WC |
$572.12
|
| Rate for Payer: Global Benefits Group Commercial |
$403.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$605.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$427.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$397.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.62
|
| Rate for Payer: Multiplan Commercial |
$504.81
|
| Rate for Payer: Networks By Design Commercial |
$336.54
|
| Rate for Payer: Prime Health Services Commercial |
$572.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$252.61
|
| Rate for Payer: United Healthcare All Other HMO |
$245.88
|
| Rate for Payer: United Healthcare HMO Rider |
$240.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$220.43
|
|
|
RITUXIMAB-ARRX 10 MG/ML INTRAVENOUS SOLUTION [229898]
|
Facility
|
IP
|
$86.02
|
|
|
Service Code
|
HCPCS Q5123
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$77.42 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Blue Shield of California Commercial |
$68.99
|
| Rate for Payer: Blue Shield of California EPN |
$43.35
|
| Rate for Payer: Cash Price |
$38.71
|
| Rate for Payer: Central Health Plan Commercial |
$68.82
|
| Rate for Payer: Cigna of CA HMO |
$60.21
|
| Rate for Payer: Cigna of CA PPO |
$60.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.41
|
| Rate for Payer: EPIC Health Plan Senior |
$34.41
|
| Rate for Payer: Galaxy Health WC |
$73.12
|
| Rate for Payer: Global Benefits Group Commercial |
$51.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$54.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.20
|
| Rate for Payer: Multiplan Commercial |
$64.52
|
| Rate for Payer: Networks By Design Commercial |
$43.01
|
| Rate for Payer: Prime Health Services Commercial |
$73.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.28
|
| Rate for Payer: United Healthcare All Other HMO |
$31.42
|
| Rate for Payer: United Healthcare HMO Rider |
$30.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.17
|
|
|
RITUXIMAB-ARRX 10 MG/ML INTRAVENOUS SOLUTION [229898]
|
Facility
|
OP
|
$86.02
|
|
|
Service Code
|
HCPCS Q5123
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$205.06 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$205.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$141.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.04
|
| Rate for Payer: Blue Shield of California Commercial |
$94.62
|
| Rate for Payer: Blue Shield of California EPN |
$86.02
|
| Rate for Payer: Cash Price |
$38.71
|
| Rate for Payer: Cash Price |
$38.71
|
| Rate for Payer: Central Health Plan Commercial |
$68.82
|
| Rate for Payer: Cigna of CA HMO |
$60.21
|
| Rate for Payer: Cigna of CA PPO |
$60.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.57
|
| Rate for Payer: EPIC Health Plan Senior |
$20.38
|
| Rate for Payer: Galaxy Health WC |
$73.12
|
| Rate for Payer: Global Benefits Group Commercial |
$51.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.42
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$54.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.83
|
| Rate for Payer: Multiplan Commercial |
$64.52
|
| Rate for Payer: Networks By Design Commercial |
$43.01
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.53
|
| Rate for Payer: Prime Health Services Commercial |
$73.12
|
| Rate for Payer: Prime Health Services Medicare |
$19.64
|
| Rate for Payer: Riverside University Health System MISP |
$20.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.28
|
| Rate for Payer: United Healthcare All Other HMO |
$31.42
|
| Rate for Payer: United Healthcare HMO Rider |
$30.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.17
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.38
|
| Rate for Payer: Vantage Medical Group Senior |
$20.38
|
|
|
RITUXIMAB-PVVR 10 MG/ML INTRAVENOUS SOLUTION [226878]
|
Facility
|
IP
|
$86.02
|
|
|
Service Code
|
HCPCS Q5119
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$77.42 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Blue Shield of California Commercial |
$68.99
|
| Rate for Payer: Blue Shield of California EPN |
$43.35
|
| Rate for Payer: Cash Price |
$38.71
|
| Rate for Payer: Central Health Plan Commercial |
$68.82
|
| Rate for Payer: Cigna of CA HMO |
$60.21
|
| Rate for Payer: Cigna of CA PPO |
$60.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.41
|
| Rate for Payer: EPIC Health Plan Senior |
$34.41
|
| Rate for Payer: Galaxy Health WC |
$73.12
|
| Rate for Payer: Global Benefits Group Commercial |
$51.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$54.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.20
|
| Rate for Payer: Multiplan Commercial |
$64.52
|
| Rate for Payer: Networks By Design Commercial |
$43.01
|
| Rate for Payer: Prime Health Services Commercial |
$73.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.28
|
| Rate for Payer: United Healthcare All Other HMO |
$31.42
|
| Rate for Payer: United Healthcare HMO Rider |
$30.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.17
|
|
|
RITUXIMAB-PVVR 10 MG/ML INTRAVENOUS SOLUTION [226878]
|
Facility
|
OP
|
$86.02
|
|
|
Service Code
|
HCPCS Q5119
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.16 |
| Max. Negotiated Rate |
$177.04 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$154.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$141.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.04
|
| Rate for Payer: Blue Shield of California Commercial |
$94.62
|
| Rate for Payer: Blue Shield of California EPN |
$86.02
|
| Rate for Payer: Cash Price |
$38.71
|
| Rate for Payer: Cash Price |
$38.71
|
| Rate for Payer: Central Health Plan Commercial |
$68.82
|
| Rate for Payer: Cigna of CA HMO |
$60.21
|
| Rate for Payer: Cigna of CA PPO |
$60.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.66
|
| Rate for Payer: EPIC Health Plan Senior |
$17.78
|
| Rate for Payer: Galaxy Health WC |
$73.12
|
| Rate for Payer: Global Benefits Group Commercial |
$51.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.42
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$54.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.65
|
| Rate for Payer: Multiplan Commercial |
$64.52
|
| Rate for Payer: Networks By Design Commercial |
$43.01
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.16
|
| Rate for Payer: Prime Health Services Commercial |
$73.12
|
| Rate for Payer: Prime Health Services Medicare |
$17.13
|
| Rate for Payer: Riverside University Health System MISP |
$17.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.28
|
| Rate for Payer: United Healthcare All Other HMO |
$31.42
|
| Rate for Payer: United Healthcare HMO Rider |
$30.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.17
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.78
|
| Rate for Payer: Vantage Medical Group Senior |
$17.78
|
|
|
RIVAROXABAN 10 MG TABLET [153876]
|
Facility
|
OP
|
$24.47
|
|
|
Service Code
|
NDC 5045858030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$22.02 |
| Rate for Payer: Adventist Health Commercial |
$4.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.23
|
| Rate for Payer: Blue Shield of California Commercial |
$15.51
|
| Rate for Payer: Blue Shield of California EPN |
$9.76
|
| Rate for Payer: Cash Price |
$11.01
|
| Rate for Payer: Central Health Plan Commercial |
$19.58
|
| Rate for Payer: Cigna of CA HMO |
$17.13
|
| Rate for Payer: Cigna of CA PPO |
$17.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.79
|
| Rate for Payer: EPIC Health Plan Senior |
$9.79
|
| Rate for Payer: Galaxy Health WC |
$20.80
|
| Rate for Payer: Global Benefits Group Commercial |
$14.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.13
|
| Rate for Payer: Multiplan Commercial |
$18.35
|
| Rate for Payer: Networks By Design Commercial |
$15.91
|
| Rate for Payer: Prime Health Services Commercial |
$20.80
|
| Rate for Payer: Riverside University Health System MISP |
$9.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.23
|
| Rate for Payer: United Healthcare All Other HMO |
$12.23
|
| Rate for Payer: United Healthcare HMO Rider |
$12.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.80
|
| Rate for Payer: Vantage Medical Group Senior |
$20.80
|
|
|
RIVAROXABAN 10 MG TABLET [153876]
|
Facility
|
IP
|
$24.47
|
|
|
Service Code
|
NDC 5045858030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$22.02 |
| Rate for Payer: Adventist Health Commercial |
$4.89
|
| Rate for Payer: Blue Shield of California Commercial |
$19.62
|
| Rate for Payer: Blue Shield of California EPN |
$12.33
|
| Rate for Payer: Cash Price |
$11.01
|
| Rate for Payer: Central Health Plan Commercial |
$19.58
|
| Rate for Payer: Cigna of CA HMO |
$17.13
|
| Rate for Payer: Cigna of CA PPO |
$17.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.79
|
| Rate for Payer: EPIC Health Plan Senior |
$9.79
|
| Rate for Payer: Galaxy Health WC |
$20.80
|
| Rate for Payer: Global Benefits Group Commercial |
$14.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.89
|
| Rate for Payer: Multiplan Commercial |
$18.35
|
| Rate for Payer: Networks By Design Commercial |
$15.91
|
| Rate for Payer: Prime Health Services Commercial |
$20.80
|
|
|
RIVAROXABAN 15 MG TABLET [153877]
|
Facility
|
OP
|
$24.47
|
|
|
Service Code
|
NDC 5045857810
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$22.02 |
| Rate for Payer: Adventist Health Commercial |
$4.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.23
|
| Rate for Payer: Blue Shield of California Commercial |
$15.51
|
| Rate for Payer: Blue Shield of California EPN |
$9.76
|
| Rate for Payer: Cash Price |
$11.01
|
| Rate for Payer: Central Health Plan Commercial |
$19.58
|
| Rate for Payer: Cigna of CA HMO |
$17.13
|
| Rate for Payer: Cigna of CA PPO |
$17.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.79
|
| Rate for Payer: EPIC Health Plan Senior |
$9.79
|
| Rate for Payer: Galaxy Health WC |
$20.80
|
| Rate for Payer: Global Benefits Group Commercial |
$14.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.13
|
| Rate for Payer: Multiplan Commercial |
$18.35
|
| Rate for Payer: Networks By Design Commercial |
$15.91
|
| Rate for Payer: Prime Health Services Commercial |
$20.80
|
| Rate for Payer: Riverside University Health System MISP |
$9.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.23
|
| Rate for Payer: United Healthcare All Other HMO |
$12.23
|
| Rate for Payer: United Healthcare HMO Rider |
$12.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.80
|
| Rate for Payer: Vantage Medical Group Senior |
$20.80
|
|
|
RIVAROXABAN 15 MG TABLET [153877]
|
Facility
|
IP
|
$24.47
|
|
|
Service Code
|
NDC 5045857810
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$22.02 |
| Rate for Payer: Adventist Health Commercial |
$4.89
|
| Rate for Payer: Blue Shield of California Commercial |
$19.62
|
| Rate for Payer: Blue Shield of California EPN |
$12.33
|
| Rate for Payer: Cash Price |
$11.01
|
| Rate for Payer: Central Health Plan Commercial |
$19.58
|
| Rate for Payer: Cigna of CA HMO |
$17.13
|
| Rate for Payer: Cigna of CA PPO |
$17.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.79
|
| Rate for Payer: EPIC Health Plan Senior |
$9.79
|
| Rate for Payer: Galaxy Health WC |
$20.80
|
| Rate for Payer: Global Benefits Group Commercial |
$14.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.89
|
| Rate for Payer: Multiplan Commercial |
$18.35
|
| Rate for Payer: Networks By Design Commercial |
$15.91
|
| Rate for Payer: Prime Health Services Commercial |
$20.80
|
|
|
RIVAROXABAN 15 MG TABLET [153877]
|
Facility
|
IP
|
$24.47
|
|
|
Service Code
|
NDC 5045857801
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$22.02 |
| Rate for Payer: Adventist Health Commercial |
$4.89
|
| Rate for Payer: Blue Shield of California Commercial |
$19.62
|
| Rate for Payer: Blue Shield of California EPN |
$12.33
|
| Rate for Payer: Cash Price |
$11.01
|
| Rate for Payer: Central Health Plan Commercial |
$19.58
|
| Rate for Payer: Cigna of CA HMO |
$17.13
|
| Rate for Payer: Cigna of CA PPO |
$17.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.79
|
| Rate for Payer: EPIC Health Plan Senior |
$9.79
|
| Rate for Payer: Galaxy Health WC |
$20.80
|
| Rate for Payer: Global Benefits Group Commercial |
$14.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.89
|
| Rate for Payer: Multiplan Commercial |
$18.35
|
| Rate for Payer: Networks By Design Commercial |
$15.91
|
| Rate for Payer: Prime Health Services Commercial |
$20.80
|
|
|
RIVAROXABAN 15 MG TABLET [153877]
|
Facility
|
OP
|
$24.47
|
|
|
Service Code
|
NDC 5045857801
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$22.02 |
| Rate for Payer: Adventist Health Commercial |
$4.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.23
|
| Rate for Payer: Blue Shield of California Commercial |
$15.51
|
| Rate for Payer: Blue Shield of California EPN |
$9.76
|
| Rate for Payer: Cash Price |
$11.01
|
| Rate for Payer: Central Health Plan Commercial |
$19.58
|
| Rate for Payer: Cigna of CA HMO |
$17.13
|
| Rate for Payer: Cigna of CA PPO |
$17.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.79
|
| Rate for Payer: EPIC Health Plan Senior |
$9.79
|
| Rate for Payer: Galaxy Health WC |
$20.80
|
| Rate for Payer: Global Benefits Group Commercial |
$14.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.13
|
| Rate for Payer: Multiplan Commercial |
$18.35
|
| Rate for Payer: Networks By Design Commercial |
$15.91
|
| Rate for Payer: Prime Health Services Commercial |
$20.80
|
| Rate for Payer: Riverside University Health System MISP |
$9.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.23
|
| Rate for Payer: United Healthcare All Other HMO |
$12.23
|
| Rate for Payer: United Healthcare HMO Rider |
$12.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.80
|
| Rate for Payer: Vantage Medical Group Senior |
$20.80
|
|
|
RIVAROXABAN 20 MG TABLET [153878]
|
Facility
|
OP
|
$24.47
|
|
|
Service Code
|
NDC 5045857930
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$22.02 |
| Rate for Payer: Adventist Health Commercial |
$4.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.23
|
| Rate for Payer: Blue Shield of California Commercial |
$15.51
|
| Rate for Payer: Blue Shield of California EPN |
$9.76
|
| Rate for Payer: Cash Price |
$11.01
|
| Rate for Payer: Central Health Plan Commercial |
$19.58
|
| Rate for Payer: Cigna of CA HMO |
$17.13
|
| Rate for Payer: Cigna of CA PPO |
$17.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.79
|
| Rate for Payer: EPIC Health Plan Senior |
$9.79
|
| Rate for Payer: Galaxy Health WC |
$20.80
|
| Rate for Payer: Global Benefits Group Commercial |
$14.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.13
|
| Rate for Payer: Multiplan Commercial |
$18.35
|
| Rate for Payer: Networks By Design Commercial |
$15.91
|
| Rate for Payer: Prime Health Services Commercial |
$20.80
|
| Rate for Payer: Riverside University Health System MISP |
$9.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.23
|
| Rate for Payer: United Healthcare All Other HMO |
$12.23
|
| Rate for Payer: United Healthcare HMO Rider |
$12.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.80
|
| Rate for Payer: Vantage Medical Group Senior |
$20.80
|
|
|
RIVAROXABAN 20 MG TABLET [153878]
|
Facility
|
OP
|
$24.47
|
|
|
Service Code
|
NDC 5045857910
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$22.02 |
| Rate for Payer: Adventist Health Commercial |
$4.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.23
|
| Rate for Payer: Blue Shield of California Commercial |
$15.51
|
| Rate for Payer: Blue Shield of California EPN |
$9.76
|
| Rate for Payer: Cash Price |
$11.01
|
| Rate for Payer: Central Health Plan Commercial |
$19.58
|
| Rate for Payer: Cigna of CA HMO |
$17.13
|
| Rate for Payer: Cigna of CA PPO |
$17.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.79
|
| Rate for Payer: EPIC Health Plan Senior |
$9.79
|
| Rate for Payer: Galaxy Health WC |
$20.80
|
| Rate for Payer: Global Benefits Group Commercial |
$14.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.13
|
| Rate for Payer: Multiplan Commercial |
$18.35
|
| Rate for Payer: Networks By Design Commercial |
$15.91
|
| Rate for Payer: Prime Health Services Commercial |
$20.80
|
| Rate for Payer: Riverside University Health System MISP |
$9.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.23
|
| Rate for Payer: United Healthcare All Other HMO |
$12.23
|
| Rate for Payer: United Healthcare HMO Rider |
$12.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.80
|
| Rate for Payer: Vantage Medical Group Senior |
$20.80
|
|
|
RIVAROXABAN 20 MG TABLET [153878]
|
Facility
|
IP
|
$24.47
|
|
|
Service Code
|
NDC 5045857910
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$22.02 |
| Rate for Payer: Adventist Health Commercial |
$4.89
|
| Rate for Payer: Blue Shield of California Commercial |
$19.62
|
| Rate for Payer: Blue Shield of California EPN |
$12.33
|
| Rate for Payer: Cash Price |
$11.01
|
| Rate for Payer: Central Health Plan Commercial |
$19.58
|
| Rate for Payer: Cigna of CA HMO |
$17.13
|
| Rate for Payer: Cigna of CA PPO |
$17.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.79
|
| Rate for Payer: EPIC Health Plan Senior |
$9.79
|
| Rate for Payer: Galaxy Health WC |
$20.80
|
| Rate for Payer: Global Benefits Group Commercial |
$14.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.89
|
| Rate for Payer: Multiplan Commercial |
$18.35
|
| Rate for Payer: Networks By Design Commercial |
$15.91
|
| Rate for Payer: Prime Health Services Commercial |
$20.80
|
|
|
RIVAROXABAN 20 MG TABLET [153878]
|
Facility
|
IP
|
$24.47
|
|
|
Service Code
|
NDC 5045857930
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$22.02 |
| Rate for Payer: Adventist Health Commercial |
$4.89
|
| Rate for Payer: Blue Shield of California Commercial |
$19.62
|
| Rate for Payer: Blue Shield of California EPN |
$12.33
|
| Rate for Payer: Cash Price |
$11.01
|
| Rate for Payer: Central Health Plan Commercial |
$19.58
|
| Rate for Payer: Cigna of CA HMO |
$17.13
|
| Rate for Payer: Cigna of CA PPO |
$17.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.79
|
| Rate for Payer: EPIC Health Plan Senior |
$9.79
|
| Rate for Payer: Galaxy Health WC |
$20.80
|
| Rate for Payer: Global Benefits Group Commercial |
$14.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.89
|
| Rate for Payer: Multiplan Commercial |
$18.35
|
| Rate for Payer: Networks By Design Commercial |
$15.91
|
| Rate for Payer: Prime Health Services Commercial |
$20.80
|
|
|
RIVAROXABAN 2.5 MG TABLET [222768]
|
Facility
|
OP
|
$1.70
|
|
|
Service Code
|
NDC 6818070906
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.53 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.99
|
| Rate for Payer: Blue Shield of California Commercial |
$1.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.68
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Central Health Plan Commercial |
$1.36
|
| Rate for Payer: Cigna of CA HMO |
$1.19
|
| Rate for Payer: Cigna of CA PPO |
$1.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.68
|
| Rate for Payer: EPIC Health Plan Senior |
$0.68
|
| Rate for Payer: Galaxy Health WC |
$1.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.19
|
| Rate for Payer: Multiplan Commercial |
$1.27
|
| Rate for Payer: Networks By Design Commercial |
$1.10
|
| Rate for Payer: Prime Health Services Commercial |
$1.45
|
| Rate for Payer: Riverside University Health System MISP |
$0.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.85
|
| Rate for Payer: United Healthcare All Other HMO |
$0.85
|
| Rate for Payer: United Healthcare HMO Rider |
$0.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1.45
|
|
|
RIVAROXABAN 2.5 MG TABLET [222768]
|
Facility
|
OP
|
$12.24
|
|
|
Service Code
|
NDC 5045857760
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Adventist Health Commercial |
$2.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.12
|
| Rate for Payer: Blue Shield of California Commercial |
$7.76
|
| Rate for Payer: Blue Shield of California EPN |
$4.88
|
| Rate for Payer: Cash Price |
$5.51
|
| Rate for Payer: Central Health Plan Commercial |
$9.79
|
| Rate for Payer: Cigna of CA HMO |
$8.57
|
| Rate for Payer: Cigna of CA PPO |
$8.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.90
|
| Rate for Payer: EPIC Health Plan Senior |
$4.90
|
| Rate for Payer: Galaxy Health WC |
$10.40
|
| Rate for Payer: Global Benefits Group Commercial |
$7.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.57
|
| Rate for Payer: Multiplan Commercial |
$9.18
|
| Rate for Payer: Networks By Design Commercial |
$7.96
|
| Rate for Payer: Prime Health Services Commercial |
$10.40
|
| Rate for Payer: Riverside University Health System MISP |
$4.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.12
|
| Rate for Payer: United Healthcare All Other HMO |
$6.12
|
| Rate for Payer: United Healthcare HMO Rider |
$6.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.40
|
| Rate for Payer: Vantage Medical Group Senior |
$10.40
|
|
|
RIVAROXABAN 2.5 MG TABLET [222768]
|
Facility
|
IP
|
$12.24
|
|
|
Service Code
|
NDC 5045857760
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Adventist Health Commercial |
$2.45
|
| Rate for Payer: Blue Shield of California Commercial |
$9.82
|
| Rate for Payer: Blue Shield of California EPN |
$6.17
|
| Rate for Payer: Cash Price |
$5.51
|
| Rate for Payer: Central Health Plan Commercial |
$9.79
|
| Rate for Payer: Cigna of CA HMO |
$8.57
|
| Rate for Payer: Cigna of CA PPO |
$8.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.90
|
| Rate for Payer: EPIC Health Plan Senior |
$4.90
|
| Rate for Payer: Galaxy Health WC |
$10.40
|
| Rate for Payer: Global Benefits Group Commercial |
$7.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.45
|
| Rate for Payer: Multiplan Commercial |
$9.18
|
| Rate for Payer: Networks By Design Commercial |
$7.96
|
| Rate for Payer: Prime Health Services Commercial |
$10.40
|
|
|
RIVAROXABAN 2.5 MG TABLET [222768]
|
Facility
|
IP
|
$1.70
|
|
|
Service Code
|
NDC 6818070906
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.53 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1.36
|
| Rate for Payer: Blue Shield of California EPN |
$0.86
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Central Health Plan Commercial |
$1.36
|
| Rate for Payer: Cigna of CA HMO |
$1.19
|
| Rate for Payer: Cigna of CA PPO |
$1.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.68
|
| Rate for Payer: EPIC Health Plan Senior |
$0.68
|
| Rate for Payer: Galaxy Health WC |
$1.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.27
|
| Rate for Payer: Networks By Design Commercial |
$1.10
|
| Rate for Payer: Prime Health Services Commercial |
$1.45
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 0378907016
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1.60
|
| Rate for Payer: Blue Shield of California EPN |
$1.01
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$1.60
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Senior |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: Networks By Design Commercial |
$1.30
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
NDC 0378907016
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.80
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$1.60
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Senior |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.40
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: Networks By Design Commercial |
$1.30
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
| Rate for Payer: Riverside University Health System MISP |
$0.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1.70
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
NDC 0378907093
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.80
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$1.60
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Senior |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.40
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: Networks By Design Commercial |
$1.30
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
| Rate for Payer: Riverside University Health System MISP |
$0.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1.70
|
|
