|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION [2851]
|
Facility
IP
|
$1.68
|
|
|
Service Code
|
NDC 0487-5901-99
|
| Hospital Charge Code |
1781099
|
|
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 |
$1.15
|
| 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 Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
|
|
Radial styloidectomy (separate procedure)
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 25230
|
| Min. Negotiated Rate |
$65.63 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: Dignity Health Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,044.21
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: IEHP Medi-Cal |
$65.63
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,684.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,095.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,448.63
|
| Rate for Payer: TriValley Medical Group Senior |
$4,044.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
Radical excision external auditory canal lesion; without neck dissection
|
Facility
OP
|
$13,902.11
|
|
|
Service Code
|
CPT 69150
|
| Min. Negotiated Rate |
$240.44 |
| Max. Negotiated Rate |
$13,902.11 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,048.59
|
| Rate for Payer: Dignity Health Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,316.90
|
| Rate for Payer: Humana Medicare |
$7,316.90
|
| Rate for Payer: IEHP Medi-Cal |
$240.44
|
| Rate for Payer: IEHP Medicare Advantage |
$7,316.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,902.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,633.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,219.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,219.29
|
| Rate for Payer: TriValley Medical Group Commercial |
$8,048.59
|
| Rate for Payer: TriValley Medical Group Senior |
$7,316.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
Radical excision of bursa, synovia of wrist, or forearm tendon sheaths (eg, tenosynovitis, fungus, Tbc, or other granulomas, rheumatoid arthritis); extensors, with or without transposition of dorsal retinaculum
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 25116
|
| Min. Negotiated Rate |
$658.04 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: Dignity Health Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,044.21
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: IEHP Medi-Cal |
$658.04
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,684.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,095.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,448.63
|
| Rate for Payer: TriValley Medical Group Senior |
$4,044.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
Radical excision of bursa, synovia of wrist, or forearm tendon sheaths (eg, tenosynovitis, fungus, Tbc, or other granulomas, rheumatoid arthritis); flexors
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 25115
|
| Min. Negotiated Rate |
$658.04 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,208.90
|
| Rate for Payer: Dignity Health Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,008.09
|
| Rate for Payer: Humana Medicare |
$2,008.09
|
| Rate for Payer: IEHP Medi-Cal |
$658.04
|
| Rate for Payer: IEHP Medicare Advantage |
$2,008.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,815.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,369.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,530.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,208.90
|
| Rate for Payer: TriValley Medical Group Senior |
$2,008.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.09
|
|
|
Radical resection of capsule, soft tissue, and heterotopic bone, elbow, with contracture release (separate procedure)
|
Facility
OP
|
$16,983.21
|
|
|
Service Code
|
CPT 24149
|
| Min. Negotiated Rate |
$1,269.61 |
| Max. Negotiated Rate |
$16,983.21 |
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: Dignity Health Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,938.53
|
| Rate for Payer: Humana Medicare |
$8,938.53
|
| Rate for Payer: IEHP Medi-Cal |
$1,269.61
|
| Rate for Payer: IEHP Medicare Advantage |
$8,938.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16,983.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,547.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,262.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,262.55
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,832.38
|
| Rate for Payer: TriValley Medical Group Senior |
$8,938.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
Radical resection of tumor (eg, sarcoma), soft tissue of back or flank; 5 cm or greater
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 21936
|
| Min. Negotiated Rate |
$366.48 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,550.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,905.29
|
| Rate for Payer: Dignity Health Senior |
$3,550.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,550.26
|
| Rate for Payer: Humana Medicare |
$3,550.26
|
| Rate for Payer: IEHP Medi-Cal |
$366.48
|
| Rate for Payer: IEHP Medicare Advantage |
$3,550.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,745.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,189.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,473.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,473.33
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,905.29
|
| Rate for Payer: TriValley Medical Group Senior |
$3,550.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Vantage Medical Group Senior |
$3,550.26
|
|
|
Radical resection of tumor (eg, sarcoma), soft tissue of neck or anterior thorax; 5 cm or greater
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 21558
|
| Min. Negotiated Rate |
$353.12 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,550.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,905.29
|
| Rate for Payer: Dignity Health Senior |
$3,550.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,550.26
|
| Rate for Payer: Humana Medicare |
$3,550.26
|
| Rate for Payer: IEHP Medi-Cal |
$353.12
|
| Rate for Payer: IEHP Medicare Advantage |
$3,550.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,745.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,189.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,473.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,473.33
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,905.29
|
| Rate for Payer: TriValley Medical Group Senior |
$3,550.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Vantage Medical Group Senior |
$3,550.26
|
|
|
Radiofrequency ablation, nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography)
|
Facility
OP
|
$4,857.00
|
|
|
Service Code
|
CPT 64625
|
| Min. Negotiated Rate |
$712.59 |
| Max. Negotiated Rate |
$4,857.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,412.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,653.62
|
| Rate for Payer: Dignity Health Senior |
$2,412.38
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,412.38
|
| Rate for Payer: Humana Medicare |
$2,412.38
|
| Rate for Payer: IEHP Medi-Cal |
$712.59
|
| Rate for Payer: IEHP Medicare Advantage |
$2,412.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,583.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,846.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,039.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,039.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,653.62
|
| Rate for Payer: TriValley Medical Group Senior |
$2,412.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Vantage Medical Group Senior |
$2,412.38
|
|
|
RADIOTHERAPY
|
Facility
IP
|
$5,358.51
|
|
|
Service Code
|
APR-DRG 6921
|
| Min. Negotiated Rate |
$5,358.51 |
| Max. Negotiated Rate |
$5,358.51 |
| Rate for Payer: IEHP Medi-Cal |
$5,358.51
|
|
|
RADIOTHERAPY
|
Facility
IP
|
$9,086.39
|
|
|
Service Code
|
APR-DRG 6922
|
| Min. Negotiated Rate |
$9,086.39 |
| Max. Negotiated Rate |
$9,086.39 |
| Rate for Payer: IEHP Medi-Cal |
$9,086.39
|
|
|
RADIOTHERAPY
|
Facility
IP
|
$29,294.71
|
|
|
Service Code
|
APR-DRG 6924
|
| Min. Negotiated Rate |
$29,294.71 |
| Max. Negotiated Rate |
$29,294.71 |
| Rate for Payer: IEHP Medi-Cal |
$29,294.71
|
|
|
RADIOTHERAPY
|
Facility
IP
|
$16,483.44
|
|
|
Service Code
|
APR-DRG 6923
|
| Min. Negotiated Rate |
$16,483.44 |
| Max. Negotiated Rate |
$16,483.44 |
| Rate for Payer: IEHP Medi-Cal |
$16,483.44
|
|
|
RADIUM RA 223 DICHLOR 1,100 KBQ/ML (30 MICROCURIE/ML) INTRAVENOUS SOLN [202157]
|
Facility
IP
|
$60,372.00
|
|
|
Service Code
|
CPT A9606
|
| Hospital Charge Code |
ERX202157
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$10,927.33 |
| Max. Negotiated Rate |
$45,279.00 |
| Rate for Payer: Adventist Health Commercial |
$12,074.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41,475.56
|
| Rate for Payer: Cash Price |
$27,167.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,600.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$40,871.84
|
| Rate for Payer: Heritage Provider Network Senior |
$40,871.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,927.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,093.00
|
| Rate for Payer: Multiplan Commercial |
$45,279.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22,011.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20,170.29
|
|
|
RADIUM RA 223 DICHLOR 1,100 KBQ/ML (30 MICROCURIE/ML) INTRAVENOUS SOLN [202157]
|
Facility
OP
|
$60,372.00
|
|
|
Service Code
|
CPT A9606
|
| Hospital Charge Code |
ERX202157
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$161.16 |
| Max. Negotiated Rate |
$45,279.00 |
| Rate for Payer: Adventist Health Commercial |
$12,074.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$378.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41,475.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$241.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$177.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$161.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$243.25
|
| Rate for Payer: Blue Shield of California Commercial |
$37,491.01
|
| Rate for Payer: Blue Shield of California EPN |
$35,438.36
|
| Rate for Payer: Cash Price |
$27,167.40
|
| Rate for Payer: Cash Price |
$27,167.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39,241.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$241.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$177.28
|
| Rate for Payer: Dignity Health Senior |
$161.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,638.08
|
| Rate for Payer: EPIC Health Plan Medicare |
$161.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$37,370.27
|
| Rate for Payer: Heritage Provider Network Senior |
$37,370.27
|
| Rate for Payer: Humana Medicare |
$161.16
|
| Rate for Payer: IEHP Medi-Cal |
$250.63
|
| Rate for Payer: IEHP Medicare Advantage |
$161.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$306.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,927.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$190.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,093.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$203.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$203.06
|
| Rate for Payer: Multiplan Commercial |
$45,279.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$177.28
|
| Rate for Payer: TriValley Medical Group Senior |
$161.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22,011.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20,170.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$241.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$177.28
|
| Rate for Payer: Vantage Medical Group Senior |
$161.16
|
|
|
RALOXIFENE 60 MG TABLET [22143]
|
Facility
OP
|
$2.77
|
|
|
Service Code
|
NDC 43598-505-30
|
| Hospital Charge Code |
1710918
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$2.35 |
| Rate for Payer: Adventist Health Commercial |
$0.55
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.08
|
| Rate for Payer: Blue Shield of California Commercial |
$1.72
|
| Rate for Payer: Blue Shield of California EPN |
$1.63
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.35
|
| Rate for Payer: Dignity Health Senior |
$2.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.71
|
| Rate for Payer: Heritage Provider Network Senior |
$1.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$2.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2.35
|
|
|
RALOXIFENE 60 MG TABLET [22143]
|
Facility
IP
|
$2.77
|
|
|
Service Code
|
NDC 43598-505-30
|
| Hospital Charge Code |
1710918
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$2.08 |
| Rate for Payer: Adventist Health Commercial |
$0.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.90
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.88
|
| Rate for Payer: Heritage Provider Network Senior |
$1.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$2.08
|
|
|
RALTEGRAVIR 400 MG TABLET [88608]
|
Facility
OP
|
$38.21
|
|
|
Service Code
|
NDC 0006-0227-61
|
| Hospital Charge Code |
1711979
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$32.48 |
| Rate for Payer: Adventist Health Commercial |
$7.64
|
| Rate for Payer: Aetna of CA Gatekeeper |
$20.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$21.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$28.66
|
| Rate for Payer: Blue Shield of California Commercial |
$23.73
|
| Rate for Payer: Blue Shield of California EPN |
$22.43
|
| Rate for Payer: Cash Price |
$17.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.48
|
| Rate for Payer: Dignity Health Senior |
$32.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.65
|
| Rate for Payer: Heritage Provider Network Senior |
$23.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.55
|
| Rate for Payer: Multiplan Commercial |
$28.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.48
|
| Rate for Payer: Vantage Medical Group Senior |
$32.48
|
|
|
RALTEGRAVIR 400 MG TABLET [88608]
|
Facility
IP
|
$38.21
|
|
|
Service Code
|
NDC 0006-0227-61
|
| Hospital Charge Code |
1711979
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$28.66 |
| Rate for Payer: Adventist Health Commercial |
$7.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.25
|
| Rate for Payer: Cash Price |
$17.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.87
|
| Rate for Payer: Heritage Provider Network Senior |
$25.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.55
|
| Rate for Payer: Multiplan Commercial |
$28.66
|
|
|
RAMIPRIL 5 MG CAPSULE [11261]
|
Facility
IP
|
$0.24
|
|
|
Service Code
|
NDC 65862-476-01
|
| Hospital Charge Code |
1712231
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.16
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Senior |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
|
|
RAMIPRIL 5 MG CAPSULE [11261]
|
Facility
OP
|
$0.24
|
|
|
Service Code
|
NDC 65862-476-01
|
| Hospital Charge Code |
1712231
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: Dignity Health Senior |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Senior |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION [205590]
|
Facility
OP
|
$166.40
|
|
|
Service Code
|
NDC 0002-7678-01
|
| Hospital Charge Code |
NDG2206
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.12 |
| Max. Negotiated Rate |
$141.44 |
| Rate for Payer: Adventist Health Commercial |
$33.28
|
| Rate for Payer: Aetna of CA Gatekeeper |
$88.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$114.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$141.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$91.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$124.80
|
| Rate for Payer: Blue Shield of California Commercial |
$103.33
|
| Rate for Payer: Blue Shield of California EPN |
$97.68
|
| Rate for Payer: Cash Price |
$74.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$76.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$141.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$141.44
|
| Rate for Payer: Dignity Health Senior |
$141.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.04
|
| Rate for Payer: Heritage Provider Network Senior |
$77.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$80.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.60
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$60.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$141.44
|
| Rate for Payer: Vantage Medical Group Senior |
$141.44
|
|
|
RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION [205590]
|
Facility
IP
|
$166.40
|
|
|
Service Code
|
NDC 0002-7669-01
|
| Hospital Charge Code |
NDG2205
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.12 |
| Max. Negotiated Rate |
$124.80 |
| Rate for Payer: Adventist Health Commercial |
$33.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$114.32
|
| Rate for Payer: Cash Price |
$74.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$76.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$112.65
|
| Rate for Payer: Heritage Provider Network Senior |
$112.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.60
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$60.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55.59
|
|
|
RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION [205590]
|
Facility
IP
|
$166.40
|
|
|
Service Code
|
NDC 0002-7678-01
|
| Hospital Charge Code |
NDG2206
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.12 |
| Max. Negotiated Rate |
$124.80 |
| Rate for Payer: Adventist Health Commercial |
$33.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$114.32
|
| Rate for Payer: Cash Price |
$74.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$76.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$112.65
|
| Rate for Payer: Heritage Provider Network Senior |
$112.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.60
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$60.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55.59
|
|
|
RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION [205590]
|
Facility
OP
|
$166.40
|
|
|
Service Code
|
NDC 0002-7669-01
|
| Hospital Charge Code |
NDG2205
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.12 |
| Max. Negotiated Rate |
$141.44 |
| Rate for Payer: Adventist Health Commercial |
$33.28
|
| Rate for Payer: Aetna of CA Gatekeeper |
$88.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$114.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$141.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$91.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$124.80
|
| Rate for Payer: Blue Shield of California Commercial |
$103.33
|
| Rate for Payer: Blue Shield of California EPN |
$97.68
|
| Rate for Payer: Cash Price |
$74.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$76.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$141.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$141.44
|
| Rate for Payer: Dignity Health Senior |
$141.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.04
|
| Rate for Payer: Heritage Provider Network Senior |
$77.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$80.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.60
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$60.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$141.44
|
| Rate for Payer: Vantage Medical Group Senior |
$141.44
|
|
