|
ROTAVIRUS VACCINE LIVE, PENTAVALENT 2 ML ORAL SOLUTION [70476]
|
Facility
|
IP
|
$58.84
|
|
|
Service Code
|
HCPCS 90680
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$52.96 |
| Rate for Payer: Adventist Health Commercial |
$11.77
|
| Rate for Payer: Blue Shield of California Commercial |
$45.48
|
| Rate for Payer: Blue Shield of California EPN |
$29.66
|
| Rate for Payer: Cash Price |
$32.36
|
| Rate for Payer: Central Health Plan Commercial |
$47.07
|
| Rate for Payer: Cigna of CA HMO |
$41.19
|
| Rate for Payer: Cigna of CA PPO |
$41.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.54
|
| Rate for Payer: EPIC Health Plan Senior |
$23.54
|
| Rate for Payer: Galaxy Health WC |
$50.01
|
| Rate for Payer: Global Benefits Group Commercial |
$35.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.77
|
| Rate for Payer: Multiplan Commercial |
$44.13
|
| Rate for Payer: Networks By Design Commercial |
$29.42
|
| Rate for Payer: Prime Health Services Commercial |
$50.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Other HMO |
$21.49
|
| Rate for Payer: United Healthcare HMO Rider |
$21.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.27
|
|
|
ROTIGOTINE 2 MG/24 HOUR TRANSDERMAL 24 HOUR PATCH [82100]
|
Facility
|
OP
|
$34.56
|
|
|
Service Code
|
NDC 50474-802-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.91 |
| Max. Negotiated Rate |
$31.10 |
| Rate for Payer: Adventist Health Commercial |
$6.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.30
|
| Rate for Payer: Blue Shield of California Commercial |
$21.12
|
| Rate for Payer: Blue Shield of California EPN |
$13.79
|
| Rate for Payer: Cash Price |
$19.01
|
| Rate for Payer: Central Health Plan Commercial |
$27.65
|
| Rate for Payer: Cigna of CA HMO |
$24.19
|
| Rate for Payer: Cigna of CA PPO |
$24.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.82
|
| Rate for Payer: EPIC Health Plan Senior |
$13.82
|
| Rate for Payer: Galaxy Health WC |
$29.38
|
| Rate for Payer: Global Benefits Group Commercial |
$20.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.10
|
| Rate for Payer: InnovAge PACE Commercial |
$17.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.19
|
| Rate for Payer: Multiplan Commercial |
$25.92
|
| Rate for Payer: Networks By Design Commercial |
$22.46
|
| Rate for Payer: Prime Health Services Commercial |
$29.38
|
| Rate for Payer: Riverside University Health System MISP |
$13.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.28
|
| Rate for Payer: United Healthcare All Other HMO |
$17.28
|
| Rate for Payer: United Healthcare HMO Rider |
$17.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.38
|
| Rate for Payer: Vantage Medical Group Senior |
$29.38
|
|
|
ROTIGOTINE 2 MG/24 HOUR TRANSDERMAL 24 HOUR PATCH [82100]
|
Facility
|
IP
|
$34.56
|
|
|
Service Code
|
NDC 50474-802-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.91 |
| Max. Negotiated Rate |
$31.10 |
| Rate for Payer: Adventist Health Commercial |
$6.91
|
| Rate for Payer: Blue Shield of California Commercial |
$26.71
|
| Rate for Payer: Blue Shield of California EPN |
$17.42
|
| Rate for Payer: Cash Price |
$19.01
|
| Rate for Payer: Central Health Plan Commercial |
$27.65
|
| Rate for Payer: Cigna of CA HMO |
$24.19
|
| Rate for Payer: Cigna of CA PPO |
$24.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.82
|
| Rate for Payer: EPIC Health Plan Senior |
$13.82
|
| Rate for Payer: Galaxy Health WC |
$29.38
|
| Rate for Payer: Global Benefits Group Commercial |
$20.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.91
|
| Rate for Payer: Multiplan Commercial |
$25.92
|
| Rate for Payer: Networks By Design Commercial |
$22.46
|
| Rate for Payer: Prime Health Services Commercial |
$29.38
|
|
|
ROTIGOTINE 4 MG/24 HOUR TRANSDERMAL 24 HOUR PATCH [82101]
|
Facility
|
IP
|
$34.56
|
|
|
Service Code
|
NDC 50474-804-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.91 |
| Max. Negotiated Rate |
$31.10 |
| Rate for Payer: Adventist Health Commercial |
$6.91
|
| Rate for Payer: Blue Shield of California Commercial |
$26.71
|
| Rate for Payer: Blue Shield of California EPN |
$17.42
|
| Rate for Payer: Cash Price |
$19.01
|
| Rate for Payer: Central Health Plan Commercial |
$27.65
|
| Rate for Payer: Cigna of CA HMO |
$24.19
|
| Rate for Payer: Cigna of CA PPO |
$24.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.82
|
| Rate for Payer: EPIC Health Plan Senior |
$13.82
|
| Rate for Payer: Galaxy Health WC |
$29.38
|
| Rate for Payer: Global Benefits Group Commercial |
$20.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.91
|
| Rate for Payer: Multiplan Commercial |
$25.92
|
| Rate for Payer: Networks By Design Commercial |
$22.46
|
| Rate for Payer: Prime Health Services Commercial |
$29.38
|
|
|
ROTIGOTINE 4 MG/24 HOUR TRANSDERMAL 24 HOUR PATCH [82101]
|
Facility
|
OP
|
$34.56
|
|
|
Service Code
|
NDC 50474-804-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.91 |
| Max. Negotiated Rate |
$31.10 |
| Rate for Payer: Adventist Health Commercial |
$6.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.30
|
| Rate for Payer: Blue Shield of California Commercial |
$21.12
|
| Rate for Payer: Blue Shield of California EPN |
$13.79
|
| Rate for Payer: Cash Price |
$19.01
|
| Rate for Payer: Central Health Plan Commercial |
$27.65
|
| Rate for Payer: Cigna of CA HMO |
$24.19
|
| Rate for Payer: Cigna of CA PPO |
$24.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.82
|
| Rate for Payer: EPIC Health Plan Senior |
$13.82
|
| Rate for Payer: Galaxy Health WC |
$29.38
|
| Rate for Payer: Global Benefits Group Commercial |
$20.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.10
|
| Rate for Payer: InnovAge PACE Commercial |
$17.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.19
|
| Rate for Payer: Multiplan Commercial |
$25.92
|
| Rate for Payer: Networks By Design Commercial |
$22.46
|
| Rate for Payer: Prime Health Services Commercial |
$29.38
|
| Rate for Payer: Riverside University Health System MISP |
$13.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.28
|
| Rate for Payer: United Healthcare All Other HMO |
$17.28
|
| Rate for Payer: United Healthcare HMO Rider |
$17.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.38
|
| Rate for Payer: Vantage Medical Group Senior |
$29.38
|
|
|
RUFINAMIDE 200 MG TABLET [95691]
|
Facility
|
IP
|
$1.50
|
|
|
Service Code
|
NDC 68462-713-08
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.35 |
| Rate for Payer: Adventist Health Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.76
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Central Health Plan Commercial |
$1.20
|
| Rate for Payer: Cigna of CA HMO |
$1.05
|
| Rate for Payer: Cigna of CA PPO |
$1.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.60
|
| Rate for Payer: EPIC Health Plan Senior |
$0.60
|
| Rate for Payer: Galaxy Health WC |
$1.27
|
| Rate for Payer: Global Benefits Group Commercial |
$0.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$1.12
|
| Rate for Payer: Networks By Design Commercial |
$0.98
|
| Rate for Payer: Prime Health Services Commercial |
$1.27
|
|
|
RUFINAMIDE 200 MG TABLET [95691]
|
Facility
|
IP
|
$3.68
|
|
|
Service Code
|
NDC 0054-0425-23
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$3.31 |
| Rate for Payer: Adventist Health Commercial |
$0.74
|
| Rate for Payer: Blue Shield of California Commercial |
$2.84
|
| Rate for Payer: Blue Shield of California EPN |
$1.85
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Central Health Plan Commercial |
$2.94
|
| Rate for Payer: Cigna of CA HMO |
$2.58
|
| Rate for Payer: Cigna of CA PPO |
$2.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.47
|
| Rate for Payer: EPIC Health Plan Senior |
$1.47
|
| Rate for Payer: Galaxy Health WC |
$3.13
|
| Rate for Payer: Global Benefits Group Commercial |
$2.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$2.76
|
| Rate for Payer: Networks By Design Commercial |
$2.39
|
| Rate for Payer: Prime Health Services Commercial |
$3.13
|
|
|
RUFINAMIDE 200 MG TABLET [95691]
|
Facility
|
OP
|
$1.80
|
|
|
Service Code
|
NDC 31722-598-12
|
| 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 |
$1.06
|
| Rate for Payer: Blue Shield of California Commercial |
$1.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.72
|
| Rate for Payer: Cash Price |
$0.99
|
| 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: 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: InnovAge PACE Commercial |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.26
|
| Rate for Payer: Molina Healthcare of CA 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
|
|
|
RUFINAMIDE 200 MG TABLET [95691]
|
Facility
|
IP
|
$0.90
|
|
|
Service Code
|
NDC 42571-391-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.81 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.70
|
| Rate for Payer: Blue Shield of California EPN |
$0.45
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Central Health Plan Commercial |
$0.72
|
| Rate for Payer: Cigna of CA HMO |
$0.63
|
| Rate for Payer: Cigna of CA PPO |
$0.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: EPIC Health Plan Senior |
$0.36
|
| Rate for Payer: Galaxy Health WC |
$0.77
|
| Rate for Payer: Global Benefits Group Commercial |
$0.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.68
|
| Rate for Payer: Networks By Design Commercial |
$0.59
|
| Rate for Payer: Prime Health Services Commercial |
$0.77
|
|
|
RUFINAMIDE 200 MG TABLET [95691]
|
Facility
|
OP
|
$3.68
|
|
|
Service Code
|
NDC 0054-0425-23
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$3.31 |
| Rate for Payer: Adventist Health Commercial |
$0.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.16
|
| Rate for Payer: Blue Shield of California Commercial |
$2.25
|
| Rate for Payer: Blue Shield of California EPN |
$1.47
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Central Health Plan Commercial |
$2.94
|
| Rate for Payer: Cigna of CA HMO |
$2.58
|
| Rate for Payer: Cigna of CA PPO |
$2.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.47
|
| Rate for Payer: EPIC Health Plan Senior |
$1.47
|
| Rate for Payer: Galaxy Health WC |
$3.13
|
| Rate for Payer: Global Benefits Group Commercial |
$2.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.31
|
| Rate for Payer: InnovAge PACE Commercial |
$1.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.58
|
| Rate for Payer: Multiplan Commercial |
$2.76
|
| Rate for Payer: Networks By Design Commercial |
$2.39
|
| Rate for Payer: Prime Health Services Commercial |
$3.13
|
| Rate for Payer: Riverside University Health System MISP |
$1.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.84
|
| Rate for Payer: United Healthcare All Other HMO |
$1.84
|
| Rate for Payer: United Healthcare HMO Rider |
$1.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3.13
|
|
|
RUFINAMIDE 200 MG TABLET [95691]
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
NDC 31722-598-12
|
| 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 |
$1.39
|
| Rate for Payer: Blue Shield of California EPN |
$0.91
|
| Rate for Payer: Cash Price |
$0.99
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.11
|
| 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
|
|
|
RUFINAMIDE 200 MG TABLET [95691]
|
Facility
|
OP
|
$1.50
|
|
|
Service Code
|
NDC 68462-713-08
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.35 |
| Rate for Payer: Adventist Health Commercial |
$0.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.92
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Central Health Plan Commercial |
$1.20
|
| Rate for Payer: Cigna of CA HMO |
$1.05
|
| Rate for Payer: Cigna of CA PPO |
$1.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.60
|
| Rate for Payer: EPIC Health Plan Senior |
$0.60
|
| Rate for Payer: Galaxy Health WC |
$1.27
|
| Rate for Payer: Global Benefits Group Commercial |
$0.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.35
|
| Rate for Payer: InnovAge PACE Commercial |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.05
|
| Rate for Payer: Multiplan Commercial |
$1.12
|
| Rate for Payer: Networks By Design Commercial |
$0.98
|
| Rate for Payer: Prime Health Services Commercial |
$1.27
|
| Rate for Payer: Riverside University Health System MISP |
$0.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.75
|
| Rate for Payer: United Healthcare All Other HMO |
$0.75
|
| Rate for Payer: United Healthcare HMO Rider |
$0.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.27
|
| Rate for Payer: Vantage Medical Group Senior |
$1.27
|
|
|
RUFINAMIDE 200 MG TABLET [95691]
|
Facility
|
OP
|
$0.90
|
|
|
Service Code
|
NDC 42571-391-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.81 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.53
|
| Rate for Payer: Blue Shield of California Commercial |
$0.55
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Central Health Plan Commercial |
$0.72
|
| Rate for Payer: Cigna of CA HMO |
$0.63
|
| Rate for Payer: Cigna of CA PPO |
$0.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: EPIC Health Plan Senior |
$0.36
|
| Rate for Payer: Galaxy Health WC |
$0.77
|
| Rate for Payer: Global Benefits Group Commercial |
$0.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.81
|
| Rate for Payer: InnovAge PACE Commercial |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.63
|
| Rate for Payer: Multiplan Commercial |
$0.68
|
| Rate for Payer: Networks By Design Commercial |
$0.59
|
| Rate for Payer: Prime Health Services Commercial |
$0.77
|
| Rate for Payer: Riverside University Health System MISP |
$0.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.45
|
| Rate for Payer: United Healthcare All Other HMO |
$0.45
|
| Rate for Payer: United Healthcare HMO Rider |
$0.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.77
|
| Rate for Payer: Vantage Medical Group Senior |
$0.77
|
|
|
RUFINAMIDE 400 MG TABLET [95692]
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
NDC 42571-392-12
|
| 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 |
$1.39
|
| Rate for Payer: Blue Shield of California EPN |
$0.91
|
| Rate for Payer: Cash Price |
$0.99
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.11
|
| 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
|
|
|
RUFINAMIDE 400 MG TABLET [95692]
|
Facility
|
IP
|
$7.37
|
|
|
Service Code
|
NDC 0054-0426-23
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$6.63 |
| Rate for Payer: Adventist Health Commercial |
$1.47
|
| Rate for Payer: Blue Shield of California Commercial |
$5.70
|
| Rate for Payer: Blue Shield of California EPN |
$3.71
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Central Health Plan Commercial |
$5.90
|
| Rate for Payer: Cigna of CA HMO |
$5.16
|
| Rate for Payer: Cigna of CA PPO |
$5.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.95
|
| Rate for Payer: EPIC Health Plan Senior |
$2.95
|
| Rate for Payer: Galaxy Health WC |
$6.26
|
| Rate for Payer: Global Benefits Group Commercial |
$4.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.47
|
| Rate for Payer: Multiplan Commercial |
$5.53
|
| Rate for Payer: Networks By Design Commercial |
$4.79
|
| Rate for Payer: Prime Health Services Commercial |
$6.26
|
|
|
RUFINAMIDE 400 MG TABLET [95692]
|
Facility
|
OP
|
$7.37
|
|
|
Service Code
|
NDC 0054-0426-23
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$6.63 |
| Rate for Payer: Adventist Health Commercial |
$1.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.33
|
| Rate for Payer: Blue Shield of California Commercial |
$4.50
|
| Rate for Payer: Blue Shield of California EPN |
$2.94
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Central Health Plan Commercial |
$5.90
|
| Rate for Payer: Cigna of CA HMO |
$5.16
|
| Rate for Payer: Cigna of CA PPO |
$5.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.95
|
| Rate for Payer: EPIC Health Plan Senior |
$2.95
|
| Rate for Payer: Galaxy Health WC |
$6.26
|
| Rate for Payer: Global Benefits Group Commercial |
$4.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.63
|
| Rate for Payer: InnovAge PACE Commercial |
$3.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.16
|
| Rate for Payer: Multiplan Commercial |
$5.53
|
| Rate for Payer: Networks By Design Commercial |
$4.79
|
| Rate for Payer: Prime Health Services Commercial |
$6.26
|
| Rate for Payer: Riverside University Health System MISP |
$2.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.69
|
| Rate for Payer: United Healthcare All Other HMO |
$3.69
|
| Rate for Payer: United Healthcare HMO Rider |
$3.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.26
|
| Rate for Payer: Vantage Medical Group Senior |
$6.26
|
|
|
RUFINAMIDE 400 MG TABLET [95692]
|
Facility
|
OP
|
$1.80
|
|
|
Service Code
|
NDC 42571-392-12
|
| 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 |
$1.06
|
| Rate for Payer: Blue Shield of California Commercial |
$1.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.72
|
| Rate for Payer: Cash Price |
$0.99
|
| 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: 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: InnovAge PACE Commercial |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.26
|
| Rate for Payer: Molina Healthcare of CA 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
|
|
|
RUFINAMIDE 40 MG/ML ORAL SUSPENSION [108804]
|
Facility
|
OP
|
$4.59
|
|
|
Service Code
|
NDC 62856-584-46
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Adventist Health Commercial |
$0.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.70
|
| Rate for Payer: Blue Shield of California Commercial |
$2.80
|
| Rate for Payer: Blue Shield of California EPN |
$1.83
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Central Health Plan Commercial |
$3.67
|
| Rate for Payer: Cigna of CA HMO |
$3.21
|
| Rate for Payer: Cigna of CA PPO |
$3.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.84
|
| Rate for Payer: EPIC Health Plan Senior |
$1.84
|
| Rate for Payer: Galaxy Health WC |
$3.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.13
|
| Rate for Payer: InnovAge PACE Commercial |
$2.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.21
|
| Rate for Payer: Multiplan Commercial |
$3.44
|
| Rate for Payer: Networks By Design Commercial |
$2.98
|
| Rate for Payer: Prime Health Services Commercial |
$3.90
|
| Rate for Payer: Riverside University Health System MISP |
$1.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.29
|
| Rate for Payer: United Healthcare All Other HMO |
$2.29
|
| Rate for Payer: United Healthcare HMO Rider |
$2.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.90
|
| Rate for Payer: Vantage Medical Group Senior |
$3.90
|
|
|
RUFINAMIDE 40 MG/ML ORAL SUSPENSION [108804]
|
Facility
|
IP
|
$4.59
|
|
|
Service Code
|
NDC 62856-584-46
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Adventist Health Commercial |
$0.92
|
| Rate for Payer: Blue Shield of California Commercial |
$3.55
|
| Rate for Payer: Blue Shield of California EPN |
$2.31
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Central Health Plan Commercial |
$3.67
|
| Rate for Payer: Cigna of CA HMO |
$3.21
|
| Rate for Payer: Cigna of CA PPO |
$3.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.84
|
| Rate for Payer: EPIC Health Plan Senior |
$1.84
|
| Rate for Payer: Galaxy Health WC |
$3.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.92
|
| Rate for Payer: Multiplan Commercial |
$3.44
|
| Rate for Payer: Networks By Design Commercial |
$2.98
|
| Rate for Payer: Prime Health Services Commercial |
$3.90
|
|
|
RUXOLITINIB 10 MG TABLET [153887]
|
Facility
|
OP
|
$352.00
|
|
|
Service Code
|
NDC 50881-010-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$70.40 |
| Max. Negotiated Rate |
$316.80 |
| Rate for Payer: Adventist Health Commercial |
$70.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$213.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$299.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$193.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$264.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$170.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.73
|
| Rate for Payer: Blue Shield of California Commercial |
$215.07
|
| Rate for Payer: Blue Shield of California EPN |
$140.45
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Central Health Plan Commercial |
$281.60
|
| Rate for Payer: Cigna of CA HMO |
$246.40
|
| Rate for Payer: Cigna of CA PPO |
$246.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$299.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$299.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$299.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.80
|
| Rate for Payer: EPIC Health Plan Senior |
$140.80
|
| Rate for Payer: Galaxy Health WC |
$299.20
|
| Rate for Payer: Global Benefits Group Commercial |
$211.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$316.80
|
| Rate for Payer: InnovAge PACE Commercial |
$176.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$234.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$246.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$246.40
|
| Rate for Payer: Multiplan Commercial |
$264.00
|
| Rate for Payer: Networks By Design Commercial |
$228.80
|
| Rate for Payer: Prime Health Services Commercial |
$299.20
|
| Rate for Payer: Riverside University Health System MISP |
$140.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$211.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$211.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$176.00
|
| Rate for Payer: United Healthcare All Other HMO |
$176.00
|
| Rate for Payer: United Healthcare HMO Rider |
$176.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$176.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$299.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$299.20
|
| Rate for Payer: Vantage Medical Group Senior |
$299.20
|
|
|
RUXOLITINIB 10 MG TABLET [153887]
|
Facility
|
IP
|
$352.00
|
|
|
Service Code
|
NDC 50881-010-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$70.40 |
| Max. Negotiated Rate |
$316.80 |
| Rate for Payer: Adventist Health Commercial |
$70.40
|
| Rate for Payer: Blue Shield of California Commercial |
$272.10
|
| Rate for Payer: Blue Shield of California EPN |
$177.41
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Central Health Plan Commercial |
$281.60
|
| Rate for Payer: Cigna of CA HMO |
$246.40
|
| Rate for Payer: Cigna of CA PPO |
$246.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.80
|
| Rate for Payer: EPIC Health Plan Senior |
$140.80
|
| Rate for Payer: Galaxy Health WC |
$299.20
|
| Rate for Payer: Global Benefits Group Commercial |
$211.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$316.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$234.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.40
|
| Rate for Payer: Multiplan Commercial |
$264.00
|
| Rate for Payer: Networks By Design Commercial |
$228.80
|
| Rate for Payer: Prime Health Services Commercial |
$299.20
|
|
|
RUXOLITINIB 15 MG TABLET [153888]
|
Facility
|
IP
|
$352.00
|
|
|
Service Code
|
NDC 50881-015-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$70.40 |
| Max. Negotiated Rate |
$316.80 |
| Rate for Payer: Adventist Health Commercial |
$70.40
|
| Rate for Payer: Blue Shield of California Commercial |
$272.10
|
| Rate for Payer: Blue Shield of California EPN |
$177.41
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Central Health Plan Commercial |
$281.60
|
| Rate for Payer: Cigna of CA HMO |
$246.40
|
| Rate for Payer: Cigna of CA PPO |
$246.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.80
|
| Rate for Payer: EPIC Health Plan Senior |
$140.80
|
| Rate for Payer: Galaxy Health WC |
$299.20
|
| Rate for Payer: Global Benefits Group Commercial |
$211.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$316.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$234.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.40
|
| Rate for Payer: Multiplan Commercial |
$264.00
|
| Rate for Payer: Networks By Design Commercial |
$228.80
|
| Rate for Payer: Prime Health Services Commercial |
$299.20
|
|
|
RUXOLITINIB 15 MG TABLET [153888]
|
Facility
|
OP
|
$352.00
|
|
|
Service Code
|
NDC 50881-015-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$70.40 |
| Max. Negotiated Rate |
$316.80 |
| Rate for Payer: Adventist Health Commercial |
$70.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$213.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$299.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$193.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$264.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$170.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.73
|
| Rate for Payer: Blue Shield of California Commercial |
$215.07
|
| Rate for Payer: Blue Shield of California EPN |
$140.45
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Central Health Plan Commercial |
$281.60
|
| Rate for Payer: Cigna of CA HMO |
$246.40
|
| Rate for Payer: Cigna of CA PPO |
$246.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$299.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$299.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$299.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.80
|
| Rate for Payer: EPIC Health Plan Senior |
$140.80
|
| Rate for Payer: Galaxy Health WC |
$299.20
|
| Rate for Payer: Global Benefits Group Commercial |
$211.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$316.80
|
| Rate for Payer: InnovAge PACE Commercial |
$176.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$234.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$246.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$246.40
|
| Rate for Payer: Multiplan Commercial |
$264.00
|
| Rate for Payer: Networks By Design Commercial |
$228.80
|
| Rate for Payer: Prime Health Services Commercial |
$299.20
|
| Rate for Payer: Riverside University Health System MISP |
$140.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$211.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$211.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$176.00
|
| Rate for Payer: United Healthcare All Other HMO |
$176.00
|
| Rate for Payer: United Healthcare HMO Rider |
$176.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$176.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$299.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$299.20
|
| Rate for Payer: Vantage Medical Group Senior |
$299.20
|
|
|
RUXOLITINIB 20 MG TABLET [153889]
|
Facility
|
IP
|
$352.00
|
|
|
Service Code
|
NDC 50881-020-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$70.40 |
| Max. Negotiated Rate |
$316.80 |
| Rate for Payer: Adventist Health Commercial |
$70.40
|
| Rate for Payer: Blue Shield of California Commercial |
$272.10
|
| Rate for Payer: Blue Shield of California EPN |
$177.41
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Central Health Plan Commercial |
$281.60
|
| Rate for Payer: Cigna of CA HMO |
$246.40
|
| Rate for Payer: Cigna of CA PPO |
$246.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.80
|
| Rate for Payer: EPIC Health Plan Senior |
$140.80
|
| Rate for Payer: Galaxy Health WC |
$299.20
|
| Rate for Payer: Global Benefits Group Commercial |
$211.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$316.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$234.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.40
|
| Rate for Payer: Multiplan Commercial |
$264.00
|
| Rate for Payer: Networks By Design Commercial |
$228.80
|
| Rate for Payer: Prime Health Services Commercial |
$299.20
|
|
|
RUXOLITINIB 20 MG TABLET [153889]
|
Facility
|
OP
|
$352.00
|
|
|
Service Code
|
NDC 50881-020-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$70.40 |
| Max. Negotiated Rate |
$316.80 |
| Rate for Payer: Adventist Health Commercial |
$70.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$213.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$299.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$193.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$264.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$170.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.73
|
| Rate for Payer: Blue Shield of California Commercial |
$215.07
|
| Rate for Payer: Blue Shield of California EPN |
$140.45
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Central Health Plan Commercial |
$281.60
|
| Rate for Payer: Cigna of CA HMO |
$246.40
|
| Rate for Payer: Cigna of CA PPO |
$246.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$299.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$299.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$299.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.80
|
| Rate for Payer: EPIC Health Plan Senior |
$140.80
|
| Rate for Payer: Galaxy Health WC |
$299.20
|
| Rate for Payer: Global Benefits Group Commercial |
$211.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$316.80
|
| Rate for Payer: InnovAge PACE Commercial |
$176.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$234.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$246.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$246.40
|
| Rate for Payer: Multiplan Commercial |
$264.00
|
| Rate for Payer: Networks By Design Commercial |
$228.80
|
| Rate for Payer: Prime Health Services Commercial |
$299.20
|
| Rate for Payer: Riverside University Health System MISP |
$140.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$211.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$211.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$176.00
|
| Rate for Payer: United Healthcare All Other HMO |
$176.00
|
| Rate for Payer: United Healthcare HMO Rider |
$176.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$176.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$299.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$299.20
|
| Rate for Payer: Vantage Medical Group Senior |
$299.20
|
|
