|
RITUXIMAB 1,600 MG/13.4 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN [218821]
|
Facility
|
IP
|
$673.08
|
|
|
Service Code
|
HCPCS J9311
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$121.83 |
| Max. Negotiated Rate |
$504.81 |
| Rate for Payer: Adventist Health Commercial |
$134.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$433.46
|
| Rate for Payer: Cash Price |
$302.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$309.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$363.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$311.64
|
| Rate for Payer: Heritage Provider Network Senior |
$311.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$121.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.27
|
| Rate for Payer: Multiplan Commercial |
$504.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$243.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$222.86
|
|
|
RITUXIMAB-ARRX 10 MG/ML INTRAVENOUS SOLUTION [229898]
|
Facility
|
IP
|
$86.02
|
|
|
Service Code
|
HCPCS Q5123
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$64.52 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$55.40
|
| Rate for Payer: Cash Price |
$38.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.83
|
| Rate for Payer: Heritage Provider Network Senior |
$39.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.50
|
| Rate for Payer: Multiplan Commercial |
$64.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.48
|
|
|
RITUXIMAB-ARRX 10 MG/ML INTRAVENOUS SOLUTION [229898]
|
Facility
|
OP
|
$86.02
|
|
|
Service Code
|
HCPCS Q5123
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$173.78 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$173.78
|
| Rate for Payer: Blue Shield of California Commercial |
$73.12
|
| Rate for Payer: Blue Shield of California EPN |
$73.12
|
| Rate for Payer: Cash Price |
$38.71
|
| Rate for Payer: Cash Price |
$38.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.83
|
| Rate for Payer: Heritage Provider Network Senior |
$39.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$41.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.83
|
| Rate for Payer: Multiplan Commercial |
$64.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$34.41
|
| Rate for Payer: TriValley Medical Group Senior |
$34.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.38
|
| Rate for Payer: Vantage Medical Group Senior |
$20.38
|
|
|
RITUXIMAB-PVVR 10 MG/ML INTRAVENOUS SOLUTION [226878]
|
Facility
|
IP
|
$86.02
|
|
|
Service Code
|
HCPCS Q5119
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$64.52 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$55.40
|
| Rate for Payer: Cash Price |
$38.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.83
|
| Rate for Payer: Heritage Provider Network Senior |
$39.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.50
|
| Rate for Payer: Multiplan Commercial |
$64.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.48
|
|
|
RITUXIMAB-PVVR 10 MG/ML INTRAVENOUS SOLUTION [226878]
|
Facility
|
OP
|
$86.02
|
|
|
Service Code
|
HCPCS Q5119
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$173.78 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$173.78
|
| Rate for Payer: Blue Shield of California Commercial |
$73.12
|
| Rate for Payer: Blue Shield of California EPN |
$73.12
|
| Rate for Payer: Cash Price |
$38.71
|
| Rate for Payer: Cash Price |
$38.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.83
|
| Rate for Payer: Heritage Provider Network Senior |
$39.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$41.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.65
|
| Rate for Payer: Multiplan Commercial |
$64.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$34.41
|
| Rate for Payer: TriValley Medical Group Senior |
$34.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.78
|
| Rate for Payer: Vantage Medical Group Senior |
$17.78
|
|
|
RIVAROXABAN 10 MG TABLET [153876]
|
Facility
|
OP
|
$24.47
|
|
|
Service Code
|
NDC 5045858030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$20.80 |
| Rate for Payer: Adventist Health Commercial |
$4.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.24
|
| Rate for Payer: Blue Shield of California Commercial |
$14.93
|
| Rate for Payer: Blue Shield of California EPN |
$11.94
|
| Rate for Payer: Cash Price |
$11.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.15
|
| Rate for Payer: Heritage Provider Network Senior |
$15.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.13
|
| Rate for Payer: Multiplan Commercial |
$18.35
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.79
|
| Rate for Payer: TriValley Medical Group Senior |
$9.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.80
|
| Rate for Payer: Vantage Medical Group Senior |
$20.80
|
|
|
RIVAROXABAN 10 MG TABLET [153876]
|
Facility
|
IP
|
$24.47
|
|
|
Service Code
|
NDC 5045858030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$18.35 |
| Rate for Payer: Adventist Health Commercial |
$4.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.76
|
| Rate for Payer: Cash Price |
$11.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.57
|
| Rate for Payer: Heritage Provider Network Senior |
$16.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.12
|
| Rate for Payer: Multiplan Commercial |
$18.35
|
|
|
RIVAROXABAN 15 MG TABLET [153877]
|
Facility
|
OP
|
$24.47
|
|
|
Service Code
|
NDC 5045857810
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$20.80 |
| Rate for Payer: Adventist Health Commercial |
$4.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.24
|
| Rate for Payer: Blue Shield of California Commercial |
$14.93
|
| Rate for Payer: Blue Shield of California EPN |
$11.94
|
| Rate for Payer: Cash Price |
$11.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.15
|
| Rate for Payer: Heritage Provider Network Senior |
$15.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.13
|
| Rate for Payer: Multiplan Commercial |
$18.35
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.79
|
| Rate for Payer: TriValley Medical Group Senior |
$9.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.80
|
| Rate for Payer: Vantage Medical Group Senior |
$20.80
|
|
|
RIVAROXABAN 15 MG TABLET [153877]
|
Facility
|
IP
|
$24.47
|
|
|
Service Code
|
NDC 5045857810
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$18.35 |
| Rate for Payer: Adventist Health Commercial |
$4.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.76
|
| Rate for Payer: Cash Price |
$11.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.57
|
| Rate for Payer: Heritage Provider Network Senior |
$16.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.12
|
| Rate for Payer: Multiplan Commercial |
$18.35
|
|
|
RIVAROXABAN 15 MG TABLET [153877]
|
Facility
|
IP
|
$24.47
|
|
|
Service Code
|
NDC 5045857801
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$18.35 |
| Rate for Payer: Adventist Health Commercial |
$4.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.76
|
| Rate for Payer: Cash Price |
$11.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.57
|
| Rate for Payer: Heritage Provider Network Senior |
$16.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.12
|
| Rate for Payer: Multiplan Commercial |
$18.35
|
|
|
RIVAROXABAN 15 MG TABLET [153877]
|
Facility
|
OP
|
$24.47
|
|
|
Service Code
|
NDC 5045857801
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$20.80 |
| Rate for Payer: Adventist Health Commercial |
$4.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.24
|
| Rate for Payer: Blue Shield of California Commercial |
$14.93
|
| Rate for Payer: Blue Shield of California EPN |
$11.94
|
| Rate for Payer: Cash Price |
$11.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.15
|
| Rate for Payer: Heritage Provider Network Senior |
$15.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.13
|
| Rate for Payer: Multiplan Commercial |
$18.35
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.79
|
| Rate for Payer: TriValley Medical Group Senior |
$9.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.80
|
| Rate for Payer: Vantage Medical Group Senior |
$20.80
|
|
|
RIVAROXABAN 20 MG TABLET [153878]
|
Facility
|
OP
|
$24.47
|
|
|
Service Code
|
NDC 5045857910
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$20.80 |
| Rate for Payer: Adventist Health Commercial |
$4.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.24
|
| Rate for Payer: Blue Shield of California Commercial |
$14.93
|
| Rate for Payer: Blue Shield of California EPN |
$11.94
|
| Rate for Payer: Cash Price |
$11.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.15
|
| Rate for Payer: Heritage Provider Network Senior |
$15.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.13
|
| Rate for Payer: Multiplan Commercial |
$18.35
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.79
|
| Rate for Payer: TriValley Medical Group Senior |
$9.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.80
|
| Rate for Payer: Vantage Medical Group Senior |
$20.80
|
|
|
RIVAROXABAN 20 MG TABLET [153878]
|
Facility
|
OP
|
$24.47
|
|
|
Service Code
|
NDC 5045857930
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$20.80 |
| Rate for Payer: Adventist Health Commercial |
$4.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.24
|
| Rate for Payer: Blue Shield of California Commercial |
$14.93
|
| Rate for Payer: Blue Shield of California EPN |
$11.94
|
| Rate for Payer: Cash Price |
$11.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.15
|
| Rate for Payer: Heritage Provider Network Senior |
$15.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.13
|
| Rate for Payer: Multiplan Commercial |
$18.35
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.79
|
| Rate for Payer: TriValley Medical Group Senior |
$9.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.80
|
| Rate for Payer: Vantage Medical Group Senior |
$20.80
|
|
|
RIVAROXABAN 20 MG TABLET [153878]
|
Facility
|
IP
|
$24.47
|
|
|
Service Code
|
NDC 5045857930
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$18.35 |
| Rate for Payer: Adventist Health Commercial |
$4.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.76
|
| Rate for Payer: Cash Price |
$11.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.57
|
| Rate for Payer: Heritage Provider Network Senior |
$16.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.12
|
| Rate for Payer: Multiplan Commercial |
$18.35
|
|
|
RIVAROXABAN 20 MG TABLET [153878]
|
Facility
|
IP
|
$24.47
|
|
|
Service Code
|
NDC 5045857910
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$18.35 |
| Rate for Payer: Adventist Health Commercial |
$4.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.76
|
| Rate for Payer: Cash Price |
$11.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.57
|
| Rate for Payer: Heritage Provider Network Senior |
$16.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.12
|
| Rate for Payer: Multiplan Commercial |
$18.35
|
|
|
RIVAROXABAN 2.5 MG TABLET [222768]
|
Facility
|
IP
|
$12.24
|
|
|
Service Code
|
NDC 5045857760
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: Adventist Health Commercial |
$2.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.88
|
| Rate for Payer: Cash Price |
$5.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.29
|
| Rate for Payer: Heritage Provider Network Senior |
$8.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.06
|
| Rate for Payer: Multiplan Commercial |
$9.18
|
|
|
RIVAROXABAN 2.5 MG TABLET [222768]
|
Facility
|
OP
|
$1.70
|
|
|
Service Code
|
NDC 6818070906
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.45 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.83
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.05
|
| Rate for Payer: Heritage Provider Network Senior |
$1.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.19
|
| Rate for Payer: Multiplan Commercial |
$1.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.68
|
| Rate for Payer: TriValley Medical Group Senior |
$0.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1.45
|
|
|
RIVAROXABAN 2.5 MG TABLET [222768]
|
Facility
|
IP
|
$1.70
|
|
|
Service Code
|
NDC 6818070906
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.27 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.09
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.15
|
| Rate for Payer: Heritage Provider Network Senior |
$1.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$1.27
|
|
|
RIVAROXABAN 2.5 MG TABLET [222768]
|
Facility
|
OP
|
$12.24
|
|
|
Service Code
|
NDC 5045857760
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.40
|
| Rate for Payer: Adventist Health Commercial |
$2.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.12
|
| Rate for Payer: Blue Shield of California Commercial |
$7.47
|
| Rate for Payer: Blue Shield of California EPN |
$5.97
|
| Rate for Payer: Cash Price |
$5.51
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.58
|
| Rate for Payer: Heritage Provider Network Senior |
$7.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.57
|
| Rate for Payer: Multiplan Commercial |
$9.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.90
|
| Rate for Payer: TriValley Medical Group Senior |
$4.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.40
|
| Rate for Payer: Vantage Medical Group Senior |
$10.40
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 0378907093
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.29
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.35
|
| Rate for Payer: Heritage Provider Network Senior |
$1.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 0378907016
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.29
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.35
|
| Rate for Payer: Heritage Provider Network Senior |
$1.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
NDC 0378907093
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.98
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.24
|
| Rate for Payer: Heritage Provider Network Senior |
$1.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.40
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.80
|
| Rate for Payer: TriValley Medical Group Senior |
$0.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1.70
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
NDC 0378907016
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.98
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.24
|
| Rate for Payer: Heritage Provider Network Senior |
$1.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.40
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.80
|
| Rate for Payer: TriValley Medical Group Senior |
$0.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1.70
|
|
|
RIZATRIPTAN 10 MG TABLET [23377]
|
Facility
|
OP
|
$1.80
|
|
|
Service Code
|
NDC 0093747219
|
| 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 Non-Gatekeeper |
$1.11
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$0.90
|
| 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 |
$0.81
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$0.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
|
|
RIZATRIPTAN 10 MG TABLET [23377]
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
NDC 6586260003
|
| 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: Aetna of CA Non-Gatekeeper |
$1.16
|
| Rate for Payer: Cash Price |
$0.81
|
| 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 Foundation Hospitals Medi-Cal |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.35
|
|
