|
RANOLAZINE ER 1,000 MG TABLET,EXTENDED RELEASE,12 HR [88007]
|
Facility
|
OP
|
$0.56
|
|
|
Service Code
|
NDC 2724112602
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.28
|
| Rate for Payer: Blue Shield of California Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.35
|
| Rate for Payer: Heritage Provider Network Senior |
$0.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$0.42
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.22
|
| Rate for Payer: TriValley Medical Group Senior |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
|
|
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
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR [70434]
|
Facility
|
IP
|
$0.35
|
|
|
Service Code
|
NDC 2724112502
|
| 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 |
$0.23
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.24
|
| Rate for Payer: Heritage Provider Network Senior |
$0.24
|
| 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
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR [70434]
|
Facility
|
IP
|
$1.68
|
|
|
Service Code
|
NDC 6068754911
|
| 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
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR [70434]
|
Facility
|
OP
|
$0.35
|
|
|
Service Code
|
NDC 2724112502
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.30
|
| 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 |
$0.18
|
| 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 |
$0.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Senior |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.17
|
| 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 |
$0.25
|
| 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 |
$0.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Vantage Medical Group Senior |
$0.30
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR [70434]
|
Facility
|
OP
|
$1.68
|
|
|
Service Code
|
NDC 6068754911
|
| 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
|
|
|
RASAGILINE 0.5 MG TABLET [76480]
|
Facility
|
IP
|
$8.25
|
|
|
Service Code
|
NDC 0093306056
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$6.19 |
| Rate for Payer: Adventist Health Commercial |
$1.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.31
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.59
|
| Rate for Payer: Heritage Provider Network Senior |
$5.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.06
|
| Rate for Payer: Multiplan Commercial |
$6.19
|
|
|
RASAGILINE 0.5 MG TABLET [76480]
|
Facility
|
OP
|
$17.80
|
|
|
Service Code
|
NDC 4778168330
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$15.13 |
| Rate for Payer: Adventist Health Commercial |
$3.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.90
|
| Rate for Payer: Blue Shield of California Commercial |
$10.86
|
| Rate for Payer: Blue Shield of California EPN |
$8.69
|
| Rate for Payer: Cash Price |
$8.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.02
|
| Rate for Payer: Heritage Provider Network Senior |
$11.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$13.35
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.12
|
| Rate for Payer: TriValley Medical Group Senior |
$7.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.13
|
| Rate for Payer: Vantage Medical Group Senior |
$15.13
|
|
|
RASAGILINE 0.5 MG TABLET [76480]
|
Facility
|
OP
|
$8.25
|
|
|
Service Code
|
NDC 0093306056
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$7.01 |
| Rate for Payer: Adventist Health Commercial |
$1.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.13
|
| Rate for Payer: Blue Shield of California Commercial |
$5.03
|
| Rate for Payer: Blue Shield of California EPN |
$4.03
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.11
|
| Rate for Payer: Heritage Provider Network Senior |
$5.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.78
|
| Rate for Payer: Multiplan Commercial |
$6.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.30
|
| Rate for Payer: TriValley Medical Group Senior |
$3.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.01
|
| Rate for Payer: Vantage Medical Group Senior |
$7.01
|
|
|
RASAGILINE 0.5 MG TABLET [76480]
|
Facility
|
IP
|
$3.44
|
|
|
Service Code
|
NDC 2315574603
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.58 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.22
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.33
|
| Rate for Payer: Heritage Provider Network Senior |
$2.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$2.58
|
|
|
RASAGILINE 0.5 MG TABLET [76480]
|
Facility
|
IP
|
$17.80
|
|
|
Service Code
|
NDC 4778168330
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$13.35 |
| Rate for Payer: Adventist Health Commercial |
$3.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.46
|
| Rate for Payer: Cash Price |
$8.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.05
|
| Rate for Payer: Heritage Provider Network Senior |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.45
|
| Rate for Payer: Multiplan Commercial |
$13.35
|
|
|
RASAGILINE 0.5 MG TABLET [76480]
|
Facility
|
OP
|
$3.44
|
|
|
Service Code
|
NDC 2315574603
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.72
|
| Rate for Payer: Blue Shield of California Commercial |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$1.68
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.13
|
| Rate for Payer: Heritage Provider Network Senior |
$2.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.41
|
| Rate for Payer: Multiplan Commercial |
$2.58
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.38
|
| Rate for Payer: TriValley Medical Group Senior |
$1.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.92
|
| Rate for Payer: Vantage Medical Group Senior |
$2.92
|
|
|
RASAGILINE 1 MG TABLET [76481]
|
Facility
|
IP
|
$3.44
|
|
|
Service Code
|
NDC 2315574703
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.58 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.22
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.33
|
| Rate for Payer: Heritage Provider Network Senior |
$2.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$2.58
|
|
|
RASAGILINE 1 MG TABLET [76481]
|
Facility
|
OP
|
$3.44
|
|
|
Service Code
|
NDC 2315574703
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.72
|
| Rate for Payer: Blue Shield of California Commercial |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$1.68
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.13
|
| Rate for Payer: Heritage Provider Network Senior |
$2.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.41
|
| Rate for Payer: Multiplan Commercial |
$2.58
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.38
|
| Rate for Payer: TriValley Medical Group Senior |
$1.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.92
|
| Rate for Payer: Vantage Medical Group Senior |
$2.92
|
|
|
RASAGILINE 1 MG TABLET [76481]
|
Facility
|
IP
|
$17.80
|
|
|
Service Code
|
NDC 4778169030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$13.35 |
| Rate for Payer: Adventist Health Commercial |
$3.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.46
|
| Rate for Payer: Cash Price |
$8.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.05
|
| Rate for Payer: Heritage Provider Network Senior |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.45
|
| Rate for Payer: Multiplan Commercial |
$13.35
|
|
|
RASAGILINE 1 MG TABLET [76481]
|
Facility
|
OP
|
$17.80
|
|
|
Service Code
|
NDC 4778169030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$15.13 |
| Rate for Payer: Adventist Health Commercial |
$3.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.90
|
| Rate for Payer: Blue Shield of California Commercial |
$10.86
|
| Rate for Payer: Blue Shield of California EPN |
$8.69
|
| Rate for Payer: Cash Price |
$8.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.02
|
| Rate for Payer: Heritage Provider Network Senior |
$11.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$13.35
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.12
|
| Rate for Payer: TriValley Medical Group Senior |
$7.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.13
|
| Rate for Payer: Vantage Medical Group Senior |
$15.13
|
|
|
RASAGILINE 1 MG TABLET [76481]
|
Facility
|
OP
|
$54.75
|
|
|
Service Code
|
NDC 6854622956
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.91 |
| Max. Negotiated Rate |
$46.54 |
| Rate for Payer: Adventist Health Commercial |
$10.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.39
|
| Rate for Payer: Blue Shield of California Commercial |
$33.40
|
| Rate for Payer: Blue Shield of California EPN |
$26.72
|
| Rate for Payer: Cash Price |
$24.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$46.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.89
|
| Rate for Payer: Heritage Provider Network Senior |
$33.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$26.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$38.33
|
| Rate for Payer: Multiplan Commercial |
$41.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.90
|
| Rate for Payer: TriValley Medical Group Senior |
$21.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.54
|
| Rate for Payer: Vantage Medical Group Senior |
$46.54
|
|
|
RASAGILINE 1 MG TABLET [76481]
|
Facility
|
OP
|
$8.25
|
|
|
Service Code
|
NDC 0093306156
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$7.01 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.10
|
| Rate for Payer: Adventist Health Commercial |
$1.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.13
|
| Rate for Payer: Blue Shield of California Commercial |
$5.03
|
| Rate for Payer: Blue Shield of California EPN |
$4.03
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.11
|
| Rate for Payer: Heritage Provider Network Senior |
$5.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.78
|
| Rate for Payer: Multiplan Commercial |
$6.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.30
|
| Rate for Payer: TriValley Medical Group Senior |
$3.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.01
|
| Rate for Payer: Vantage Medical Group Senior |
$7.01
|
|
|
RASAGILINE 1 MG TABLET [76481]
|
Facility
|
IP
|
$54.75
|
|
|
Service Code
|
NDC 6854622956
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.91 |
| Max. Negotiated Rate |
$41.06 |
| Rate for Payer: Adventist Health Commercial |
$10.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.26
|
| Rate for Payer: Cash Price |
$24.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.07
|
| Rate for Payer: Heritage Provider Network Senior |
$37.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.69
|
| Rate for Payer: Multiplan Commercial |
$41.06
|
|
|
RASAGILINE 1 MG TABLET [76481]
|
Facility
|
IP
|
$8.25
|
|
|
Service Code
|
NDC 0093306156
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$6.19 |
| Rate for Payer: Adventist Health Commercial |
$1.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.31
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.59
|
| Rate for Payer: Heritage Provider Network Senior |
$5.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.06
|
| Rate for Payer: Multiplan Commercial |
$6.19
|
|
|
RASBURICASE 1.5 MG INTRAVENOUS SOLUTION [33591]
|
Facility
|
OP
|
$1,341.68
|
|
|
Service Code
|
HCPCS J2783
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$242.84 |
| Max. Negotiated Rate |
$1,006.26 |
| Rate for Payer: Adventist Health Commercial |
$268.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$829.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$484.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$426.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$426.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$250.92
|
| Rate for Payer: Blue Shield of California Commercial |
$365.34
|
| Rate for Payer: Blue Shield of California EPN |
$365.34
|
| Rate for Payer: Cash Price |
$603.76
|
| Rate for Payer: Cash Price |
$603.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$617.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$484.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$426.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$426.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$858.68
|
| Rate for Payer: EPIC Health Plan Medicare |
$387.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$621.20
|
| Rate for Payer: Heritage Provider Network Senior |
$621.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$387.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$639.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$242.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$445.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$335.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$519.18
|
| Rate for Payer: Multiplan Commercial |
$1,006.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$536.67
|
| Rate for Payer: TriValley Medical Group Senior |
$536.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$484.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$444.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$484.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$426.19
|
| Rate for Payer: Vantage Medical Group Senior |
$426.19
|
|
|
RASBURICASE 1.5 MG INTRAVENOUS SOLUTION [33591]
|
Facility
|
IP
|
$1,341.68
|
|
|
Service Code
|
HCPCS J2783
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$242.84 |
| Max. Negotiated Rate |
$1,006.26 |
| Rate for Payer: Adventist Health Commercial |
$268.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$864.04
|
| Rate for Payer: Cash Price |
$603.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$617.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$724.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$621.20
|
| Rate for Payer: Heritage Provider Network Senior |
$621.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$242.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$335.42
|
| Rate for Payer: Multiplan Commercial |
$1,006.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$484.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$444.23
|
|
|
RAVULIZUMAB-CWVZ 100 MG/ML INTRAVENOUS SOLUTION [229668]
|
Facility
|
OP
|
$2,678.15
|
|
|
Service Code
|
HCPCS J1303
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$217.74 |
| Max. Negotiated Rate |
$2,008.61 |
| Rate for Payer: Adventist Health Commercial |
$535.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,655.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$283.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$249.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$249.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$517.47
|
| Rate for Payer: Blue Shield of California Commercial |
$217.74
|
| Rate for Payer: Blue Shield of California EPN |
$217.74
|
| Rate for Payer: Cash Price |
$1,205.17
|
| Rate for Payer: Cash Price |
$1,205.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,231.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$283.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$249.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$249.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,714.02
|
| Rate for Payer: EPIC Health Plan Medicare |
$226.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,239.98
|
| Rate for Payer: Heritage Provider Network Senior |
$1,239.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,277.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$484.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$260.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$669.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$304.07
|
| Rate for Payer: Multiplan Commercial |
$2,008.61
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,071.26
|
| Rate for Payer: TriValley Medical Group Senior |
$1,071.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$967.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$886.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$283.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$249.61
|
| Rate for Payer: Vantage Medical Group Senior |
$249.61
|
|
|
RAVULIZUMAB-CWVZ 100 MG/ML INTRAVENOUS SOLUTION [229668]
|
Facility
|
IP
|
$2,678.15
|
|
|
Service Code
|
HCPCS J1303
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$484.75 |
| Max. Negotiated Rate |
$2,008.61 |
| Rate for Payer: Adventist Health Commercial |
$535.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,724.73
|
| Rate for Payer: Cash Price |
$1,205.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,231.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,446.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,239.98
|
| Rate for Payer: Heritage Provider Network Senior |
$1,239.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$484.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$669.54
|
| Rate for Payer: Multiplan Commercial |
$2,008.61
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$967.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$886.74
|
|
|
RECONSTRUCTION, ANGULAR DEFORMITY OF TOE, SOFT TISSUE PROCEDURES ONLY (EG, OVERLAPPING SECOND TOE, FIFTH TOE, CURLY TOES)
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 28313
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,208.34 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| 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 |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,208.34
|
| Rate for Payer: Heritage Provider Network Senior |
$5,176.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,995.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,839.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,629.17
|
| Rate for Payer: TriValley Medical Group Senior |
$4,629.17
|
| 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 |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
