|
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
|
|
|
RIZATRIPTAN 10 MG TABLET [23377]
|
Facility
|
OP
|
$1.80
|
|
|
Service Code
|
NDC 6586260012
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.05
|
| Rate for Payer: Blue Shield of California Commercial |
$1.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.72
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Central Health Plan Commercial |
$1.44
|
| Rate for Payer: Cigna of CA HMO |
$1.26
|
| Rate for Payer: Cigna of CA PPO |
$1.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Senior |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$1.53
|
| Rate for Payer: Global Benefits Group Commercial |
$1.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$1.35
|
| Rate for Payer: Networks By Design Commercial |
$1.17
|
| Rate for Payer: Prime Health Services Commercial |
$1.53
|
| Rate for Payer: Riverside University Health System MISP |
$0.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.90
|
| Rate for Payer: United Healthcare All Other HMO |
$0.90
|
| Rate for Payer: United Healthcare HMO Rider |
$0.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1.53
|
|
|
RIZATRIPTAN 10 MG TABLET [23377]
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
NDC 6586260003
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$1.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.91
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Central Health Plan Commercial |
$1.44
|
| Rate for Payer: Cigna of CA HMO |
$1.26
|
| Rate for Payer: Cigna of CA PPO |
$1.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Senior |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$1.53
|
| Rate for Payer: Global Benefits Group Commercial |
$1.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.35
|
| Rate for Payer: Networks By Design Commercial |
$1.17
|
| Rate for Payer: Prime Health Services Commercial |
$1.53
|
|
|
RIZATRIPTAN 10 MG TABLET [23377]
|
Facility
|
OP
|
$1.19
|
|
|
Service Code
|
NDC 5723708863
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.07 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.69
|
| Rate for Payer: Blue Shield of California Commercial |
$0.75
|
| Rate for Payer: Blue Shield of California EPN |
$0.47
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Central Health Plan Commercial |
$0.95
|
| Rate for Payer: Cigna of CA HMO |
$0.83
|
| Rate for Payer: Cigna of CA PPO |
$0.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Senior |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.83
|
| Rate for Payer: Multiplan Commercial |
$0.89
|
| Rate for Payer: Networks By Design Commercial |
$0.77
|
| Rate for Payer: Prime Health Services Commercial |
$1.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.60
|
| Rate for Payer: United Healthcare All Other HMO |
$0.60
|
| Rate for Payer: United Healthcare HMO Rider |
$0.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.01
|
| Rate for Payer: Vantage Medical Group Senior |
$1.01
|
|
|
RIZATRIPTAN 10 MG TABLET [23377]
|
Facility
|
OP
|
$1.80
|
|
|
Service Code
|
NDC 0093747219
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.05
|
| Rate for Payer: Blue Shield of California Commercial |
$1.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.72
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Central Health Plan Commercial |
$1.44
|
| Rate for Payer: Cigna of CA HMO |
$1.26
|
| Rate for Payer: Cigna of CA PPO |
$1.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Senior |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$1.53
|
| Rate for Payer: Global Benefits Group Commercial |
$1.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$1.35
|
| Rate for Payer: Networks By Design Commercial |
$1.17
|
| Rate for Payer: Prime Health Services Commercial |
$1.53
|
| Rate for Payer: Riverside University Health System MISP |
$0.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.90
|
| Rate for Payer: United Healthcare All Other HMO |
$0.90
|
| Rate for Payer: United Healthcare HMO Rider |
$0.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1.53
|
|
|
RIZATRIPTAN 10 MG TABLET [23377]
|
Facility
|
IP
|
$1.19
|
|
|
Service Code
|
NDC 5723708863
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.07 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California Commercial |
$0.95
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Central Health Plan Commercial |
$0.95
|
| Rate for Payer: Cigna of CA HMO |
$0.83
|
| Rate for Payer: Cigna of CA PPO |
$0.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Senior |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.89
|
| Rate for Payer: Networks By Design Commercial |
$0.77
|
| Rate for Payer: Prime Health Services Commercial |
$1.01
|
|
|
RIZATRIPTAN 10 MG TABLET [23377]
|
Facility
|
OP
|
$1.80
|
|
|
Service Code
|
NDC 6586260003
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.05
|
| Rate for Payer: Blue Shield of California Commercial |
$1.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.72
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Central Health Plan Commercial |
$1.44
|
| Rate for Payer: Cigna of CA HMO |
$1.26
|
| Rate for Payer: Cigna of CA PPO |
$1.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Senior |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$1.53
|
| Rate for Payer: Global Benefits Group Commercial |
$1.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$1.35
|
| Rate for Payer: Networks By Design Commercial |
$1.17
|
| Rate for Payer: Prime Health Services Commercial |
$1.53
|
| Rate for Payer: Riverside University Health System MISP |
$0.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.90
|
| Rate for Payer: United Healthcare All Other HMO |
$0.90
|
| Rate for Payer: United Healthcare HMO Rider |
$0.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1.53
|
|
|
RIZATRIPTAN 10 MG TABLET [23377]
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
NDC 6586260012
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$1.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.91
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Central Health Plan Commercial |
$1.44
|
| Rate for Payer: Cigna of CA HMO |
$1.26
|
| Rate for Payer: Cigna of CA PPO |
$1.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Senior |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$1.53
|
| Rate for Payer: Global Benefits Group Commercial |
$1.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.35
|
| Rate for Payer: Networks By Design Commercial |
$1.17
|
| Rate for Payer: Prime Health Services Commercial |
$1.53
|
|
|
RIZATRIPTAN 10 MG TABLET [23377]
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
NDC 0093747219
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$1.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.91
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Central Health Plan Commercial |
$1.44
|
| Rate for Payer: Cigna of CA HMO |
$1.26
|
| Rate for Payer: Cigna of CA PPO |
$1.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Senior |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$1.53
|
| Rate for Payer: Global Benefits Group Commercial |
$1.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.35
|
| Rate for Payer: Networks By Design Commercial |
$1.17
|
| Rate for Payer: Prime Health Services Commercial |
$1.53
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION [95812]
|
Facility
|
OP
|
$0.50
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Adventist Health Commercial |
$0.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.36
|
| Rate for Payer: Blue Shield of California Commercial |
$1.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.61
|
| Rate for Payer: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California EPN |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.72
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: Central Health Plan Commercial |
$0.77
|
| Rate for Payer: Central Health Plan Commercial |
$0.40
|
| Rate for Payer: Central Health Plan Commercial |
$1.45
|
| Rate for Payer: Cigna of CA HMO |
$1.27
|
| Rate for Payer: Cigna of CA HMO |
$0.35
|
| Rate for Payer: Cigna of CA HMO |
$0.67
|
| Rate for Payer: Cigna of CA PPO |
$0.67
|
| Rate for Payer: Cigna of CA PPO |
$1.27
|
| Rate for Payer: Cigna of CA PPO |
$0.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.38
|
| Rate for Payer: EPIC Health Plan Senior |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$0.43
|
| Rate for Payer: Galaxy Health WC |
$0.82
|
| Rate for Payer: Galaxy Health WC |
$1.54
|
| Rate for Payer: Global Benefits Group Commercial |
$0.58
|
| Rate for Payer: Global Benefits Group Commercial |
$0.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.36
|
| Rate for Payer: Multiplan Commercial |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$0.72
|
| Rate for Payer: Networks By Design Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.91
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.82
|
| Rate for Payer: Prime Health Services Commercial |
$1.54
|
| Rate for Payer: Prime Health Services Commercial |
$0.43
|
| Rate for Payer: Riverside University Health System MISP |
$0.20
|
| Rate for Payer: Riverside University Health System MISP |
$0.38
|
| Rate for Payer: Riverside University Health System MISP |
$0.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.19
|
| Rate for Payer: United Healthcare All Other HMO |
$0.66
|
| Rate for Payer: United Healthcare All Other HMO |
$0.35
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.65
|
| Rate for Payer: United Healthcare HMO Rider |
$0.34
|
| Rate for Payer: United Healthcare HMO Rider |
$0.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.54
|
| Rate for Payer: Vantage Medical Group Senior |
$0.82
|
| Rate for Payer: Vantage Medical Group Senior |
$1.54
|
| Rate for Payer: Vantage Medical Group Senior |
$0.43
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION [95812]
|
Facility
|
IP
|
$1.81
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.63 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Adventist Health Commercial |
$0.19
|
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$1.45
|
| Rate for Payer: Blue Shield of California Commercial |
$0.77
|
| Rate for Payer: Blue Shield of California Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California EPN |
$0.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.91
|
| Rate for Payer: Blue Shield of California EPN |
$0.48
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: Central Health Plan Commercial |
$0.77
|
| Rate for Payer: Central Health Plan Commercial |
$0.40
|
| Rate for Payer: Central Health Plan Commercial |
$1.45
|
| Rate for Payer: Cigna of CA HMO |
$1.27
|
| Rate for Payer: Cigna of CA HMO |
$0.35
|
| Rate for Payer: Cigna of CA HMO |
$0.67
|
| Rate for Payer: Cigna of CA PPO |
$1.27
|
| Rate for Payer: Cigna of CA PPO |
$0.67
|
| Rate for Payer: Cigna of CA PPO |
$0.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Senior |
$0.38
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$0.82
|
| Rate for Payer: Galaxy Health WC |
$0.43
|
| Rate for Payer: Galaxy Health WC |
$1.54
|
| Rate for Payer: Global Benefits Group Commercial |
$1.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.58
|
| Rate for Payer: Global Benefits Group Commercial |
$0.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$1.36
|
| Rate for Payer: Multiplan Commercial |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$0.38
|
| Rate for Payer: Networks By Design Commercial |
$0.91
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.48
|
| Rate for Payer: Prime Health Services Commercial |
$0.82
|
| Rate for Payer: Prime Health Services Commercial |
$1.54
|
| Rate for Payer: Prime Health Services Commercial |
$0.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.36
|
| Rate for Payer: United Healthcare All Other HMO |
$0.35
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.66
|
| Rate for Payer: United Healthcare HMO Rider |
$0.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.34
|
| Rate for Payer: United Healthcare HMO Rider |
$0.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
|
|
ROCURONIUM 50 MG/5 ML VIAL- CODE [40895812]
|
Facility
|
IP
|
$1.16
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California Commercial |
$0.93
|
| Rate for Payer: Blue Shield of California EPN |
$0.58
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Central Health Plan Commercial |
$0.93
|
| Rate for Payer: Cigna of CA HMO |
$0.81
|
| Rate for Payer: Cigna of CA PPO |
$0.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: EPIC Health Plan Senior |
$0.46
|
| Rate for Payer: Galaxy Health WC |
$0.99
|
| Rate for Payer: Global Benefits Group Commercial |
$0.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.87
|
| Rate for Payer: Networks By Design Commercial |
$0.58
|
| Rate for Payer: Prime Health Services Commercial |
$0.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.44
|
| Rate for Payer: United Healthcare All Other HMO |
$0.42
|
| Rate for Payer: United Healthcare HMO Rider |
$0.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.38
|
|
|
ROCURONIUM 50 MG/5 ML VIAL- CODE [40895812]
|
Facility
|
OP
|
$1.16
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.87
|
| Rate for Payer: Blue Shield of California Commercial |
$0.74
|
| Rate for Payer: Blue Shield of California EPN |
$0.46
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Central Health Plan Commercial |
$0.93
|
| Rate for Payer: Cigna of CA HMO |
$0.81
|
| Rate for Payer: Cigna of CA PPO |
$0.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: EPIC Health Plan Senior |
$0.46
|
| Rate for Payer: Galaxy Health WC |
$0.99
|
| Rate for Payer: Global Benefits Group Commercial |
$0.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.81
|
| Rate for Payer: Multiplan Commercial |
$0.87
|
| Rate for Payer: Networks By Design Commercial |
$0.58
|
| Rate for Payer: Prime Health Services Commercial |
$0.99
|
| Rate for Payer: Riverside University Health System MISP |
$0.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.44
|
| Rate for Payer: United Healthcare All Other HMO |
$0.42
|
| Rate for Payer: United Healthcare HMO Rider |
$0.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: Vantage Medical Group Senior |
$0.99
|
|
|
ROFLUMILAST 500 MCG TABLET [109401]
|
Facility
|
OP
|
$18.83
|
|
|
Service Code
|
NDC 0310009530
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$16.95 |
| Rate for Payer: Adventist Health Commercial |
$3.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.95
|
| Rate for Payer: Blue Shield of California Commercial |
$11.94
|
| Rate for Payer: Blue Shield of California EPN |
$7.51
|
| Rate for Payer: Cash Price |
$8.47
|
| Rate for Payer: Central Health Plan Commercial |
$15.06
|
| Rate for Payer: Cigna of CA HMO |
$13.18
|
| Rate for Payer: Cigna of CA PPO |
$13.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.53
|
| Rate for Payer: EPIC Health Plan Senior |
$7.53
|
| Rate for Payer: Galaxy Health WC |
$16.01
|
| Rate for Payer: Global Benefits Group Commercial |
$11.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.18
|
| Rate for Payer: Multiplan Commercial |
$14.12
|
| Rate for Payer: Networks By Design Commercial |
$12.24
|
| Rate for Payer: Prime Health Services Commercial |
$16.01
|
| Rate for Payer: Riverside University Health System MISP |
$7.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.41
|
| Rate for Payer: United Healthcare All Other HMO |
$9.41
|
| Rate for Payer: United Healthcare HMO Rider |
$9.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.01
|
| Rate for Payer: Vantage Medical Group Senior |
$16.01
|
|
|
ROFLUMILAST 500 MCG TABLET [109401]
|
Facility
|
IP
|
$0.72
|
|
|
Service Code
|
NDC 7220520030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.58
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Central Health Plan Commercial |
$0.58
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: EPIC Health Plan Senior |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.61
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.61
|
|
|
ROFLUMILAST 500 MCG TABLET [109401]
|
Facility
|
IP
|
$18.83
|
|
|
Service Code
|
NDC 0310009530
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$16.95 |
| Rate for Payer: Adventist Health Commercial |
$3.77
|
| Rate for Payer: Blue Shield of California Commercial |
$15.10
|
| Rate for Payer: Blue Shield of California EPN |
$9.49
|
| Rate for Payer: Cash Price |
$8.47
|
| Rate for Payer: Central Health Plan Commercial |
$15.06
|
| Rate for Payer: Cigna of CA HMO |
$13.18
|
| Rate for Payer: Cigna of CA PPO |
$13.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.53
|
| Rate for Payer: EPIC Health Plan Senior |
$7.53
|
| Rate for Payer: Galaxy Health WC |
$16.01
|
| Rate for Payer: Global Benefits Group Commercial |
$11.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.77
|
| Rate for Payer: Multiplan Commercial |
$14.12
|
| Rate for Payer: Networks By Design Commercial |
$12.24
|
| Rate for Payer: Prime Health Services Commercial |
$16.01
|
|
|
ROFLUMILAST 500 MCG TABLET [109401]
|
Facility
|
OP
|
$0.72
|
|
|
Service Code
|
NDC 7220520030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.42
|
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Central Health Plan Commercial |
$0.58
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: EPIC Health Plan Senior |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.61
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.61
|
| Rate for Payer: Riverside University Health System MISP |
$0.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.36
|
| Rate for Payer: United Healthcare All Other HMO |
$0.36
|
| Rate for Payer: United Healthcare HMO Rider |
$0.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.61
|
| Rate for Payer: Vantage Medical Group Senior |
$0.61
|
|
|
ROMIDEPSIN 10 MG/2 ML INTRAVENOUS POWDER FOR SOLUTION [100344]
|
Facility
|
OP
|
$3,838.38
|
|
|
Service Code
|
HCPCS J9319
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.71 |
| Max. Negotiated Rate |
$3,454.54 |
| Rate for Payer: Adventist Health Commercial |
$767.68
|
| Rate for Payer: Adventist Health Medi-Cal |
$30.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$195.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$63.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.92
|
| Rate for Payer: Blue Shield of California Commercial |
$41.82
|
| Rate for Payer: Blue Shield of California EPN |
$38.02
|
| Rate for Payer: Cash Price |
$1,727.27
|
| Rate for Payer: Cash Price |
$1,727.27
|
| Rate for Payer: Central Health Plan Commercial |
$3,070.70
|
| Rate for Payer: Cigna of CA HMO |
$2,686.87
|
| Rate for Payer: Cigna of CA PPO |
$2,686.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,686.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.67
|
| Rate for Payer: EPIC Health Plan Senior |
$33.78
|
| Rate for Payer: Galaxy Health WC |
$3,262.62
|
| Rate for Payer: Global Benefits Group Commercial |
$2,303.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,454.54
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$50.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$30.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,437.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$767.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$41.15
|
| Rate for Payer: Multiplan Commercial |
$2,878.78
|
| Rate for Payer: Networks By Design Commercial |
$1,919.19
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$30.71
|
| Rate for Payer: Prime Health Services Commercial |
$3,262.62
|
| Rate for Payer: Prime Health Services Medicare |
$32.55
|
| Rate for Payer: Riverside University Health System MISP |
$33.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,303.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,303.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,440.54
|
| Rate for Payer: United Healthcare All Other HMO |
$1,402.16
|
| Rate for Payer: United Healthcare HMO Rider |
$1,371.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,257.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$30.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.78
|
| Rate for Payer: Vantage Medical Group Senior |
$33.78
|
|
|
ROMIDEPSIN 10 MG/2 ML INTRAVENOUS POWDER FOR SOLUTION [100344]
|
Facility
|
IP
|
$3,838.38
|
|
|
Service Code
|
HCPCS J9319
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$767.68 |
| Max. Negotiated Rate |
$3,454.54 |
| Rate for Payer: Adventist Health Commercial |
$767.68
|
| Rate for Payer: Blue Shield of California Commercial |
$3,078.38
|
| Rate for Payer: Blue Shield of California EPN |
$1,934.54
|
| Rate for Payer: Cash Price |
$1,727.27
|
| Rate for Payer: Central Health Plan Commercial |
$3,070.70
|
| Rate for Payer: Cigna of CA HMO |
$2,686.87
|
| Rate for Payer: Cigna of CA PPO |
$2,686.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,686.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,535.35
|
| Rate for Payer: EPIC Health Plan Senior |
$1,535.35
|
| Rate for Payer: Galaxy Health WC |
$3,262.62
|
| Rate for Payer: Global Benefits Group Commercial |
$2,303.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,454.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,437.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,264.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$767.68
|
| Rate for Payer: Multiplan Commercial |
$2,878.78
|
| Rate for Payer: Networks By Design Commercial |
$1,919.19
|
| Rate for Payer: Prime Health Services Commercial |
$3,262.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,440.54
|
| Rate for Payer: United Healthcare All Other HMO |
$1,402.16
|
| Rate for Payer: United Healthcare HMO Rider |
$1,371.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,257.07
|
|
|
ROMIPLOSTIM 125 MCG SUBCUTANEOUS SOLUTION [226462]
|
Facility
|
IP
|
$1,734.43
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$346.89 |
| Max. Negotiated Rate |
$1,560.99 |
| Rate for Payer: Adventist Health Commercial |
$346.89
|
| Rate for Payer: Blue Shield of California Commercial |
$1,391.01
|
| Rate for Payer: Blue Shield of California EPN |
$874.15
|
| Rate for Payer: Cash Price |
$780.49
|
| Rate for Payer: Central Health Plan Commercial |
$1,387.54
|
| Rate for Payer: Cigna of CA HMO |
$1,214.10
|
| Rate for Payer: Cigna of CA PPO |
$1,214.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,214.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$693.77
|
| Rate for Payer: EPIC Health Plan Senior |
$693.77
|
| Rate for Payer: Galaxy Health WC |
$1,474.27
|
| Rate for Payer: Global Benefits Group Commercial |
$1,040.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,560.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,101.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,023.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$346.89
|
| Rate for Payer: Multiplan Commercial |
$1,300.82
|
| Rate for Payer: Networks By Design Commercial |
$867.22
|
| Rate for Payer: Prime Health Services Commercial |
$1,474.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$650.93
|
| Rate for Payer: United Healthcare All Other HMO |
$633.59
|
| Rate for Payer: United Healthcare HMO Rider |
$619.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$568.03
|
|
|
ROMIPLOSTIM 125 MCG SUBCUTANEOUS SOLUTION [226462]
|
Facility
|
OP
|
$1,734.43
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.62 |
| Max. Negotiated Rate |
$1,560.99 |
| Rate for Payer: Adventist Health Commercial |
$346.89
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$65.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.93
|
| Rate for Payer: Blue Shield of California Commercial |
$13.85
|
| Rate for Payer: Blue Shield of California EPN |
$12.59
|
| Rate for Payer: Cash Price |
$780.49
|
| Rate for Payer: Cash Price |
$780.49
|
| Rate for Payer: Central Health Plan Commercial |
$1,387.54
|
| Rate for Payer: Cigna of CA HMO |
$1,214.10
|
| Rate for Payer: Cigna of CA PPO |
$1,214.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,214.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.17
|
| Rate for Payer: EPIC Health Plan Senior |
$12.78
|
| Rate for Payer: Galaxy Health WC |
$1,474.27
|
| Rate for Payer: Global Benefits Group Commercial |
$1,040.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,560.99
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,101.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$346.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.57
|
| Rate for Payer: Multiplan Commercial |
$1,300.82
|
| Rate for Payer: Networks By Design Commercial |
$867.22
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.62
|
| Rate for Payer: Prime Health Services Commercial |
$1,474.27
|
| Rate for Payer: Prime Health Services Medicare |
$12.32
|
| Rate for Payer: Riverside University Health System MISP |
$12.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,040.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,040.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$650.93
|
| Rate for Payer: United Healthcare All Other HMO |
$633.59
|
| Rate for Payer: United Healthcare HMO Rider |
$619.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$568.03
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.78
|
| Rate for Payer: Vantage Medical Group Senior |
$12.78
|
|
|
ROMIPLOSTIM 250 MCG SUBCUTANEOUS SOLUTION [93566]
|
Facility
|
IP
|
$3,468.80
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$693.76 |
| Max. Negotiated Rate |
$3,121.92 |
| Rate for Payer: Adventist Health Commercial |
$693.76
|
| Rate for Payer: Blue Shield of California Commercial |
$2,781.98
|
| Rate for Payer: Blue Shield of California EPN |
$1,748.28
|
| Rate for Payer: Cash Price |
$1,560.96
|
| Rate for Payer: Central Health Plan Commercial |
$2,775.04
|
| Rate for Payer: Cigna of CA HMO |
$2,428.16
|
| Rate for Payer: Cigna of CA PPO |
$2,428.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,428.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,387.52
|
| Rate for Payer: EPIC Health Plan Senior |
$1,387.52
|
| Rate for Payer: Galaxy Health WC |
$2,948.48
|
| Rate for Payer: Global Benefits Group Commercial |
$2,081.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,121.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,202.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,046.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$693.76
|
| Rate for Payer: Multiplan Commercial |
$2,601.60
|
| Rate for Payer: Networks By Design Commercial |
$1,734.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,948.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,301.84
|
| Rate for Payer: United Healthcare All Other HMO |
$1,267.15
|
| Rate for Payer: United Healthcare HMO Rider |
$1,239.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,136.03
|
|
|
ROMIPLOSTIM 250 MCG SUBCUTANEOUS SOLUTION [93566]
|
Facility
|
OP
|
$3,468.80
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.62 |
| Max. Negotiated Rate |
$3,121.92 |
| Rate for Payer: Adventist Health Commercial |
$693.76
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$65.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.93
|
| Rate for Payer: Blue Shield of California Commercial |
$13.85
|
| Rate for Payer: Blue Shield of California EPN |
$12.59
|
| Rate for Payer: Cash Price |
$1,560.96
|
| Rate for Payer: Cash Price |
$1,560.96
|
| Rate for Payer: Central Health Plan Commercial |
$2,775.04
|
| Rate for Payer: Cigna of CA HMO |
$2,428.16
|
| Rate for Payer: Cigna of CA PPO |
$2,428.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,428.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.17
|
| Rate for Payer: EPIC Health Plan Senior |
$12.78
|
| Rate for Payer: Galaxy Health WC |
$2,948.48
|
| Rate for Payer: Global Benefits Group Commercial |
$2,081.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,121.92
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,202.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$693.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.57
|
| Rate for Payer: Multiplan Commercial |
$2,601.60
|
| Rate for Payer: Networks By Design Commercial |
$1,734.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.62
|
| Rate for Payer: Prime Health Services Commercial |
$2,948.48
|
| Rate for Payer: Prime Health Services Medicare |
$12.32
|
| Rate for Payer: Riverside University Health System MISP |
$12.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,081.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,081.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,301.84
|
| Rate for Payer: United Healthcare All Other HMO |
$1,267.15
|
| Rate for Payer: United Healthcare HMO Rider |
$1,239.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,136.03
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.78
|
| Rate for Payer: Vantage Medical Group Senior |
$12.78
|
|
|
ROMIPLOSTIM 500 MCG SUBCUTANEOUS SOLUTION [93567]
|
Facility
|
OP
|
$6,937.58
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.62 |
| Max. Negotiated Rate |
$6,243.82 |
| Rate for Payer: Adventist Health Commercial |
$1,387.52
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$65.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.93
|
| Rate for Payer: Blue Shield of California Commercial |
$13.85
|
| Rate for Payer: Blue Shield of California EPN |
$12.59
|
| Rate for Payer: Cash Price |
$3,121.91
|
| Rate for Payer: Cash Price |
$3,121.91
|
| Rate for Payer: Central Health Plan Commercial |
$5,550.06
|
| Rate for Payer: Cigna of CA HMO |
$4,856.31
|
| Rate for Payer: Cigna of CA PPO |
$4,856.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,856.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.17
|
| Rate for Payer: EPIC Health Plan Senior |
$12.78
|
| Rate for Payer: Galaxy Health WC |
$5,896.94
|
| Rate for Payer: Global Benefits Group Commercial |
$4,162.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,243.82
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,405.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,387.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.57
|
| Rate for Payer: Multiplan Commercial |
$5,203.19
|
| Rate for Payer: Networks By Design Commercial |
$3,468.79
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.62
|
| Rate for Payer: Prime Health Services Commercial |
$5,896.94
|
| Rate for Payer: Prime Health Services Medicare |
$12.32
|
| Rate for Payer: Riverside University Health System MISP |
$12.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,162.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,162.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,603.67
|
| Rate for Payer: United Healthcare All Other HMO |
$2,534.30
|
| Rate for Payer: United Healthcare HMO Rider |
$2,479.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,272.06
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.78
|
| Rate for Payer: Vantage Medical Group Senior |
$12.78
|
|
|
ROMIPLOSTIM 500 MCG SUBCUTANEOUS SOLUTION [93567]
|
Facility
|
IP
|
$6,937.58
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,387.52 |
| Max. Negotiated Rate |
$6,243.82 |
| Rate for Payer: Adventist Health Commercial |
$1,387.52
|
| Rate for Payer: Blue Shield of California Commercial |
$5,563.94
|
| Rate for Payer: Blue Shield of California EPN |
$3,496.54
|
| Rate for Payer: Cash Price |
$3,121.91
|
| Rate for Payer: Central Health Plan Commercial |
$5,550.06
|
| Rate for Payer: Cigna of CA HMO |
$4,856.31
|
| Rate for Payer: Cigna of CA PPO |
$4,856.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,856.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,775.03
|
| Rate for Payer: EPIC Health Plan Senior |
$2,775.03
|
| Rate for Payer: Galaxy Health WC |
$5,896.94
|
| Rate for Payer: Global Benefits Group Commercial |
$4,162.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,243.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,405.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,093.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,387.52
|
| Rate for Payer: Multiplan Commercial |
$5,203.19
|
| Rate for Payer: Networks By Design Commercial |
$3,468.79
|
| Rate for Payer: Prime Health Services Commercial |
$5,896.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,603.67
|
| Rate for Payer: United Healthcare All Other HMO |
$2,534.30
|
| Rate for Payer: United Healthcare HMO Rider |
$2,479.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,272.06
|
|
