RISPERIDONE 1 MG TABLET [18313]
|
Facility
IP
|
$0.50
|
|
Service Code
|
NDC 68084-272-01
|
Hospital Charge Code |
1712178
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.12 |
Max. Negotiated Rate |
$0.43 |
Rate for Payer: Blue Shield of California Commercial |
$0.36
|
Rate for Payer: Blue Shield of California EPN |
$0.26
|
Rate for Payer: Cash Price |
$0.23
|
Rate for Payer: Cigna of CA HMO |
$0.35
|
Rate for Payer: Cigna of CA PPO |
$0.35
|
Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
Rate for Payer: Galaxy Health WC |
$0.43
|
Rate for Payer: Global Benefits Group Commercial |
$0.30
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
Rate for Payer: Multiplan Commercial |
$0.40
|
Rate for Payer: Networks By Design Commercial |
$0.33
|
Rate for Payer: Prime Health Services Commercial |
$0.43
|
|
RISPERIDONE 1 MG TABLET [18313]
|
Facility
IP
|
$0.50
|
|
Service Code
|
NDC 68084-272-11
|
Hospital Charge Code |
1712178
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.12 |
Max. Negotiated Rate |
$0.43 |
Rate for Payer: Blue Shield of California Commercial |
$0.36
|
Rate for Payer: Blue Shield of California EPN |
$0.26
|
Rate for Payer: Cash Price |
$0.23
|
Rate for Payer: Cigna of CA HMO |
$0.35
|
Rate for Payer: Cigna of CA PPO |
$0.35
|
Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
Rate for Payer: Galaxy Health WC |
$0.43
|
Rate for Payer: Global Benefits Group Commercial |
$0.30
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
Rate for Payer: Multiplan Commercial |
$0.40
|
Rate for Payer: Networks By Design Commercial |
$0.33
|
Rate for Payer: Prime Health Services Commercial |
$0.43
|
|
RISPERIDONE 1 MG TABLET [18313]
|
Facility
OP
|
$0.21
|
|
Service Code
|
NDC 0904-6359-61
|
Hospital Charge Code |
1712178
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.05 |
Max. Negotiated Rate |
$0.18 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.18
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.12
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.12
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.13
|
Rate for Payer: BCBS Transplant Transplant |
$0.13
|
Rate for Payer: Blue Shield of California Commercial |
$0.15
|
Rate for Payer: Blue Shield of California EPN |
$0.12
|
Rate for Payer: Cash Price |
$0.09
|
Rate for Payer: Cigna of CA HMO |
$0.15
|
Rate for Payer: Cigna of CA PPO |
$0.15
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.18
|
Rate for Payer: Dignity Health Media |
$0.18
|
Rate for Payer: Dignity Health Medi-Cal |
$0.18
|
Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
Rate for Payer: EPIC Health Plan Transplant |
$0.08
|
Rate for Payer: Galaxy Health WC |
$0.18
|
Rate for Payer: Global Benefits Group Commercial |
$0.13
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.16
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.14
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
Rate for Payer: Multiplan Commercial |
$0.17
|
Rate for Payer: Networks By Design Commercial |
$0.14
|
Rate for Payer: Prime Health Services Commercial |
$0.18
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.13
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.13
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.13
|
Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
Rate for Payer: United Healthcare All Other HMO |
$0.11
|
Rate for Payer: United Healthcare HMO Rider |
$0.11
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.18
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.18
|
Rate for Payer: Vantage Medical Group Senior |
$0.18
|
|
RISPERIDONE 2 MG DISINTEGRATING TABLET [35688]
|
Facility
IP
|
$7.97
|
|
Service Code
|
NDC 49884-401-52
|
Hospital Charge Code |
1713153
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$1.91 |
Max. Negotiated Rate |
$6.77 |
Rate for Payer: Blue Shield of California Commercial |
$5.67
|
Rate for Payer: Blue Shield of California EPN |
$4.08
|
Rate for Payer: Cash Price |
$3.59
|
Rate for Payer: Cigna of CA HMO |
$5.58
|
Rate for Payer: Cigna of CA PPO |
$5.58
|
Rate for Payer: EPIC Health Plan Commercial |
$3.19
|
Rate for Payer: Galaxy Health WC |
$6.77
|
Rate for Payer: Global Benefits Group Commercial |
$4.78
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.32
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.04
|
Rate for Payer: LLUH Dept of Risk Management WC |
$1.91
|
Rate for Payer: Multiplan Commercial |
$6.38
|
Rate for Payer: Networks By Design Commercial |
$5.18
|
Rate for Payer: Prime Health Services Commercial |
$6.77
|
|
RISPERIDONE 2 MG DISINTEGRATING TABLET [35688]
|
Facility
OP
|
$7.97
|
|
Service Code
|
NDC 49884-401-52
|
Hospital Charge Code |
1713153
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$1.91 |
Max. Negotiated Rate |
$6.77 |
Rate for Payer: Aetna of CA HMO/PPO |
$5.23
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.77
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.38
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.38
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.75
|
Rate for Payer: BCBS Transplant Transplant |
$4.78
|
Rate for Payer: Blue Shield of California Commercial |
$5.87
|
Rate for Payer: Blue Shield of California EPN |
$4.65
|
Rate for Payer: Cash Price |
$3.59
|
Rate for Payer: Cigna of CA HMO |
$5.58
|
Rate for Payer: Cigna of CA PPO |
$5.58
|
Rate for Payer: Dignity Health Commercial/Exchange |
$6.77
|
Rate for Payer: Dignity Health Media |
$6.77
|
Rate for Payer: Dignity Health Medi-Cal |
$6.77
|
Rate for Payer: EPIC Health Plan Commercial |
$3.19
|
Rate for Payer: EPIC Health Plan Transplant |
$3.19
|
Rate for Payer: Galaxy Health WC |
$6.77
|
Rate for Payer: Global Benefits Group Commercial |
$4.78
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.98
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.32
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.04
|
Rate for Payer: LLUH Dept of Risk Management WC |
$1.91
|
Rate for Payer: Multiplan Commercial |
$6.38
|
Rate for Payer: Networks By Design Commercial |
$5.18
|
Rate for Payer: Prime Health Services Commercial |
$6.77
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.78
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.78
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.78
|
Rate for Payer: United Healthcare All Other Commercial |
$3.98
|
Rate for Payer: United Healthcare All Other HMO |
$3.98
|
Rate for Payer: United Healthcare HMO Rider |
$3.98
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$3.98
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.77
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$6.77
|
Rate for Payer: Vantage Medical Group Senior |
$6.77
|
|
RISPERIDONE 2 MG DISINTEGRATING TABLET [35688]
|
Facility
OP
|
$7.36
|
|
Service Code
|
NDC 0781-5312-06
|
Hospital Charge Code |
1713153
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$1.77 |
Max. Negotiated Rate |
$6.26 |
Rate for Payer: Galaxy Health WC |
$6.26
|
Rate for Payer: Aetna of CA HMO/PPO |
$4.83
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.26
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.05
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.05
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.39
|
Rate for Payer: BCBS Transplant Transplant |
$4.42
|
Rate for Payer: Blue Shield of California Commercial |
$5.42
|
Rate for Payer: Blue Shield of California EPN |
$4.30
|
Rate for Payer: Cash Price |
$3.31
|
Rate for Payer: Cigna of CA HMO |
$5.15
|
Rate for Payer: Cigna of CA PPO |
$5.15
|
Rate for Payer: Dignity Health Commercial/Exchange |
$6.26
|
Rate for Payer: Dignity Health Media |
$6.26
|
Rate for Payer: Dignity Health Medi-Cal |
$6.26
|
Rate for Payer: EPIC Health Plan Commercial |
$2.94
|
Rate for Payer: EPIC Health Plan Transplant |
$2.94
|
Rate for Payer: Global Benefits Group Commercial |
$4.42
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.52
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.91
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.80
|
Rate for Payer: LLUH Dept of Risk Management WC |
$1.77
|
Rate for Payer: Multiplan Commercial |
$5.89
|
Rate for Payer: Networks By Design Commercial |
$4.78
|
Rate for Payer: Prime Health Services Commercial |
$6.26
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.42
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.42
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.42
|
Rate for Payer: United Healthcare All Other Commercial |
$3.68
|
Rate for Payer: United Healthcare All Other HMO |
$3.68
|
Rate for Payer: United Healthcare HMO Rider |
$3.68
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$3.68
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.26
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$6.26
|
Rate for Payer: Vantage Medical Group Senior |
$6.26
|
|
RISPERIDONE 2 MG DISINTEGRATING TABLET [35688]
|
Facility
IP
|
$7.97
|
|
Service Code
|
NDC 49884-401-91
|
Hospital Charge Code |
1713153
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$1.91 |
Max. Negotiated Rate |
$6.77 |
Rate for Payer: Blue Shield of California Commercial |
$5.67
|
Rate for Payer: Blue Shield of California EPN |
$4.08
|
Rate for Payer: Cash Price |
$3.59
|
Rate for Payer: Cigna of CA HMO |
$5.58
|
Rate for Payer: Cigna of CA PPO |
$5.58
|
Rate for Payer: EPIC Health Plan Commercial |
$3.19
|
Rate for Payer: Galaxy Health WC |
$6.77
|
Rate for Payer: Global Benefits Group Commercial |
$4.78
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.32
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.04
|
Rate for Payer: LLUH Dept of Risk Management WC |
$1.91
|
Rate for Payer: Multiplan Commercial |
$6.38
|
Rate for Payer: Networks By Design Commercial |
$5.18
|
Rate for Payer: Prime Health Services Commercial |
$6.77
|
|
RISPERIDONE 2 MG DISINTEGRATING TABLET [35688]
|
Facility
IP
|
$4.01
|
|
Service Code
|
NDC 59746-030-22
|
Hospital Charge Code |
1713153
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.96 |
Max. Negotiated Rate |
$3.41 |
Rate for Payer: Blue Shield of California Commercial |
$2.86
|
Rate for Payer: Blue Shield of California EPN |
$2.05
|
Rate for Payer: Cash Price |
$1.80
|
Rate for Payer: Cigna of CA HMO |
$2.81
|
Rate for Payer: Cigna of CA PPO |
$2.81
|
Rate for Payer: EPIC Health Plan Commercial |
$1.60
|
Rate for Payer: Galaxy Health WC |
$3.41
|
Rate for Payer: Global Benefits Group Commercial |
$2.41
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.67
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.53
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.96
|
Rate for Payer: Multiplan Commercial |
$3.21
|
Rate for Payer: Networks By Design Commercial |
$2.61
|
Rate for Payer: Prime Health Services Commercial |
$3.41
|
|
RISPERIDONE 2 MG DISINTEGRATING TABLET [35688]
|
Facility
OP
|
$7.97
|
|
Service Code
|
NDC 49884-401-91
|
Hospital Charge Code |
1713153
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$1.91 |
Max. Negotiated Rate |
$6.77 |
Rate for Payer: Aetna of CA HMO/PPO |
$5.23
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.77
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.38
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.38
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.75
|
Rate for Payer: BCBS Transplant Transplant |
$4.78
|
Rate for Payer: Blue Shield of California Commercial |
$5.87
|
Rate for Payer: Blue Shield of California EPN |
$4.65
|
Rate for Payer: Cash Price |
$3.59
|
Rate for Payer: Cigna of CA HMO |
$5.58
|
Rate for Payer: Cigna of CA PPO |
$5.58
|
Rate for Payer: Dignity Health Commercial/Exchange |
$6.77
|
Rate for Payer: Dignity Health Media |
$6.77
|
Rate for Payer: Dignity Health Medi-Cal |
$6.77
|
Rate for Payer: EPIC Health Plan Commercial |
$3.19
|
Rate for Payer: EPIC Health Plan Transplant |
$3.19
|
Rate for Payer: Galaxy Health WC |
$6.77
|
Rate for Payer: Global Benefits Group Commercial |
$4.78
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.98
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.32
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.04
|
Rate for Payer: LLUH Dept of Risk Management WC |
$1.91
|
Rate for Payer: Multiplan Commercial |
$6.38
|
Rate for Payer: Networks By Design Commercial |
$5.18
|
Rate for Payer: Prime Health Services Commercial |
$6.77
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.78
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.78
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.78
|
Rate for Payer: United Healthcare All Other Commercial |
$3.98
|
Rate for Payer: United Healthcare All Other HMO |
$3.98
|
Rate for Payer: United Healthcare HMO Rider |
$3.98
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$3.98
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.77
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$6.77
|
Rate for Payer: Vantage Medical Group Senior |
$6.77
|
|
RISPERIDONE 2 MG DISINTEGRATING TABLET [35688]
|
Facility
IP
|
$7.36
|
|
Service Code
|
NDC 0781-5312-06
|
Hospital Charge Code |
1713153
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$1.77 |
Max. Negotiated Rate |
$6.26 |
Rate for Payer: Blue Shield of California Commercial |
$5.24
|
Rate for Payer: Blue Shield of California EPN |
$3.77
|
Rate for Payer: Cash Price |
$3.31
|
Rate for Payer: Cigna of CA HMO |
$5.15
|
Rate for Payer: Cigna of CA PPO |
$5.15
|
Rate for Payer: EPIC Health Plan Commercial |
$2.94
|
Rate for Payer: Galaxy Health WC |
$6.26
|
Rate for Payer: Global Benefits Group Commercial |
$4.42
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.91
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.80
|
Rate for Payer: LLUH Dept of Risk Management WC |
$1.77
|
Rate for Payer: Multiplan Commercial |
$5.89
|
Rate for Payer: Networks By Design Commercial |
$4.78
|
Rate for Payer: Prime Health Services Commercial |
$6.26
|
|
RISPERIDONE 2 MG DISINTEGRATING TABLET [35688]
|
Facility
IP
|
$7.36
|
|
Service Code
|
NDC 0781-5312-08
|
Hospital Charge Code |
1713153
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$1.77 |
Max. Negotiated Rate |
$6.26 |
Rate for Payer: Blue Shield of California Commercial |
$5.24
|
Rate for Payer: Blue Shield of California EPN |
$3.77
|
Rate for Payer: Cash Price |
$3.31
|
Rate for Payer: Cigna of CA HMO |
$5.15
|
Rate for Payer: Cigna of CA PPO |
$5.15
|
Rate for Payer: EPIC Health Plan Commercial |
$2.94
|
Rate for Payer: Galaxy Health WC |
$6.26
|
Rate for Payer: Global Benefits Group Commercial |
$4.42
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.91
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.80
|
Rate for Payer: LLUH Dept of Risk Management WC |
$1.77
|
Rate for Payer: Multiplan Commercial |
$5.89
|
Rate for Payer: Networks By Design Commercial |
$4.78
|
Rate for Payer: Prime Health Services Commercial |
$6.26
|
|
RISPERIDONE 2 MG DISINTEGRATING TABLET [35688]
|
Facility
OP
|
$4.01
|
|
Service Code
|
NDC 59746-030-22
|
Hospital Charge Code |
1713153
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.96 |
Max. Negotiated Rate |
$3.41 |
Rate for Payer: Aetna of CA HMO/PPO |
$2.63
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.41
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.21
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.21
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.39
|
Rate for Payer: BCBS Transplant Transplant |
$2.41
|
Rate for Payer: Blue Shield of California Commercial |
$2.96
|
Rate for Payer: Blue Shield of California EPN |
$2.34
|
Rate for Payer: Cash Price |
$1.80
|
Rate for Payer: Cigna of CA HMO |
$2.81
|
Rate for Payer: Cigna of CA PPO |
$2.81
|
Rate for Payer: Dignity Health Commercial/Exchange |
$3.41
|
Rate for Payer: Dignity Health Media |
$3.41
|
Rate for Payer: Dignity Health Medi-Cal |
$3.41
|
Rate for Payer: EPIC Health Plan Commercial |
$1.60
|
Rate for Payer: EPIC Health Plan Transplant |
$1.60
|
Rate for Payer: Galaxy Health WC |
$3.41
|
Rate for Payer: Global Benefits Group Commercial |
$2.41
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.01
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.67
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.53
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.96
|
Rate for Payer: Multiplan Commercial |
$3.21
|
Rate for Payer: Networks By Design Commercial |
$2.61
|
Rate for Payer: Prime Health Services Commercial |
$3.41
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.41
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.41
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.41
|
Rate for Payer: United Healthcare All Other Commercial |
$2.00
|
Rate for Payer: United Healthcare All Other HMO |
$2.00
|
Rate for Payer: United Healthcare HMO Rider |
$2.00
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$2.00
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.41
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$3.41
|
Rate for Payer: Vantage Medical Group Senior |
$3.41
|
|
RISPERIDONE 2 MG DISINTEGRATING TABLET [35688]
|
Facility
OP
|
$7.36
|
|
Service Code
|
NDC 0781-5312-08
|
Hospital Charge Code |
1713153
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$1.77 |
Max. Negotiated Rate |
$6.26 |
Rate for Payer: Aetna of CA HMO/PPO |
$4.83
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.26
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.05
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.05
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.39
|
Rate for Payer: BCBS Transplant Transplant |
$4.42
|
Rate for Payer: Blue Shield of California Commercial |
$5.42
|
Rate for Payer: Blue Shield of California EPN |
$4.30
|
Rate for Payer: Cash Price |
$3.31
|
Rate for Payer: Cigna of CA HMO |
$5.15
|
Rate for Payer: Cigna of CA PPO |
$5.15
|
Rate for Payer: Dignity Health Commercial/Exchange |
$6.26
|
Rate for Payer: Dignity Health Media |
$6.26
|
Rate for Payer: Dignity Health Medi-Cal |
$6.26
|
Rate for Payer: EPIC Health Plan Commercial |
$2.94
|
Rate for Payer: EPIC Health Plan Transplant |
$2.94
|
Rate for Payer: Galaxy Health WC |
$6.26
|
Rate for Payer: Global Benefits Group Commercial |
$4.42
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.52
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.91
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.80
|
Rate for Payer: LLUH Dept of Risk Management WC |
$1.77
|
Rate for Payer: Multiplan Commercial |
$5.89
|
Rate for Payer: Networks By Design Commercial |
$4.78
|
Rate for Payer: Prime Health Services Commercial |
$6.26
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.42
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.42
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.42
|
Rate for Payer: United Healthcare All Other Commercial |
$3.68
|
Rate for Payer: United Healthcare All Other HMO |
$3.68
|
Rate for Payer: United Healthcare HMO Rider |
$3.68
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$3.68
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.26
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$6.26
|
Rate for Payer: Vantage Medical Group Senior |
$6.26
|
|
RISPERIDONE 2 MG TABLET [18311]
|
Facility
OP
|
$0.23
|
|
Service Code
|
NDC 0904-6360-61
|
Hospital Charge Code |
1712188
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.06 |
Max. Negotiated Rate |
$0.20 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.15
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.20
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.13
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.13
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
Rate for Payer: BCBS Transplant Transplant |
$0.14
|
Rate for Payer: Blue Shield of California Commercial |
$0.17
|
Rate for Payer: Blue Shield of California EPN |
$0.13
|
Rate for Payer: Cash Price |
$0.10
|
Rate for Payer: Cigna of CA HMO |
$0.16
|
Rate for Payer: Cigna of CA PPO |
$0.16
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
Rate for Payer: Dignity Health Media |
$0.20
|
Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
Rate for Payer: EPIC Health Plan Transplant |
$0.09
|
Rate for Payer: Galaxy Health WC |
$0.20
|
Rate for Payer: Global Benefits Group Commercial |
$0.14
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.17
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
Rate for Payer: Multiplan Commercial |
$0.18
|
Rate for Payer: Networks By Design Commercial |
$0.15
|
Rate for Payer: Prime Health Services Commercial |
$0.20
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.14
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
Rate for Payer: United Healthcare All Other HMO |
$0.12
|
Rate for Payer: United Healthcare HMO Rider |
$0.12
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
RISPERIDONE 2 MG TABLET [18311]
|
Facility
IP
|
$0.23
|
|
Service Code
|
NDC 0904-6360-61
|
Hospital Charge Code |
1712188
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.06 |
Max. Negotiated Rate |
$0.20 |
Rate for Payer: Blue Shield of California Commercial |
$0.16
|
Rate for Payer: Blue Shield of California EPN |
$0.12
|
Rate for Payer: Cash Price |
$0.10
|
Rate for Payer: Cigna of CA HMO |
$0.16
|
Rate for Payer: Cigna of CA PPO |
$0.16
|
Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
Rate for Payer: Galaxy Health WC |
$0.20
|
Rate for Payer: Global Benefits Group Commercial |
$0.14
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
Rate for Payer: Multiplan Commercial |
$0.18
|
Rate for Payer: Networks By Design Commercial |
$0.15
|
Rate for Payer: Prime Health Services Commercial |
$0.20
|
|
RISPERIDONE 3 MG TABLET [18312]
|
Facility
OP
|
$0.61
|
|
Service Code
|
NDC 68084-274-01
|
Hospital Charge Code |
1712189
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.15 |
Max. Negotiated Rate |
$0.52 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.40
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.52
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.34
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.34
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.36
|
Rate for Payer: BCBS Transplant Transplant |
$0.37
|
Rate for Payer: Blue Shield of California Commercial |
$0.45
|
Rate for Payer: Blue Shield of California EPN |
$0.36
|
Rate for Payer: Cash Price |
$0.27
|
Rate for Payer: Cigna of CA HMO |
$0.43
|
Rate for Payer: Cigna of CA PPO |
$0.43
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.52
|
Rate for Payer: Dignity Health Media |
$0.52
|
Rate for Payer: Dignity Health Medi-Cal |
$0.52
|
Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
Rate for Payer: EPIC Health Plan Transplant |
$0.24
|
Rate for Payer: Galaxy Health WC |
$0.52
|
Rate for Payer: Global Benefits Group Commercial |
$0.37
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.46
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
Rate for Payer: Multiplan Commercial |
$0.49
|
Rate for Payer: Networks By Design Commercial |
$0.40
|
Rate for Payer: Prime Health Services Commercial |
$0.52
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.37
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.37
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.37
|
Rate for Payer: United Healthcare All Other Commercial |
$0.31
|
Rate for Payer: United Healthcare All Other HMO |
$0.31
|
Rate for Payer: United Healthcare HMO Rider |
$0.31
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.31
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.52
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.52
|
Rate for Payer: Vantage Medical Group Senior |
$0.52
|
|
RISPERIDONE 3 MG TABLET [18312]
|
Facility
IP
|
$0.61
|
|
Service Code
|
NDC 68084-274-01
|
Hospital Charge Code |
1712189
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.15 |
Max. Negotiated Rate |
$0.52 |
Rate for Payer: Blue Shield of California Commercial |
$0.43
|
Rate for Payer: Blue Shield of California EPN |
$0.31
|
Rate for Payer: Cash Price |
$0.27
|
Rate for Payer: Cigna of CA HMO |
$0.43
|
Rate for Payer: Cigna of CA PPO |
$0.43
|
Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
Rate for Payer: Galaxy Health WC |
$0.52
|
Rate for Payer: Global Benefits Group Commercial |
$0.37
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
Rate for Payer: Multiplan Commercial |
$0.49
|
Rate for Payer: Networks By Design Commercial |
$0.40
|
Rate for Payer: Prime Health Services Commercial |
$0.52
|
|
RISPERIDONE 3 MG TABLET [18312]
|
Facility
IP
|
$0.61
|
|
Service Code
|
NDC 68084-274-11
|
Hospital Charge Code |
1712189
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.15 |
Max. Negotiated Rate |
$0.52 |
Rate for Payer: Blue Shield of California Commercial |
$0.43
|
Rate for Payer: Blue Shield of California EPN |
$0.31
|
Rate for Payer: Cash Price |
$0.27
|
Rate for Payer: Cigna of CA HMO |
$0.43
|
Rate for Payer: Cigna of CA PPO |
$0.43
|
Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
Rate for Payer: Galaxy Health WC |
$0.52
|
Rate for Payer: Global Benefits Group Commercial |
$0.37
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
Rate for Payer: Multiplan Commercial |
$0.49
|
Rate for Payer: Networks By Design Commercial |
$0.40
|
Rate for Payer: Prime Health Services Commercial |
$0.52
|
|
RISPERIDONE 3 MG TABLET [18312]
|
Facility
OP
|
$0.61
|
|
Service Code
|
NDC 68084-274-11
|
Hospital Charge Code |
1712189
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.15 |
Max. Negotiated Rate |
$0.52 |
Rate for Payer: BCBS Transplant Transplant |
$0.37
|
Rate for Payer: Aetna of CA HMO/PPO |
$0.40
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.52
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.34
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.34
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.36
|
Rate for Payer: Blue Shield of California Commercial |
$0.45
|
Rate for Payer: Blue Shield of California EPN |
$0.36
|
Rate for Payer: Cash Price |
$0.27
|
Rate for Payer: Cigna of CA HMO |
$0.43
|
Rate for Payer: Cigna of CA PPO |
$0.43
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.52
|
Rate for Payer: Dignity Health Media |
$0.52
|
Rate for Payer: Dignity Health Medi-Cal |
$0.52
|
Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
Rate for Payer: EPIC Health Plan Transplant |
$0.24
|
Rate for Payer: Galaxy Health WC |
$0.52
|
Rate for Payer: Global Benefits Group Commercial |
$0.37
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.46
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
Rate for Payer: Multiplan Commercial |
$0.49
|
Rate for Payer: Networks By Design Commercial |
$0.40
|
Rate for Payer: Prime Health Services Commercial |
$0.52
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.37
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.37
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.37
|
Rate for Payer: United Healthcare All Other Commercial |
$0.31
|
Rate for Payer: United Healthcare All Other HMO |
$0.31
|
Rate for Payer: United Healthcare HMO Rider |
$0.31
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.31
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.52
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.52
|
Rate for Payer: Vantage Medical Group Senior |
$0.52
|
|
RISPERIDONE 4 MG TABLET [18310]
|
Facility
IP
|
$0.61
|
|
Service Code
|
NDC 68084-277-01
|
Hospital Charge Code |
1712190
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.15 |
Max. Negotiated Rate |
$0.52 |
Rate for Payer: Blue Shield of California Commercial |
$0.43
|
Rate for Payer: Blue Shield of California EPN |
$0.31
|
Rate for Payer: Cash Price |
$0.27
|
Rate for Payer: Cigna of CA HMO |
$0.43
|
Rate for Payer: Cigna of CA PPO |
$0.43
|
Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
Rate for Payer: Galaxy Health WC |
$0.52
|
Rate for Payer: Global Benefits Group Commercial |
$0.37
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
Rate for Payer: Multiplan Commercial |
$0.49
|
Rate for Payer: Networks By Design Commercial |
$0.40
|
Rate for Payer: Prime Health Services Commercial |
$0.52
|
|
RISPERIDONE 4 MG TABLET [18310]
|
Facility
OP
|
$0.61
|
|
Service Code
|
NDC 68084-277-11
|
Hospital Charge Code |
1712190
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.15 |
Max. Negotiated Rate |
$0.52 |
Rate for Payer: Galaxy Health WC |
$0.52
|
Rate for Payer: Aetna of CA HMO/PPO |
$0.40
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.52
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.34
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.34
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.36
|
Rate for Payer: BCBS Transplant Transplant |
$0.37
|
Rate for Payer: Blue Shield of California Commercial |
$0.45
|
Rate for Payer: Blue Shield of California EPN |
$0.36
|
Rate for Payer: Cash Price |
$0.27
|
Rate for Payer: Cigna of CA HMO |
$0.43
|
Rate for Payer: Cigna of CA PPO |
$0.43
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.52
|
Rate for Payer: Dignity Health Media |
$0.52
|
Rate for Payer: Dignity Health Medi-Cal |
$0.52
|
Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
Rate for Payer: EPIC Health Plan Transplant |
$0.24
|
Rate for Payer: Global Benefits Group Commercial |
$0.37
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.46
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
Rate for Payer: Multiplan Commercial |
$0.49
|
Rate for Payer: Networks By Design Commercial |
$0.40
|
Rate for Payer: Prime Health Services Commercial |
$0.52
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.37
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.37
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.37
|
Rate for Payer: United Healthcare All Other Commercial |
$0.31
|
Rate for Payer: United Healthcare All Other HMO |
$0.31
|
Rate for Payer: United Healthcare HMO Rider |
$0.31
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.31
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.52
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.52
|
Rate for Payer: Vantage Medical Group Senior |
$0.52
|
|
RISPERIDONE 4 MG TABLET [18310]
|
Facility
OP
|
$0.61
|
|
Service Code
|
NDC 68084-277-01
|
Hospital Charge Code |
1712190
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.15 |
Max. Negotiated Rate |
$0.52 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.40
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.52
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.34
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.34
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.36
|
Rate for Payer: BCBS Transplant Transplant |
$0.37
|
Rate for Payer: Blue Shield of California Commercial |
$0.45
|
Rate for Payer: Blue Shield of California EPN |
$0.36
|
Rate for Payer: Cash Price |
$0.27
|
Rate for Payer: Cigna of CA HMO |
$0.43
|
Rate for Payer: Cigna of CA PPO |
$0.43
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.52
|
Rate for Payer: Dignity Health Media |
$0.52
|
Rate for Payer: Dignity Health Medi-Cal |
$0.52
|
Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
Rate for Payer: EPIC Health Plan Transplant |
$0.24
|
Rate for Payer: Galaxy Health WC |
$0.52
|
Rate for Payer: Global Benefits Group Commercial |
$0.37
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.46
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
Rate for Payer: Multiplan Commercial |
$0.49
|
Rate for Payer: Networks By Design Commercial |
$0.40
|
Rate for Payer: Prime Health Services Commercial |
$0.52
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.37
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.37
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.37
|
Rate for Payer: United Healthcare All Other Commercial |
$0.31
|
Rate for Payer: United Healthcare All Other HMO |
$0.31
|
Rate for Payer: United Healthcare HMO Rider |
$0.31
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.31
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.52
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.52
|
Rate for Payer: Vantage Medical Group Senior |
$0.52
|
|
RISPERIDONE 4 MG TABLET [18310]
|
Facility
OP
|
$0.27
|
|
Service Code
|
NDC 0904-6362-61
|
Hospital Charge Code |
1712190
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.06 |
Max. Negotiated Rate |
$0.23 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.23
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.15
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.15
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
Rate for Payer: BCBS Transplant Transplant |
$0.16
|
Rate for Payer: Blue Shield of California Commercial |
$0.20
|
Rate for Payer: Blue Shield of California EPN |
$0.16
|
Rate for Payer: Cash Price |
$0.12
|
Rate for Payer: Cigna of CA HMO |
$0.19
|
Rate for Payer: Cigna of CA PPO |
$0.19
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.23
|
Rate for Payer: Dignity Health Media |
$0.23
|
Rate for Payer: Dignity Health Medi-Cal |
$0.23
|
Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
Rate for Payer: EPIC Health Plan Transplant |
$0.11
|
Rate for Payer: Galaxy Health WC |
$0.23
|
Rate for Payer: Global Benefits Group Commercial |
$0.16
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.20
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.18
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
Rate for Payer: Multiplan Commercial |
$0.22
|
Rate for Payer: Networks By Design Commercial |
$0.18
|
Rate for Payer: Prime Health Services Commercial |
$0.23
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.16
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.16
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.16
|
Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
Rate for Payer: United Healthcare All Other HMO |
$0.14
|
Rate for Payer: United Healthcare HMO Rider |
$0.14
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.14
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.23
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.23
|
Rate for Payer: Vantage Medical Group Senior |
$0.23
|
|
RISPERIDONE 4 MG TABLET [18310]
|
Facility
IP
|
$0.27
|
|
Service Code
|
NDC 0904-6362-61
|
Hospital Charge Code |
1712190
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.06 |
Max. Negotiated Rate |
$0.23 |
Rate for Payer: Blue Shield of California Commercial |
$0.19
|
Rate for Payer: Blue Shield of California EPN |
$0.14
|
Rate for Payer: Cash Price |
$0.12
|
Rate for Payer: Cigna of CA HMO |
$0.19
|
Rate for Payer: Cigna of CA PPO |
$0.19
|
Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
Rate for Payer: Galaxy Health WC |
$0.23
|
Rate for Payer: Global Benefits Group Commercial |
$0.16
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.18
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
Rate for Payer: Multiplan Commercial |
$0.22
|
Rate for Payer: Networks By Design Commercial |
$0.18
|
Rate for Payer: Prime Health Services Commercial |
$0.23
|
|
RISPERIDONE 4 MG TABLET [18310]
|
Facility
IP
|
$0.61
|
|
Service Code
|
NDC 68084-277-11
|
Hospital Charge Code |
1712190
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.15 |
Max. Negotiated Rate |
$0.52 |
Rate for Payer: Blue Shield of California Commercial |
$0.43
|
Rate for Payer: Blue Shield of California EPN |
$0.31
|
Rate for Payer: Cash Price |
$0.27
|
Rate for Payer: Cigna of CA HMO |
$0.43
|
Rate for Payer: Cigna of CA PPO |
$0.43
|
Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
Rate for Payer: Galaxy Health WC |
$0.52
|
Rate for Payer: Global Benefits Group Commercial |
$0.37
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
Rate for Payer: Multiplan Commercial |
$0.49
|
Rate for Payer: Networks By Design Commercial |
$0.40
|
Rate for Payer: Prime Health Services Commercial |
$0.52
|
|