|
ROTIGOTINE 2 MG/24 HOUR TRANSDERMAL 24 HOUR PATCH [82100]
|
Facility
IP
|
$32.26
|
|
|
Service Code
|
NDC 50474-802-03
|
| Hospital Charge Code |
ERX82100
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.45 |
| 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 |
$24.20
|
| Rate for Payer: Blue Shield of California EPN |
$17.23
|
| Rate for Payer: Cash Price |
$14.52
|
| Rate for Payer: Cash Price |
$14.52
|
| Rate for Payer: Central Health Plan Commercial |
$25.81
|
| Rate for Payer: Cigna of CA HMO |
$22.58
|
| Rate for Payer: Cigna of CA PPO |
$22.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.90
|
| Rate for Payer: Galaxy Health WC |
$27.42
|
| Rate for Payer: Global Benefits Group Commercial |
$19.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.45
|
| Rate for Payer: Multiplan Commercial |
$24.20
|
| Rate for Payer: Networks By Design Commercial |
$20.97
|
| Rate for Payer: Prime Health Services Commercial |
$27.42
|
|
|
ROTIGOTINE 2 MG/24 HOUR TRANSDERMAL 24 HOUR PATCH [82100]
|
Facility
OP
|
$32.26
|
|
|
Service Code
|
NDC 50474-802-03
|
| Hospital Charge Code |
ERX82100
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.45 |
| Max. Negotiated Rate |
$29.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.42
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.06
|
| Rate for Payer: BCBS Transplant Transplant |
$19.36
|
| Rate for Payer: Blue Shield of California Commercial |
$20.29
|
| Rate for Payer: Blue Shield of California EPN |
$15.78
|
| Rate for Payer: Cash Price |
$14.52
|
| Rate for Payer: Central Health Plan Commercial |
$25.81
|
| Rate for Payer: Cigna of CA HMO |
$22.58
|
| Rate for Payer: Cigna of CA PPO |
$22.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.90
|
| Rate for Payer: Galaxy Health WC |
$27.42
|
| Rate for Payer: Global Benefits Group Commercial |
$19.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.03
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$24.20
|
| Rate for Payer: IEHP medi-cal |
$11.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.45
|
| Rate for Payer: Multiplan Commercial |
$24.20
|
| Rate for Payer: Networks By Design Commercial |
$20.97
|
| Rate for Payer: Prime Health Services Commercial |
$27.42
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$19.36
|
| Rate for Payer: Riverside University Health MISP |
$12.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.13
|
| Rate for Payer: United Healthcare All Other HMO |
$16.13
|
| Rate for Payer: United Healthcare HMO Rider |
$16.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.42
|
| Rate for Payer: Vantage Medical Group Senior |
$27.42
|
|
|
ROTIGOTINE 4 MG/24 HOUR TRANSDERMAL 24 HOUR PATCH [82101]
|
Facility
IP
|
$32.26
|
|
|
Service Code
|
NDC 50474-804-03
|
| Hospital Charge Code |
ERX82101
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.45 |
| 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 |
$24.20
|
| Rate for Payer: Blue Shield of California EPN |
$17.23
|
| Rate for Payer: Cash Price |
$14.52
|
| Rate for Payer: Cash Price |
$14.52
|
| Rate for Payer: Central Health Plan Commercial |
$25.81
|
| Rate for Payer: Cigna of CA HMO |
$22.58
|
| Rate for Payer: Cigna of CA PPO |
$22.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.90
|
| Rate for Payer: Galaxy Health WC |
$27.42
|
| Rate for Payer: Global Benefits Group Commercial |
$19.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.45
|
| Rate for Payer: Multiplan Commercial |
$24.20
|
| Rate for Payer: Networks By Design Commercial |
$20.97
|
| Rate for Payer: Prime Health Services Commercial |
$27.42
|
|
|
ROTIGOTINE 4 MG/24 HOUR TRANSDERMAL 24 HOUR PATCH [82101]
|
Facility
OP
|
$32.26
|
|
|
Service Code
|
NDC 50474-804-03
|
| Hospital Charge Code |
ERX82101
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.45 |
| Max. Negotiated Rate |
$29.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.42
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.06
|
| Rate for Payer: BCBS Transplant Transplant |
$19.36
|
| Rate for Payer: Blue Shield of California Commercial |
$20.29
|
| Rate for Payer: Blue Shield of California EPN |
$15.78
|
| Rate for Payer: Cash Price |
$14.52
|
| Rate for Payer: Central Health Plan Commercial |
$25.81
|
| Rate for Payer: Cigna of CA HMO |
$22.58
|
| Rate for Payer: Cigna of CA PPO |
$22.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.90
|
| Rate for Payer: Galaxy Health WC |
$27.42
|
| Rate for Payer: Global Benefits Group Commercial |
$19.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.03
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$24.20
|
| Rate for Payer: IEHP medi-cal |
$11.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.45
|
| Rate for Payer: Multiplan Commercial |
$24.20
|
| Rate for Payer: Networks By Design Commercial |
$20.97
|
| Rate for Payer: Prime Health Services Commercial |
$27.42
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$19.36
|
| Rate for Payer: Riverside University Health MISP |
$12.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.13
|
| Rate for Payer: United Healthcare All Other HMO |
$16.13
|
| Rate for Payer: United Healthcare HMO Rider |
$16.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.42
|
| Rate for Payer: Vantage Medical Group Senior |
$27.42
|
|
|
RUFINAMIDE 200 MG TABLET [95691]
|
Facility
OP
|
$3.69
|
|
|
Service Code
|
NDC 0054-0425-23
|
| Hospital Charge Code |
1712406
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.18
|
| Rate for Payer: BCBS Transplant Transplant |
$2.21
|
| Rate for Payer: Blue Shield of California Commercial |
$2.32
|
| Rate for Payer: Blue Shield of California EPN |
$1.80
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Central Health Plan Commercial |
$2.95
|
| Rate for Payer: Cigna of CA HMO |
$2.58
|
| Rate for Payer: Cigna of CA PPO |
$2.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.48
|
| Rate for Payer: Galaxy Health WC |
$3.14
|
| Rate for Payer: Global Benefits Group Commercial |
$2.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.32
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.77
|
| Rate for Payer: IEHP medi-cal |
$1.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$2.77
|
| Rate for Payer: Networks By Design Commercial |
$2.40
|
| Rate for Payer: Prime Health Services Commercial |
$3.14
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.21
|
| Rate for Payer: Riverside University Health MISP |
$1.48
|
| 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 Medi-Cal |
$3.14
|
| Rate for Payer: Vantage Medical Group Senior |
$3.14
|
|
|
RUFINAMIDE 200 MG TABLET [95691]
|
Facility
OP
|
$3.69
|
|
|
Service Code
|
NDC 68462-713-08
|
| Hospital Charge Code |
1712406
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.18
|
| Rate for Payer: BCBS Transplant Transplant |
$2.21
|
| Rate for Payer: Blue Shield of California Commercial |
$2.32
|
| Rate for Payer: Blue Shield of California EPN |
$1.80
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Central Health Plan Commercial |
$2.95
|
| Rate for Payer: Cigna of CA HMO |
$2.58
|
| Rate for Payer: Cigna of CA PPO |
$2.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.48
|
| Rate for Payer: Galaxy Health WC |
$3.14
|
| Rate for Payer: Global Benefits Group Commercial |
$2.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.32
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.77
|
| Rate for Payer: IEHP medi-cal |
$1.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$2.77
|
| Rate for Payer: Networks By Design Commercial |
$2.40
|
| Rate for Payer: Prime Health Services Commercial |
$3.14
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.21
|
| Rate for Payer: Riverside University Health MISP |
$1.48
|
| 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 Medi-Cal |
$3.14
|
| Rate for Payer: Vantage Medical Group Senior |
$3.14
|
|
|
RUFINAMIDE 200 MG TABLET [95691]
|
Facility
IP
|
$3.69
|
|
|
Service Code
|
NDC 0054-0425-23
|
| Hospital Charge Code |
1712406
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.74 |
| 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 |
$2.77
|
| Rate for Payer: Blue Shield of California EPN |
$1.97
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Central Health Plan Commercial |
$2.95
|
| Rate for Payer: Cigna of CA HMO |
$2.58
|
| Rate for Payer: Cigna of CA PPO |
$2.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.48
|
| Rate for Payer: Galaxy Health WC |
$3.14
|
| Rate for Payer: Global Benefits Group Commercial |
$2.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$2.77
|
| Rate for Payer: Networks By Design Commercial |
$2.40
|
| Rate for Payer: Prime Health Services Commercial |
$3.14
|
|
|
RUFINAMIDE 200 MG TABLET [95691]
|
Facility
IP
|
$3.69
|
|
|
Service Code
|
NDC 68462-713-08
|
| Hospital Charge Code |
1712406
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.74 |
| 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 |
$2.77
|
| Rate for Payer: Blue Shield of California EPN |
$1.97
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Central Health Plan Commercial |
$2.95
|
| Rate for Payer: Cigna of CA HMO |
$2.58
|
| Rate for Payer: Cigna of CA PPO |
$2.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.48
|
| Rate for Payer: Galaxy Health WC |
$3.14
|
| Rate for Payer: Global Benefits Group Commercial |
$2.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$2.77
|
| Rate for Payer: Networks By Design Commercial |
$2.40
|
| Rate for Payer: Prime Health Services Commercial |
$3.14
|
|
|
RUFINAMIDE 400 MG TABLET [95692]
|
Facility
IP
|
$7.37
|
|
|
Service Code
|
NDC 0054-0426-23
|
| Hospital Charge Code |
1712407
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.47 |
| 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 |
$5.53
|
| Rate for Payer: Blue Shield of California EPN |
$3.94
|
| Rate for Payer: Cash Price |
$3.32
|
| Rate for Payer: Cash Price |
$3.32
|
| 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: 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: 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 |
1712407
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$6.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.35
|
| Rate for Payer: BCBS Transplant Transplant |
$4.42
|
| Rate for Payer: Blue Shield of California Commercial |
$4.64
|
| Rate for Payer: Blue Shield of California EPN |
$3.60
|
| Rate for Payer: Cash Price |
$3.32
|
| 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: EPIC Health Plan Commercial |
$2.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.95
|
| Rate for Payer: Galaxy Health WC |
$6.26
|
| Rate for Payer: Global Benefits Group Commercial |
$4.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.63
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.53
|
| Rate for Payer: IEHP medi-cal |
$2.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.92
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.42
|
| Rate for Payer: Riverside University Health 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 |
$3.68
|
| Rate for Payer: United Healthcare All Other HMO |
$3.68
|
| Rate for Payer: United Healthcare HMO Rider |
$3.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.26
|
| Rate for Payer: Vantage Medical Group Senior |
$6.26
|
|
|
RUFINAMIDE 40 MG/ML ORAL SUSPENSION [108804]
|
Facility
OP
|
$4.59
|
|
|
Service Code
|
NDC 62856-584-46
|
| Hospital Charge Code |
1715258
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.71
|
| Rate for Payer: BCBS Transplant Transplant |
$2.75
|
| Rate for Payer: Blue Shield of California Commercial |
$2.89
|
| Rate for Payer: Blue Shield of California EPN |
$2.24
|
| Rate for Payer: Cash Price |
$2.07
|
| 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: EPIC Health Plan Commercial |
$1.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$3.44
|
| Rate for Payer: IEHP medi-cal |
$1.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.06
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.75
|
| Rate for Payer: Riverside University Health 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 |
$2.30
|
| Rate for Payer: United Healthcare All Other HMO |
$2.30
|
| Rate for Payer: United Healthcare HMO Rider |
$2.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.30
|
| 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 |
1715258
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.92 |
| 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 |
$3.44
|
| Rate for Payer: Blue Shield of California EPN |
$2.45
|
| Rate for Payer: Cash Price |
$2.07
|
| Rate for Payer: Cash Price |
$2.07
|
| 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: 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: 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
|
$333.72
|
|
|
Service Code
|
NDC 50881-010-60
|
| Hospital Charge Code |
ERX153887
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$66.74 |
| Max. Negotiated Rate |
$300.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$202.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$283.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$183.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$183.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$161.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$197.16
|
| Rate for Payer: BCBS Transplant Transplant |
$200.23
|
| Rate for Payer: Blue Shield of California Commercial |
$209.91
|
| Rate for Payer: Blue Shield of California EPN |
$163.19
|
| Rate for Payer: Cash Price |
$150.17
|
| Rate for Payer: Central Health Plan Commercial |
$266.98
|
| Rate for Payer: Cigna of CA HMO |
$233.60
|
| Rate for Payer: Cigna of CA PPO |
$233.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$283.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$133.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$133.49
|
| Rate for Payer: Galaxy Health WC |
$283.66
|
| Rate for Payer: Global Benefits Group Commercial |
$200.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$300.35
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$250.29
|
| Rate for Payer: IEHP medi-cal |
$116.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$222.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.74
|
| Rate for Payer: Multiplan Commercial |
$250.29
|
| Rate for Payer: Networks By Design Commercial |
$216.92
|
| Rate for Payer: Prime Health Services Commercial |
$283.66
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$200.23
|
| Rate for Payer: Riverside University Health MISP |
$133.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$200.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$200.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$166.86
|
| Rate for Payer: United Healthcare All Other HMO |
$166.86
|
| Rate for Payer: United Healthcare HMO Rider |
$166.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$166.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.66
|
| Rate for Payer: Vantage Medical Group Senior |
$283.66
|
|
|
RUXOLITINIB 10 MG TABLET [153887]
|
Facility
IP
|
$333.72
|
|
|
Service Code
|
NDC 50881-010-60
|
| Hospital Charge Code |
ERX153887
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$66.74 |
| 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 |
$250.29
|
| Rate for Payer: Blue Shield of California EPN |
$178.21
|
| Rate for Payer: Cash Price |
$150.17
|
| Rate for Payer: Cash Price |
$150.17
|
| Rate for Payer: Central Health Plan Commercial |
$266.98
|
| Rate for Payer: Cigna of CA HMO |
$233.60
|
| Rate for Payer: Cigna of CA PPO |
$233.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$133.49
|
| Rate for Payer: Galaxy Health WC |
$283.66
|
| Rate for Payer: Global Benefits Group Commercial |
$200.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$300.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$222.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.74
|
| Rate for Payer: Multiplan Commercial |
$250.29
|
| Rate for Payer: Networks By Design Commercial |
$216.92
|
| Rate for Payer: Prime Health Services Commercial |
$283.66
|
|
|
RUXOLITINIB 15 MG TABLET [153888]
|
Facility
IP
|
$333.72
|
|
|
Service Code
|
NDC 50881-015-60
|
| Hospital Charge Code |
ERX153888
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$66.74 |
| 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 |
$250.29
|
| Rate for Payer: Blue Shield of California EPN |
$178.21
|
| Rate for Payer: Cash Price |
$150.17
|
| Rate for Payer: Cash Price |
$150.17
|
| Rate for Payer: Central Health Plan Commercial |
$266.98
|
| Rate for Payer: Cigna of CA HMO |
$233.60
|
| Rate for Payer: Cigna of CA PPO |
$233.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$133.49
|
| Rate for Payer: Galaxy Health WC |
$283.66
|
| Rate for Payer: Global Benefits Group Commercial |
$200.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$300.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$222.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.74
|
| Rate for Payer: Multiplan Commercial |
$250.29
|
| Rate for Payer: Networks By Design Commercial |
$216.92
|
| Rate for Payer: Prime Health Services Commercial |
$283.66
|
|
|
RUXOLITINIB 15 MG TABLET [153888]
|
Facility
OP
|
$333.72
|
|
|
Service Code
|
NDC 50881-015-60
|
| Hospital Charge Code |
ERX153888
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$66.74 |
| Max. Negotiated Rate |
$300.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$202.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$283.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$183.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$183.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$161.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$197.16
|
| Rate for Payer: BCBS Transplant Transplant |
$200.23
|
| Rate for Payer: Blue Shield of California Commercial |
$209.91
|
| Rate for Payer: Blue Shield of California EPN |
$163.19
|
| Rate for Payer: Cash Price |
$150.17
|
| Rate for Payer: Central Health Plan Commercial |
$266.98
|
| Rate for Payer: Cigna of CA HMO |
$233.60
|
| Rate for Payer: Cigna of CA PPO |
$233.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$283.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$133.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$133.49
|
| Rate for Payer: Galaxy Health WC |
$283.66
|
| Rate for Payer: Global Benefits Group Commercial |
$200.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$300.35
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$250.29
|
| Rate for Payer: IEHP medi-cal |
$116.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$222.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.74
|
| Rate for Payer: Multiplan Commercial |
$250.29
|
| Rate for Payer: Networks By Design Commercial |
$216.92
|
| Rate for Payer: Prime Health Services Commercial |
$283.66
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$200.23
|
| Rate for Payer: Riverside University Health MISP |
$133.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$200.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$200.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$166.86
|
| Rate for Payer: United Healthcare All Other HMO |
$166.86
|
| Rate for Payer: United Healthcare HMO Rider |
$166.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$166.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.66
|
| Rate for Payer: Vantage Medical Group Senior |
$283.66
|
|
|
RUXOLITINIB 20 MG TABLET [153889]
|
Facility
OP
|
$333.72
|
|
|
Service Code
|
NDC 50881-020-60
|
| Hospital Charge Code |
ERX153889
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$66.74 |
| Max. Negotiated Rate |
$300.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$202.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$283.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$183.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$183.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$161.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$197.16
|
| Rate for Payer: BCBS Transplant Transplant |
$200.23
|
| Rate for Payer: Blue Shield of California Commercial |
$209.91
|
| Rate for Payer: Blue Shield of California EPN |
$163.19
|
| Rate for Payer: Cash Price |
$150.17
|
| Rate for Payer: Central Health Plan Commercial |
$266.98
|
| Rate for Payer: Cigna of CA HMO |
$233.60
|
| Rate for Payer: Cigna of CA PPO |
$233.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$283.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$133.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$133.49
|
| Rate for Payer: Galaxy Health WC |
$283.66
|
| Rate for Payer: Global Benefits Group Commercial |
$200.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$300.35
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$250.29
|
| Rate for Payer: IEHP medi-cal |
$116.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$222.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.74
|
| Rate for Payer: Multiplan Commercial |
$250.29
|
| Rate for Payer: Networks By Design Commercial |
$216.92
|
| Rate for Payer: Prime Health Services Commercial |
$283.66
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$200.23
|
| Rate for Payer: Riverside University Health MISP |
$133.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$200.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$200.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$166.86
|
| Rate for Payer: United Healthcare All Other HMO |
$166.86
|
| Rate for Payer: United Healthcare HMO Rider |
$166.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$166.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.66
|
| Rate for Payer: Vantage Medical Group Senior |
$283.66
|
|
|
RUXOLITINIB 20 MG TABLET [153889]
|
Facility
IP
|
$333.72
|
|
|
Service Code
|
NDC 50881-020-60
|
| Hospital Charge Code |
ERX153889
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$66.74 |
| 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 |
$250.29
|
| Rate for Payer: Blue Shield of California EPN |
$178.21
|
| Rate for Payer: Cash Price |
$150.17
|
| Rate for Payer: Cash Price |
$150.17
|
| Rate for Payer: Central Health Plan Commercial |
$266.98
|
| Rate for Payer: Cigna of CA HMO |
$233.60
|
| Rate for Payer: Cigna of CA PPO |
$233.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$133.49
|
| Rate for Payer: Galaxy Health WC |
$283.66
|
| Rate for Payer: Global Benefits Group Commercial |
$200.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$300.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$222.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.74
|
| Rate for Payer: Multiplan Commercial |
$250.29
|
| Rate for Payer: Networks By Design Commercial |
$216.92
|
| Rate for Payer: Prime Health Services Commercial |
$283.66
|
|
|
RUXOLITINIB 25 MG TABLET [153890]
|
Facility
OP
|
$333.72
|
|
|
Service Code
|
NDC 50881-025-60
|
| Hospital Charge Code |
ERX153890
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$66.74 |
| Max. Negotiated Rate |
$300.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$202.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$283.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$183.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$183.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$161.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$197.16
|
| Rate for Payer: BCBS Transplant Transplant |
$200.23
|
| Rate for Payer: Blue Shield of California Commercial |
$209.91
|
| Rate for Payer: Blue Shield of California EPN |
$163.19
|
| Rate for Payer: Cash Price |
$150.17
|
| Rate for Payer: Central Health Plan Commercial |
$266.98
|
| Rate for Payer: Cigna of CA HMO |
$233.60
|
| Rate for Payer: Cigna of CA PPO |
$233.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$283.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$133.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$133.49
|
| Rate for Payer: Galaxy Health WC |
$283.66
|
| Rate for Payer: Global Benefits Group Commercial |
$200.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$300.35
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$250.29
|
| Rate for Payer: IEHP medi-cal |
$116.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$222.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.74
|
| Rate for Payer: Multiplan Commercial |
$250.29
|
| Rate for Payer: Networks By Design Commercial |
$216.92
|
| Rate for Payer: Prime Health Services Commercial |
$283.66
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$200.23
|
| Rate for Payer: Riverside University Health MISP |
$133.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$200.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$200.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$166.86
|
| Rate for Payer: United Healthcare All Other HMO |
$166.86
|
| Rate for Payer: United Healthcare HMO Rider |
$166.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$166.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.66
|
| Rate for Payer: Vantage Medical Group Senior |
$283.66
|
|
|
RUXOLITINIB 25 MG TABLET [153890]
|
Facility
IP
|
$333.72
|
|
|
Service Code
|
NDC 50881-025-60
|
| Hospital Charge Code |
ERX153890
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$66.74 |
| 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 |
$250.29
|
| Rate for Payer: Blue Shield of California EPN |
$178.21
|
| Rate for Payer: Cash Price |
$150.17
|
| Rate for Payer: Cash Price |
$150.17
|
| Rate for Payer: Central Health Plan Commercial |
$266.98
|
| Rate for Payer: Cigna of CA HMO |
$233.60
|
| Rate for Payer: Cigna of CA PPO |
$233.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$133.49
|
| Rate for Payer: Galaxy Health WC |
$283.66
|
| Rate for Payer: Global Benefits Group Commercial |
$200.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$300.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$222.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.74
|
| Rate for Payer: Multiplan Commercial |
$250.29
|
| Rate for Payer: Networks By Design Commercial |
$216.92
|
| Rate for Payer: Prime Health Services Commercial |
$283.66
|
|
|
RUXOLITINIB 5 MG TABLET [153886]
|
Facility
OP
|
$333.72
|
|
|
Service Code
|
NDC 50881-005-60
|
| Hospital Charge Code |
ERX153886
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$66.74 |
| Max. Negotiated Rate |
$300.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$202.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$283.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$183.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$183.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$161.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$197.16
|
| Rate for Payer: BCBS Transplant Transplant |
$200.23
|
| Rate for Payer: Blue Shield of California Commercial |
$209.91
|
| Rate for Payer: Blue Shield of California EPN |
$163.19
|
| Rate for Payer: Cash Price |
$150.17
|
| Rate for Payer: Central Health Plan Commercial |
$266.98
|
| Rate for Payer: Cigna of CA HMO |
$233.60
|
| Rate for Payer: Cigna of CA PPO |
$233.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$283.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$133.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$133.49
|
| Rate for Payer: Galaxy Health WC |
$283.66
|
| Rate for Payer: Global Benefits Group Commercial |
$200.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$300.35
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$250.29
|
| Rate for Payer: IEHP medi-cal |
$116.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$222.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.74
|
| Rate for Payer: Multiplan Commercial |
$250.29
|
| Rate for Payer: Networks By Design Commercial |
$216.92
|
| Rate for Payer: Prime Health Services Commercial |
$283.66
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$200.23
|
| Rate for Payer: Riverside University Health MISP |
$133.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$200.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$200.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$166.86
|
| Rate for Payer: United Healthcare All Other HMO |
$166.86
|
| Rate for Payer: United Healthcare HMO Rider |
$166.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$166.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.66
|
| Rate for Payer: Vantage Medical Group Senior |
$283.66
|
|
|
RUXOLITINIB 5 MG TABLET [153886]
|
Facility
IP
|
$333.72
|
|
|
Service Code
|
NDC 50881-005-60
|
| Hospital Charge Code |
ERX153886
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$66.74 |
| 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 |
$250.29
|
| Rate for Payer: Blue Shield of California EPN |
$178.21
|
| Rate for Payer: Cash Price |
$150.17
|
| Rate for Payer: Cash Price |
$150.17
|
| Rate for Payer: Central Health Plan Commercial |
$266.98
|
| Rate for Payer: Cigna of CA HMO |
$233.60
|
| Rate for Payer: Cigna of CA PPO |
$233.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$133.49
|
| Rate for Payer: Galaxy Health WC |
$283.66
|
| Rate for Payer: Global Benefits Group Commercial |
$200.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$300.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$222.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.74
|
| Rate for Payer: Multiplan Commercial |
$250.29
|
| Rate for Payer: Networks By Design Commercial |
$216.92
|
| Rate for Payer: Prime Health Services Commercial |
$283.66
|
|
|
SACITUZUMAB GOVITECAN-HZIY 180 MG INTRAVENOUS SOLUTION [227764]
|
Facility
IP
|
$2,814.28
|
|
|
Service Code
|
NDC 55135-132-01
|
| Hospital Charge Code |
ERX227764
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$562.86 |
| 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 |
$2,110.71
|
| Rate for Payer: Blue Shield of California EPN |
$1,502.83
|
| Rate for Payer: Cash Price |
$1,266.43
|
| Rate for Payer: Cash Price |
$1,266.43
|
| Rate for Payer: Central Health Plan Commercial |
$2,251.42
|
| Rate for Payer: Cigna of CA HMO |
$1,970.00
|
| Rate for Payer: Cigna of CA PPO |
$1,970.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,125.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,125.71
|
| Rate for Payer: Galaxy Health WC |
$2,392.14
|
| Rate for Payer: Global Benefits Group Commercial |
$1,688.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,532.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,877.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$562.86
|
| Rate for Payer: Multiplan Commercial |
$2,110.71
|
| Rate for Payer: Networks By Design Commercial |
$1,407.14
|
| Rate for Payer: Prime Health Services Commercial |
$2,392.14
|
|
|
SACITUZUMAB GOVITECAN-HZIY 180 MG INTRAVENOUS SOLUTION [227764]
|
Facility
OP
|
$2,814.28
|
|
|
Service Code
|
NDC 55135-132-01
|
| Hospital Charge Code |
ERX227764
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$562.86 |
| Max. Negotiated Rate |
$2,532.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,709.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,392.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,547.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,547.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,362.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,662.68
|
| Rate for Payer: BCBS Transplant Transplant |
$1,688.57
|
| Rate for Payer: Blue Shield of California Commercial |
$1,770.18
|
| Rate for Payer: Blue Shield of California EPN |
$1,376.18
|
| Rate for Payer: Cash Price |
$1,266.43
|
| Rate for Payer: Cash Price |
$1,266.43
|
| Rate for Payer: Central Health Plan Commercial |
$2,251.42
|
| Rate for Payer: Cigna of CA HMO |
$1,970.00
|
| Rate for Payer: Cigna of CA PPO |
$1,970.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,392.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,125.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,125.71
|
| Rate for Payer: Galaxy Health WC |
$2,392.14
|
| Rate for Payer: Global Benefits Group Commercial |
$1,688.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,532.85
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,110.71
|
| Rate for Payer: IEHP medi-cal |
$985.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,877.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$562.86
|
| Rate for Payer: Multiplan Commercial |
$2,110.71
|
| Rate for Payer: Networks By Design Commercial |
$1,407.14
|
| Rate for Payer: Prime Health Services Commercial |
$2,392.14
|
| Rate for Payer: Riverside University Health MISP |
$1,125.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,688.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,688.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,407.14
|
| Rate for Payer: United Healthcare All Other HMO |
$1,407.14
|
| Rate for Payer: United Healthcare HMO Rider |
$1,407.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,407.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,392.14
|
| Rate for Payer: Vantage Medical Group Senior |
$2,392.14
|
|
|
SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET [210397]
|
Facility
IP
|
$13.36
|
|
|
Service Code
|
NDC 0078-0659-20
|
| Hospital Charge Code |
ERX210397
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.67 |
| 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 |
$10.02
|
| Rate for Payer: Blue Shield of California EPN |
$7.13
|
| Rate for Payer: Cash Price |
$6.01
|
| Rate for Payer: Cash Price |
$6.01
|
| Rate for Payer: Central Health Plan Commercial |
$10.69
|
| Rate for Payer: Cigna of CA HMO |
$9.35
|
| Rate for Payer: Cigna of CA PPO |
$9.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.34
|
| Rate for Payer: Galaxy Health WC |
$11.36
|
| Rate for Payer: Global Benefits Group Commercial |
$8.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.67
|
| Rate for Payer: Multiplan Commercial |
$10.02
|
| Rate for Payer: Networks By Design Commercial |
$8.68
|
| Rate for Payer: Prime Health Services Commercial |
$11.36
|
|
