|
RHO(D) IMMUNE GLOBULIN-MALTOSE 1,500 UNIT (300 MCG)/1.3 ML INJECT.SOLN [70575]
|
Facility
OP
|
$498.31
|
|
|
Service Code
|
CPT J2792
|
| Hospital Charge Code |
1721148
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.96 |
| Max. Negotiated Rate |
$423.56 |
| Rate for Payer: IEHP Medicare Advantage |
$32.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$207.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$41.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$36.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$36.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.83
|
| Rate for Payer: BCBS Transplant Transplant |
$298.99
|
| Rate for Payer: Blue Shield of California Commercial |
$367.25
|
| Rate for Payer: Blue Shield of California EPN |
$41.17
|
| Rate for Payer: Cash Price |
$224.24
|
| Rate for Payer: Cash Price |
$224.24
|
| Rate for Payer: Cigna of CA HMO |
$348.82
|
| Rate for Payer: Cigna of CA PPO |
$348.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$49.45
|
| Rate for Payer: Dignity Health Media |
$32.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.50
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$32.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$32.96
|
| Rate for Payer: Galaxy Health WC |
$423.56
|
| Rate for Payer: Global Benefits Group Commercial |
$298.99
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$373.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.06
|
| Rate for Payer: Heritage Provider Network Transplant |
$54.06
|
| Rate for Payer: IEHP Medi-Cal |
$53.40
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$53.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$332.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.17
|
| Rate for Payer: Multiplan Commercial |
$398.65
|
| Rate for Payer: Networks By Design Commercial |
$249.16
|
| Rate for Payer: Prime Health Services Commercial |
$423.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$298.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$298.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$249.16
|
| Rate for Payer: United Healthcare All Other HMO |
$249.16
|
| Rate for Payer: United Healthcare HMO Rider |
$249.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$249.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$49.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.26
|
| Rate for Payer: Vantage Medical Group Senior |
$32.96
|
|
|
RHO(D) IMMUNE GLOBULIN-MALTOSE 1,500 UNIT (300 MCG)/1.3 ML INJECT.SOLN [70575]
|
Facility
IP
|
$498.31
|
|
|
Service Code
|
CPT J2792
|
| Hospital Charge Code |
1721148
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.59 |
| Max. Negotiated Rate |
$423.56 |
| Rate for Payer: Blue Shield of California Commercial |
$354.80
|
| Rate for Payer: Blue Shield of California EPN |
$255.13
|
| Rate for Payer: Cash Price |
$224.24
|
| Rate for Payer: Cigna of CA HMO |
$348.82
|
| Rate for Payer: Cigna of CA PPO |
$348.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$199.32
|
| Rate for Payer: Galaxy Health WC |
$423.56
|
| Rate for Payer: Global Benefits Group Commercial |
$298.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$332.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.59
|
| Rate for Payer: Multiplan Commercial |
$398.65
|
| Rate for Payer: Networks By Design Commercial |
$249.16
|
| Rate for Payer: Prime Health Services Commercial |
$423.56
|
|
|
RHO(D) IMMUNE GLOBULIN-MALTOSE 2,500 UNIT (500 MCG)/2.2 ML INJECT.SOLN [70573]
|
Facility
OP
|
$493.81
|
|
|
Service Code
|
CPT J2792
|
| Hospital Charge Code |
NDG70573
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.96 |
| Max. Negotiated Rate |
$419.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$207.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$41.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$36.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$36.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.83
|
| Rate for Payer: BCBS Transplant Transplant |
$296.29
|
| Rate for Payer: Blue Shield of California Commercial |
$363.94
|
| Rate for Payer: Blue Shield of California EPN |
$41.17
|
| Rate for Payer: Cash Price |
$222.21
|
| Rate for Payer: Cash Price |
$222.21
|
| Rate for Payer: Cigna of CA HMO |
$345.67
|
| Rate for Payer: Cigna of CA PPO |
$345.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$49.45
|
| Rate for Payer: Dignity Health Media |
$32.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.50
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$32.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$32.96
|
| Rate for Payer: Galaxy Health WC |
$419.74
|
| Rate for Payer: Global Benefits Group Commercial |
$296.29
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$370.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.06
|
| Rate for Payer: Heritage Provider Network Transplant |
$54.06
|
| Rate for Payer: IEHP Medi-Cal |
$53.40
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$53.40
|
| Rate for Payer: IEHP Medicare Advantage |
$32.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$329.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.17
|
| Rate for Payer: Multiplan Commercial |
$395.05
|
| Rate for Payer: Networks By Design Commercial |
$246.90
|
| Rate for Payer: Prime Health Services Commercial |
$419.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$296.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$296.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.90
|
| Rate for Payer: United Healthcare All Other HMO |
$246.90
|
| Rate for Payer: United Healthcare HMO Rider |
$246.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$49.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.26
|
| Rate for Payer: Vantage Medical Group Senior |
$32.96
|
|
|
RHO(D) IMMUNE GLOBULIN-MALTOSE 2,500 UNIT (500 MCG)/2.2 ML INJECT.SOLN [70573]
|
Facility
IP
|
$493.81
|
|
|
Service Code
|
CPT J2792
|
| Hospital Charge Code |
NDG70573
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$118.51 |
| Max. Negotiated Rate |
$419.74 |
| Rate for Payer: Blue Shield of California Commercial |
$351.59
|
| Rate for Payer: Blue Shield of California EPN |
$252.83
|
| Rate for Payer: Cash Price |
$222.21
|
| Rate for Payer: Cigna of CA HMO |
$345.67
|
| Rate for Payer: Cigna of CA PPO |
$345.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$197.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$197.52
|
| Rate for Payer: Galaxy Health WC |
$419.74
|
| Rate for Payer: Global Benefits Group Commercial |
$296.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$329.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.51
|
| Rate for Payer: Multiplan Commercial |
$395.05
|
| Rate for Payer: Networks By Design Commercial |
$246.90
|
| Rate for Payer: Prime Health Services Commercial |
$419.74
|
|
|
RHO(D) IMMUNE GLOBULIN-MALTOSE 5,000 UNIT (1,000 MCG)/4.4 ML INJ. SOLN [70574]
|
Facility
IP
|
$493.81
|
|
|
Service Code
|
CPT J2792
|
| Hospital Charge Code |
1721149
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$118.51 |
| Max. Negotiated Rate |
$419.74 |
| Rate for Payer: Blue Shield of California Commercial |
$351.59
|
| Rate for Payer: Blue Shield of California EPN |
$252.83
|
| Rate for Payer: Cash Price |
$222.21
|
| Rate for Payer: Cigna of CA HMO |
$345.67
|
| Rate for Payer: Cigna of CA PPO |
$345.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$197.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$197.52
|
| Rate for Payer: Galaxy Health WC |
$419.74
|
| Rate for Payer: Global Benefits Group Commercial |
$296.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$329.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.51
|
| Rate for Payer: Multiplan Commercial |
$395.05
|
| Rate for Payer: Networks By Design Commercial |
$246.90
|
| Rate for Payer: Prime Health Services Commercial |
$419.74
|
|
|
RHO(D) IMMUNE GLOBULIN-MALTOSE 5,000 UNIT (1,000 MCG)/4.4 ML INJ. SOLN [70574]
|
Facility
OP
|
$493.81
|
|
|
Service Code
|
CPT J2792
|
| Hospital Charge Code |
1721149
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.96 |
| Max. Negotiated Rate |
$419.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$207.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$41.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$36.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$36.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.83
|
| Rate for Payer: BCBS Transplant Transplant |
$296.29
|
| Rate for Payer: Blue Shield of California Commercial |
$363.94
|
| Rate for Payer: Blue Shield of California EPN |
$41.17
|
| Rate for Payer: Cash Price |
$222.21
|
| Rate for Payer: Cash Price |
$222.21
|
| Rate for Payer: Cigna of CA HMO |
$345.67
|
| Rate for Payer: Cigna of CA PPO |
$345.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$49.45
|
| Rate for Payer: Dignity Health Media |
$32.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.50
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$32.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$32.96
|
| Rate for Payer: Galaxy Health WC |
$419.74
|
| Rate for Payer: Global Benefits Group Commercial |
$296.29
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$370.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.06
|
| Rate for Payer: Heritage Provider Network Transplant |
$54.06
|
| Rate for Payer: IEHP Medi-Cal |
$53.40
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$53.40
|
| Rate for Payer: IEHP Medicare Advantage |
$32.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$329.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.17
|
| Rate for Payer: Multiplan Commercial |
$395.05
|
| Rate for Payer: Networks By Design Commercial |
$246.90
|
| Rate for Payer: Prime Health Services Commercial |
$419.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$296.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$296.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.90
|
| Rate for Payer: United Healthcare All Other HMO |
$246.90
|
| Rate for Payer: United Healthcare HMO Rider |
$246.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$49.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.26
|
| Rate for Payer: Vantage Medical Group Senior |
$32.96
|
|
|
RIBAVIRIN 200 MG TABLET [11287]
|
Facility
IP
|
$0.74
|
|
|
Service Code
|
NDC 65862-207-68
|
| Hospital Charge Code |
ERX11287
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.63 |
| Rate for Payer: Blue Shield of California Commercial |
$0.53
|
| Rate for Payer: Blue Shield of California EPN |
$0.38
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cigna of CA HMO |
$0.52
|
| Rate for Payer: Cigna of CA PPO |
$0.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
| Rate for Payer: Galaxy Health WC |
$0.63
|
| Rate for Payer: Global Benefits Group Commercial |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: Networks By Design Commercial |
$0.48
|
| Rate for Payer: Prime Health Services Commercial |
$0.63
|
|
|
RIBAVIRIN 200 MG TABLET [11287]
|
Facility
OP
|
$0.74
|
|
|
Service Code
|
NDC 65862-207-68
|
| Hospital Charge Code |
ERX11287
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.44
|
| Rate for Payer: BCBS Transplant Transplant |
$0.44
|
| Rate for Payer: Blue Shield of California Commercial |
$0.55
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cigna of CA HMO |
$0.52
|
| Rate for Payer: Cigna of CA PPO |
$0.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.63
|
| Rate for Payer: Dignity Health Media |
$0.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.30
|
| Rate for Payer: Galaxy Health WC |
$0.63
|
| Rate for Payer: Global Benefits Group Commercial |
$0.44
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: Networks By Design Commercial |
$0.48
|
| Rate for Payer: Prime Health Services Commercial |
$0.63
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.37
|
| Rate for Payer: United Healthcare All Other HMO |
$0.37
|
| Rate for Payer: United Healthcare HMO Rider |
$0.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.63
|
| Rate for Payer: Vantage Medical Group Senior |
$0.63
|
|
|
RIBOFLAVIN (VITAMIN B2) 100 MG TABLET [11288]
|
Facility
OP
|
$0.04
|
|
|
Service Code
|
NDC 4329256000
|
| Hospital Charge Code |
1712617
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: BCBS Transplant Transplant |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Media |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
RIBOFLAVIN (VITAMIN B2) 100 MG TABLET [11288]
|
Facility
IP
|
$0.06
|
|
|
Service Code
|
NDC 7985420195
|
| Hospital Charge Code |
1712617
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
|
|
RIBOFLAVIN (VITAMIN B2) 100 MG TABLET [11288]
|
Facility
IP
|
$0.05
|
|
|
Service Code
|
NDC 761003220
|
| Hospital Charge Code |
1712617
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
|
|
RIBOFLAVIN (VITAMIN B2) 100 MG TABLET [11288]
|
Facility
OP
|
$0.09
|
|
|
Service Code
|
NDC 1184571401
|
| Hospital Charge Code |
1712617
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: BCBS Transplant Transplant |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.08
|
| Rate for Payer: Dignity Health Media |
$0.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
|
RIBOFLAVIN (VITAMIN B2) 100 MG TABLET [11288]
|
Facility
OP
|
$0.05
|
|
|
Service Code
|
NDC 761003220
|
| Hospital Charge Code |
1712617
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: BCBS Transplant Transplant |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.04
|
| Rate for Payer: Dignity Health Media |
$0.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.04
|
|
|
RIBOFLAVIN (VITAMIN B2) 100 MG TABLET [11288]
|
Facility
OP
|
$0.06
|
|
|
Service Code
|
NDC 7985420195
|
| Hospital Charge Code |
1712617
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: BCBS Transplant Transplant |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: Dignity Health Media |
$0.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
|
RIBOFLAVIN (VITAMIN B2) 100 MG TABLET [11288]
|
Facility
IP
|
$0.09
|
|
|
Service Code
|
NDC 1184571401
|
| Hospital Charge Code |
1712617
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
|
|
RIBOFLAVIN (VITAMIN B2) 100 MG TABLET [11288]
|
Facility
IP
|
$0.04
|
|
|
Service Code
|
NDC 4329256000
|
| Hospital Charge Code |
1712617
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
RIBOFLAVIN (VITAMIN B2) 50 MG TABLET [11289]
|
Facility
OP
|
$0.05
|
|
|
Service Code
|
NDC 3504600120
|
| Hospital Charge Code |
ERX11289
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: BCBS Transplant Transplant |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.04
|
| Rate for Payer: Dignity Health Media |
$0.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.04
|
|
|
RIBOFLAVIN (VITAMIN B2) 50 MG TABLET [11289]
|
Facility
IP
|
$0.05
|
|
|
Service Code
|
NDC 3504600120
|
| Hospital Charge Code |
ERX11289
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
|
|
RIFABUTIN 150 MG CAPSULE [11290]
|
Facility
OP
|
$16.79
|
|
|
Service Code
|
NDC 59762-1350-1
|
| Hospital Charge Code |
1712193
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.03 |
| Max. Negotiated Rate |
$14.27 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.00
|
| Rate for Payer: BCBS Transplant Transplant |
$10.07
|
| Rate for Payer: Blue Shield of California Commercial |
$12.37
|
| Rate for Payer: Blue Shield of California EPN |
$9.81
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: Cigna of CA HMO |
$11.75
|
| Rate for Payer: Cigna of CA PPO |
$11.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.27
|
| Rate for Payer: Dignity Health Media |
$14.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.72
|
| Rate for Payer: Galaxy Health WC |
$14.27
|
| Rate for Payer: Global Benefits Group Commercial |
$10.07
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.03
|
| Rate for Payer: Multiplan Commercial |
$13.43
|
| Rate for Payer: Networks By Design Commercial |
$10.91
|
| Rate for Payer: Prime Health Services Commercial |
$14.27
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.40
|
| Rate for Payer: United Healthcare All Other HMO |
$8.40
|
| Rate for Payer: United Healthcare HMO Rider |
$8.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.27
|
| Rate for Payer: Vantage Medical Group Senior |
$14.27
|
|
|
RIFABUTIN 150 MG CAPSULE [11290]
|
Facility
IP
|
$16.79
|
|
|
Service Code
|
NDC 59762-1350-1
|
| Hospital Charge Code |
1712193
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.03 |
| Max. Negotiated Rate |
$14.27 |
| Rate for Payer: Blue Shield of California Commercial |
$11.95
|
| Rate for Payer: Blue Shield of California EPN |
$8.60
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: Cigna of CA HMO |
$11.75
|
| Rate for Payer: Cigna of CA PPO |
$11.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.72
|
| Rate for Payer: Galaxy Health WC |
$14.27
|
| Rate for Payer: Global Benefits Group Commercial |
$10.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.03
|
| Rate for Payer: Multiplan Commercial |
$13.43
|
| Rate for Payer: Networks By Design Commercial |
$10.91
|
| Rate for Payer: Prime Health Services Commercial |
$14.27
|
|
|
RIFAMPIN 150 MG CAPSULE [11292]
|
Facility
IP
|
$1.91
|
|
|
Service Code
|
NDC 60687-575-11
|
| Hospital Charge Code |
1712082
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: Blue Shield of California Commercial |
$1.36
|
| Rate for Payer: Blue Shield of California EPN |
$0.98
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cigna of CA HMO |
$1.34
|
| Rate for Payer: Cigna of CA PPO |
$1.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.76
|
| Rate for Payer: Galaxy Health WC |
$1.62
|
| Rate for Payer: Global Benefits Group Commercial |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.46
|
| Rate for Payer: Multiplan Commercial |
$1.53
|
| Rate for Payer: Networks By Design Commercial |
$1.24
|
| Rate for Payer: Prime Health Services Commercial |
$1.62
|
|
|
RIFAMPIN 150 MG CAPSULE [11292]
|
Facility
IP
|
$1.91
|
|
|
Service Code
|
NDC 60687-575-21
|
| Hospital Charge Code |
1712082
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: Blue Shield of California Commercial |
$1.36
|
| Rate for Payer: Blue Shield of California EPN |
$0.98
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cigna of CA HMO |
$1.34
|
| Rate for Payer: Cigna of CA PPO |
$1.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.76
|
| Rate for Payer: Galaxy Health WC |
$1.62
|
| Rate for Payer: Global Benefits Group Commercial |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.46
|
| Rate for Payer: Multiplan Commercial |
$1.53
|
| Rate for Payer: Networks By Design Commercial |
$1.24
|
| Rate for Payer: Prime Health Services Commercial |
$1.62
|
|
|
RIFAMPIN 150 MG CAPSULE [11292]
|
Facility
OP
|
$1.91
|
|
|
Service Code
|
NDC 60687-575-21
|
| Hospital Charge Code |
1712082
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.14
|
| Rate for Payer: BCBS Transplant Transplant |
$1.15
|
| Rate for Payer: Blue Shield of California Commercial |
$1.41
|
| Rate for Payer: Blue Shield of California EPN |
$1.12
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cigna of CA HMO |
$1.34
|
| Rate for Payer: Cigna of CA PPO |
$1.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.62
|
| Rate for Payer: Dignity Health Media |
$1.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.76
|
| Rate for Payer: Galaxy Health WC |
$1.62
|
| Rate for Payer: Global Benefits Group Commercial |
$1.15
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.46
|
| Rate for Payer: Multiplan Commercial |
$1.53
|
| Rate for Payer: Networks By Design Commercial |
$1.24
|
| Rate for Payer: Prime Health Services Commercial |
$1.62
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.96
|
| Rate for Payer: United Healthcare All Other HMO |
$0.96
|
| Rate for Payer: United Healthcare HMO Rider |
$0.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.62
|
| Rate for Payer: Vantage Medical Group Senior |
$1.62
|
|
|
RIFAMPIN 150 MG CAPSULE [11292]
|
Facility
OP
|
$1.91
|
|
|
Service Code
|
NDC 60687-575-11
|
| Hospital Charge Code |
1712082
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: Galaxy Health WC |
$1.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.14
|
| Rate for Payer: BCBS Transplant Transplant |
$1.15
|
| Rate for Payer: Blue Shield of California Commercial |
$1.41
|
| Rate for Payer: Blue Shield of California EPN |
$1.12
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cigna of CA HMO |
$1.34
|
| Rate for Payer: Cigna of CA PPO |
$1.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.62
|
| Rate for Payer: Dignity Health Media |
$1.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.76
|
| Rate for Payer: Global Benefits Group Commercial |
$1.15
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.46
|
| Rate for Payer: Multiplan Commercial |
$1.53
|
| Rate for Payer: Networks By Design Commercial |
$1.24
|
| Rate for Payer: Prime Health Services Commercial |
$1.62
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.96
|
| Rate for Payer: United Healthcare All Other HMO |
$0.96
|
| Rate for Payer: United Healthcare HMO Rider |
$0.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.62
|
| Rate for Payer: Vantage Medical Group Senior |
$1.62
|
|
|
RIFAMPIN 150 MG CAPSULE [11292]
|
Facility
IP
|
$1.18
|
|
|
Service Code
|
NDC 61748-015-30
|
| Hospital Charge Code |
1712082
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Blue Shield of California Commercial |
$0.84
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: Cigna of CA HMO |
$0.83
|
| Rate for Payer: Cigna of CA PPO |
$0.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.47
|
| Rate for Payer: Galaxy Health WC |
$1.00
|
| Rate for Payer: Global Benefits Group Commercial |
$0.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$0.94
|
| Rate for Payer: Networks By Design Commercial |
$0.77
|
| Rate for Payer: Prime Health Services Commercial |
$1.00
|
|
