|
RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP [22120]
|
Facility
|
IP
|
$521.53
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.40 |
| Max. Negotiated Rate |
$391.15 |
| Rate for Payer: Adventist Health Commercial |
$104.31
|
| Rate for Payer: Cash Price |
$286.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$239.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$241.47
|
| Rate for Payer: Heritage Provider Network Senior |
$241.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.38
|
| Rate for Payer: Multiplan Commercial |
$391.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$188.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$172.68
|
|
|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION [2851]
|
Facility
|
OP
|
$1.68
|
|
|
Service Code
|
NDC 0487-5901-99
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.82
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.43
|
| Rate for Payer: Dignity Health Senior |
$1.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.67
|
| Rate for Payer: TriValley Medical Group Senior |
$0.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1.43
|
|
|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION [2851]
|
Facility
|
IP
|
$1.68
|
|
|
Service Code
|
NDC 0487-5901-99
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.14
|
| Rate for Payer: Heritage Provider Network Senior |
$1.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
|
|
RADIOPAQUE PVC MARKERS-BARIUM SULFATE 24 MARKERS CAPSULE [21381]
|
Facility
|
OP
|
$119.88
|
|
|
Service Code
|
HCPCS A9698
|
| Hospital Charge Code |
901700042
|
|
Hospital Revenue Code
|
254
|
| Min. Negotiated Rate |
$21.70 |
| Max. Negotiated Rate |
$101.90 |
| Rate for Payer: Adventist Health Commercial |
$23.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$89.91
|
| Rate for Payer: Blue Shield of California Commercial |
$73.13
|
| Rate for Payer: Blue Shield of California EPN |
$58.50
|
| Rate for Payer: Cash Price |
$65.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$77.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$101.90
|
| Rate for Payer: Dignity Health Senior |
$101.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.21
|
| Rate for Payer: Heritage Provider Network Senior |
$74.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$57.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$83.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.92
|
| Rate for Payer: Multiplan Commercial |
$89.91
|
| Rate for Payer: TriValley Medical Group Commercial |
$47.95
|
| Rate for Payer: TriValley Medical Group Senior |
$47.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$59.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$59.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.90
|
| Rate for Payer: Vantage Medical Group Senior |
$101.90
|
|
|
RADIOPAQUE PVC MARKERS-BARIUM SULFATE 24 MARKERS CAPSULE [21381]
|
Facility
|
IP
|
$119.88
|
|
|
Service Code
|
HCPCS A9698
|
| Hospital Charge Code |
901700042
|
|
Hospital Revenue Code
|
254
|
| Min. Negotiated Rate |
$21.70 |
| Max. Negotiated Rate |
$89.91 |
| Rate for Payer: Adventist Health Commercial |
$23.98
|
| Rate for Payer: Cash Price |
$65.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.16
|
| Rate for Payer: Heritage Provider Network Senior |
$81.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.97
|
| Rate for Payer: Multiplan Commercial |
$89.91
|
|
|
RALOXIFENE 60 MG TABLET [22143]
|
Facility
|
IP
|
$0.78
|
|
|
Service Code
|
NDC 43598-505-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.53
|
| Rate for Payer: Heritage Provider Network Senior |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
|
|
RALOXIFENE 60 MG TABLET [22143]
|
Facility
|
OP
|
$0.78
|
|
|
Service Code
|
NDC 43598-505-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.59
|
| Rate for Payer: Blue Shield of California Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California EPN |
$0.38
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.66
|
| Rate for Payer: Dignity Health Senior |
$0.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.48
|
| Rate for Payer: Heritage Provider Network Senior |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.31
|
| Rate for Payer: TriValley Medical Group Senior |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: Vantage Medical Group Senior |
$0.66
|
|
|
RALOXIFENE 60 MG TABLET [22143]
|
Facility
|
IP
|
$3.73
|
|
|
Service Code
|
NDC 50268-694-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.53
|
| Rate for Payer: Heritage Provider Network Senior |
$2.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.93
|
| Rate for Payer: Multiplan Commercial |
$2.80
|
|
|
RALOXIFENE 60 MG TABLET [22143]
|
Facility
|
OP
|
$3.73
|
|
|
Service Code
|
NDC 50268-694-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$3.17 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2.28
|
| Rate for Payer: Blue Shield of California EPN |
$1.82
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.17
|
| Rate for Payer: Dignity Health Senior |
$3.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.31
|
| Rate for Payer: Heritage Provider Network Senior |
$2.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.61
|
| Rate for Payer: Multiplan Commercial |
$2.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.49
|
| Rate for Payer: TriValley Medical Group Senior |
$1.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.17
|
| Rate for Payer: Vantage Medical Group Senior |
$3.17
|
|
|
RALOXIFENE 60 MG TABLET [22143]
|
Facility
|
OP
|
$3.73
|
|
|
Service Code
|
NDC 50268-694-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$3.17 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2.28
|
| Rate for Payer: Blue Shield of California EPN |
$1.82
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.17
|
| Rate for Payer: Dignity Health Senior |
$3.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.31
|
| Rate for Payer: Heritage Provider Network Senior |
$2.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.61
|
| Rate for Payer: Multiplan Commercial |
$2.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.49
|
| Rate for Payer: TriValley Medical Group Senior |
$1.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.17
|
| Rate for Payer: Vantage Medical Group Senior |
$3.17
|
|
|
RALOXIFENE 60 MG TABLET [22143]
|
Facility
|
IP
|
$3.73
|
|
|
Service Code
|
NDC 50268-694-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.53
|
| Rate for Payer: Heritage Provider Network Senior |
$2.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.93
|
| Rate for Payer: Multiplan Commercial |
$2.80
|
|
|
RALTEGRAVIR 400 MG TABLET [88608]
|
Facility
|
IP
|
$41.66
|
|
|
Service Code
|
NDC 0006-0227-61
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$31.25 |
| Rate for Payer: Adventist Health Commercial |
$8.33
|
| Rate for Payer: Cash Price |
$22.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.20
|
| Rate for Payer: Heritage Provider Network Senior |
$28.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.41
|
| Rate for Payer: Multiplan Commercial |
$31.25
|
|
|
RALTEGRAVIR 400 MG TABLET [88608]
|
Facility
|
OP
|
$41.66
|
|
|
Service Code
|
NDC 0006-0227-61
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$35.41 |
| Rate for Payer: Adventist Health Commercial |
$8.33
|
| Rate for Payer: Aetna of CA Gatekeeper |
$22.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.25
|
| Rate for Payer: Blue Shield of California Commercial |
$25.41
|
| Rate for Payer: Blue Shield of California EPN |
$20.33
|
| Rate for Payer: Cash Price |
$22.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.41
|
| Rate for Payer: Dignity Health Senior |
$35.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.79
|
| Rate for Payer: Heritage Provider Network Senior |
$25.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$19.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.16
|
| Rate for Payer: Multiplan Commercial |
$31.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.66
|
| Rate for Payer: TriValley Medical Group Senior |
$16.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.41
|
| Rate for Payer: Vantage Medical Group Senior |
$35.41
|
|
|
RAMIPRIL 5 MG CAPSULE [11261]
|
Facility
|
IP
|
$0.24
|
|
|
Service Code
|
NDC 65862-476-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Senior |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
|
|
RAMIPRIL 5 MG CAPSULE [11261]
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
NDC 65862-476-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.18
|
| 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 |
$0.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: Dignity Health Senior |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Senior |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION [205590]
|
Facility
|
IP
|
$180.10
|
|
|
Service Code
|
HCPCS J9308
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.60 |
| Max. Negotiated Rate |
$135.07 |
| Rate for Payer: Adventist Health Commercial |
$36.02
|
| Rate for Payer: Adventist Health Commercial |
$36.02
|
| Rate for Payer: Cash Price |
$99.05
|
| Rate for Payer: Cash Price |
$99.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$82.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$82.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.39
|
| Rate for Payer: Heritage Provider Network Senior |
$83.39
|
| Rate for Payer: Heritage Provider Network Senior |
$83.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.02
|
| Rate for Payer: Multiplan Commercial |
$135.07
|
| Rate for Payer: Multiplan Commercial |
$135.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$65.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$65.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$59.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$59.63
|
|
|
RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION [205590]
|
Facility
|
OP
|
$180.09
|
|
|
Service Code
|
HCPCS J9308
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.60 |
| Max. Negotiated Rate |
$190.53 |
| Rate for Payer: Adventist Health Commercial |
$36.02
|
| Rate for Payer: Adventist Health Commercial |
$36.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$96.26
|
| Rate for Payer: Aetna of CA Gatekeeper |
$96.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$123.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$123.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$111.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$111.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$81.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$81.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$81.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$81.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$190.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$190.53
|
| Rate for Payer: Blue Shield of California Commercial |
$74.30
|
| Rate for Payer: Blue Shield of California Commercial |
$74.30
|
| Rate for Payer: Blue Shield of California EPN |
$74.30
|
| Rate for Payer: Blue Shield of California EPN |
$74.30
|
| Rate for Payer: Cash Price |
$99.05
|
| Rate for Payer: Cash Price |
$99.05
|
| Rate for Payer: Cash Price |
$99.05
|
| Rate for Payer: Cash Price |
$99.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$82.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$82.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.90
|
| Rate for Payer: Dignity Health Senior |
$81.90
|
| Rate for Payer: Dignity Health Senior |
$81.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.26
|
| Rate for Payer: EPIC Health Plan Medicare |
$74.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$74.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.39
|
| Rate for Payer: Heritage Provider Network Senior |
$83.38
|
| Rate for Payer: Heritage Provider Network Senior |
$83.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$73.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$73.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$74.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$74.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$85.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$85.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$85.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$85.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$93.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$93.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$93.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$93.81
|
| Rate for Payer: Multiplan Commercial |
$135.07
|
| Rate for Payer: Multiplan Commercial |
$135.07
|
| Rate for Payer: TriValley Medical Group Commercial |
$72.04
|
| Rate for Payer: TriValley Medical Group Commercial |
$72.04
|
| Rate for Payer: TriValley Medical Group Senior |
$72.04
|
| Rate for Payer: TriValley Medical Group Senior |
$72.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$65.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$65.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$59.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$59.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.90
|
| Rate for Payer: Vantage Medical Group Senior |
$81.90
|
| Rate for Payer: Vantage Medical Group Senior |
$81.90
|
|
|
RANOLAZINE ER 1,000 MG TABLET,EXTENDED RELEASE,12 HR [88007]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 27241-126-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.68
|
| Rate for Payer: Heritage Provider Network Senior |
$0.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
|
|
RANOLAZINE ER 1,000 MG TABLET,EXTENDED RELEASE,12 HR [88007]
|
Facility
|
OP
|
$0.34
|
|
|
Service Code
|
NDC 42291-774-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.26
|
| 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 |
$0.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.29
|
| Rate for Payer: Dignity Health Senior |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.21
|
| Rate for Payer: Heritage Provider Network Senior |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.29
|
| 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
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 27241-126-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.75
|
| Rate for Payer: Blue Shield of California Commercial |
$0.61
|
| Rate for Payer: Blue Shield of California EPN |
$0.49
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: Dignity Health Senior |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.62
|
| Rate for Payer: Heritage Provider Network Senior |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.40
|
| Rate for Payer: TriValley Medical Group Senior |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
RANOLAZINE ER 1,000 MG TABLET,EXTENDED RELEASE,12 HR [88007]
|
Facility
|
IP
|
$0.34
|
|
|
Service Code
|
NDC 42291-774-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.23
|
| Rate for Payer: Heritage Provider Network Senior |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR [70434]
|
Facility
|
IP
|
$0.60
|
|
|
Service Code
|
NDC 27241-125-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.41
|
| Rate for Payer: Heritage Provider Network Senior |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR [70434]
|
Facility
|
OP
|
$0.60
|
|
|
Service Code
|
NDC 27241-125-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.45
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.51
|
| Rate for Payer: Dignity Health Senior |
$0.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.37
|
| Rate for Payer: Heritage Provider Network Senior |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.24
|
| Rate for Payer: TriValley Medical Group Senior |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| 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
|
IP
|
$1.68
|
|
|
Service Code
|
NDC 60687-549-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.14
|
| Rate for Payer: Heritage Provider Network Senior |
$1.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR [70434]
|
Facility
|
OP
|
$1.68
|
|
|
Service Code
|
NDC 60687-549-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.82
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.43
|
| Rate for Payer: Dignity Health Senior |
$1.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.67
|
| Rate for Payer: TriValley Medical Group Senior |
$0.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1.43
|
|
