|
RIZATRIPTAN 10 MG TABLET [23377]
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
NDC 0093747219
|
| 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
|
|
|
RIZATRIPTAN 10 MG TABLET [23377]
|
Facility
|
OP
|
$1.19
|
|
|
Service Code
|
NDC 5723708863
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$1.01 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.60
|
| Rate for Payer: Blue Shield of California Commercial |
$0.73
|
| Rate for Payer: Blue Shield of California EPN |
$0.58
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.74
|
| Rate for Payer: Heritage Provider Network Senior |
$0.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.83
|
| Rate for Payer: Multiplan Commercial |
$0.89
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.48
|
| Rate for Payer: TriValley Medical Group Senior |
$0.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.01
|
| Rate for Payer: Vantage Medical Group Senior |
$1.01
|
|
|
RIZATRIPTAN 10 MG TABLET [23377]
|
Facility
|
OP
|
$1.80
|
|
|
Service Code
|
NDC 6586260012
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.53 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.11
|
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| 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
|
OP
|
$1.80
|
|
|
Service Code
|
NDC 6586260003
|
| 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
|
$1.19
|
|
|
Service Code
|
NDC 5723708863
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.89 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.77
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.81
|
| Rate for Payer: Heritage Provider Network Senior |
$0.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$0.89
|
|
|
RIZATRIPTAN 10 MG TABLET [23377]
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
NDC 6586260012
|
| 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
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION [95812]
|
Facility
|
IP
|
$1.81
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.36 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Adventist Health Commercial |
$0.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.32
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.23
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.44
|
| Rate for Payer: Heritage Provider Network Senior |
$0.44
|
| Rate for Payer: Heritage Provider Network Senior |
$0.23
|
| Rate for Payer: Heritage Provider Network Senior |
$0.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.36
|
| Rate for Payer: Multiplan Commercial |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$0.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.65
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.32
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION [95812]
|
Facility
|
OP
|
$0.50
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Adventist Health Commercial |
$0.19
|
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.72
|
| Rate for Payer: Blue Shield of California Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California Commercial |
$1.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.59
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.47
|
| Rate for Payer: Blue Shield of California EPN |
$0.88
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.23
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.84
|
| Rate for Payer: Heritage Provider Network Senior |
$0.44
|
| Rate for Payer: Heritage Provider Network Senior |
$0.23
|
| Rate for Payer: Heritage Provider Network Senior |
$0.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.67
|
| Rate for Payer: Multiplan Commercial |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$1.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.72
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.38
|
| Rate for Payer: TriValley Medical Group Senior |
$0.38
|
| Rate for Payer: TriValley Medical Group Senior |
$0.72
|
| Rate for Payer: TriValley Medical Group Senior |
$0.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.54
|
| Rate for Payer: Vantage Medical Group Senior |
$1.54
|
| Rate for Payer: Vantage Medical Group Senior |
$0.43
|
| Rate for Payer: Vantage Medical Group Senior |
$0.82
|
|
|
ROCURONIUM 50 MG/5 ML VIAL- CODE [40895812]
|
Facility
|
IP
|
$1.16
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.87 |
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.75
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.54
|
| Rate for Payer: Heritage Provider Network Senior |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.38
|
|
|
ROCURONIUM 50 MG/5 ML VIAL- CODE [40895812]
|
Facility
|
OP
|
$1.16
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.87
|
| Rate for Payer: Blue Shield of California Commercial |
$0.71
|
| Rate for Payer: Blue Shield of California EPN |
$0.57
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.54
|
| Rate for Payer: Heritage Provider Network Senior |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.81
|
| Rate for Payer: Multiplan Commercial |
$0.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.46
|
| Rate for Payer: TriValley Medical Group Senior |
$0.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: Vantage Medical Group Senior |
$0.99
|
|
|
ROFLUMILAST 500 MCG TABLET [109401]
|
Facility
|
OP
|
$0.72
|
|
|
Service Code
|
NDC 7220520030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.45
|
| Rate for Payer: Heritage Provider Network Senior |
$0.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Senior |
$0.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.61
|
| Rate for Payer: Vantage Medical Group Senior |
$0.61
|
|
|
ROFLUMILAST 500 MCG TABLET [109401]
|
Facility
|
IP
|
$0.72
|
|
|
Service Code
|
NDC 7220520030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.46
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.49
|
| Rate for Payer: Heritage Provider Network Senior |
$0.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
|
|
ROFLUMILAST 500 MCG TABLET [109401]
|
Facility
|
OP
|
$18.83
|
|
|
Service Code
|
NDC 0310009530
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$16.01 |
| Rate for Payer: Adventist Health Commercial |
$3.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.42
|
| Rate for Payer: Blue Shield of California Commercial |
$11.49
|
| Rate for Payer: Blue Shield of California EPN |
$9.19
|
| Rate for Payer: Cash Price |
$8.47
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.66
|
| Rate for Payer: Heritage Provider Network Senior |
$11.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.18
|
| Rate for Payer: Multiplan Commercial |
$14.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.53
|
| Rate for Payer: TriValley Medical Group Senior |
$7.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.01
|
| Rate for Payer: Vantage Medical Group Senior |
$16.01
|
|
|
ROFLUMILAST 500 MCG TABLET [109401]
|
Facility
|
IP
|
$18.83
|
|
|
Service Code
|
NDC 0310009530
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$14.12 |
| Rate for Payer: Adventist Health Commercial |
$3.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.13
|
| Rate for Payer: Cash Price |
$8.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.75
|
| Rate for Payer: Heritage Provider Network Senior |
$12.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.71
|
| Rate for Payer: Multiplan Commercial |
$14.12
|
|
|
ROMIDEPSIN 10 MG/2 ML INTRAVENOUS POWDER FOR SOLUTION [100344]
|
Facility
|
IP
|
$3,838.38
|
|
|
Service Code
|
HCPCS J9319
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$694.75 |
| Max. Negotiated Rate |
$2,878.78 |
| Rate for Payer: Adventist Health Commercial |
$767.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,471.92
|
| Rate for Payer: Cash Price |
$1,727.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,765.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,072.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,777.17
|
| Rate for Payer: Heritage Provider Network Senior |
$1,777.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$694.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$959.60
|
| Rate for Payer: Multiplan Commercial |
$2,878.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,386.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,270.89
|
|
|
ROMIDEPSIN 10 MG/2 ML INTRAVENOUS POWDER FOR SOLUTION [100344]
|
Facility
|
OP
|
$3,838.38
|
|
|
Service Code
|
HCPCS J9319
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.71 |
| Max. Negotiated Rate |
$2,878.78 |
| Rate for Payer: Adventist Health Commercial |
$767.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,372.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.46
|
| Rate for Payer: Blue Shield of California Commercial |
$32.32
|
| Rate for Payer: Blue Shield of California EPN |
$32.32
|
| Rate for Payer: Cash Price |
$1,727.27
|
| Rate for Payer: Cash Price |
$1,727.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,765.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,456.56
|
| Rate for Payer: EPIC Health Plan Medicare |
$30.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,777.17
|
| Rate for Payer: Heritage Provider Network Senior |
$1,777.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$30.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,830.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$694.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$959.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$41.15
|
| Rate for Payer: Multiplan Commercial |
$2,878.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,535.35
|
| Rate for Payer: TriValley Medical Group Senior |
$1,535.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,386.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,270.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.78
|
| Rate for Payer: Vantage Medical Group Senior |
$33.78
|
|
|
ROMIPLOSTIM 125 MCG SUBCUTANEOUS SOLUTION [226462]
|
Facility
|
OP
|
$1,734.43
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$1,300.82 |
| Rate for Payer: Adventist Health Commercial |
$346.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,071.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.45
|
| Rate for Payer: Blue Shield of California Commercial |
$10.70
|
| Rate for Payer: Blue Shield of California EPN |
$10.70
|
| Rate for Payer: Cash Price |
$780.49
|
| Rate for Payer: Cash Price |
$780.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$797.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,110.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$803.04
|
| Rate for Payer: Heritage Provider Network Senior |
$803.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$827.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$313.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$433.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.57
|
| Rate for Payer: Multiplan Commercial |
$1,300.82
|
| Rate for Payer: TriValley Medical Group Commercial |
$693.77
|
| Rate for Payer: TriValley Medical Group Senior |
$693.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$574.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.78
|
| Rate for Payer: Vantage Medical Group Senior |
$12.78
|
|
|
ROMIPLOSTIM 125 MCG SUBCUTANEOUS SOLUTION [226462]
|
Facility
|
IP
|
$1,734.43
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$313.93 |
| Max. Negotiated Rate |
$1,300.82 |
| Rate for Payer: Adventist Health Commercial |
$346.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,116.97
|
| Rate for Payer: Cash Price |
$780.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$797.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$803.04
|
| Rate for Payer: Heritage Provider Network Senior |
$803.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$313.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$433.61
|
| Rate for Payer: Multiplan Commercial |
$1,300.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$574.27
|
|
|
ROMIPLOSTIM 250 MCG SUBCUTANEOUS SOLUTION [93566]
|
Facility
|
IP
|
$3,468.80
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$627.85 |
| Max. Negotiated Rate |
$2,601.60 |
| Rate for Payer: Adventist Health Commercial |
$693.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,233.91
|
| Rate for Payer: Cash Price |
$1,560.96
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,595.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,873.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,606.05
|
| Rate for Payer: Heritage Provider Network Senior |
$1,606.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$627.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$867.20
|
| Rate for Payer: Multiplan Commercial |
$2,601.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,253.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,148.52
|
|
|
ROMIPLOSTIM 250 MCG SUBCUTANEOUS SOLUTION [93566]
|
Facility
|
OP
|
$3,468.80
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$2,601.60 |
| Rate for Payer: Adventist Health Commercial |
$693.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,143.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.45
|
| Rate for Payer: Blue Shield of California Commercial |
$10.70
|
| Rate for Payer: Blue Shield of California EPN |
$10.70
|
| Rate for Payer: Cash Price |
$1,560.96
|
| Rate for Payer: Cash Price |
$1,560.96
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,595.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,220.03
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,606.05
|
| Rate for Payer: Heritage Provider Network Senior |
$1,606.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,654.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$627.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$867.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.57
|
| Rate for Payer: Multiplan Commercial |
$2,601.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,387.52
|
| Rate for Payer: TriValley Medical Group Senior |
$1,387.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,253.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,148.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.78
|
| Rate for Payer: Vantage Medical Group Senior |
$12.78
|
|
|
ROMIPLOSTIM 500 MCG SUBCUTANEOUS SOLUTION [93567]
|
Facility
|
OP
|
$6,937.58
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$5,203.19 |
| Rate for Payer: Adventist Health Commercial |
$1,387.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,287.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.45
|
| Rate for Payer: Blue Shield of California Commercial |
$10.70
|
| Rate for Payer: Blue Shield of California EPN |
$10.70
|
| Rate for Payer: Cash Price |
$3,121.91
|
| Rate for Payer: Cash Price |
$3,121.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,191.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,440.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,212.10
|
| Rate for Payer: Heritage Provider Network Senior |
$3,212.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,309.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,255.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,734.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.57
|
| Rate for Payer: Multiplan Commercial |
$5,203.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,775.03
|
| Rate for Payer: TriValley Medical Group Senior |
$2,775.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,506.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,297.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.78
|
| Rate for Payer: Vantage Medical Group Senior |
$12.78
|
|
|
ROMIPLOSTIM 500 MCG SUBCUTANEOUS SOLUTION [93567]
|
Facility
|
IP
|
$6,937.58
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,255.70 |
| Max. Negotiated Rate |
$5,203.19 |
| Rate for Payer: Adventist Health Commercial |
$1,387.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,467.80
|
| Rate for Payer: Cash Price |
$3,121.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,191.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,746.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,212.10
|
| Rate for Payer: Heritage Provider Network Senior |
$3,212.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,255.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,734.39
|
| Rate for Payer: Multiplan Commercial |
$5,203.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,506.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,297.03
|
|
|
ROPINIROLE 0.25 MG TABLET [21688]
|
Facility
|
IP
|
$0.66
|
|
|
Service Code
|
NDC 6068757711
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.43
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.45
|
| Rate for Payer: Heritage Provider Network Senior |
$0.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
|
|
ROPINIROLE 0.25 MG TABLET [21688]
|
Facility
|
OP
|
$0.66
|
|
|
Service Code
|
NDC 6068757711
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.33
|
| Rate for Payer: Blue Shield of California Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California EPN |
$0.32
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.41
|
| Rate for Payer: Heritage Provider Network Senior |
$0.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.46
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.26
|
| Rate for Payer: TriValley Medical Group Senior |
$0.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.56
|
| Rate for Payer: Vantage Medical Group Senior |
$0.56
|
|
|
ROPINIROLE 0.25 MG TABLET [21688]
|
Facility
|
OP
|
$0.66
|
|
|
Service Code
|
NDC 6068757701
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.33
|
| Rate for Payer: Blue Shield of California Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California EPN |
$0.32
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.41
|
| Rate for Payer: Heritage Provider Network Senior |
$0.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.46
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.26
|
| Rate for Payer: TriValley Medical Group Senior |
$0.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.56
|
| Rate for Payer: Vantage Medical Group Senior |
$0.56
|
|
