|
RITONAVIR 100 MG TABLET [100995]
|
Facility
|
IP
|
$6.40
|
|
|
Service Code
|
NDC 0054-0407-13
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: Adventist Health Commercial |
$1.28
|
| Rate for Payer: Cash Price |
$3.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.33
|
| Rate for Payer: Heritage Provider Network Senior |
$4.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.60
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
|
|
RITONAVIR 100 MG TABLET [100995]
|
Facility
|
OP
|
$6.40
|
|
|
Service Code
|
NDC 0054-0407-13
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$5.44 |
| Rate for Payer: Adventist Health Commercial |
$1.28
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3.90
|
| Rate for Payer: Blue Shield of California EPN |
$3.12
|
| Rate for Payer: Cash Price |
$3.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.44
|
| Rate for Payer: Dignity Health Senior |
$5.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.96
|
| Rate for Payer: Heritage Provider Network Senior |
$3.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.48
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.56
|
| Rate for Payer: TriValley Medical Group Senior |
$2.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.44
|
| Rate for Payer: Vantage Medical Group Senior |
$5.44
|
|
|
RITONAVIR 100 MG TABLET [100995]
|
Facility
|
OP
|
$3.20
|
|
|
Service Code
|
NDC 65862-687-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: Adventist Health Commercial |
$0.64
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1.95
|
| Rate for Payer: Blue Shield of California EPN |
$1.56
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.72
|
| Rate for Payer: Dignity Health Senior |
$2.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.98
|
| Rate for Payer: Heritage Provider Network Senior |
$1.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.24
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.28
|
| Rate for Payer: TriValley Medical Group Senior |
$1.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.72
|
| Rate for Payer: Vantage Medical Group Senior |
$2.72
|
|
|
RITONAVIR 100 MG TABLET [100995]
|
Facility
|
IP
|
$3.20
|
|
|
Service Code
|
NDC 31722-597-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: Adventist Health Commercial |
$0.64
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.17
|
| Rate for Payer: Heritage Provider Network Senior |
$2.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
|
|
RITONAVIR 100 MG TABLET [100995]
|
Facility
|
OP
|
$3.20
|
|
|
Service Code
|
NDC 31722-597-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: Adventist Health Commercial |
$0.64
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1.95
|
| Rate for Payer: Blue Shield of California EPN |
$1.56
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.72
|
| Rate for Payer: Dignity Health Senior |
$2.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.98
|
| Rate for Payer: Heritage Provider Network Senior |
$1.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.24
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.28
|
| Rate for Payer: TriValley Medical Group Senior |
$1.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.72
|
| Rate for Payer: Vantage Medical Group Senior |
$2.72
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS [22149]
|
Facility
|
OP
|
$112.74
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.41 |
| Max. Negotiated Rate |
$243.33 |
| Rate for Payer: Adventist Health Commercial |
$22.55
|
| Rate for Payer: Aetna of CA Gatekeeper |
$60.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$77.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$83.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$243.33
|
| Rate for Payer: Blue Shield of California Commercial |
$95.83
|
| Rate for Payer: Blue Shield of California EPN |
$95.83
|
| Rate for Payer: Cash Price |
$62.01
|
| Rate for Payer: Cash Price |
$62.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$51.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$94.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.52
|
| Rate for Payer: Dignity Health Senior |
$83.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$75.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.20
|
| Rate for Payer: Heritage Provider Network Senior |
$52.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$76.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$53.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$87.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$95.67
|
| Rate for Payer: Multiplan Commercial |
$84.56
|
| Rate for Payer: TriValley Medical Group Commercial |
$45.10
|
| Rate for Payer: TriValley Medical Group Senior |
$45.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$40.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$94.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.52
|
| Rate for Payer: Vantage Medical Group Senior |
$83.52
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS [22149]
|
Facility
|
IP
|
$112.74
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.41 |
| Max. Negotiated Rate |
$84.56 |
| Rate for Payer: Adventist Health Commercial |
$22.55
|
| Rate for Payer: Cash Price |
$62.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$51.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.20
|
| Rate for Payer: Heritage Provider Network Senior |
$52.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.18
|
| Rate for Payer: Multiplan Commercial |
$84.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$40.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.33
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS NON-ONCOLOGY [4081336]
|
Facility
|
OP
|
$112.74
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.41 |
| Max. Negotiated Rate |
$243.33 |
| Rate for Payer: Adventist Health Commercial |
$22.55
|
| Rate for Payer: Aetna of CA Gatekeeper |
$60.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$77.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$83.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$243.33
|
| Rate for Payer: Blue Shield of California Commercial |
$95.83
|
| Rate for Payer: Blue Shield of California EPN |
$95.83
|
| Rate for Payer: Cash Price |
$62.01
|
| Rate for Payer: Cash Price |
$62.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$51.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$94.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.52
|
| Rate for Payer: Dignity Health Senior |
$83.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$75.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.20
|
| Rate for Payer: Heritage Provider Network Senior |
$52.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$76.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$53.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$87.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$95.67
|
| Rate for Payer: Multiplan Commercial |
$84.56
|
| Rate for Payer: TriValley Medical Group Commercial |
$45.10
|
| Rate for Payer: TriValley Medical Group Senior |
$45.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$40.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$94.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.52
|
| Rate for Payer: Vantage Medical Group Senior |
$83.52
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS NON-ONCOLOGY [4081336]
|
Facility
|
IP
|
$112.74
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.41 |
| Max. Negotiated Rate |
$84.56 |
| Rate for Payer: Adventist Health Commercial |
$22.55
|
| Rate for Payer: Cash Price |
$62.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$51.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.20
|
| Rate for Payer: Heritage Provider Network Senior |
$52.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.18
|
| Rate for Payer: Multiplan Commercial |
$84.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$40.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.33
|
|
|
RITUXIMAB 1,400 MG/11.7 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN [218742]
|
Facility
|
IP
|
$674.52
|
|
|
Service Code
|
HCPCS J9311
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$122.09 |
| Max. Negotiated Rate |
$505.89 |
| Rate for Payer: Adventist Health Commercial |
$134.90
|
| Rate for Payer: Cash Price |
$370.99
|
| Rate for Payer: Cigna of CA HMO/PPO |
$310.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$364.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$312.30
|
| Rate for Payer: Heritage Provider Network Senior |
$312.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.63
|
| Rate for Payer: Multiplan Commercial |
$505.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$243.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$223.33
|
|
|
RITUXIMAB 1,400 MG/11.7 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN [218742]
|
Facility
|
OP
|
$674.52
|
|
|
Service Code
|
HCPCS J9311
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.96 |
| Max. Negotiated Rate |
$505.89 |
| Rate for Payer: Adventist Health Commercial |
$134.90
|
| Rate for Payer: Aetna of CA Gatekeeper |
$360.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$463.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.66
|
| Rate for Payer: Blue Shield of California Commercial |
$47.91
|
| Rate for Payer: Blue Shield of California EPN |
$47.91
|
| Rate for Payer: Cash Price |
$370.99
|
| Rate for Payer: Cash Price |
$370.99
|
| Rate for Payer: Cigna of CA HMO/PPO |
$310.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.66
|
| Rate for Payer: Dignity Health Senior |
$40.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$431.69
|
| Rate for Payer: EPIC Health Plan Medicare |
$36.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$312.30
|
| Rate for Payer: Heritage Provider Network Senior |
$312.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$36.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$321.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46.57
|
| Rate for Payer: Multiplan Commercial |
$505.89
|
| Rate for Payer: TriValley Medical Group Commercial |
$269.81
|
| Rate for Payer: TriValley Medical Group Senior |
$269.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$243.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$223.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.66
|
| Rate for Payer: Vantage Medical Group Senior |
$40.66
|
|
|
RITUXIMAB 1,600 MG/13.4 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN [218821]
|
Facility
|
OP
|
$673.08
|
|
|
Service Code
|
HCPCS J9311
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.96 |
| Max. Negotiated Rate |
$504.81 |
| Rate for Payer: Adventist Health Commercial |
$134.62
|
| Rate for Payer: Aetna of CA Gatekeeper |
$359.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$462.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.66
|
| Rate for Payer: Blue Shield of California Commercial |
$47.91
|
| Rate for Payer: Blue Shield of California EPN |
$47.91
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$309.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.66
|
| Rate for Payer: Dignity Health Senior |
$40.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$430.77
|
| Rate for Payer: EPIC Health Plan Medicare |
$36.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$311.64
|
| Rate for Payer: Heritage Provider Network Senior |
$311.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$36.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$321.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46.57
|
| Rate for Payer: Multiplan Commercial |
$504.81
|
| Rate for Payer: TriValley Medical Group Commercial |
$269.23
|
| Rate for Payer: TriValley Medical Group Senior |
$269.23
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$243.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$222.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.66
|
| Rate for Payer: Vantage Medical Group Senior |
$40.66
|
|
|
RITUXIMAB 1,600 MG/13.4 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN [218821]
|
Facility
|
IP
|
$673.08
|
|
|
Service Code
|
HCPCS J9311
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$121.83 |
| Max. Negotiated Rate |
$504.81 |
| Rate for Payer: Adventist Health Commercial |
$134.62
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$309.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$363.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$311.64
|
| Rate for Payer: Heritage Provider Network Senior |
$311.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.27
|
| Rate for Payer: Multiplan Commercial |
$504.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$243.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$222.86
|
|
|
RITUXIMAB-ARRX 10 MG/ML INTRAVENOUS SOLUTION [229898]
|
Facility
|
IP
|
$86.02
|
|
|
Service Code
|
HCPCS Q5123
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$64.52 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Cash Price |
$47.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.83
|
| Rate for Payer: Heritage Provider Network Senior |
$39.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.50
|
| Rate for Payer: Multiplan Commercial |
$64.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.48
|
|
|
RITUXIMAB-ARRX 10 MG/ML INTRAVENOUS SOLUTION [229898]
|
Facility
|
OP
|
$86.02
|
|
|
Service Code
|
HCPCS Q5123
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$185.66 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$45.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$185.66
|
| Rate for Payer: Blue Shield of California Commercial |
$73.12
|
| Rate for Payer: Blue Shield of California EPN |
$73.12
|
| Rate for Payer: Cash Price |
$47.31
|
| Rate for Payer: Cash Price |
$47.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.91
|
| Rate for Payer: Dignity Health Senior |
$32.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$29.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.83
|
| Rate for Payer: Heritage Provider Network Senior |
$39.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.70
|
| Rate for Payer: Multiplan Commercial |
$64.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$34.41
|
| Rate for Payer: TriValley Medical Group Senior |
$34.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.91
|
| Rate for Payer: Vantage Medical Group Senior |
$32.91
|
|
|
RITUXIMAB-PVVR 10 MG/ML INTRAVENOUS SOLUTION [226878]
|
Facility
|
IP
|
$86.02
|
|
|
Service Code
|
HCPCS Q5119
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$64.52 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Cash Price |
$47.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.83
|
| Rate for Payer: Heritage Provider Network Senior |
$39.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.50
|
| Rate for Payer: Multiplan Commercial |
$64.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.48
|
|
|
RITUXIMAB-PVVR 10 MG/ML INTRAVENOUS SOLUTION [226878]
|
Facility
|
OP
|
$86.02
|
|
|
Service Code
|
HCPCS Q5119
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$185.66 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$45.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$185.66
|
| Rate for Payer: Blue Shield of California Commercial |
$73.12
|
| Rate for Payer: Blue Shield of California EPN |
$73.12
|
| Rate for Payer: Cash Price |
$47.31
|
| Rate for Payer: Cash Price |
$47.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.15
|
| Rate for Payer: Dignity Health Senior |
$29.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$26.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.83
|
| Rate for Payer: Heritage Provider Network Senior |
$39.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.39
|
| Rate for Payer: Multiplan Commercial |
$64.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$34.41
|
| Rate for Payer: TriValley Medical Group Senior |
$34.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.15
|
| Rate for Payer: Vantage Medical Group Senior |
$29.15
|
|
|
RIVAROXABAN 10 MG TABLET [153876]
|
Facility
|
OP
|
$23.92
|
|
|
Service Code
|
NDC 50458-580-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.33 |
| Max. Negotiated Rate |
$20.33 |
| Rate for Payer: Adventist Health Commercial |
$4.78
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.94
|
| Rate for Payer: Blue Shield of California Commercial |
$14.59
|
| Rate for Payer: Blue Shield of California EPN |
$11.67
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.33
|
| Rate for Payer: Dignity Health Senior |
$20.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.81
|
| Rate for Payer: Heritage Provider Network Senior |
$14.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.74
|
| Rate for Payer: Multiplan Commercial |
$17.94
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.57
|
| Rate for Payer: TriValley Medical Group Senior |
$9.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.33
|
| Rate for Payer: Vantage Medical Group Senior |
$20.33
|
|
|
RIVAROXABAN 10 MG TABLET [153876]
|
Facility
|
IP
|
$23.92
|
|
|
Service Code
|
NDC 50458-580-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.33 |
| Max. Negotiated Rate |
$17.94 |
| Rate for Payer: Adventist Health Commercial |
$4.78
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.19
|
| Rate for Payer: Heritage Provider Network Senior |
$16.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.98
|
| Rate for Payer: Multiplan Commercial |
$17.94
|
|
|
RIVAROXABAN 15 MG TABLET [153877]
|
Facility
|
OP
|
$23.92
|
|
|
Service Code
|
NDC 50458-578-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.33 |
| Max. Negotiated Rate |
$20.33 |
| Rate for Payer: Adventist Health Commercial |
$4.78
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.94
|
| Rate for Payer: Blue Shield of California Commercial |
$14.59
|
| Rate for Payer: Blue Shield of California EPN |
$11.67
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.33
|
| Rate for Payer: Dignity Health Senior |
$20.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.81
|
| Rate for Payer: Heritage Provider Network Senior |
$14.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.74
|
| Rate for Payer: Multiplan Commercial |
$17.94
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.57
|
| Rate for Payer: TriValley Medical Group Senior |
$9.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.33
|
| Rate for Payer: Vantage Medical Group Senior |
$20.33
|
|
|
RIVAROXABAN 15 MG TABLET [153877]
|
Facility
|
IP
|
$23.92
|
|
|
Service Code
|
NDC 50458-578-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.33 |
| Max. Negotiated Rate |
$17.94 |
| Rate for Payer: Adventist Health Commercial |
$4.78
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.19
|
| Rate for Payer: Heritage Provider Network Senior |
$16.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.98
|
| Rate for Payer: Multiplan Commercial |
$17.94
|
|
|
RIVAROXABAN 15 MG TABLET [153877]
|
Facility
|
IP
|
$23.92
|
|
|
Service Code
|
NDC 50458-578-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.33 |
| Max. Negotiated Rate |
$17.94 |
| Rate for Payer: Adventist Health Commercial |
$4.78
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.19
|
| Rate for Payer: Heritage Provider Network Senior |
$16.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.98
|
| Rate for Payer: Multiplan Commercial |
$17.94
|
|
|
RIVAROXABAN 15 MG TABLET [153877]
|
Facility
|
OP
|
$23.92
|
|
|
Service Code
|
NDC 50458-578-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.33 |
| Max. Negotiated Rate |
$20.33 |
| Rate for Payer: Adventist Health Commercial |
$4.78
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.94
|
| Rate for Payer: Blue Shield of California Commercial |
$14.59
|
| Rate for Payer: Blue Shield of California EPN |
$11.67
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.33
|
| Rate for Payer: Dignity Health Senior |
$20.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.81
|
| Rate for Payer: Heritage Provider Network Senior |
$14.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.74
|
| Rate for Payer: Multiplan Commercial |
$17.94
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.57
|
| Rate for Payer: TriValley Medical Group Senior |
$9.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.33
|
| Rate for Payer: Vantage Medical Group Senior |
$20.33
|
|
|
RIVAROXABAN 20 MG TABLET [153878]
|
Facility
|
OP
|
$23.92
|
|
|
Service Code
|
NDC 50458-579-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.33 |
| Max. Negotiated Rate |
$20.33 |
| Rate for Payer: Adventist Health Commercial |
$4.78
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.94
|
| Rate for Payer: Blue Shield of California Commercial |
$14.59
|
| Rate for Payer: Blue Shield of California EPN |
$11.67
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.33
|
| Rate for Payer: Dignity Health Senior |
$20.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.81
|
| Rate for Payer: Heritage Provider Network Senior |
$14.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.74
|
| Rate for Payer: Multiplan Commercial |
$17.94
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.57
|
| Rate for Payer: TriValley Medical Group Senior |
$9.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.33
|
| Rate for Payer: Vantage Medical Group Senior |
$20.33
|
|
|
RIVAROXABAN 20 MG TABLET [153878]
|
Facility
|
IP
|
$23.92
|
|
|
Service Code
|
NDC 50458-579-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.33 |
| Max. Negotiated Rate |
$17.94 |
| Rate for Payer: Adventist Health Commercial |
$4.78
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.19
|
| Rate for Payer: Heritage Provider Network Senior |
$16.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.98
|
| Rate for Payer: Multiplan Commercial |
$17.94
|
|
