|
RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP [22120]
|
Facility
|
OP
|
$542.39
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$98.17 |
| Max. Negotiated Rate |
$444.85 |
| Rate for Payer: Adventist Health Commercial |
$108.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$335.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$414.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$365.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$365.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$353.55
|
| Rate for Payer: Blue Shield of California Commercial |
$422.19
|
| Rate for Payer: Blue Shield of California EPN |
$422.19
|
| Rate for Payer: Cash Price |
$244.08
|
| Rate for Payer: Cash Price |
$244.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$249.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$414.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$365.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$365.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.13
|
| Rate for Payer: EPIC Health Plan Medicare |
$331.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$251.13
|
| Rate for Payer: Heritage Provider Network Senior |
$251.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$331.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$258.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$98.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$381.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$444.85
|
| Rate for Payer: Multiplan Commercial |
$406.79
|
| Rate for Payer: TriValley Medical Group Commercial |
$216.96
|
| Rate for Payer: TriValley Medical Group Senior |
$216.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$195.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$179.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$414.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$365.18
|
| Rate for Payer: Vantage Medical Group Senior |
$365.18
|
|
|
RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP [22120]
|
Facility
|
IP
|
$542.39
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$98.17 |
| Max. Negotiated Rate |
$406.79 |
| Rate for Payer: Adventist Health Commercial |
$108.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$349.30
|
| Rate for Payer: Cash Price |
$244.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$249.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$292.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$251.13
|
| Rate for Payer: Heritage Provider Network Senior |
$251.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$98.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.60
|
| Rate for Payer: Multiplan Commercial |
$406.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$195.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$179.59
|
|
|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION [2851]
|
Facility
|
OP
|
$1.68
|
|
|
Service Code
|
NDC 0487590199
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.82
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.67
|
| Rate for Payer: TriValley Medical Group Senior |
$0.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1.43
|
|
|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION [2851]
|
Facility
|
IP
|
$1.68
|
|
|
Service Code
|
NDC 0487590199
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.08
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.14
|
| Rate for Payer: Heritage Provider Network Senior |
$1.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
|
|
RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF FACE OR SCALP; 2 CM OR GREATER
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 21016
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,735.95 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,735.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,109.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,735.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,735.95
|
| Rate for Payer: Heritage Provider Network Senior |
$4,595.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,735.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,098.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,296.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,006.17
|
| Rate for Payer: Multiplan WC |
$5,794.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,109.55
|
| Rate for Payer: TriValley Medical Group Senior |
$4,109.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,735.95
|
|
|
RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF NECK OR ANTERIOR THORAX; 5 CM OR GREATER
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 21558
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,735.95 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,735.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,109.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,735.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,735.95
|
| Rate for Payer: Heritage Provider Network Senior |
$4,595.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,735.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,098.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,296.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,006.17
|
| Rate for Payer: Multiplan WC |
$5,794.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,109.55
|
| Rate for Payer: TriValley Medical Group Senior |
$4,109.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,735.95
|
|
|
RADIOPAQUE PVC MARKERS-BARIUM SULFATE 24 MARKERS CAPSULE [21381]
|
Facility
|
IP
|
$119.88
|
|
|
Service Code
|
HCPCS A9698
|
| Hospital Charge Code |
901700042
|
|
Hospital Revenue Code
|
254
|
| Min. Negotiated Rate |
$21.70 |
| Max. Negotiated Rate |
$89.91 |
| Rate for Payer: Adventist Health Commercial |
$23.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$77.20
|
| Rate for Payer: Cash Price |
$53.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.16
|
| Rate for Payer: Heritage Provider Network Senior |
$81.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.97
|
| Rate for Payer: Multiplan Commercial |
$89.91
|
|
|
RADIOPAQUE PVC MARKERS-BARIUM SULFATE 24 MARKERS CAPSULE [21381]
|
Facility
|
OP
|
$119.88
|
|
|
Service Code
|
HCPCS A9698
|
| Hospital Charge Code |
901700042
|
|
Hospital Revenue Code
|
254
|
| Min. Negotiated Rate |
$21.70 |
| Max. Negotiated Rate |
$101.90 |
| Rate for Payer: Adventist Health Commercial |
$23.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$89.91
|
| Rate for Payer: Blue Shield of California Commercial |
$73.13
|
| Rate for Payer: Blue Shield of California EPN |
$58.50
|
| Rate for Payer: Cash Price |
$53.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$77.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$101.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$101.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.21
|
| Rate for Payer: Heritage Provider Network Senior |
$74.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$57.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$83.92
|
| Rate for Payer: Multiplan Commercial |
$89.91
|
| Rate for Payer: TriValley Medical Group Commercial |
$47.95
|
| Rate for Payer: TriValley Medical Group Senior |
$47.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$59.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$59.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.90
|
| Rate for Payer: Vantage Medical Group Senior |
$101.90
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$42,307.26
|
|
|
Service Code
|
MSDRG 849
|
| Min. Negotiated Rate |
$31,572.58 |
| Max. Negotiated Rate |
$42,307.26 |
| Rate for Payer: EPIC Health Plan Medicare |
$31,572.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31,572.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36,308.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$42,307.26
|
|
|
RADIUM RA 223 DICHLOR 1,100 KBQ/ML (30 MICROCURIE/ML) INTRAVENOUS SOLN [202157]
|
Facility
|
IP
|
$60,372.00
|
|
|
Service Code
|
HCPCS A9606
|
| Hospital Charge Code |
901700056
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$10,927.33 |
| Max. Negotiated Rate |
$45,279.00 |
| Rate for Payer: Adventist Health Commercial |
$12,074.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38,879.57
|
| Rate for Payer: Cash Price |
$27,167.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,600.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$40,871.84
|
| Rate for Payer: Heritage Provider Network Senior |
$40,871.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,927.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,093.00
|
| Rate for Payer: Multiplan Commercial |
$45,279.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21,812.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19,989.17
|
|
|
RADIUM RA 223 DICHLOR 1,100 KBQ/ML (30 MICROCURIE/ML) INTRAVENOUS SOLN [202157]
|
Facility
|
OP
|
$60,372.00
|
|
|
Service Code
|
HCPCS A9606
|
| Hospital Charge Code |
901700056
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$181.55 |
| Max. Negotiated Rate |
$45,279.00 |
| Rate for Payer: Adventist Health Commercial |
$12,074.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37,309.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$226.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$199.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$199.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$275.93
|
| Rate for Payer: Blue Shield of California Commercial |
$36,826.92
|
| Rate for Payer: Blue Shield of California EPN |
$29,461.54
|
| Rate for Payer: Cash Price |
$27,167.40
|
| Rate for Payer: Cash Price |
$27,167.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39,241.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$226.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$199.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$199.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,638.08
|
| Rate for Payer: EPIC Health Plan Medicare |
$181.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$37,370.27
|
| Rate for Payer: Heritage Provider Network Senior |
$37,370.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$181.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$28,797.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,927.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$208.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,093.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$243.28
|
| Rate for Payer: Multiplan Commercial |
$45,279.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$199.71
|
| Rate for Payer: TriValley Medical Group Senior |
$181.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21,812.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19,989.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$226.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$199.71
|
| Rate for Payer: Vantage Medical Group Senior |
$199.71
|
|
|
RALOXIFENE 60 MG TABLET [22143]
|
Facility
|
OP
|
$0.78
|
|
|
Service Code
|
NDC 4359850530
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.39
|
| Rate for Payer: Blue Shield of California Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California EPN |
$0.38
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.48
|
| Rate for Payer: Heritage Provider Network Senior |
$0.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.31
|
| Rate for Payer: TriValley Medical Group Senior |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: Vantage Medical Group Senior |
$0.66
|
|
|
RALOXIFENE 60 MG TABLET [22143]
|
Facility
|
IP
|
$3.73
|
|
|
Service Code
|
NDC 5026869411
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.40
|
| Rate for Payer: Cash Price |
$1.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.53
|
| Rate for Payer: Heritage Provider Network Senior |
$2.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.93
|
| Rate for Payer: Multiplan Commercial |
$2.80
|
|
|
RALOXIFENE 60 MG TABLET [22143]
|
Facility
|
OP
|
$3.73
|
|
|
Service Code
|
NDC 5026869411
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$3.17 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2.28
|
| Rate for Payer: Blue Shield of California EPN |
$1.82
|
| Rate for Payer: Cash Price |
$1.68
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.31
|
| Rate for Payer: Heritage Provider Network Senior |
$2.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.61
|
| Rate for Payer: Multiplan Commercial |
$2.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.49
|
| Rate for Payer: TriValley Medical Group Senior |
$1.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.17
|
| Rate for Payer: Vantage Medical Group Senior |
$3.17
|
|
|
RALOXIFENE 60 MG TABLET [22143]
|
Facility
|
IP
|
$0.78
|
|
|
Service Code
|
NDC 4359850530
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.50
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.53
|
| Rate for Payer: Heritage Provider Network Senior |
$0.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
|
|
RALOXIFENE 60 MG TABLET [22143]
|
Facility
|
IP
|
$3.73
|
|
|
Service Code
|
NDC 5026869415
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.40
|
| Rate for Payer: Cash Price |
$1.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.53
|
| Rate for Payer: Heritage Provider Network Senior |
$2.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.93
|
| Rate for Payer: Multiplan Commercial |
$2.80
|
|
|
RALOXIFENE 60 MG TABLET [22143]
|
Facility
|
OP
|
$3.73
|
|
|
Service Code
|
NDC 5026869415
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$3.17 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2.28
|
| Rate for Payer: Blue Shield of California EPN |
$1.82
|
| Rate for Payer: Cash Price |
$1.68
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.31
|
| Rate for Payer: Heritage Provider Network Senior |
$2.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.61
|
| Rate for Payer: Multiplan Commercial |
$2.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.49
|
| Rate for Payer: TriValley Medical Group Senior |
$1.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.17
|
| Rate for Payer: Vantage Medical Group Senior |
$3.17
|
|
|
RALTEGRAVIR 400 MG TABLET [88608]
|
Facility
|
OP
|
$42.62
|
|
|
Service Code
|
NDC 0006022761
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.71 |
| Max. Negotiated Rate |
$36.23 |
| Rate for Payer: Adventist Health Commercial |
$8.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.32
|
| Rate for Payer: Blue Shield of California Commercial |
$26.00
|
| Rate for Payer: Blue Shield of California EPN |
$20.80
|
| Rate for Payer: Cash Price |
$19.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.38
|
| Rate for Payer: Heritage Provider Network Senior |
$26.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$20.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.83
|
| Rate for Payer: Multiplan Commercial |
$31.96
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.05
|
| Rate for Payer: TriValley Medical Group Senior |
$17.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.23
|
| Rate for Payer: Vantage Medical Group Senior |
$36.23
|
|
|
RALTEGRAVIR 400 MG TABLET [88608]
|
Facility
|
IP
|
$42.62
|
|
|
Service Code
|
NDC 0006022761
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.71 |
| Max. Negotiated Rate |
$31.96 |
| Rate for Payer: Adventist Health Commercial |
$8.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.45
|
| Rate for Payer: Cash Price |
$19.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.85
|
| Rate for Payer: Heritage Provider Network Senior |
$28.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.65
|
| Rate for Payer: Multiplan Commercial |
$31.96
|
|
|
RAMIPRIL 5 MG CAPSULE [11261]
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
NDC 6586247601
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Senior |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
RAMIPRIL 5 MG CAPSULE [11261]
|
Facility
|
IP
|
$0.24
|
|
|
Service Code
|
NDC 6586247601
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.15
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Senior |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
|
|
RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION [205590]
|
Facility
|
IP
|
$182.80
|
|
|
Service Code
|
HCPCS J9308
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.09 |
| Max. Negotiated Rate |
$137.10 |
| Rate for Payer: Adventist Health Commercial |
$36.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$117.72
|
| Rate for Payer: Cash Price |
$82.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$84.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$84.64
|
| Rate for Payer: Heritage Provider Network Senior |
$84.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.70
|
| Rate for Payer: Multiplan Commercial |
$137.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$66.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$60.53
|
|
|
RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION [205590]
|
Facility
|
OP
|
$182.80
|
|
|
Service Code
|
HCPCS J9308
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.09 |
| Max. Negotiated Rate |
$137.10 |
| Rate for Payer: Adventist Health Commercial |
$36.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$112.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.66
|
| Rate for Payer: Blue Shield of California Commercial |
$74.30
|
| Rate for Payer: Blue Shield of California EPN |
$74.30
|
| Rate for Payer: Cash Price |
$82.26
|
| Rate for Payer: Cash Price |
$82.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$84.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$95.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$84.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.99
|
| Rate for Payer: EPIC Health Plan Medicare |
$76.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$84.64
|
| Rate for Payer: Heritage Provider Network Senior |
$84.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$87.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$102.60
|
| Rate for Payer: Multiplan Commercial |
$137.10
|
| Rate for Payer: TriValley Medical Group Commercial |
$73.12
|
| Rate for Payer: TriValley Medical Group Senior |
$73.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$66.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$60.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$95.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.23
|
| Rate for Payer: Vantage Medical Group Senior |
$84.23
|
|
|
RANOLAZINE ER 1,000 MG TABLET,EXTENDED RELEASE,12 HR [88007]
|
Facility
|
OP
|
$0.34
|
|
|
Service Code
|
NDC 4229177460
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.21
|
| Rate for Payer: Heritage Provider Network Senior |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Vantage Medical Group Senior |
$0.29
|
|
|
RANOLAZINE ER 1,000 MG TABLET,EXTENDED RELEASE,12 HR [88007]
|
Facility
|
IP
|
$0.34
|
|
|
Service Code
|
NDC 4229177460
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.22
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.23
|
| Rate for Payer: Heritage Provider Network Senior |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
|
