|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS [22149]
|
Facility
IP
|
$112.74
|
|
|
Service Code
|
CPT J9312
|
| Hospital Charge Code |
1755782
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.41 |
| Max. Negotiated Rate |
$84.56 |
| Rate for Payer: Adventist Health Commercial |
$22.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$77.45
|
| Rate for Payer: Cash Price |
$50.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$51.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$76.32
|
| Rate for Payer: Heritage Provider Network Senior |
$76.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.18
|
| Rate for Payer: Multiplan Commercial |
$84.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$41.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.67
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS [22149]
|
Facility
IP
|
$112.74
|
|
|
Service Code
|
CPT J9312
|
| Hospital Charge Code |
1755659
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.41 |
| Max. Negotiated Rate |
$84.56 |
| Rate for Payer: Adventist Health Commercial |
$22.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$77.45
|
| Rate for Payer: Cash Price |
$50.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$51.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$76.32
|
| Rate for Payer: Heritage Provider Network Senior |
$76.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.18
|
| Rate for Payer: Multiplan Commercial |
$84.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$41.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.67
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS NON-ONCOLOGY [4081336]
|
Facility
IP
|
$112.74
|
|
|
Service Code
|
NDC 50242-053-06
|
| Hospital Charge Code |
1755782
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.41 |
| Max. Negotiated Rate |
$84.56 |
| Rate for Payer: Adventist Health Commercial |
$22.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$77.45
|
| Rate for Payer: Cash Price |
$50.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$51.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$76.32
|
| Rate for Payer: Heritage Provider Network Senior |
$76.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.18
|
| Rate for Payer: Multiplan Commercial |
$84.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$41.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.67
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS NON-ONCOLOGY [4081336]
|
Facility
OP
|
$112.74
|
|
|
Service Code
|
NDC 50242-053-06
|
| Hospital Charge Code |
1755782
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.41 |
| Max. Negotiated Rate |
$95.83 |
| Rate for Payer: Adventist Health Commercial |
$22.55
|
| Rate for Payer: Aetna of CA Gatekeeper |
$60.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$77.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$95.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$62.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$84.56
|
| Rate for Payer: Blue Shield of California Commercial |
$70.01
|
| Rate for Payer: Blue Shield of California EPN |
$66.18
|
| Rate for Payer: Cash Price |
$50.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$51.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$95.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$95.83
|
| Rate for Payer: Dignity Health Senior |
$95.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.20
|
| Rate for Payer: Heritage Provider Network Senior |
$52.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$54.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.18
|
| Rate for Payer: Multiplan Commercial |
$84.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$41.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$95.83
|
| Rate for Payer: Vantage Medical Group Senior |
$95.83
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS NON-ONCOLOGY [4081336]
|
Facility
OP
|
$112.74
|
|
|
Service Code
|
NDC 50242-051-21
|
| Hospital Charge Code |
1755659
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.41 |
| Max. Negotiated Rate |
$95.83 |
| Rate for Payer: Adventist Health Commercial |
$22.55
|
| Rate for Payer: Aetna of CA Gatekeeper |
$60.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$77.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$95.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$62.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$84.56
|
| Rate for Payer: Blue Shield of California Commercial |
$70.01
|
| Rate for Payer: Blue Shield of California EPN |
$66.18
|
| Rate for Payer: Cash Price |
$50.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$51.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$95.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$95.83
|
| Rate for Payer: Dignity Health Senior |
$95.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.20
|
| Rate for Payer: Heritage Provider Network Senior |
$52.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$54.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.18
|
| Rate for Payer: Multiplan Commercial |
$84.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$41.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$95.83
|
| Rate for Payer: Vantage Medical Group Senior |
$95.83
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS NON-ONCOLOGY [4081336]
|
Facility
IP
|
$112.74
|
|
|
Service Code
|
NDC 50242-051-21
|
| Hospital Charge Code |
1755659
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.41 |
| Max. Negotiated Rate |
$84.56 |
| Rate for Payer: Adventist Health Commercial |
$22.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$77.45
|
| Rate for Payer: Cash Price |
$50.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$51.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$76.32
|
| Rate for Payer: Heritage Provider Network Senior |
$76.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.18
|
| Rate for Payer: Multiplan Commercial |
$84.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$41.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.67
|
|
|
RITUXIMAB 1,400 MG/11.7 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN [218742]
|
Facility
IP
|
$674.52
|
|
|
Service Code
|
CPT J9311
|
| Hospital Charge Code |
NDG218742
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$122.09 |
| Max. Negotiated Rate |
$505.89 |
| Rate for Payer: Adventist Health Commercial |
$134.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$463.40
|
| Rate for Payer: Cash Price |
$303.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$310.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$364.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$456.65
|
| Rate for Payer: Heritage Provider Network Senior |
$456.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.63
|
| Rate for Payer: Multiplan Commercial |
$505.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$245.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$225.36
|
|
|
RITUXIMAB 1,400 MG/11.7 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN [218742]
|
Facility
OP
|
$674.52
|
|
|
Service Code
|
CPT J9311
|
| Hospital Charge Code |
NDG218742
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$505.89 |
| Rate for Payer: Adventist Health Commercial |
$134.90
|
| Rate for Payer: Aetna of CA Gatekeeper |
$73.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$463.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$46.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$41.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$41.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.42
|
| Rate for Payer: Blue Shield of California Commercial |
$47.91
|
| Rate for Payer: Blue Shield of California EPN |
$47.91
|
| Rate for Payer: Cash Price |
$303.53
|
| Rate for Payer: Cash Price |
$303.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$310.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.15
|
| Rate for Payer: Dignity Health Senior |
$41.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$431.69
|
| Rate for Payer: EPIC Health Plan Medicare |
$37.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$312.30
|
| Rate for Payer: Heritage Provider Network Senior |
$312.30
|
| Rate for Payer: Humana Medicare |
$37.40
|
| Rate for Payer: IEHP Medi-Cal |
$65.32
|
| Rate for Payer: IEHP Medicare Advantage |
$37.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$71.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.13
|
| Rate for Payer: Multiplan Commercial |
$505.89
|
| Rate for Payer: TriValley Medical Group Commercial |
$41.15
|
| Rate for Payer: TriValley Medical Group Senior |
$37.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$245.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$225.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.15
|
| Rate for Payer: Vantage Medical Group Senior |
$37.40
|
|
|
RITUXIMAB 1,600 MG/13.4 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN [218821]
|
Facility
IP
|
$673.08
|
|
|
Service Code
|
CPT J9311
|
| Hospital Charge Code |
NDG218821
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$121.83 |
| Max. Negotiated Rate |
$504.81 |
| Rate for Payer: Adventist Health Commercial |
$134.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$462.41
|
| Rate for Payer: Cash Price |
$302.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$309.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$363.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$455.68
|
| Rate for Payer: Heritage Provider Network Senior |
$455.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.27
|
| Rate for Payer: Multiplan Commercial |
$504.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$245.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$224.88
|
|
|
RITUXIMAB 1,600 MG/13.4 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN [218821]
|
Facility
OP
|
$673.08
|
|
|
Service Code
|
CPT J9311
|
| Hospital Charge Code |
NDG218821
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$504.81 |
| Rate for Payer: Adventist Health Commercial |
$134.62
|
| Rate for Payer: Aetna of CA Gatekeeper |
$73.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$462.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$46.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$41.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$41.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.42
|
| Rate for Payer: Blue Shield of California Commercial |
$47.91
|
| Rate for Payer: Blue Shield of California EPN |
$47.91
|
| Rate for Payer: Cash Price |
$302.89
|
| Rate for Payer: Cash Price |
$302.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$309.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.15
|
| Rate for Payer: Dignity Health Senior |
$41.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$430.77
|
| Rate for Payer: EPIC Health Plan Medicare |
$37.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$311.64
|
| Rate for Payer: Heritage Provider Network Senior |
$311.64
|
| Rate for Payer: Humana Medicare |
$37.40
|
| Rate for Payer: IEHP Medi-Cal |
$65.32
|
| Rate for Payer: IEHP Medicare Advantage |
$37.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$71.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.13
|
| Rate for Payer: Multiplan Commercial |
$504.81
|
| Rate for Payer: TriValley Medical Group Commercial |
$41.15
|
| Rate for Payer: TriValley Medical Group Senior |
$37.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$245.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$224.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.15
|
| Rate for Payer: Vantage Medical Group Senior |
$37.40
|
|
|
RITUXIMAB-ARRX 10 MG/ML INTRAVENOUS SOLUTION [229898]
|
Facility
IP
|
$86.02
|
|
|
Service Code
|
CPT Q5123
|
| Hospital Charge Code |
NDG229898
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$64.52 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.10
|
| Rate for Payer: Cash Price |
$38.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.24
|
| Rate for Payer: Heritage Provider Network Senior |
$58.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.50
|
| Rate for Payer: Multiplan Commercial |
$64.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.74
|
|
|
RITUXIMAB-ARRX 10 MG/ML INTRAVENOUS SOLUTION [229898]
|
Facility
OP
|
$86.02
|
|
|
Service Code
|
CPT Q5123
|
| Hospital Charge Code |
NDG229898
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$153.20 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$101.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$51.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$45.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$45.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.20
|
| Rate for Payer: Blue Shield of California Commercial |
$73.12
|
| Rate for Payer: Blue Shield of California EPN |
$73.12
|
| Rate for Payer: Cash Price |
$38.71
|
| Rate for Payer: Cash Price |
$38.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.56
|
| Rate for Payer: Dignity Health Senior |
$45.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$41.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.83
|
| Rate for Payer: Heritage Provider Network Senior |
$39.83
|
| Rate for Payer: Humana Medicare |
$41.42
|
| Rate for Payer: IEHP Medi-Cal |
$71.57
|
| Rate for Payer: IEHP Medicare Advantage |
$41.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$78.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$52.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$52.19
|
| Rate for Payer: Multiplan Commercial |
$64.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$45.56
|
| Rate for Payer: TriValley Medical Group Senior |
$41.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.56
|
| Rate for Payer: Vantage Medical Group Senior |
$45.56
|
|
|
RITUXIMAB-PVVR 10 MG/ML INTRAVENOUS SOLUTION [226878]
|
Facility
IP
|
$86.02
|
|
|
Service Code
|
CPT Q5119
|
| Hospital Charge Code |
NDG226878
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$64.52 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.10
|
| Rate for Payer: Cash Price |
$38.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.24
|
| Rate for Payer: Heritage Provider Network Senior |
$58.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.50
|
| Rate for Payer: Multiplan Commercial |
$64.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.74
|
|
|
RITUXIMAB-PVVR 10 MG/ML INTRAVENOUS SOLUTION [226878]
|
Facility
OP
|
$86.02
|
|
|
Service Code
|
CPT Q5119
|
| Hospital Charge Code |
NDG22687A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$153.20 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$40.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.49
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.20
|
| Rate for Payer: Blue Shield of California Commercial |
$73.12
|
| Rate for Payer: Blue Shield of California EPN |
$73.12
|
| Rate for Payer: Cash Price |
$38.71
|
| Rate for Payer: Cash Price |
$38.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.49
|
| Rate for Payer: Dignity Health Senior |
$22.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.83
|
| Rate for Payer: Heritage Provider Network Senior |
$39.83
|
| Rate for Payer: Humana Medicare |
$20.45
|
| Rate for Payer: IEHP Medi-Cal |
$38.86
|
| Rate for Payer: IEHP Medicare Advantage |
$20.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$38.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.76
|
| Rate for Payer: Multiplan Commercial |
$64.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.49
|
| Rate for Payer: TriValley Medical Group Senior |
$20.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.49
|
| Rate for Payer: Vantage Medical Group Senior |
$22.49
|
|
|
RITUXIMAB-PVVR 10 MG/ML INTRAVENOUS SOLUTION [226878]
|
Facility
OP
|
$86.02
|
|
|
Service Code
|
CPT Q5119
|
| Hospital Charge Code |
NDG226878
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$153.20 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$40.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.49
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.20
|
| Rate for Payer: Blue Shield of California Commercial |
$73.12
|
| Rate for Payer: Blue Shield of California EPN |
$73.12
|
| Rate for Payer: Cash Price |
$38.71
|
| Rate for Payer: Cash Price |
$38.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.49
|
| Rate for Payer: Dignity Health Senior |
$22.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.83
|
| Rate for Payer: Heritage Provider Network Senior |
$39.83
|
| Rate for Payer: Humana Medicare |
$20.45
|
| Rate for Payer: IEHP Medi-Cal |
$38.86
|
| Rate for Payer: IEHP Medicare Advantage |
$20.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$38.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.76
|
| Rate for Payer: Multiplan Commercial |
$64.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.49
|
| Rate for Payer: TriValley Medical Group Senior |
$20.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.49
|
| Rate for Payer: Vantage Medical Group Senior |
$22.49
|
|
|
RITUXIMAB-PVVR 10 MG/ML INTRAVENOUS SOLUTION [226878]
|
Facility
IP
|
$86.02
|
|
|
Service Code
|
CPT Q5119
|
| Hospital Charge Code |
NDG22687A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$64.52 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.10
|
| Rate for Payer: Cash Price |
$38.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.24
|
| Rate for Payer: Heritage Provider Network Senior |
$58.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.50
|
| Rate for Payer: Multiplan Commercial |
$64.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.74
|
|
|
RIVAROXABAN 10 MG TABLET [153876]
|
Facility
IP
|
$21.70
|
|
|
Service Code
|
NDC 50458-580-30
|
| Hospital Charge Code |
1712514
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$16.28 |
| Rate for Payer: Adventist Health Commercial |
$4.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.91
|
| Rate for Payer: Cash Price |
$9.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.69
|
| Rate for Payer: Heritage Provider Network Senior |
$14.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.42
|
| Rate for Payer: Multiplan Commercial |
$16.28
|
|
|
RIVAROXABAN 10 MG TABLET [153876]
|
Facility
OP
|
$21.70
|
|
|
Service Code
|
NDC 50458-580-30
|
| Hospital Charge Code |
1712514
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$18.44 |
| Rate for Payer: Adventist Health Commercial |
$4.34
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.94
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.28
|
| Rate for Payer: Blue Shield of California Commercial |
$13.48
|
| Rate for Payer: Blue Shield of California EPN |
$12.74
|
| Rate for Payer: Cash Price |
$9.77
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.44
|
| Rate for Payer: Dignity Health Senior |
$18.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.43
|
| Rate for Payer: Heritage Provider Network Senior |
$13.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.42
|
| Rate for Payer: Multiplan Commercial |
$16.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.44
|
| Rate for Payer: Vantage Medical Group Senior |
$18.44
|
|
|
RIVAROXABAN 15 MG TABLET [153877]
|
Facility
OP
|
$21.70
|
|
|
Service Code
|
NDC 50458-578-01
|
| Hospital Charge Code |
1712515
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$18.44 |
| Rate for Payer: Adventist Health Commercial |
$4.34
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.94
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.28
|
| Rate for Payer: Blue Shield of California Commercial |
$13.48
|
| Rate for Payer: Blue Shield of California EPN |
$12.74
|
| Rate for Payer: Cash Price |
$9.77
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.44
|
| Rate for Payer: Dignity Health Senior |
$18.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.43
|
| Rate for Payer: Heritage Provider Network Senior |
$13.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.42
|
| Rate for Payer: Multiplan Commercial |
$16.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.44
|
| Rate for Payer: Vantage Medical Group Senior |
$18.44
|
|
|
RIVAROXABAN 15 MG TABLET [153877]
|
Facility
IP
|
$21.70
|
|
|
Service Code
|
NDC 50458-578-01
|
| Hospital Charge Code |
1712515
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$16.28 |
| Rate for Payer: Adventist Health Commercial |
$4.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.91
|
| Rate for Payer: Cash Price |
$9.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.69
|
| Rate for Payer: Heritage Provider Network Senior |
$14.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.42
|
| Rate for Payer: Multiplan Commercial |
$16.28
|
|
|
RIVAROXABAN 15 MG TABLET [153877]
|
Facility
IP
|
$21.70
|
|
|
Service Code
|
NDC 50458-578-10
|
| Hospital Charge Code |
1712515
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$16.28 |
| Rate for Payer: Adventist Health Commercial |
$4.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.91
|
| Rate for Payer: Cash Price |
$9.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.69
|
| Rate for Payer: Heritage Provider Network Senior |
$14.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.42
|
| Rate for Payer: Multiplan Commercial |
$16.28
|
|
|
RIVAROXABAN 15 MG TABLET [153877]
|
Facility
OP
|
$21.70
|
|
|
Service Code
|
NDC 50458-578-10
|
| Hospital Charge Code |
1712515
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$18.44 |
| Rate for Payer: Adventist Health Commercial |
$4.34
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.94
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.28
|
| Rate for Payer: Blue Shield of California Commercial |
$13.48
|
| Rate for Payer: Blue Shield of California EPN |
$12.74
|
| Rate for Payer: Cash Price |
$9.77
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.44
|
| Rate for Payer: Dignity Health Senior |
$18.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.43
|
| Rate for Payer: Heritage Provider Network Senior |
$13.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.42
|
| Rate for Payer: Multiplan Commercial |
$16.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.44
|
| Rate for Payer: Vantage Medical Group Senior |
$18.44
|
|
|
RIVAROXABAN 20 MG TABLET [153878]
|
Facility
IP
|
$21.70
|
|
|
Service Code
|
NDC 50458-579-30
|
| Hospital Charge Code |
1712516
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$16.28 |
| Rate for Payer: Adventist Health Commercial |
$4.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.91
|
| Rate for Payer: Cash Price |
$9.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.69
|
| Rate for Payer: Heritage Provider Network Senior |
$14.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.42
|
| Rate for Payer: Multiplan Commercial |
$16.28
|
|
|
RIVAROXABAN 20 MG TABLET [153878]
|
Facility
IP
|
$21.70
|
|
|
Service Code
|
NDC 50458-579-10
|
| Hospital Charge Code |
1712516
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$16.28 |
| Rate for Payer: Adventist Health Commercial |
$4.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.91
|
| Rate for Payer: Cash Price |
$9.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.69
|
| Rate for Payer: Heritage Provider Network Senior |
$14.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.42
|
| Rate for Payer: Multiplan Commercial |
$16.28
|
|
|
RIVAROXABAN 20 MG TABLET [153878]
|
Facility
OP
|
$21.70
|
|
|
Service Code
|
NDC 50458-579-10
|
| Hospital Charge Code |
1712516
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$18.44 |
| Rate for Payer: Adventist Health Commercial |
$4.34
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.94
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.28
|
| Rate for Payer: Blue Shield of California Commercial |
$13.48
|
| Rate for Payer: Blue Shield of California EPN |
$12.74
|
| Rate for Payer: Cash Price |
$9.77
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.44
|
| Rate for Payer: Dignity Health Senior |
$18.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.43
|
| Rate for Payer: Heritage Provider Network Senior |
$13.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.42
|
| Rate for Payer: Multiplan Commercial |
$16.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.44
|
| Rate for Payer: Vantage Medical Group Senior |
$18.44
|
|
