|
ROSUVASTATIN 40 MG TABLET [35136]
|
Facility
|
IP
|
$17.90
|
|
|
Service Code
|
NDC 71205-078-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$13.43 |
| Rate for Payer: Adventist Health Commercial |
$3.58
|
| Rate for Payer: Cash Price |
$9.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.12
|
| Rate for Payer: Heritage Provider Network Senior |
$12.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.47
|
| Rate for Payer: Multiplan Commercial |
$13.43
|
|
|
ROSUVASTATIN 40 MG TABLET [35136]
|
Facility
|
OP
|
$17.90
|
|
|
Service Code
|
NDC 71205-078-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$15.21 |
| Rate for Payer: Adventist Health Commercial |
$3.58
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.43
|
| Rate for Payer: Blue Shield of California Commercial |
$10.92
|
| Rate for Payer: Blue Shield of California EPN |
$8.74
|
| Rate for Payer: Cash Price |
$9.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.21
|
| Rate for Payer: Dignity Health Senior |
$15.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.08
|
| Rate for Payer: Heritage Provider Network Senior |
$11.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.53
|
| Rate for Payer: Multiplan Commercial |
$13.43
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.16
|
| Rate for Payer: TriValley Medical Group Senior |
$7.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.21
|
| Rate for Payer: Vantage Medical Group Senior |
$15.21
|
|
|
ROSUVASTATIN 40 MG TABLET [35136]
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
NDC 68462-264-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| 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 |
$0.17
|
|
|
ROTAVIRUS VACCINE LIVE, PENTAVALENT 2 ML ORAL SOLUTION [70476]
|
Facility
|
OP
|
$58.84
|
|
|
Service Code
|
HCPCS 90680
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$255.61 |
| Rate for Payer: Adventist Health Commercial |
$11.77
|
| Rate for Payer: Aetna of CA Gatekeeper |
$31.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$255.61
|
| Rate for Payer: Blue Shield of California Commercial |
$100.67
|
| Rate for Payer: Blue Shield of California EPN |
$100.67
|
| Rate for Payer: Cash Price |
$32.36
|
| Rate for Payer: Cash Price |
$32.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.01
|
| Rate for Payer: Dignity Health Senior |
$50.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.24
|
| Rate for Payer: Heritage Provider Network Senior |
$27.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$166.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$28.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.19
|
| Rate for Payer: Multiplan Commercial |
$44.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$23.54
|
| Rate for Payer: TriValley Medical Group Senior |
$23.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.01
|
| Rate for Payer: Vantage Medical Group Senior |
$50.01
|
|
|
ROTAVIRUS VACCINE LIVE, PENTAVALENT 2 ML ORAL SOLUTION [70476]
|
Facility
|
IP
|
$58.84
|
|
|
Service Code
|
HCPCS 90680
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$44.13 |
| Rate for Payer: Adventist Health Commercial |
$11.77
|
| Rate for Payer: Cash Price |
$32.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.24
|
| Rate for Payer: Heritage Provider Network Senior |
$27.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.71
|
| Rate for Payer: Multiplan Commercial |
$44.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.48
|
|
|
ROTIGOTINE 2 MG/24 HOUR TRANSDERMAL 24 HOUR PATCH [82100]
|
Facility
|
IP
|
$34.56
|
|
|
Service Code
|
NDC 50474-802-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.26 |
| Max. Negotiated Rate |
$25.92 |
| Rate for Payer: Adventist Health Commercial |
$6.91
|
| Rate for Payer: Cash Price |
$19.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.40
|
| Rate for Payer: Heritage Provider Network Senior |
$23.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Multiplan Commercial |
$25.92
|
|
|
ROTIGOTINE 2 MG/24 HOUR TRANSDERMAL 24 HOUR PATCH [82100]
|
Facility
|
OP
|
$34.56
|
|
|
Service Code
|
NDC 50474-802-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.26 |
| Max. Negotiated Rate |
$29.38 |
| Rate for Payer: Adventist Health Commercial |
$6.91
|
| Rate for Payer: Aetna of CA Gatekeeper |
$18.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.92
|
| Rate for Payer: Blue Shield of California Commercial |
$21.08
|
| Rate for Payer: Blue Shield of California EPN |
$16.87
|
| Rate for Payer: Cash Price |
$19.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.38
|
| Rate for Payer: Dignity Health Senior |
$29.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.39
|
| Rate for Payer: Heritage Provider Network Senior |
$21.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.19
|
| Rate for Payer: Multiplan Commercial |
$25.92
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.82
|
| Rate for Payer: TriValley Medical Group Senior |
$13.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.38
|
| Rate for Payer: Vantage Medical Group Senior |
$29.38
|
|
|
ROTIGOTINE 4 MG/24 HOUR TRANSDERMAL 24 HOUR PATCH [82101]
|
Facility
|
IP
|
$34.56
|
|
|
Service Code
|
NDC 50474-804-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.26 |
| Max. Negotiated Rate |
$25.92 |
| Rate for Payer: Adventist Health Commercial |
$6.91
|
| Rate for Payer: Cash Price |
$19.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.40
|
| Rate for Payer: Heritage Provider Network Senior |
$23.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Multiplan Commercial |
$25.92
|
|
|
ROTIGOTINE 4 MG/24 HOUR TRANSDERMAL 24 HOUR PATCH [82101]
|
Facility
|
OP
|
$34.56
|
|
|
Service Code
|
NDC 50474-804-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.26 |
| Max. Negotiated Rate |
$29.38 |
| Rate for Payer: Adventist Health Commercial |
$6.91
|
| Rate for Payer: Aetna of CA Gatekeeper |
$18.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.92
|
| Rate for Payer: Blue Shield of California Commercial |
$21.08
|
| Rate for Payer: Blue Shield of California EPN |
$16.87
|
| Rate for Payer: Cash Price |
$19.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.38
|
| Rate for Payer: Dignity Health Senior |
$29.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.39
|
| Rate for Payer: Heritage Provider Network Senior |
$21.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.19
|
| Rate for Payer: Multiplan Commercial |
$25.92
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.82
|
| Rate for Payer: TriValley Medical Group Senior |
$13.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.38
|
| Rate for Payer: Vantage Medical Group Senior |
$29.38
|
|
|
RUFINAMIDE 200 MG TABLET [95691]
|
Facility
|
OP
|
$3.68
|
|
|
Service Code
|
NDC 0054-0425-23
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$3.13 |
| Rate for Payer: Adventist Health Commercial |
$0.74
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.76
|
| Rate for Payer: Blue Shield of California Commercial |
$2.24
|
| Rate for Payer: Blue Shield of California EPN |
$1.80
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.13
|
| Rate for Payer: Dignity Health Senior |
$3.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.28
|
| Rate for Payer: Heritage Provider Network Senior |
$2.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.58
|
| Rate for Payer: Multiplan Commercial |
$2.76
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.47
|
| Rate for Payer: TriValley Medical Group Senior |
$1.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3.13
|
|
|
RUFINAMIDE 200 MG TABLET [95691]
|
Facility
|
IP
|
$3.68
|
|
|
Service Code
|
NDC 0054-0425-23
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$2.76 |
| Rate for Payer: Adventist Health Commercial |
$0.74
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.49
|
| Rate for Payer: Heritage Provider Network Senior |
$2.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.92
|
| Rate for Payer: Multiplan Commercial |
$2.76
|
|
|
RUFINAMIDE 200 MG TABLET [95691]
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
NDC 31722-598-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.35 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.22
|
| Rate for Payer: Heritage Provider Network Senior |
$1.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.35
|
|
|
RUFINAMIDE 200 MG TABLET [95691]
|
Facility
|
OP
|
$1.50
|
|
|
Service Code
|
NDC 68462-713-08
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.27 |
| Rate for Payer: Adventist Health Commercial |
$0.30
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.92
|
| Rate for Payer: Blue Shield of California EPN |
$0.73
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.27
|
| Rate for Payer: Dignity Health Senior |
$1.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.93
|
| Rate for Payer: Heritage Provider Network Senior |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.05
|
| Rate for Payer: Multiplan Commercial |
$1.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.60
|
| Rate for Payer: TriValley Medical Group Senior |
$0.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.27
|
| Rate for Payer: Vantage Medical Group Senior |
$1.27
|
|
|
RUFINAMIDE 200 MG TABLET [95691]
|
Facility
|
IP
|
$1.50
|
|
|
Service Code
|
NDC 68462-713-08
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.12 |
| Rate for Payer: Adventist Health Commercial |
$0.30
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.02
|
| Rate for Payer: Heritage Provider Network Senior |
$1.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$1.12
|
|
|
RUFINAMIDE 200 MG TABLET [95691]
|
Facility
|
OP
|
$0.90
|
|
|
Service Code
|
NDC 42571-391-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.68
|
| Rate for Payer: Blue Shield of California Commercial |
$0.55
|
| Rate for Payer: Blue Shield of California EPN |
$0.44
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.77
|
| Rate for Payer: Dignity Health Senior |
$0.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.56
|
| Rate for Payer: Heritage Provider Network Senior |
$0.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.63
|
| Rate for Payer: Multiplan Commercial |
$0.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.36
|
| Rate for Payer: TriValley Medical Group Senior |
$0.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.77
|
| Rate for Payer: Vantage Medical Group Senior |
$0.77
|
|
|
RUFINAMIDE 200 MG TABLET [95691]
|
Facility
|
IP
|
$0.90
|
|
|
Service Code
|
NDC 42571-391-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.61
|
| Rate for Payer: Heritage Provider Network Senior |
$0.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.68
|
|
|
RUFINAMIDE 200 MG TABLET [95691]
|
Facility
|
OP
|
$1.80
|
|
|
Service Code
|
NDC 31722-598-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.53 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.88
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.53
|
| Rate for Payer: Dignity Health Senior |
$1.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.11
|
| Rate for Payer: Heritage Provider Network Senior |
$1.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$1.35
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.72
|
| Rate for Payer: TriValley Medical Group Senior |
$0.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1.53
|
|
|
RUFINAMIDE 400 MG TABLET [95692]
|
Facility
|
IP
|
$7.37
|
|
|
Service Code
|
NDC 0054-0426-23
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$5.53 |
| Rate for Payer: Adventist Health Commercial |
$1.47
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.99
|
| Rate for Payer: Heritage Provider Network Senior |
$4.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.84
|
| Rate for Payer: Multiplan Commercial |
$5.53
|
|
|
RUFINAMIDE 400 MG TABLET [95692]
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
NDC 42571-392-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.35 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.22
|
| Rate for Payer: Heritage Provider Network Senior |
$1.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.35
|
|
|
RUFINAMIDE 400 MG TABLET [95692]
|
Facility
|
OP
|
$1.80
|
|
|
Service Code
|
NDC 42571-392-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.53 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.88
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.53
|
| Rate for Payer: Dignity Health Senior |
$1.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.11
|
| Rate for Payer: Heritage Provider Network Senior |
$1.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$1.35
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.72
|
| Rate for Payer: TriValley Medical Group Senior |
$0.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1.53
|
|
|
RUFINAMIDE 400 MG TABLET [95692]
|
Facility
|
OP
|
$7.37
|
|
|
Service Code
|
NDC 0054-0426-23
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$6.26 |
| Rate for Payer: Adventist Health Commercial |
$1.47
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.53
|
| Rate for Payer: Blue Shield of California Commercial |
$4.50
|
| Rate for Payer: Blue Shield of California EPN |
$3.60
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.26
|
| Rate for Payer: Dignity Health Senior |
$6.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.56
|
| Rate for Payer: Heritage Provider Network Senior |
$4.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.16
|
| Rate for Payer: Multiplan Commercial |
$5.53
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.95
|
| Rate for Payer: TriValley Medical Group Senior |
$2.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.26
|
| Rate for Payer: Vantage Medical Group Senior |
$6.26
|
|
|
RUFINAMIDE 40 MG/ML ORAL SUSPENSION [108804]
|
Facility
|
OP
|
$4.59
|
|
|
Service Code
|
NDC 62856-584-46
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Adventist Health Commercial |
$0.92
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.44
|
| Rate for Payer: Blue Shield of California Commercial |
$2.80
|
| Rate for Payer: Blue Shield of California EPN |
$2.24
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.90
|
| Rate for Payer: Dignity Health Senior |
$3.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.84
|
| Rate for Payer: Heritage Provider Network Senior |
$2.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.21
|
| Rate for Payer: Multiplan Commercial |
$3.44
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.84
|
| Rate for Payer: TriValley Medical Group Senior |
$1.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.90
|
| Rate for Payer: Vantage Medical Group Senior |
$3.90
|
|
|
RUFINAMIDE 40 MG/ML ORAL SUSPENSION [108804]
|
Facility
|
IP
|
$4.59
|
|
|
Service Code
|
NDC 62856-584-46
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$3.44 |
| Rate for Payer: Adventist Health Commercial |
$0.92
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.11
|
| Rate for Payer: Heritage Provider Network Senior |
$3.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.15
|
| Rate for Payer: Multiplan Commercial |
$3.44
|
|
|
RUXOLITINIB 10 MG TABLET [153887]
|
Facility
|
IP
|
$352.00
|
|
|
Service Code
|
NDC 50881-010-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$63.71 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: Adventist Health Commercial |
$70.40
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$238.30
|
| Rate for Payer: Heritage Provider Network Senior |
$238.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.00
|
| Rate for Payer: Multiplan Commercial |
$264.00
|
|
|
RUXOLITINIB 10 MG TABLET [153887]
|
Facility
|
OP
|
$352.00
|
|
|
Service Code
|
NDC 50881-010-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$63.71 |
| Max. Negotiated Rate |
$299.20 |
| Rate for Payer: Adventist Health Commercial |
$70.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$188.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$241.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$299.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$193.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$264.00
|
| Rate for Payer: Blue Shield of California Commercial |
$214.72
|
| Rate for Payer: Blue Shield of California EPN |
$171.78
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$228.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$299.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$299.20
|
| Rate for Payer: Dignity Health Senior |
$299.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$225.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$217.89
|
| Rate for Payer: Heritage Provider Network Senior |
$217.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$167.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$246.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$246.40
|
| Rate for Payer: Multiplan Commercial |
$264.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$140.80
|
| Rate for Payer: TriValley Medical Group Senior |
$140.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$176.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$176.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$299.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$299.20
|
| Rate for Payer: Vantage Medical Group Senior |
$299.20
|
|
