|
RISPERIDONE 0.5 MG DISINTEGRATING TABLET [35686]
|
Facility
|
IP
|
$3.87
|
|
|
Service Code
|
NDC 0781-5310-08
|
| Hospital Charge Code |
1713151
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.13 |
| Max. Negotiated Rate |
$3.10 |
| Rate for Payer: Cash Price |
$1.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.10
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.13
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.90
|
|
|
RISPERIDONE 0.5 MG DISINTEGRATING TABLET [35686]
|
Facility
|
OP
|
$1.99
|
|
|
Service Code
|
NDC 59746-010-32
|
| Hospital Charge Code |
1713151
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$1.49 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.19
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.19
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.09
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.49
|
|
|
RISPERIDONE 0.5 MG DISINTEGRATING TABLET [35686]
|
Facility
|
OP
|
$4.20
|
|
|
Service Code
|
NDC 49884-311-91
|
| Hospital Charge Code |
1713151
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.31 |
| Max. Negotiated Rate |
$3.15 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$2.52
|
| Rate for Payer: Aetna of CA Government/Medicare |
$2.52
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$2.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.31
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$3.15
|
|
|
RISPERIDONE 0.5 MG DISINTEGRATING TABLET [35686]
|
Facility
|
IP
|
$1.99
|
|
|
Service Code
|
NDC 59746-010-32
|
| Hospital Charge Code |
1713151
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$1.59 |
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.59
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.09
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.49
|
|
|
RISPERIDONE 0.5 MG DISINTEGRATING TABLET [35686]
|
Facility
|
OP
|
$4.20
|
|
|
Service Code
|
NDC 49884-311-52
|
| Hospital Charge Code |
1713151
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.31 |
| Max. Negotiated Rate |
$3.15 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$2.52
|
| Rate for Payer: Aetna of CA Government/Medicare |
$2.52
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$2.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.31
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$3.15
|
|
|
RISPERIDONE 0.5 MG DISINTEGRATING TABLET [35686]
|
Facility
|
IP
|
$4.20
|
|
|
Service Code
|
NDC 49884-311-52
|
| Hospital Charge Code |
1713151
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.31 |
| Max. Negotiated Rate |
$3.36 |
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.36
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.31
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$3.15
|
|
|
RISPERIDONE 0.5 MG DISINTEGRATING TABLET [35686]
|
Facility
|
IP
|
$4.20
|
|
|
Service Code
|
NDC 49884-311-91
|
| Hospital Charge Code |
1713151
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.31 |
| Max. Negotiated Rate |
$3.36 |
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.36
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.31
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$3.15
|
|
|
RISPERIDONE 0.5 MG TABLET [25520]
|
Facility
|
IP
|
$0.15
|
|
|
Service Code
|
NDC 68382-113-14
|
| Hospital Charge Code |
1712232
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.11
|
|
|
RISPERIDONE 0.5 MG TABLET [25520]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 43547-340-06
|
| Hospital Charge Code |
1712232
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.13
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.13
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.17
|
|
|
RISPERIDONE 0.5 MG TABLET [25520]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 43547-340-06
|
| Hospital Charge Code |
1712232
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.17
|
|
|
RISPERIDONE 0.5 MG TABLET [25520]
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
NDC 0904-6358-61
|
| Hospital Charge Code |
1712232
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.14
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.14
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.18
|
|
|
RISPERIDONE 0.5 MG TABLET [25520]
|
Facility
|
IP
|
$0.24
|
|
|
Service Code
|
NDC 0904-6358-61
|
| Hospital Charge Code |
1712232
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.19
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.18
|
|
|
RISPERIDONE 0.5 MG TABLET [25520]
|
Facility
|
OP
|
$0.15
|
|
|
Service Code
|
NDC 68382-113-14
|
| Hospital Charge Code |
1712232
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.09
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.09
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.11
|
|
|
RISPERIDONE 1 MG DISINTEGRATING TABLET [35687]
|
Facility
|
IP
|
$4.90
|
|
|
Service Code
|
NDC 49884-315-55
|
| Hospital Charge Code |
1713152
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$3.92 |
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.92
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.70
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$3.68
|
|
|
RISPERIDONE 1 MG DISINTEGRATING TABLET [35687]
|
Facility
|
IP
|
$2.61
|
|
|
Service Code
|
NDC 59746-020-22
|
| Hospital Charge Code |
1713152
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$2.09 |
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.09
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.96
|
|
|
RISPERIDONE 1 MG DISINTEGRATING TABLET [35687]
|
Facility
|
IP
|
$5.42
|
|
|
Service Code
|
NDC 0781-5311-06
|
| Hospital Charge Code |
1713152
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$4.34 |
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.34
|
| Rate for Payer: Health Smart Auto/Commercial |
$3.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.98
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$4.06
|
|
|
RISPERIDONE 1 MG DISINTEGRATING TABLET [35687]
|
Facility
|
OP
|
$4.90
|
|
|
Service Code
|
NDC 49884-315-52
|
| Hospital Charge Code |
1713152
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$3.68 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$2.94
|
| Rate for Payer: Aetna of CA Government/Medicare |
$2.94
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$2.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.70
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$3.68
|
|
|
RISPERIDONE 1 MG DISINTEGRATING TABLET [35687]
|
Facility
|
IP
|
$5.42
|
|
|
Service Code
|
NDC 0781-5311-08
|
| Hospital Charge Code |
1713152
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$4.34 |
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.34
|
| Rate for Payer: Health Smart Auto/Commercial |
$3.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.98
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$4.06
|
|
|
RISPERIDONE 1 MG DISINTEGRATING TABLET [35687]
|
Facility
|
OP
|
$5.42
|
|
|
Service Code
|
NDC 0781-5311-06
|
| Hospital Charge Code |
1713152
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$4.06 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$3.25
|
| Rate for Payer: Aetna of CA Government/Medicare |
$3.25
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Health Smart Auto/Commercial |
$3.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$3.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.98
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$4.06
|
|
|
RISPERIDONE 1 MG DISINTEGRATING TABLET [35687]
|
Facility
|
OP
|
$4.90
|
|
|
Service Code
|
NDC 49884-315-55
|
| Hospital Charge Code |
1713152
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$3.68 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$2.94
|
| Rate for Payer: Aetna of CA Government/Medicare |
$2.94
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$2.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.70
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$3.68
|
|
|
RISPERIDONE 1 MG DISINTEGRATING TABLET [35687]
|
Facility
|
OP
|
$2.61
|
|
|
Service Code
|
NDC 59746-020-22
|
| Hospital Charge Code |
1713152
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$1.96 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.57
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.57
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.96
|
|
|
RISPERIDONE 1 MG DISINTEGRATING TABLET [35687]
|
Facility
|
IP
|
$4.90
|
|
|
Service Code
|
NDC 49884-315-52
|
| Hospital Charge Code |
1713152
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$3.92 |
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.92
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.70
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$3.68
|
|
|
RISPERIDONE 1 MG DISINTEGRATING TABLET [35687]
|
Facility
|
OP
|
$5.42
|
|
|
Service Code
|
NDC 0781-5311-08
|
| Hospital Charge Code |
1713152
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$4.06 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$3.25
|
| Rate for Payer: Aetna of CA Government/Medicare |
$3.25
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Health Smart Auto/Commercial |
$3.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$3.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.98
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$4.06
|
|
|
RISPERIDONE 1 MG/ML ORAL SOLUTION [17377]
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
NDC 0054-0063-44
|
| Hospital Charge Code |
1715198
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.96
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.90
|
|
|
RISPERIDONE 1 MG/ML ORAL SOLUTION [17377]
|
Facility
|
IP
|
$0.84
|
|
|
Service Code
|
NDC 65162-673-84
|
| Hospital Charge Code |
1715198
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: Cash Price |
$0.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.67
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.46
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.63
|
|
