|
RADIUM RA 223 DICHLOR 1,100 KBQ/ML (30 MICROCURIE/ML) INTRAVENOUS SOLN [202157]
|
Facility
IP
|
$60,372.00
|
|
|
Service Code
|
CPT A9606
|
| Hospital Charge Code |
ERX202157
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$12,074.40 |
| Max. Negotiated Rate |
$54,334.80 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$45,279.00
|
| Rate for Payer: Blue Shield of California EPN |
$32,238.65
|
| Rate for Payer: Cash Price |
$27,167.40
|
| Rate for Payer: Cash Price |
$27,167.40
|
| Rate for Payer: Central Health Plan Commercial |
$48,297.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,148.80
|
| Rate for Payer: Galaxy Health WC |
$51,316.20
|
| Rate for Payer: Global Benefits Group Commercial |
$36,223.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$54,334.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40,268.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,074.40
|
| Rate for Payer: Multiplan Commercial |
$45,279.00
|
| Rate for Payer: Networks By Design Commercial |
$39,241.80
|
| Rate for Payer: Prime Health Services Commercial |
$51,316.20
|
|
|
RADIUM RA 223 DICHLOR 1,100 KBQ/ML (30 MICROCURIE/ML) INTRAVENOUS SOLN [202157]
|
Facility
OP
|
$60,372.00
|
|
|
Service Code
|
CPT A9606
|
| Hospital Charge Code |
ERX202157
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$161.16 |
| Max. Negotiated Rate |
$54,334.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$161.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$954.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$241.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$177.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$161.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$225.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$246.65
|
| Rate for Payer: BCBS Transplant Transplant |
$36,223.20
|
| Rate for Payer: Blue Shield of California Commercial |
$37,309.90
|
| Rate for Payer: Blue Shield of California EPN |
$29,340.79
|
| Rate for Payer: Caremore Medicare Advantage |
$161.16
|
| Rate for Payer: Cash Price |
$27,167.40
|
| Rate for Payer: Cash Price |
$27,167.40
|
| Rate for Payer: Central Health Plan Commercial |
$48,297.60
|
| Rate for Payer: Cigna of CA HMO |
$38,638.08
|
| Rate for Payer: Cigna of CA PPO |
$44,675.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$241.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$217.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$161.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$161.16
|
| Rate for Payer: Galaxy Health WC |
$51,316.20
|
| Rate for Payer: Global Benefits Group Commercial |
$36,223.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$54,334.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$45,279.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$264.31
|
| Rate for Payer: IEHP medi-cal |
$265.92
|
| Rate for Payer: IEHP Medicare Advantage |
$161.16
|
| Rate for Payer: Innovage PACE Commercial |
$241.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40,268.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$161.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,074.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$215.96
|
| Rate for Payer: Multiplan Commercial |
$45,279.00
|
| Rate for Payer: Networks By Design Commercial |
$39,241.80
|
| Rate for Payer: Prime Health Services Commercial |
$51,316.20
|
| Rate for Payer: Prime Health Services Medicare |
$170.83
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$36,223.20
|
| Rate for Payer: Riverside University Health MISP |
$177.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36,223.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36,223.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$30,186.00
|
| Rate for Payer: United Healthcare All Other HMO |
$30,186.00
|
| Rate for Payer: United Healthcare HMO Rider |
$30,186.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,186.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$241.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$177.28
|
| Rate for Payer: Vantage Medical Group Senior |
$161.16
|
|
|
RALOXIFENE 60 MG TABLET [22143]
|
Facility
OP
|
$2.77
|
|
|
Service Code
|
NDC 43598-505-30
|
| Hospital Charge Code |
1710918
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$2.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.64
|
| Rate for Payer: BCBS Transplant Transplant |
$1.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1.74
|
| Rate for Payer: Blue Shield of California EPN |
$1.35
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Central Health Plan Commercial |
$2.22
|
| Rate for Payer: Cigna of CA HMO |
$1.94
|
| Rate for Payer: Cigna of CA PPO |
$1.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.11
|
| Rate for Payer: Galaxy Health WC |
$2.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.49
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.08
|
| Rate for Payer: IEHP medi-cal |
$0.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$2.08
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Prime Health Services Commercial |
$2.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.66
|
| Rate for Payer: Riverside University Health MISP |
$1.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.38
|
| Rate for Payer: United Healthcare All Other HMO |
$1.38
|
| Rate for Payer: United Healthcare HMO Rider |
$1.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2.35
|
|
|
RALOXIFENE 60 MG TABLET [22143]
|
Facility
IP
|
$2.77
|
|
|
Service Code
|
NDC 43598-505-30
|
| Hospital Charge Code |
1710918
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2.08
|
| Rate for Payer: Blue Shield of California EPN |
$1.48
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Central Health Plan Commercial |
$2.22
|
| Rate for Payer: Cigna of CA HMO |
$1.94
|
| Rate for Payer: Cigna of CA PPO |
$1.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.11
|
| Rate for Payer: Galaxy Health WC |
$2.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$2.08
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Prime Health Services Commercial |
$2.35
|
|
|
RALTEGRAVIR 400 MG TABLET [88608]
|
Facility
OP
|
$38.21
|
|
|
Service Code
|
NDC 0006-0227-61
|
| Hospital Charge Code |
1711979
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.64 |
| Max. Negotiated Rate |
$34.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$23.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$21.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.57
|
| Rate for Payer: BCBS Transplant Transplant |
$22.93
|
| Rate for Payer: Blue Shield of California Commercial |
$24.03
|
| Rate for Payer: Blue Shield of California EPN |
$18.68
|
| Rate for Payer: Cash Price |
$17.19
|
| Rate for Payer: Central Health Plan Commercial |
$30.57
|
| Rate for Payer: Cigna of CA HMO |
$26.75
|
| Rate for Payer: Cigna of CA PPO |
$26.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.28
|
| Rate for Payer: Galaxy Health WC |
$32.48
|
| Rate for Payer: Global Benefits Group Commercial |
$22.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.39
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$28.66
|
| Rate for Payer: IEHP medi-cal |
$13.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.64
|
| Rate for Payer: Multiplan Commercial |
$28.66
|
| Rate for Payer: Networks By Design Commercial |
$24.84
|
| Rate for Payer: Prime Health Services Commercial |
$32.48
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$22.93
|
| Rate for Payer: Riverside University Health MISP |
$15.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.10
|
| Rate for Payer: United Healthcare All Other HMO |
$19.10
|
| Rate for Payer: United Healthcare HMO Rider |
$19.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.48
|
| Rate for Payer: Vantage Medical Group Senior |
$32.48
|
|
|
RALTEGRAVIR 400 MG TABLET [88608]
|
Facility
IP
|
$38.21
|
|
|
Service Code
|
NDC 0006-0227-61
|
| Hospital Charge Code |
1711979
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.64 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$28.66
|
| Rate for Payer: Blue Shield of California EPN |
$20.40
|
| Rate for Payer: Cash Price |
$17.19
|
| Rate for Payer: Cash Price |
$17.19
|
| Rate for Payer: Central Health Plan Commercial |
$30.57
|
| Rate for Payer: Cigna of CA HMO |
$26.75
|
| Rate for Payer: Cigna of CA PPO |
$26.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.28
|
| Rate for Payer: Galaxy Health WC |
$32.48
|
| Rate for Payer: Global Benefits Group Commercial |
$22.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.64
|
| Rate for Payer: Multiplan Commercial |
$28.66
|
| Rate for Payer: Networks By Design Commercial |
$24.84
|
| Rate for Payer: Prime Health Services Commercial |
$32.48
|
|
|
RAMIPRIL 5 MG CAPSULE [11261]
|
Facility
OP
|
$0.24
|
|
|
Service Code
|
NDC 65862-476-01
|
| Hospital Charge Code |
1712231
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
| Rate for Payer: BCBS Transplant Transplant |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Central Health Plan Commercial |
$0.19
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.22
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.18
|
| Rate for Payer: IEHP medi-cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: Riverside University Health MISP |
$0.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO |
$0.12
|
| Rate for Payer: United Healthcare HMO Rider |
$0.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
RAMIPRIL 5 MG CAPSULE [11261]
|
Facility
IP
|
$0.24
|
|
|
Service Code
|
NDC 65862-476-01
|
| Hospital Charge Code |
1712231
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Central Health Plan Commercial |
$0.19
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
|
|
RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION [205590]
|
Facility
IP
|
$166.40
|
|
|
Service Code
|
NDC 0002-7678-01
|
| Hospital Charge Code |
NDG2206
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.28 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$124.80
|
| Rate for Payer: Blue Shield of California EPN |
$88.86
|
| Rate for Payer: Cash Price |
$74.88
|
| Rate for Payer: Cash Price |
$74.88
|
| Rate for Payer: Central Health Plan Commercial |
$133.12
|
| Rate for Payer: Cigna of CA HMO |
$116.48
|
| Rate for Payer: Cigna of CA PPO |
$116.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$66.56
|
| Rate for Payer: Galaxy Health WC |
$141.44
|
| Rate for Payer: Global Benefits Group Commercial |
$99.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$149.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.28
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: Networks By Design Commercial |
$83.20
|
| Rate for Payer: Prime Health Services Commercial |
$141.44
|
|
|
RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION [205590]
|
Facility
OP
|
$166.40
|
|
|
Service Code
|
NDC 0002-7678-01
|
| Hospital Charge Code |
NDG2206
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.28 |
| Max. Negotiated Rate |
$149.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$101.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$141.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$91.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$91.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$80.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.31
|
| Rate for Payer: BCBS Transplant Transplant |
$99.84
|
| Rate for Payer: Blue Shield of California Commercial |
$104.67
|
| Rate for Payer: Blue Shield of California EPN |
$81.37
|
| Rate for Payer: Cash Price |
$74.88
|
| Rate for Payer: Cash Price |
$74.88
|
| Rate for Payer: Central Health Plan Commercial |
$133.12
|
| Rate for Payer: Cigna of CA HMO |
$116.48
|
| Rate for Payer: Cigna of CA PPO |
$116.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$141.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$66.56
|
| Rate for Payer: Galaxy Health WC |
$141.44
|
| Rate for Payer: Global Benefits Group Commercial |
$99.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$149.76
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$124.80
|
| Rate for Payer: IEHP medi-cal |
$58.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.28
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: Networks By Design Commercial |
$83.20
|
| Rate for Payer: Prime Health Services Commercial |
$141.44
|
| Rate for Payer: Riverside University Health MISP |
$66.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$99.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$99.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$83.20
|
| Rate for Payer: United Healthcare All Other HMO |
$83.20
|
| Rate for Payer: United Healthcare HMO Rider |
$83.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$83.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$141.44
|
| Rate for Payer: Vantage Medical Group Senior |
$141.44
|
|
|
RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION [205590]
|
Facility
IP
|
$166.40
|
|
|
Service Code
|
NDC 0002-7669-01
|
| Hospital Charge Code |
NDG2205
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.28 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$124.80
|
| Rate for Payer: Blue Shield of California EPN |
$88.86
|
| Rate for Payer: Cash Price |
$74.88
|
| Rate for Payer: Cash Price |
$74.88
|
| Rate for Payer: Central Health Plan Commercial |
$133.12
|
| Rate for Payer: Cigna of CA HMO |
$116.48
|
| Rate for Payer: Cigna of CA PPO |
$116.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$66.56
|
| Rate for Payer: Galaxy Health WC |
$141.44
|
| Rate for Payer: Global Benefits Group Commercial |
$99.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$149.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.28
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: Networks By Design Commercial |
$83.20
|
| Rate for Payer: Prime Health Services Commercial |
$141.44
|
|
|
RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION [205590]
|
Facility
OP
|
$166.40
|
|
|
Service Code
|
NDC 0002-7669-01
|
| Hospital Charge Code |
NDG2205
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.28 |
| Max. Negotiated Rate |
$149.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$101.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$141.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$91.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$91.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$80.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.31
|
| Rate for Payer: BCBS Transplant Transplant |
$99.84
|
| Rate for Payer: Blue Shield of California Commercial |
$104.67
|
| Rate for Payer: Blue Shield of California EPN |
$81.37
|
| Rate for Payer: Cash Price |
$74.88
|
| Rate for Payer: Cash Price |
$74.88
|
| Rate for Payer: Central Health Plan Commercial |
$133.12
|
| Rate for Payer: Cigna of CA HMO |
$116.48
|
| Rate for Payer: Cigna of CA PPO |
$116.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$141.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$66.56
|
| Rate for Payer: Galaxy Health WC |
$141.44
|
| Rate for Payer: Global Benefits Group Commercial |
$99.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$149.76
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$124.80
|
| Rate for Payer: IEHP medi-cal |
$58.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.28
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: Networks By Design Commercial |
$83.20
|
| Rate for Payer: Prime Health Services Commercial |
$141.44
|
| Rate for Payer: Riverside University Health MISP |
$66.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$99.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$99.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$83.20
|
| Rate for Payer: United Healthcare All Other HMO |
$83.20
|
| Rate for Payer: United Healthcare HMO Rider |
$83.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$83.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$141.44
|
| Rate for Payer: Vantage Medical Group Senior |
$141.44
|
|
|
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SOLUTION FOR INJECTION [197046]
|
Facility
OP
|
$28,080.00
|
|
|
Service Code
|
NDC 50242-082-02
|
| Hospital Charge Code |
NDG197046
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,616.00 |
| Max. Negotiated Rate |
$25,272.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17,052.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$23,868.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15,444.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15,444.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13,596.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,589.66
|
| Rate for Payer: BCBS Transplant Transplant |
$16,848.00
|
| Rate for Payer: Blue Shield of California Commercial |
$17,662.32
|
| Rate for Payer: Blue Shield of California EPN |
$13,731.12
|
| Rate for Payer: Cash Price |
$12,636.00
|
| Rate for Payer: Cash Price |
$12,636.00
|
| Rate for Payer: Central Health Plan Commercial |
$22,464.00
|
| Rate for Payer: Cigna of CA HMO |
$19,656.00
|
| Rate for Payer: Cigna of CA PPO |
$19,656.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,868.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,232.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$11,232.00
|
| Rate for Payer: Galaxy Health WC |
$23,868.00
|
| Rate for Payer: Global Benefits Group Commercial |
$16,848.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,272.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$21,060.00
|
| Rate for Payer: IEHP medi-cal |
$9,828.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,729.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,616.00
|
| Rate for Payer: Multiplan Commercial |
$21,060.00
|
| Rate for Payer: Networks By Design Commercial |
$14,040.00
|
| Rate for Payer: Prime Health Services Commercial |
$23,868.00
|
| Rate for Payer: Riverside University Health MISP |
$11,232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,848.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16,848.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,040.00
|
| Rate for Payer: United Healthcare All Other HMO |
$14,040.00
|
| Rate for Payer: United Healthcare HMO Rider |
$14,040.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,040.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,868.00
|
| Rate for Payer: Vantage Medical Group Senior |
$23,868.00
|
|
|
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SOLUTION FOR INJECTION [197046]
|
Facility
IP
|
$28,080.00
|
|
|
Service Code
|
NDC 50242-082-02
|
| Hospital Charge Code |
NDG197046
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,616.00 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$21,060.00
|
| Rate for Payer: Blue Shield of California EPN |
$14,994.72
|
| Rate for Payer: Cash Price |
$12,636.00
|
| Rate for Payer: Cash Price |
$12,636.00
|
| Rate for Payer: Central Health Plan Commercial |
$22,464.00
|
| Rate for Payer: Cigna of CA HMO |
$19,656.00
|
| Rate for Payer: Cigna of CA PPO |
$19,656.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,232.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$11,232.00
|
| Rate for Payer: Galaxy Health WC |
$23,868.00
|
| Rate for Payer: Global Benefits Group Commercial |
$16,848.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,272.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,729.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,616.00
|
| Rate for Payer: Multiplan Commercial |
$21,060.00
|
| Rate for Payer: Networks By Design Commercial |
$14,040.00
|
| Rate for Payer: Prime Health Services Commercial |
$23,868.00
|
|
|
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SOLUTION FOR INJECTION [76790]
|
Facility
IP
|
$46,800.00
|
|
|
Service Code
|
CPT J2778
|
| Hospital Charge Code |
NDG76790
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,360.00 |
| Max. Negotiated Rate |
$42,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$35,100.00
|
| Rate for Payer: Blue Shield of California EPN |
$24,991.20
|
| Rate for Payer: Cash Price |
$21,060.00
|
| Rate for Payer: Cash Price |
$21,060.00
|
| Rate for Payer: Central Health Plan Commercial |
$37,440.00
|
| Rate for Payer: Cigna of CA HMO |
$32,760.00
|
| Rate for Payer: Cigna of CA PPO |
$32,760.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,720.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$18,720.00
|
| Rate for Payer: Galaxy Health WC |
$39,780.00
|
| Rate for Payer: Global Benefits Group Commercial |
$28,080.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$42,120.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31,215.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,360.00
|
| Rate for Payer: Multiplan Commercial |
$35,100.00
|
| Rate for Payer: Networks By Design Commercial |
$23,400.00
|
| Rate for Payer: Prime Health Services Commercial |
$39,780.00
|
|
|
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SOLUTION FOR INJECTION [76790]
|
Facility
OP
|
$46,800.00
|
|
|
Service Code
|
CPT J2778
|
| Hospital Charge Code |
NDG76790
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$42,120.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$187.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,162.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$234.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$206.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$206.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$804.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$880.33
|
| Rate for Payer: BCBS Transplant Transplant |
$28,080.00
|
| Rate for Payer: Blue Shield of California Commercial |
$514.80
|
| Rate for Payer: Blue Shield of California EPN |
$468.00
|
| Rate for Payer: Caremore Medicare Advantage |
$187.55
|
| Rate for Payer: Cash Price |
$21,060.00
|
| Rate for Payer: Cash Price |
$21,060.00
|
| Rate for Payer: Central Health Plan Commercial |
$37,440.00
|
| Rate for Payer: Cigna of CA HMO |
$32,760.00
|
| Rate for Payer: Cigna of CA PPO |
$32,760.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$281.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.20
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$187.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$187.55
|
| Rate for Payer: Galaxy Health WC |
$39,780.00
|
| Rate for Payer: Global Benefits Group Commercial |
$28,080.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$42,120.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$35,100.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$307.59
|
| Rate for Payer: IEHP medi-cal |
$309.46
|
| Rate for Payer: IEHP Medicare Advantage |
$187.55
|
| Rate for Payer: Innovage PACE Commercial |
$281.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31,215.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$187.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,360.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$251.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$251.32
|
| Rate for Payer: Multiplan Commercial |
$35,100.00
|
| Rate for Payer: Networks By Design Commercial |
$23,400.00
|
| Rate for Payer: Prime Health Services Commercial |
$39,780.00
|
| Rate for Payer: Prime Health Services Medicare |
$198.81
|
| Rate for Payer: Riverside University Health MISP |
$206.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28,080.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28,080.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$23,400.00
|
| Rate for Payer: United Healthcare All Other HMO |
$23,400.00
|
| Rate for Payer: United Healthcare HMO Rider |
$23,400.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23,400.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$281.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$206.31
|
| Rate for Payer: Vantage Medical Group Senior |
$187.55
|
|
|
RANOLAZINE ER 1,000 MG TABLET,EXTENDED RELEASE,12 HR [88007]
|
Facility
IP
|
$0.34
|
|
|
Service Code
|
NDC 42291-774-60
|
| Hospital Charge Code |
1711990
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.24
|
| Rate for Payer: Cigna of CA PPO |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Networks By Design Commercial |
$0.22
|
| Rate for Payer: Prime Health Services Commercial |
$0.29
|
|
|
RANOLAZINE ER 1,000 MG TABLET,EXTENDED RELEASE,12 HR [88007]
|
Facility
OP
|
$0.34
|
|
|
Service Code
|
NDC 42291-774-60
|
| Hospital Charge Code |
1711990
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.29
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.20
|
| Rate for Payer: BCBS Transplant Transplant |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.24
|
| Rate for Payer: Cigna of CA PPO |
$0.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.31
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.26
|
| Rate for Payer: IEHP medi-cal |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Networks By Design Commercial |
$0.22
|
| Rate for Payer: Prime Health Services Commercial |
$0.29
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: Riverside University Health MISP |
$0.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Vantage Medical Group Senior |
$0.29
|
|
|
RANOLAZINE ER 1,000 MG TABLET,EXTENDED RELEASE,12 HR [88007]
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
NDC 27241-126-02
|
| Hospital Charge Code |
1711990
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.75
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Central Health Plan Commercial |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
|
|
RANOLAZINE ER 1,000 MG TABLET,EXTENDED RELEASE,12 HR [88007]
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
NDC 27241-126-02
|
| Hospital Charge Code |
1711990
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.59
|
| Rate for Payer: BCBS Transplant Transplant |
$0.60
|
| Rate for Payer: Blue Shield of California Commercial |
$0.63
|
| Rate for Payer: Blue Shield of California EPN |
$0.49
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Central Health Plan Commercial |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.75
|
| Rate for Payer: IEHP medi-cal |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: Riverside University Health MISP |
$0.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR [70434]
|
Facility
IP
|
$8.22
|
|
|
Service Code
|
NDC 61958-1003-1
|
| Hospital Charge Code |
1711999
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$6.16
|
| Rate for Payer: Blue Shield of California EPN |
$4.39
|
| Rate for Payer: Cash Price |
$3.70
|
| Rate for Payer: Cash Price |
$3.70
|
| Rate for Payer: Central Health Plan Commercial |
$6.58
|
| Rate for Payer: Cigna of CA HMO |
$5.75
|
| Rate for Payer: Cigna of CA PPO |
$5.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.29
|
| Rate for Payer: Galaxy Health WC |
$6.99
|
| Rate for Payer: Global Benefits Group Commercial |
$4.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.64
|
| Rate for Payer: Multiplan Commercial |
$6.16
|
| Rate for Payer: Networks By Design Commercial |
$5.34
|
| Rate for Payer: Prime Health Services Commercial |
$6.99
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR [70434]
|
Facility
IP
|
$0.60
|
|
|
Service Code
|
NDC 27241-125-02
|
| Hospital Charge Code |
1711999
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.32
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.48
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR [70434]
|
Facility
OP
|
$0.60
|
|
|
Service Code
|
NDC 27241-125-02
|
| Hospital Charge Code |
1711999
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.35
|
| Rate for Payer: BCBS Transplant Transplant |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.48
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.54
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.45
|
| Rate for Payer: IEHP medi-cal |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: Riverside University Health MISP |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR [70434]
|
Facility
OP
|
$8.22
|
|
|
Service Code
|
NDC 61958-1003-1
|
| Hospital Charge Code |
1711999
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$7.40 |
| Rate for Payer: IEHP medi-cal |
$2.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.99
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.86
|
| Rate for Payer: BCBS Transplant Transplant |
$4.93
|
| Rate for Payer: Blue Shield of California Commercial |
$5.17
|
| Rate for Payer: Blue Shield of California EPN |
$4.02
|
| Rate for Payer: Cash Price |
$3.70
|
| Rate for Payer: Central Health Plan Commercial |
$6.58
|
| Rate for Payer: Cigna of CA HMO |
$5.75
|
| Rate for Payer: Cigna of CA PPO |
$5.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.29
|
| Rate for Payer: Galaxy Health WC |
$6.99
|
| Rate for Payer: Global Benefits Group Commercial |
$4.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.64
|
| Rate for Payer: Multiplan Commercial |
$6.16
|
| Rate for Payer: Networks By Design Commercial |
$5.34
|
| Rate for Payer: Prime Health Services Commercial |
$6.99
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.93
|
| Rate for Payer: Riverside University Health MISP |
$3.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.11
|
| Rate for Payer: United Healthcare All Other HMO |
$4.11
|
| Rate for Payer: United Healthcare HMO Rider |
$4.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.99
|
| Rate for Payer: Vantage Medical Group Senior |
$6.99
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR [70434]
|
Facility
IP
|
$1.68
|
|
|
Service Code
|
NDC 60687-549-11
|
| Hospital Charge Code |
1711999
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.90
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Central Health Plan Commercial |
$1.34
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
|
