|
RASAGILINE 0.5 MG TABLET [76480]
|
Facility
|
IP
|
$3.44
|
|
|
Service Code
|
NDC 23155-746-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.58 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.33
|
| Rate for Payer: Heritage Provider Network Senior |
$2.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$2.58
|
|
|
RASAGILINE 0.5 MG TABLET [76480]
|
Facility
|
OP
|
$3.44
|
|
|
Service Code
|
NDC 23155-746-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.58
|
| Rate for Payer: Blue Shield of California Commercial |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$1.68
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.92
|
| Rate for Payer: Dignity Health Senior |
$2.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.13
|
| Rate for Payer: Heritage Provider Network Senior |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.41
|
| Rate for Payer: Multiplan Commercial |
$2.58
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.38
|
| Rate for Payer: TriValley Medical Group Senior |
$1.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.92
|
| Rate for Payer: Vantage Medical Group Senior |
$2.92
|
|
|
RASAGILINE 0.5 MG TABLET [76480]
|
Facility
|
IP
|
$17.80
|
|
|
Service Code
|
NDC 47781-683-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$13.35 |
| Rate for Payer: Adventist Health Commercial |
$3.56
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.05
|
| Rate for Payer: Heritage Provider Network Senior |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.45
|
| Rate for Payer: Multiplan Commercial |
$13.35
|
|
|
RASAGILINE 0.5 MG TABLET [76480]
|
Facility
|
IP
|
$8.25
|
|
|
Service Code
|
NDC 0093-3060-56
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$6.19 |
| Rate for Payer: Adventist Health Commercial |
$1.65
|
| Rate for Payer: Cash Price |
$4.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.59
|
| Rate for Payer: Heritage Provider Network Senior |
$5.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.06
|
| Rate for Payer: Multiplan Commercial |
$6.19
|
|
|
RASAGILINE 0.5 MG TABLET [76480]
|
Facility
|
OP
|
$17.80
|
|
|
Service Code
|
NDC 47781-683-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$15.13 |
| Rate for Payer: Adventist Health Commercial |
$3.56
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.35
|
| Rate for Payer: Blue Shield of California Commercial |
$10.86
|
| Rate for Payer: Blue Shield of California EPN |
$8.69
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.13
|
| Rate for Payer: Dignity Health Senior |
$15.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.02
|
| Rate for Payer: Heritage Provider Network Senior |
$11.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$13.35
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.12
|
| Rate for Payer: TriValley Medical Group Senior |
$7.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.13
|
| Rate for Payer: Vantage Medical Group Senior |
$15.13
|
|
|
RASAGILINE 0.5 MG TABLET [76480]
|
Facility
|
OP
|
$8.25
|
|
|
Service Code
|
NDC 0093-3060-56
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$7.01 |
| Rate for Payer: Adventist Health Commercial |
$1.65
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.19
|
| Rate for Payer: Blue Shield of California Commercial |
$5.03
|
| Rate for Payer: Blue Shield of California EPN |
$4.03
|
| Rate for Payer: Cash Price |
$4.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.01
|
| Rate for Payer: Dignity Health Senior |
$7.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.11
|
| Rate for Payer: Heritage Provider Network Senior |
$5.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.78
|
| Rate for Payer: Multiplan Commercial |
$6.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.30
|
| Rate for Payer: TriValley Medical Group Senior |
$3.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.01
|
| Rate for Payer: Vantage Medical Group Senior |
$7.01
|
|
|
RASAGILINE 1 MG TABLET [76481]
|
Facility
|
IP
|
$3.44
|
|
|
Service Code
|
NDC 23155-747-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.58 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.33
|
| Rate for Payer: Heritage Provider Network Senior |
$2.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$2.58
|
|
|
RASAGILINE 1 MG TABLET [76481]
|
Facility
|
IP
|
$8.25
|
|
|
Service Code
|
NDC 0093-3061-56
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$6.19 |
| Rate for Payer: Adventist Health Commercial |
$1.65
|
| Rate for Payer: Cash Price |
$4.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.59
|
| Rate for Payer: Heritage Provider Network Senior |
$5.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.06
|
| Rate for Payer: Multiplan Commercial |
$6.19
|
|
|
RASAGILINE 1 MG TABLET [76481]
|
Facility
|
OP
|
$8.25
|
|
|
Service Code
|
NDC 0093-3061-56
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$7.01 |
| Rate for Payer: Adventist Health Commercial |
$1.65
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.19
|
| Rate for Payer: Blue Shield of California Commercial |
$5.03
|
| Rate for Payer: Blue Shield of California EPN |
$4.03
|
| Rate for Payer: Cash Price |
$4.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.01
|
| Rate for Payer: Dignity Health Senior |
$7.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.11
|
| Rate for Payer: Heritage Provider Network Senior |
$5.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.78
|
| Rate for Payer: Multiplan Commercial |
$6.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.30
|
| Rate for Payer: TriValley Medical Group Senior |
$3.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.01
|
| Rate for Payer: Vantage Medical Group Senior |
$7.01
|
|
|
RASAGILINE 1 MG TABLET [76481]
|
Facility
|
OP
|
$3.44
|
|
|
Service Code
|
NDC 23155-747-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.58
|
| Rate for Payer: Blue Shield of California Commercial |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$1.68
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.92
|
| Rate for Payer: Dignity Health Senior |
$2.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.13
|
| Rate for Payer: Heritage Provider Network Senior |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.41
|
| Rate for Payer: Multiplan Commercial |
$2.58
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.38
|
| Rate for Payer: TriValley Medical Group Senior |
$1.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.92
|
| Rate for Payer: Vantage Medical Group Senior |
$2.92
|
|
|
RASAGILINE 1 MG TABLET [76481]
|
Facility
|
IP
|
$17.80
|
|
|
Service Code
|
NDC 47781-690-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$13.35 |
| Rate for Payer: Adventist Health Commercial |
$3.56
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.05
|
| Rate for Payer: Heritage Provider Network Senior |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.45
|
| Rate for Payer: Multiplan Commercial |
$13.35
|
|
|
RASAGILINE 1 MG TABLET [76481]
|
Facility
|
OP
|
$17.80
|
|
|
Service Code
|
NDC 47781-690-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$15.13 |
| Rate for Payer: Adventist Health Commercial |
$3.56
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.35
|
| Rate for Payer: Blue Shield of California Commercial |
$10.86
|
| Rate for Payer: Blue Shield of California EPN |
$8.69
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.13
|
| Rate for Payer: Dignity Health Senior |
$15.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.02
|
| Rate for Payer: Heritage Provider Network Senior |
$11.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$13.35
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.12
|
| Rate for Payer: TriValley Medical Group Senior |
$7.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.13
|
| Rate for Payer: Vantage Medical Group Senior |
$15.13
|
|
|
RASAGILINE 1 MG TABLET [76481]
|
Facility
|
IP
|
$50.04
|
|
|
Service Code
|
NDC 68546-229-56
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.06 |
| Max. Negotiated Rate |
$37.53 |
| Rate for Payer: Adventist Health Commercial |
$10.01
|
| Rate for Payer: Cash Price |
$27.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.88
|
| Rate for Payer: Heritage Provider Network Senior |
$33.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.51
|
| Rate for Payer: Multiplan Commercial |
$37.53
|
|
|
RASAGILINE 1 MG TABLET [76481]
|
Facility
|
OP
|
$50.04
|
|
|
Service Code
|
NDC 68546-229-56
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.06 |
| Max. Negotiated Rate |
$42.53 |
| Rate for Payer: Adventist Health Commercial |
$10.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$26.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.53
|
| Rate for Payer: Blue Shield of California Commercial |
$30.52
|
| Rate for Payer: Blue Shield of California EPN |
$24.42
|
| Rate for Payer: Cash Price |
$27.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.53
|
| Rate for Payer: Dignity Health Senior |
$42.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.97
|
| Rate for Payer: Heritage Provider Network Senior |
$30.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$23.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.03
|
| Rate for Payer: Multiplan Commercial |
$37.53
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.02
|
| Rate for Payer: TriValley Medical Group Senior |
$20.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$25.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.53
|
| Rate for Payer: Vantage Medical Group Senior |
$42.53
|
|
|
REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE [91408]
|
Facility
|
IP
|
$4.80
|
|
|
Service Code
|
HCPCS J2785
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Adventist Health Commercial |
$0.96
|
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Cash Price |
$3.96
|
| Rate for Payer: Cash Price |
$2.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.22
|
| Rate for Payer: Heritage Provider Network Senior |
$2.22
|
| Rate for Payer: Heritage Provider Network Senior |
$3.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: Multiplan Commercial |
$3.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.59
|
|
|
REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE [91408]
|
Facility
|
OP
|
$7.20
|
|
|
Service Code
|
HCPCS J2785
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$19.42 |
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Adventist Health Commercial |
$0.96
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.57
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.42
|
| Rate for Payer: Blue Shield of California Commercial |
$7.65
|
| Rate for Payer: Blue Shield of California Commercial |
$7.65
|
| Rate for Payer: Blue Shield of California EPN |
$7.65
|
| Rate for Payer: Blue Shield of California EPN |
$7.65
|
| Rate for Payer: Cash Price |
$3.96
|
| Rate for Payer: Cash Price |
$2.64
|
| Rate for Payer: Cash Price |
$2.64
|
| Rate for Payer: Cash Price |
$3.96
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: Dignity Health Senior |
$4.08
|
| Rate for Payer: Dignity Health Senior |
$6.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.22
|
| Rate for Payer: Heritage Provider Network Senior |
$2.22
|
| Rate for Payer: Heritage Provider Network Senior |
$3.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.04
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: Multiplan Commercial |
$3.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.92
|
| Rate for Payer: TriValley Medical Group Senior |
$1.92
|
| Rate for Payer: TriValley Medical Group Senior |
$2.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$4.08
|
| Rate for Payer: Vantage Medical Group Senior |
$6.12
|
|
|
RELUGOLIX 120 MG TABLET [229912]
|
Facility
|
IP
|
$110.49
|
|
|
Service Code
|
NDC 72974-120-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$82.87 |
| Rate for Payer: Adventist Health Commercial |
$22.10
|
| Rate for Payer: Cash Price |
$60.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.80
|
| Rate for Payer: Heritage Provider Network Senior |
$74.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.62
|
| Rate for Payer: Multiplan Commercial |
$82.87
|
|
|
RELUGOLIX 120 MG TABLET [229912]
|
Facility
|
OP
|
$110.49
|
|
|
Service Code
|
NDC 72974-120-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$93.92 |
| Rate for Payer: Adventist Health Commercial |
$22.10
|
| Rate for Payer: Aetna of CA Gatekeeper |
$59.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$75.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.87
|
| Rate for Payer: Blue Shield of California Commercial |
$67.40
|
| Rate for Payer: Blue Shield of California EPN |
$53.92
|
| Rate for Payer: Cash Price |
$60.77
|
| Rate for Payer: Cigna of CA HMO/PPO |
$71.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.92
|
| Rate for Payer: Dignity Health Senior |
$93.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.39
|
| Rate for Payer: Heritage Provider Network Senior |
$68.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$52.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$77.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77.34
|
| Rate for Payer: Multiplan Commercial |
$82.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$44.20
|
| Rate for Payer: TriValley Medical Group Senior |
$44.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$55.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.92
|
| Rate for Payer: Vantage Medical Group Senior |
$93.92
|
|
|
REMDESIVIR 100 MG INTRAVENOUS POWDER FOR SOLUTION [227996]
|
Facility
|
OP
|
$780.86
|
|
|
Service Code
|
HCPCS J0248
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.11 |
| Max. Negotiated Rate |
$585.64 |
| Rate for Payer: Adventist Health Commercial |
$156.17
|
| Rate for Payer: Aetna of CA Gatekeeper |
$417.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$536.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.45
|
| Rate for Payer: Blue Shield of California Commercial |
$6.11
|
| Rate for Payer: Blue Shield of California EPN |
$6.11
|
| Rate for Payer: Cash Price |
$429.48
|
| Rate for Payer: Cash Price |
$429.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$359.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.40
|
| Rate for Payer: Dignity Health Senior |
$7.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$361.54
|
| Rate for Payer: Heritage Provider Network Senior |
$361.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$372.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.48
|
| Rate for Payer: Multiplan Commercial |
$585.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$312.34
|
| Rate for Payer: TriValley Medical Group Senior |
$312.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$282.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$258.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.40
|
| Rate for Payer: Vantage Medical Group Senior |
$7.40
|
|
|
REMDESIVIR 100 MG INTRAVENOUS POWDER FOR SOLUTION [227996]
|
Facility
|
IP
|
$780.86
|
|
|
Service Code
|
HCPCS J0248
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$141.34 |
| Max. Negotiated Rate |
$585.64 |
| Rate for Payer: Adventist Health Commercial |
$156.17
|
| Rate for Payer: Cash Price |
$429.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$359.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$421.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$361.54
|
| Rate for Payer: Heritage Provider Network Senior |
$361.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.22
|
| Rate for Payer: Multiplan Commercial |
$585.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$282.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$258.54
|
|
|
REMDESIVIR 100 MG LYOPHILIZED POWDER FOR INJECTION - COMMERCIAL PRODUCT [4082058626]
|
Facility
|
OP
|
$780.86
|
|
|
Service Code
|
HCPCS J0248
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.11 |
| Max. Negotiated Rate |
$585.64 |
| Rate for Payer: Adventist Health Commercial |
$156.17
|
| Rate for Payer: Aetna of CA Gatekeeper |
$417.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$536.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.45
|
| Rate for Payer: Blue Shield of California Commercial |
$6.11
|
| Rate for Payer: Blue Shield of California EPN |
$6.11
|
| Rate for Payer: Cash Price |
$429.48
|
| Rate for Payer: Cash Price |
$429.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$359.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.40
|
| Rate for Payer: Dignity Health Senior |
$7.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$361.54
|
| Rate for Payer: Heritage Provider Network Senior |
$361.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$372.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.48
|
| Rate for Payer: Multiplan Commercial |
$585.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$312.34
|
| Rate for Payer: TriValley Medical Group Senior |
$312.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$282.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$258.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.40
|
| Rate for Payer: Vantage Medical Group Senior |
$7.40
|
|
|
REMDESIVIR 100 MG LYOPHILIZED POWDER FOR INJECTION - COMMERCIAL PRODUCT [4082058626]
|
Facility
|
IP
|
$780.86
|
|
|
Service Code
|
HCPCS J0248
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$141.34 |
| Max. Negotiated Rate |
$585.64 |
| Rate for Payer: Adventist Health Commercial |
$156.17
|
| Rate for Payer: Cash Price |
$429.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$359.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$421.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$361.54
|
| Rate for Payer: Heritage Provider Network Senior |
$361.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.22
|
| Rate for Payer: Multiplan Commercial |
$585.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$282.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$258.54
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
|
IP
|
$87.97
|
|
|
Service Code
|
NDC 63323-723-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.92 |
| Max. Negotiated Rate |
$65.98 |
| Rate for Payer: Adventist Health Commercial |
$17.59
|
| Rate for Payer: Cash Price |
$48.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.56
|
| Rate for Payer: Heritage Provider Network Senior |
$59.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.99
|
| Rate for Payer: Multiplan Commercial |
$65.98
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
|
IP
|
$80.83
|
|
|
Service Code
|
NDC 72078-034-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.63 |
| Max. Negotiated Rate |
$60.62 |
| Rate for Payer: Adventist Health Commercial |
$16.17
|
| Rate for Payer: Cash Price |
$44.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.72
|
| Rate for Payer: Heritage Provider Network Senior |
$54.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.21
|
| Rate for Payer: Multiplan Commercial |
$60.62
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
|
IP
|
$87.97
|
|
|
Service Code
|
NDC 63323-723-03
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.92 |
| Max. Negotiated Rate |
$65.98 |
| Rate for Payer: Adventist Health Commercial |
$17.59
|
| Rate for Payer: Cash Price |
$48.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.56
|
| Rate for Payer: Heritage Provider Network Senior |
$59.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.99
|
| Rate for Payer: Multiplan Commercial |
$65.98
|
|
