|
RIFAXIMIN ORAL SUSPENSION COMPOUND 20 MG/ML [4080332]
|
Facility
OP
|
$1.33
|
|
|
Service Code
|
NDC 9994-0803-32
|
| Hospital Charge Code |
1715270
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.13 |
| Rate for Payer: BCBS Transplant Transplant |
$0.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.73
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.79
|
| Rate for Payer: Blue Shield of California Commercial |
$0.98
|
| Rate for Payer: Blue Shield of California EPN |
$0.78
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna of CA HMO |
$0.93
|
| Rate for Payer: Cigna of CA PPO |
$0.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.13
|
| Rate for Payer: Dignity Health Media |
$1.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.53
|
| Rate for Payer: Galaxy Health WC |
$1.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$1.06
|
| Rate for Payer: Networks By Design Commercial |
$0.86
|
| Rate for Payer: Prime Health Services Commercial |
$1.13
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.67
|
| Rate for Payer: United Healthcare All Other HMO |
$0.67
|
| Rate for Payer: United Healthcare HMO Rider |
$0.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.13
|
| Rate for Payer: Vantage Medical Group Senior |
$1.13
|
|
|
RIFAXIMIN ORAL SUSPENSION COMPOUND 20 MG/ML [4080332]
|
Facility
IP
|
$1.33
|
|
|
Service Code
|
NDC 9994-0803-32
|
| Hospital Charge Code |
1715270
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.13 |
| Rate for Payer: Blue Shield of California Commercial |
$0.95
|
| Rate for Payer: Blue Shield of California EPN |
$0.68
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna of CA HMO |
$0.93
|
| Rate for Payer: Cigna of CA PPO |
$0.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.53
|
| Rate for Payer: Galaxy Health WC |
$1.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$1.06
|
| Rate for Payer: Networks By Design Commercial |
$0.86
|
| Rate for Payer: Prime Health Services Commercial |
$1.13
|
|
|
RILPIVIRINE HCL 25 MG TABLET [109909]
|
Facility
IP
|
$54.01
|
|
|
Service Code
|
NDC 59676-278-01
|
| Hospital Charge Code |
1712619
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$45.91 |
| Rate for Payer: Blue Shield of California Commercial |
$38.46
|
| Rate for Payer: Blue Shield of California EPN |
$27.65
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna of CA HMO |
$37.81
|
| Rate for Payer: Cigna of CA PPO |
$37.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: Galaxy Health WC |
$45.91
|
| Rate for Payer: Global Benefits Group Commercial |
$32.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.96
|
| Rate for Payer: Multiplan Commercial |
$43.21
|
| Rate for Payer: Networks By Design Commercial |
$35.11
|
| Rate for Payer: Prime Health Services Commercial |
$45.91
|
|
|
RILPIVIRINE HCL 25 MG TABLET [109909]
|
Facility
OP
|
$54.01
|
|
|
Service Code
|
NDC 59676-278-01
|
| Hospital Charge Code |
1712619
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$45.91 |
| Rate for Payer: Aetna of CA HMO/PPO |
$35.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$45.91
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$29.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$29.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.18
|
| Rate for Payer: BCBS Transplant Transplant |
$32.41
|
| Rate for Payer: Blue Shield of California Commercial |
$39.81
|
| Rate for Payer: Blue Shield of California EPN |
$31.54
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna of CA HMO |
$37.81
|
| Rate for Payer: Cigna of CA PPO |
$37.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.91
|
| Rate for Payer: Dignity Health Media |
$45.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.60
|
| Rate for Payer: Galaxy Health WC |
$45.91
|
| Rate for Payer: Global Benefits Group Commercial |
$32.41
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$40.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.96
|
| Rate for Payer: Multiplan Commercial |
$43.21
|
| Rate for Payer: Networks By Design Commercial |
$35.11
|
| Rate for Payer: Prime Health Services Commercial |
$45.91
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$32.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27.00
|
| Rate for Payer: United Healthcare HMO Rider |
$27.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.91
|
| Rate for Payer: Vantage Medical Group Senior |
$45.91
|
|
|
RILUZOLE 50 MG TABLET [16124]
|
Facility
IP
|
$1.58
|
|
|
Service Code
|
NDC 68462-381-60
|
| Hospital Charge Code |
1712269
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Blue Shield of California Commercial |
$1.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.81
|
| Rate for Payer: Cash Price |
$0.71
|
| Rate for Payer: Cigna of CA HMO |
$1.11
|
| Rate for Payer: Cigna of CA PPO |
$1.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.63
|
| Rate for Payer: Galaxy Health WC |
$1.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
| Rate for Payer: Networks By Design Commercial |
$1.03
|
| Rate for Payer: Prime Health Services Commercial |
$1.34
|
|
|
RILUZOLE 50 MG TABLET [16124]
|
Facility
IP
|
$1.58
|
|
|
Service Code
|
NDC 62756-538-86
|
| Hospital Charge Code |
1712269
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Blue Shield of California Commercial |
$1.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.81
|
| Rate for Payer: Cash Price |
$0.71
|
| Rate for Payer: Cigna of CA HMO |
$1.11
|
| Rate for Payer: Cigna of CA PPO |
$1.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.63
|
| Rate for Payer: Galaxy Health WC |
$1.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
| Rate for Payer: Networks By Design Commercial |
$1.03
|
| Rate for Payer: Prime Health Services Commercial |
$1.34
|
|
|
RILUZOLE 50 MG TABLET [16124]
|
Facility
IP
|
$0.80
|
|
|
Service Code
|
NDC 67877-286-60
|
| Hospital Charge Code |
1712269
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California EPN |
$0.41
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cigna of CA HMO |
$0.56
|
| Rate for Payer: Cigna of CA PPO |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.68
|
| Rate for Payer: Global Benefits Group Commercial |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.64
|
| Rate for Payer: Networks By Design Commercial |
$0.52
|
| Rate for Payer: Prime Health Services Commercial |
$0.68
|
|
|
RILUZOLE 50 MG TABLET [16124]
|
Facility
OP
|
$0.80
|
|
|
Service Code
|
NDC 67877-286-60
|
| Hospital Charge Code |
1712269
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.48
|
| Rate for Payer: BCBS Transplant Transplant |
$0.48
|
| Rate for Payer: Blue Shield of California Commercial |
$0.59
|
| Rate for Payer: Blue Shield of California EPN |
$0.47
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cigna of CA HMO |
$0.56
|
| Rate for Payer: Cigna of CA PPO |
$0.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.68
|
| Rate for Payer: Dignity Health Media |
$0.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.68
|
| Rate for Payer: Global Benefits Group Commercial |
$0.48
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.64
|
| Rate for Payer: Networks By Design Commercial |
$0.52
|
| Rate for Payer: Prime Health Services Commercial |
$0.68
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO |
$0.40
|
| Rate for Payer: United Healthcare HMO Rider |
$0.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.68
|
| Rate for Payer: Vantage Medical Group Senior |
$0.68
|
|
|
RILUZOLE 50 MG TABLET [16124]
|
Facility
OP
|
$1.58
|
|
|
Service Code
|
NDC 62756-538-86
|
| Hospital Charge Code |
1712269
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.94
|
| Rate for Payer: BCBS Transplant Transplant |
$0.95
|
| Rate for Payer: Blue Shield of California Commercial |
$1.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.92
|
| Rate for Payer: Cash Price |
$0.71
|
| Rate for Payer: Cigna of CA HMO |
$1.11
|
| Rate for Payer: Cigna of CA PPO |
$1.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.34
|
| Rate for Payer: Dignity Health Media |
$1.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.63
|
| Rate for Payer: Galaxy Health WC |
$1.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.95
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
| Rate for Payer: Networks By Design Commercial |
$1.03
|
| Rate for Payer: Prime Health Services Commercial |
$1.34
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.79
|
| Rate for Payer: United Healthcare All Other HMO |
$0.79
|
| Rate for Payer: United Healthcare HMO Rider |
$0.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1.34
|
|
|
RILUZOLE 50 MG TABLET [16124]
|
Facility
OP
|
$1.58
|
|
|
Service Code
|
NDC 68462-381-60
|
| Hospital Charge Code |
1712269
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Galaxy Health WC |
$1.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.94
|
| Rate for Payer: BCBS Transplant Transplant |
$0.95
|
| Rate for Payer: Blue Shield of California Commercial |
$1.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.92
|
| Rate for Payer: Cash Price |
$0.71
|
| Rate for Payer: Cigna of CA HMO |
$1.11
|
| Rate for Payer: Cigna of CA PPO |
$1.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.34
|
| Rate for Payer: Dignity Health Media |
$1.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.63
|
| Rate for Payer: Global Benefits Group Commercial |
$0.95
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
| Rate for Payer: Networks By Design Commercial |
$1.03
|
| Rate for Payer: Prime Health Services Commercial |
$1.34
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.79
|
| Rate for Payer: United Healthcare All Other HMO |
$0.79
|
| Rate for Payer: United Healthcare HMO Rider |
$0.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1.34
|
|
|
RIMABOTULINUMTOXINB 2,500 UNIT/0.5 ML INTRAMUSCULAR SOLUTION [108078]
|
Facility
IP
|
$747.14
|
|
|
Service Code
|
CPT J0587
|
| Hospital Charge Code |
NDG108078
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$179.31 |
| Max. Negotiated Rate |
$635.07 |
| Rate for Payer: Blue Shield of California Commercial |
$531.96
|
| Rate for Payer: Blue Shield of California EPN |
$382.54
|
| Rate for Payer: Cash Price |
$336.21
|
| Rate for Payer: Cigna of CA HMO |
$523.00
|
| Rate for Payer: Cigna of CA PPO |
$523.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$298.86
|
| Rate for Payer: Galaxy Health WC |
$635.07
|
| Rate for Payer: Global Benefits Group Commercial |
$448.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$498.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$284.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.31
|
| Rate for Payer: Multiplan Commercial |
$597.71
|
| Rate for Payer: Networks By Design Commercial |
$373.57
|
| Rate for Payer: Prime Health Services Commercial |
$635.07
|
|
|
RIMABOTULINUMTOXINB 2,500 UNIT/0.5 ML INTRAMUSCULAR SOLUTION [108078]
|
Facility
OP
|
$747.14
|
|
|
Service Code
|
CPT J0587
|
| Hospital Charge Code |
NDG108078
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.03 |
| Max. Negotiated Rate |
$635.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$81.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.37
|
| Rate for Payer: BCBS Transplant Transplant |
$448.28
|
| Rate for Payer: Blue Shield of California Commercial |
$550.64
|
| Rate for Payer: Blue Shield of California EPN |
$13.94
|
| Rate for Payer: Cash Price |
$336.21
|
| Rate for Payer: Cash Price |
$336.21
|
| Rate for Payer: Cigna of CA HMO |
$523.00
|
| Rate for Payer: Cigna of CA PPO |
$523.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.54
|
| Rate for Payer: Dignity Health Media |
$13.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.59
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.03
|
| Rate for Payer: Galaxy Health WC |
$635.07
|
| Rate for Payer: Global Benefits Group Commercial |
$448.28
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$560.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.36
|
| Rate for Payer: Heritage Provider Network Transplant |
$21.36
|
| Rate for Payer: IEHP Medi-Cal |
$21.10
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$21.10
|
| Rate for Payer: IEHP Medicare Advantage |
$13.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$498.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.45
|
| Rate for Payer: Multiplan Commercial |
$597.71
|
| Rate for Payer: Networks By Design Commercial |
$373.57
|
| Rate for Payer: Prime Health Services Commercial |
$635.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$448.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$448.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$373.57
|
| Rate for Payer: United Healthcare All Other HMO |
$373.57
|
| Rate for Payer: United Healthcare HMO Rider |
$373.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$373.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Vantage Medical Group Senior |
$13.03
|
|
|
RINGER'S INTRAVENOUS SOLUTION [11295]
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
NDC 0264-7780-00
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: BCBS Transplant Transplant |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Media |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
RINGER'S INTRAVENOUS SOLUTION [11295]
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
NDC 0264-7780-00
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
RIOCIGUAT 0.5 MG TABLET [203879]
|
Facility
IP
|
$164.16
|
|
|
Service Code
|
NDC 50419-250-01
|
| Hospital Charge Code |
ERX203879
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.40 |
| Max. Negotiated Rate |
$139.54 |
| Rate for Payer: Blue Shield of California Commercial |
$116.88
|
| Rate for Payer: Blue Shield of California EPN |
$84.05
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Cigna of CA HMO |
$114.91
|
| Rate for Payer: Cigna of CA PPO |
$114.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.66
|
| Rate for Payer: Galaxy Health WC |
$139.54
|
| Rate for Payer: Global Benefits Group Commercial |
$98.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.40
|
| Rate for Payer: Multiplan Commercial |
$131.33
|
| Rate for Payer: Networks By Design Commercial |
$106.70
|
| Rate for Payer: Prime Health Services Commercial |
$139.54
|
|
|
RIOCIGUAT 0.5 MG TABLET [203879]
|
Facility
OP
|
$164.16
|
|
|
Service Code
|
NDC 50419-250-91
|
| Hospital Charge Code |
ERX203879
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.40 |
| Max. Negotiated Rate |
$139.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$107.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$139.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$90.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$90.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.81
|
| Rate for Payer: BCBS Transplant Transplant |
$98.50
|
| Rate for Payer: Blue Shield of California Commercial |
$120.99
|
| Rate for Payer: Blue Shield of California EPN |
$95.87
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Cigna of CA HMO |
$114.91
|
| Rate for Payer: Cigna of CA PPO |
$114.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$139.54
|
| Rate for Payer: Dignity Health Media |
$139.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$139.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$65.66
|
| Rate for Payer: Galaxy Health WC |
$139.54
|
| Rate for Payer: Global Benefits Group Commercial |
$98.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$123.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.40
|
| Rate for Payer: Multiplan Commercial |
$131.33
|
| Rate for Payer: Networks By Design Commercial |
$106.70
|
| Rate for Payer: Prime Health Services Commercial |
$139.54
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$98.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$98.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$98.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.08
|
| Rate for Payer: United Healthcare All Other HMO |
$82.08
|
| Rate for Payer: United Healthcare HMO Rider |
$82.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$139.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$139.54
|
| Rate for Payer: Vantage Medical Group Senior |
$139.54
|
|
|
RIOCIGUAT 0.5 MG TABLET [203879]
|
Facility
IP
|
$164.16
|
|
|
Service Code
|
NDC 50419-250-91
|
| Hospital Charge Code |
ERX203879
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.40 |
| Max. Negotiated Rate |
$139.54 |
| Rate for Payer: Blue Shield of California Commercial |
$116.88
|
| Rate for Payer: Blue Shield of California EPN |
$84.05
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Cigna of CA HMO |
$114.91
|
| Rate for Payer: Cigna of CA PPO |
$114.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.66
|
| Rate for Payer: Galaxy Health WC |
$139.54
|
| Rate for Payer: Global Benefits Group Commercial |
$98.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.40
|
| Rate for Payer: Multiplan Commercial |
$131.33
|
| Rate for Payer: Networks By Design Commercial |
$106.70
|
| Rate for Payer: Prime Health Services Commercial |
$139.54
|
|
|
RIOCIGUAT 0.5 MG TABLET [203879]
|
Facility
OP
|
$164.16
|
|
|
Service Code
|
NDC 50419-250-01
|
| Hospital Charge Code |
ERX203879
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.40 |
| Max. Negotiated Rate |
$139.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$107.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$139.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$90.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$90.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.81
|
| Rate for Payer: BCBS Transplant Transplant |
$98.50
|
| Rate for Payer: Blue Shield of California Commercial |
$120.99
|
| Rate for Payer: Blue Shield of California EPN |
$95.87
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Cigna of CA HMO |
$114.91
|
| Rate for Payer: Cigna of CA PPO |
$114.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$139.54
|
| Rate for Payer: Dignity Health Media |
$139.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$139.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$65.66
|
| Rate for Payer: Galaxy Health WC |
$139.54
|
| Rate for Payer: Global Benefits Group Commercial |
$98.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$123.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.40
|
| Rate for Payer: Multiplan Commercial |
$131.33
|
| Rate for Payer: Networks By Design Commercial |
$106.70
|
| Rate for Payer: Prime Health Services Commercial |
$139.54
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$98.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$98.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$98.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.08
|
| Rate for Payer: United Healthcare All Other HMO |
$82.08
|
| Rate for Payer: United Healthcare HMO Rider |
$82.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$139.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$139.54
|
| Rate for Payer: Vantage Medical Group Senior |
$139.54
|
|
|
RIOCIGUAT 1 MG TABLET [203880]
|
Facility
OP
|
$164.16
|
|
|
Service Code
|
NDC 50419-251-01
|
| Hospital Charge Code |
ERX203880
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.40 |
| Max. Negotiated Rate |
$139.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$107.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$139.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$90.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$90.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.81
|
| Rate for Payer: BCBS Transplant Transplant |
$98.50
|
| Rate for Payer: Blue Shield of California Commercial |
$120.99
|
| Rate for Payer: Blue Shield of California EPN |
$95.87
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Cigna of CA HMO |
$114.91
|
| Rate for Payer: Cigna of CA PPO |
$114.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$139.54
|
| Rate for Payer: Dignity Health Media |
$139.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$139.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$65.66
|
| Rate for Payer: Galaxy Health WC |
$139.54
|
| Rate for Payer: Global Benefits Group Commercial |
$98.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$123.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.40
|
| Rate for Payer: Multiplan Commercial |
$131.33
|
| Rate for Payer: Networks By Design Commercial |
$106.70
|
| Rate for Payer: Prime Health Services Commercial |
$139.54
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$98.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$98.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$98.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.08
|
| Rate for Payer: United Healthcare All Other HMO |
$82.08
|
| Rate for Payer: United Healthcare HMO Rider |
$82.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$139.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$139.54
|
| Rate for Payer: Vantage Medical Group Senior |
$139.54
|
|
|
RIOCIGUAT 1 MG TABLET [203880]
|
Facility
IP
|
$164.16
|
|
|
Service Code
|
NDC 50419-251-01
|
| Hospital Charge Code |
ERX203880
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.40 |
| Max. Negotiated Rate |
$139.54 |
| Rate for Payer: Blue Shield of California Commercial |
$116.88
|
| Rate for Payer: Blue Shield of California EPN |
$84.05
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Cigna of CA HMO |
$114.91
|
| Rate for Payer: Cigna of CA PPO |
$114.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.66
|
| Rate for Payer: Galaxy Health WC |
$139.54
|
| Rate for Payer: Global Benefits Group Commercial |
$98.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.40
|
| Rate for Payer: Multiplan Commercial |
$131.33
|
| Rate for Payer: Networks By Design Commercial |
$106.70
|
| Rate for Payer: Prime Health Services Commercial |
$139.54
|
|
|
RIOCIGUAT 1 MG TABLET [203880]
|
Facility
IP
|
$164.16
|
|
|
Service Code
|
NDC 50419-251-91
|
| Hospital Charge Code |
ERX203880
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.40 |
| Max. Negotiated Rate |
$139.54 |
| Rate for Payer: Blue Shield of California Commercial |
$116.88
|
| Rate for Payer: Blue Shield of California EPN |
$84.05
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Cigna of CA HMO |
$114.91
|
| Rate for Payer: Cigna of CA PPO |
$114.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.66
|
| Rate for Payer: Galaxy Health WC |
$139.54
|
| Rate for Payer: Global Benefits Group Commercial |
$98.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.40
|
| Rate for Payer: Multiplan Commercial |
$131.33
|
| Rate for Payer: Networks By Design Commercial |
$106.70
|
| Rate for Payer: Prime Health Services Commercial |
$139.54
|
|
|
RIOCIGUAT 1 MG TABLET [203880]
|
Facility
OP
|
$164.16
|
|
|
Service Code
|
NDC 50419-251-91
|
| Hospital Charge Code |
ERX203880
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.40 |
| Max. Negotiated Rate |
$139.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$107.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$139.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$90.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$90.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.81
|
| Rate for Payer: BCBS Transplant Transplant |
$98.50
|
| Rate for Payer: Blue Shield of California Commercial |
$120.99
|
| Rate for Payer: Blue Shield of California EPN |
$95.87
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Cigna of CA HMO |
$114.91
|
| Rate for Payer: Cigna of CA PPO |
$114.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$139.54
|
| Rate for Payer: Dignity Health Media |
$139.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$139.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$65.66
|
| Rate for Payer: Galaxy Health WC |
$139.54
|
| Rate for Payer: Global Benefits Group Commercial |
$98.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$123.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.40
|
| Rate for Payer: Multiplan Commercial |
$131.33
|
| Rate for Payer: Networks By Design Commercial |
$106.70
|
| Rate for Payer: Prime Health Services Commercial |
$139.54
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$98.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$98.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$98.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.08
|
| Rate for Payer: United Healthcare All Other HMO |
$82.08
|
| Rate for Payer: United Healthcare HMO Rider |
$82.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$139.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$139.54
|
| Rate for Payer: Vantage Medical Group Senior |
$139.54
|
|
|
RIOCIGUAT 2.5 MG TABLET [203883]
|
Facility
OP
|
$164.16
|
|
|
Service Code
|
NDC 50419-254-91
|
| Hospital Charge Code |
ERX203883
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.40 |
| Max. Negotiated Rate |
$139.54 |
| Rate for Payer: Cigna of CA HMO |
$114.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$139.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$90.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$90.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.81
|
| Rate for Payer: BCBS Transplant Transplant |
$98.50
|
| Rate for Payer: Blue Shield of California Commercial |
$120.99
|
| Rate for Payer: Blue Shield of California EPN |
$95.87
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Cigna of CA PPO |
$114.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$139.54
|
| Rate for Payer: Dignity Health Media |
$139.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$139.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$65.66
|
| Rate for Payer: Galaxy Health WC |
$139.54
|
| Rate for Payer: Global Benefits Group Commercial |
$98.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$123.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.40
|
| Rate for Payer: Multiplan Commercial |
$131.33
|
| Rate for Payer: Networks By Design Commercial |
$106.70
|
| Rate for Payer: Prime Health Services Commercial |
$139.54
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$98.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$98.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$98.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.08
|
| Rate for Payer: United Healthcare All Other HMO |
$82.08
|
| Rate for Payer: United Healthcare HMO Rider |
$82.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$139.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$139.54
|
| Rate for Payer: Vantage Medical Group Senior |
$139.54
|
|
|
RIOCIGUAT 2.5 MG TABLET [203883]
|
Facility
IP
|
$164.16
|
|
|
Service Code
|
NDC 50419-254-01
|
| Hospital Charge Code |
ERX203883
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.40 |
| Max. Negotiated Rate |
$139.54 |
| Rate for Payer: Blue Shield of California Commercial |
$116.88
|
| Rate for Payer: Blue Shield of California EPN |
$84.05
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Cigna of CA HMO |
$114.91
|
| Rate for Payer: Cigna of CA PPO |
$114.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.66
|
| Rate for Payer: Galaxy Health WC |
$139.54
|
| Rate for Payer: Global Benefits Group Commercial |
$98.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.40
|
| Rate for Payer: Multiplan Commercial |
$131.33
|
| Rate for Payer: Networks By Design Commercial |
$106.70
|
| Rate for Payer: Prime Health Services Commercial |
$139.54
|
|
|
RIOCIGUAT 2.5 MG TABLET [203883]
|
Facility
OP
|
$164.16
|
|
|
Service Code
|
NDC 50419-254-01
|
| Hospital Charge Code |
ERX203883
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.40 |
| Max. Negotiated Rate |
$139.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$107.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$139.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$90.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$90.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.81
|
| Rate for Payer: BCBS Transplant Transplant |
$98.50
|
| Rate for Payer: Blue Shield of California Commercial |
$120.99
|
| Rate for Payer: Blue Shield of California EPN |
$95.87
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Cigna of CA HMO |
$114.91
|
| Rate for Payer: Cigna of CA PPO |
$114.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$139.54
|
| Rate for Payer: Dignity Health Media |
$139.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$139.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$65.66
|
| Rate for Payer: Galaxy Health WC |
$139.54
|
| Rate for Payer: Global Benefits Group Commercial |
$98.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$123.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.40
|
| Rate for Payer: Multiplan Commercial |
$131.33
|
| Rate for Payer: Networks By Design Commercial |
$106.70
|
| Rate for Payer: Prime Health Services Commercial |
$139.54
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$98.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$98.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$98.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.08
|
| Rate for Payer: United Healthcare All Other HMO |
$82.08
|
| Rate for Payer: United Healthcare HMO Rider |
$82.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$139.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$139.54
|
| Rate for Payer: Vantage Medical Group Senior |
$139.54
|
|
