|
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SOLUTION FOR INJECTION [197046]
|
Facility
OP
|
$28,080.00
|
|
|
Service Code
|
NDC 50242-082-02
|
| Hospital Charge Code |
NDG197046
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,082.48 |
| Max. Negotiated Rate |
$23,868.00 |
| Rate for Payer: Adventist Health Commercial |
$5,616.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15,008.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19,290.96
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$23,868.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15,444.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21,060.00
|
| Rate for Payer: Blue Shield of California Commercial |
$17,437.68
|
| Rate for Payer: Blue Shield of California EPN |
$16,482.96
|
| Rate for Payer: Cash Price |
$12,636.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12,916.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,868.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,868.00
|
| Rate for Payer: Dignity Health Senior |
$23,868.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,971.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,001.04
|
| Rate for Payer: Heritage Provider Network Senior |
$13,001.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,534.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,082.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,020.00
|
| Rate for Payer: Multiplan Commercial |
$21,060.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,237.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9,381.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,868.00
|
| Rate for Payer: Vantage Medical Group Senior |
$23,868.00
|
|
|
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SOLUTION FOR INJECTION [197046]
|
Facility
IP
|
$28,080.00
|
|
|
Service Code
|
NDC 50242-082-02
|
| Hospital Charge Code |
NDG197046
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,082.48 |
| Max. Negotiated Rate |
$21,060.00 |
| Rate for Payer: Adventist Health Commercial |
$5,616.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19,290.96
|
| Rate for Payer: Cash Price |
$12,636.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12,916.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,163.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$19,010.16
|
| Rate for Payer: Heritage Provider Network Senior |
$19,010.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,082.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,020.00
|
| Rate for Payer: Multiplan Commercial |
$21,060.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,237.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9,381.53
|
|
|
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SOLUTION FOR INJECTION [76790]
|
Facility
IP
|
$46,800.00
|
|
|
Service Code
|
CPT J2778
|
| Hospital Charge Code |
NDG76790
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8,470.80 |
| Max. Negotiated Rate |
$35,100.00 |
| Rate for Payer: Adventist Health Commercial |
$9,360.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32,151.60
|
| Rate for Payer: Cash Price |
$21,060.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$21,528.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$25,272.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$31,683.60
|
| Rate for Payer: Heritage Provider Network Senior |
$31,683.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,470.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,700.00
|
| Rate for Payer: Multiplan Commercial |
$35,100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,063.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,635.88
|
|
|
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SOLUTION FOR INJECTION [76790]
|
Facility
OP
|
$46,800.00
|
|
|
Service Code
|
CPT J2778
|
| Hospital Charge Code |
NDG76790
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$35,100.00 |
| Rate for Payer: Adventist Health Commercial |
$9,360.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$460.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32,151.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$234.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$206.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$206.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$868.22
|
| Rate for Payer: Blue Shield of California Commercial |
$397.80
|
| Rate for Payer: Blue Shield of California EPN |
$397.80
|
| Rate for Payer: Cash Price |
$21,060.00
|
| Rate for Payer: Cash Price |
$21,060.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$21,528.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$281.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$206.31
|
| Rate for Payer: Dignity Health Senior |
$206.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,952.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$187.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$21,668.40
|
| Rate for Payer: Heritage Provider Network Senior |
$21,668.40
|
| Rate for Payer: Humana Medicare |
$187.55
|
| Rate for Payer: IEHP Medi-Cal |
$299.54
|
| Rate for Payer: IEHP Medicare Advantage |
$187.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$356.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,470.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$221.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,700.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$236.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$236.32
|
| Rate for Payer: Multiplan Commercial |
$35,100.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$206.31
|
| Rate for Payer: TriValley Medical Group Senior |
$187.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,063.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,635.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$281.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$206.31
|
| Rate for Payer: Vantage Medical Group Senior |
$187.55
|
|
|
RANOLAZINE ER 1,000 MG TABLET,EXTENDED RELEASE,12 HR [88007]
|
Facility
OP
|
$0.34
|
|
|
Service Code
|
NDC 42291-774-60
|
| Hospital Charge Code |
1711990
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.29
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.29
|
| Rate for Payer: Dignity Health Senior |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.21
|
| Rate for Payer: Heritage Provider Network Senior |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Vantage Medical Group Senior |
$0.29
|
|
|
RANOLAZINE ER 1,000 MG TABLET,EXTENDED RELEASE,12 HR [88007]
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
NDC 27241-126-02
|
| Hospital Charge Code |
1711990
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.69
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.68
|
| Rate for Payer: Heritage Provider Network Senior |
$0.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
|
|
RANOLAZINE ER 1,000 MG TABLET,EXTENDED RELEASE,12 HR [88007]
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
NDC 27241-126-02
|
| Hospital Charge Code |
1711990
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.75
|
| Rate for Payer: Blue Shield of California Commercial |
$0.62
|
| Rate for Payer: Blue Shield of California EPN |
$0.59
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: Dignity Health Senior |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.62
|
| Rate for Payer: Heritage Provider Network Senior |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
RANOLAZINE ER 1,000 MG TABLET,EXTENDED RELEASE,12 HR [88007]
|
Facility
IP
|
$0.34
|
|
|
Service Code
|
NDC 42291-774-60
|
| Hospital Charge Code |
1711990
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.23
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.23
|
| Rate for Payer: Heritage Provider Network Senior |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR [70434]
|
Facility
IP
|
$8.22
|
|
|
Service Code
|
NDC 61958-1003-1
|
| Hospital Charge Code |
1711999
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$6.16 |
| Rate for Payer: Adventist Health Commercial |
$1.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.65
|
| Rate for Payer: Cash Price |
$3.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.56
|
| Rate for Payer: Heritage Provider Network Senior |
$5.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.06
|
| Rate for Payer: Multiplan Commercial |
$6.16
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR [70434]
|
Facility
OP
|
$8.22
|
|
|
Service Code
|
NDC 61958-1003-1
|
| Hospital Charge Code |
1711999
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$6.99 |
| Rate for Payer: Adventist Health Commercial |
$1.64
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.65
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.99
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.16
|
| Rate for Payer: Blue Shield of California Commercial |
$5.10
|
| Rate for Payer: Blue Shield of California EPN |
$4.83
|
| Rate for Payer: Cash Price |
$3.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.99
|
| Rate for Payer: Dignity Health Senior |
$6.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.09
|
| Rate for Payer: Heritage Provider Network Senior |
$5.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.06
|
| Rate for Payer: Multiplan Commercial |
$6.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.99
|
| Rate for Payer: Vantage Medical Group Senior |
$6.99
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR [70434]
|
Facility
OP
|
$0.60
|
|
|
Service Code
|
NDC 27241-125-02
|
| Hospital Charge Code |
1711999
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.45
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.51
|
| Rate for Payer: Dignity Health Senior |
$0.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.37
|
| Rate for Payer: Heritage Provider Network Senior |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR [70434]
|
Facility
IP
|
$0.60
|
|
|
Service Code
|
NDC 27241-125-02
|
| Hospital Charge Code |
1711999
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.41
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.41
|
| Rate for Payer: Heritage Provider Network Senior |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR [70434]
|
Facility
OP
|
$1.68
|
|
|
Service Code
|
NDC 60687-549-11
|
| Hospital Charge Code |
1711999
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.99
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.43
|
| Rate for Payer: Dignity Health Senior |
$1.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.81
|
| 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
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1.43
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR [70434]
|
Facility
IP
|
$1.68
|
|
|
Service Code
|
NDC 60687-549-11
|
| Hospital Charge Code |
1711999
|
|
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
|
|
|
RASAGILINE 0.5 MG TABLET [76480]
|
Facility
OP
|
$3.44
|
|
|
Service Code
|
NDC 23155-746-03
|
| Hospital Charge Code |
1711909
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.58
|
| Rate for Payer: Blue Shield of California Commercial |
$2.14
|
| Rate for Payer: Blue Shield of California EPN |
$2.02
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.92
|
| Rate for Payer: Dignity Health Senior |
$2.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.13
|
| Rate for Payer: Heritage Provider Network Senior |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$2.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.92
|
| Rate for Payer: Vantage Medical Group Senior |
$2.92
|
|
|
RASAGILINE 0.5 MG TABLET [76480]
|
Facility
OP
|
$8.25
|
|
|
Service Code
|
NDC 0093-3060-56
|
| Hospital Charge Code |
1711909
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$7.01 |
| Rate for Payer: Adventist Health Commercial |
$1.65
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.54
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.19
|
| Rate for Payer: Blue Shield of California Commercial |
$5.12
|
| Rate for Payer: Blue Shield of California EPN |
$4.84
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.01
|
| Rate for Payer: Dignity Health Senior |
$7.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.11
|
| Rate for Payer: Heritage Provider Network Senior |
$5.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.06
|
| Rate for Payer: Multiplan Commercial |
$6.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.01
|
| Rate for Payer: Vantage Medical Group Senior |
$7.01
|
|
|
RASAGILINE 0.5 MG TABLET [76480]
|
Facility
IP
|
$8.25
|
|
|
Service Code
|
NDC 0093-3060-56
|
| Hospital Charge Code |
1711909
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$6.19 |
| Rate for Payer: Adventist Health Commercial |
$1.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.67
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.59
|
| Rate for Payer: Heritage Provider Network Senior |
$5.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.06
|
| Rate for Payer: Multiplan Commercial |
$6.19
|
|
|
RASAGILINE 0.5 MG TABLET [76480]
|
Facility
OP
|
$17.80
|
|
|
Service Code
|
NDC 47781-683-30
|
| Hospital Charge Code |
1711909
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$15.13 |
| Rate for Payer: Adventist Health Commercial |
$3.56
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.35
|
| Rate for Payer: Blue Shield of California Commercial |
$11.05
|
| Rate for Payer: Blue Shield of California EPN |
$10.45
|
| Rate for Payer: Cash Price |
$8.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.13
|
| Rate for Payer: Dignity Health Senior |
$15.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.02
|
| Rate for Payer: Heritage Provider Network Senior |
$11.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.45
|
| Rate for Payer: Multiplan Commercial |
$13.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.13
|
| Rate for Payer: Vantage Medical Group Senior |
$15.13
|
|
|
RASAGILINE 0.5 MG TABLET [76480]
|
Facility
IP
|
$17.80
|
|
|
Service Code
|
NDC 47781-683-30
|
| Hospital Charge Code |
1711909
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$13.35 |
| Rate for Payer: Adventist Health Commercial |
$3.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.23
|
| Rate for Payer: Cash Price |
$8.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.05
|
| Rate for Payer: Heritage Provider Network Senior |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.45
|
| Rate for Payer: Multiplan Commercial |
$13.35
|
|
|
RASAGILINE 0.5 MG TABLET [76480]
|
Facility
IP
|
$3.44
|
|
|
Service Code
|
NDC 23155-746-03
|
| Hospital Charge Code |
1711909
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.58 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.36
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.33
|
| Rate for Payer: Heritage Provider Network Senior |
$2.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$2.58
|
|
|
RASAGILINE 1 MG TABLET [76481]
|
Facility
IP
|
$8.25
|
|
|
Service Code
|
NDC 0093-3061-56
|
| Hospital Charge Code |
1711908
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$6.19 |
| Rate for Payer: Adventist Health Commercial |
$1.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.67
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.59
|
| Rate for Payer: Heritage Provider Network Senior |
$5.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.06
|
| Rate for Payer: Multiplan Commercial |
$6.19
|
|
|
RASAGILINE 1 MG TABLET [76481]
|
Facility
OP
|
$3.44
|
|
|
Service Code
|
NDC 23155-747-03
|
| Hospital Charge Code |
1711908
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.58
|
| Rate for Payer: Blue Shield of California Commercial |
$2.14
|
| Rate for Payer: Blue Shield of California EPN |
$2.02
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.92
|
| Rate for Payer: Dignity Health Senior |
$2.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.13
|
| Rate for Payer: Heritage Provider Network Senior |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$2.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.92
|
| Rate for Payer: Vantage Medical Group Senior |
$2.92
|
|
|
RASAGILINE 1 MG TABLET [76481]
|
Facility
IP
|
$3.44
|
|
|
Service Code
|
NDC 23155-747-03
|
| Hospital Charge Code |
1711908
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.58 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.36
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.33
|
| Rate for Payer: Heritage Provider Network Senior |
$2.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$2.58
|
|
|
RASAGILINE 1 MG TABLET [76481]
|
Facility
OP
|
$17.80
|
|
|
Service Code
|
NDC 47781-690-30
|
| Hospital Charge Code |
1711908
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$15.13 |
| Rate for Payer: Adventist Health Commercial |
$3.56
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.35
|
| Rate for Payer: Blue Shield of California Commercial |
$11.05
|
| Rate for Payer: Blue Shield of California EPN |
$10.45
|
| Rate for Payer: Cash Price |
$8.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.13
|
| Rate for Payer: Dignity Health Senior |
$15.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.02
|
| Rate for Payer: Heritage Provider Network Senior |
$11.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.45
|
| Rate for Payer: Multiplan Commercial |
$13.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.13
|
| Rate for Payer: Vantage Medical Group Senior |
$15.13
|
|
|
RASAGILINE 1 MG TABLET [76481]
|
Facility
OP
|
$8.25
|
|
|
Service Code
|
NDC 0093-3061-56
|
| Hospital Charge Code |
1711908
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$7.01 |
| Rate for Payer: Adventist Health Commercial |
$1.65
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.54
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.19
|
| Rate for Payer: Blue Shield of California Commercial |
$5.12
|
| Rate for Payer: Blue Shield of California EPN |
$4.84
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.01
|
| Rate for Payer: Dignity Health Senior |
$7.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.11
|
| Rate for Payer: Heritage Provider Network Senior |
$5.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.06
|
| Rate for Payer: Multiplan Commercial |
$6.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.01
|
| Rate for Payer: Vantage Medical Group Senior |
$7.01
|
|
