|
RILUZOLE 50 MG TABLET [16124]
|
Facility
|
OP
|
$1.58
|
|
|
Service Code
|
NDC 68462-381-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Adventist Health Commercial |
$0.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.97
|
| Rate for Payer: Cash Price |
$0.87
|
| 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 Medi-Cal |
$1.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.63
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$0.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.11
|
| 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: 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
|
$762.10
|
|
|
Service Code
|
HCPCS J0587
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$152.42 |
| Max. Negotiated Rate |
$647.78 |
| Rate for Payer: Adventist Health Commercial |
$152.42
|
| Rate for Payer: Blue Shield of California Commercial |
$562.43
|
| Rate for Payer: Blue Shield of California EPN |
$370.38
|
| Rate for Payer: Cash Price |
$419.15
|
| Rate for Payer: Cigna of CA HMO |
$533.47
|
| Rate for Payer: Cigna of CA PPO |
$533.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$304.84
|
| Rate for Payer: EPIC Health Plan Senior |
$304.84
|
| Rate for Payer: Galaxy Health WC |
$647.78
|
| Rate for Payer: Global Benefits Group Commercial |
$457.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$508.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$290.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$471.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.90
|
| Rate for Payer: Multiplan Commercial |
$609.68
|
| Rate for Payer: Networks By Design Commercial |
$381.05
|
| Rate for Payer: Prime Health Services Commercial |
$647.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$286.02
|
| Rate for Payer: United Healthcare All Other HMO |
$278.40
|
| Rate for Payer: United Healthcare HMO Rider |
$272.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$249.59
|
|
|
RIMABOTULINUMTOXINB 2,500 UNIT/0.5 ML INTRAMUSCULAR SOLUTION [108078]
|
Facility
|
OP
|
$762.10
|
|
|
Service Code
|
HCPCS J0587
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$647.78 |
| Rate for Payer: Adventist Health Commercial |
$152.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$499.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.50
|
| Rate for Payer: Blue Shield of California Commercial |
$14.94
|
| Rate for Payer: Blue Shield of California EPN |
$14.94
|
| Rate for Payer: Cash Price |
$419.15
|
| Rate for Payer: Cash Price |
$419.15
|
| Rate for Payer: Cigna of CA HMO |
$533.47
|
| Rate for Payer: Cigna of CA PPO |
$533.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.01
|
| Rate for Payer: EPIC Health Plan Senior |
$13.34
|
| Rate for Payer: Galaxy Health WC |
$647.78
|
| Rate for Payer: Global Benefits Group Commercial |
$457.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$508.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.88
|
| Rate for Payer: Multiplan Commercial |
$609.68
|
| Rate for Payer: Networks By Design Commercial |
$381.05
|
| Rate for Payer: Prime Health Services Commercial |
$647.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$457.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$457.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$286.02
|
| Rate for Payer: United Healthcare All Other HMO |
$278.40
|
| Rate for Payer: United Healthcare HMO Rider |
$272.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$249.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.68
|
| Rate for Payer: Vantage Medical Group Senior |
$14.68
|
|
|
RINGER'S INTRAVENOUS SOLUTION [11295]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 0264-7780-00
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| 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
|
|
|
RINGER'S INTRAVENOUS SOLUTION [11295]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 0264-7780-00
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Cash Price |
$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 Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| 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
|
|
|
RIOCIGUAT 0.5 MG TABLET [203879]
|
Facility
|
OP
|
$188.14
|
|
|
Service Code
|
NDC 50419-250-91
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$37.63 |
| Max. Negotiated Rate |
$159.92 |
| Rate for Payer: Adventist Health Commercial |
$37.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$123.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$159.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$141.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.54
|
| Rate for Payer: Cash Price |
$103.47
|
| Rate for Payer: Cigna of CA HMO |
$131.70
|
| Rate for Payer: Cigna of CA PPO |
$131.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$159.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$159.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.26
|
| Rate for Payer: EPIC Health Plan Senior |
$75.26
|
| Rate for Payer: Galaxy Health WC |
$159.92
|
| Rate for Payer: Global Benefits Group Commercial |
$112.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$125.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$131.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$131.70
|
| Rate for Payer: Multiplan Commercial |
$150.51
|
| Rate for Payer: Networks By Design Commercial |
$122.29
|
| Rate for Payer: Prime Health Services Commercial |
$159.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$112.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$112.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.07
|
| Rate for Payer: United Healthcare All Other HMO |
$94.07
|
| Rate for Payer: United Healthcare HMO Rider |
$94.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$159.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.92
|
| Rate for Payer: Vantage Medical Group Senior |
$159.92
|
|
|
RIOCIGUAT 0.5 MG TABLET [203879]
|
Facility
|
IP
|
$188.14
|
|
|
Service Code
|
NDC 50419-250-91
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$37.63 |
| Max. Negotiated Rate |
$159.92 |
| Rate for Payer: Adventist Health Commercial |
$37.63
|
| Rate for Payer: Blue Shield of California Commercial |
$138.85
|
| Rate for Payer: Blue Shield of California EPN |
$91.44
|
| Rate for Payer: Cash Price |
$103.47
|
| Rate for Payer: Cigna of CA HMO |
$131.70
|
| Rate for Payer: Cigna of CA PPO |
$131.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.26
|
| Rate for Payer: EPIC Health Plan Senior |
$75.26
|
| Rate for Payer: Galaxy Health WC |
$159.92
|
| Rate for Payer: Global Benefits Group Commercial |
$112.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$125.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.15
|
| Rate for Payer: Multiplan Commercial |
$150.51
|
| Rate for Payer: Networks By Design Commercial |
$122.29
|
| Rate for Payer: Prime Health Services Commercial |
$159.92
|
|
|
RIOCIGUAT 0.5 MG TABLET [203879]
|
Facility
|
IP
|
$188.14
|
|
|
Service Code
|
NDC 50419-250-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$37.63 |
| Max. Negotiated Rate |
$159.92 |
| Rate for Payer: Adventist Health Commercial |
$37.63
|
| Rate for Payer: Blue Shield of California Commercial |
$138.85
|
| Rate for Payer: Blue Shield of California EPN |
$91.44
|
| Rate for Payer: Cash Price |
$103.47
|
| Rate for Payer: Cigna of CA HMO |
$131.70
|
| Rate for Payer: Cigna of CA PPO |
$131.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.26
|
| Rate for Payer: EPIC Health Plan Senior |
$75.26
|
| Rate for Payer: Galaxy Health WC |
$159.92
|
| Rate for Payer: Global Benefits Group Commercial |
$112.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$125.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.15
|
| Rate for Payer: Multiplan Commercial |
$150.51
|
| Rate for Payer: Networks By Design Commercial |
$122.29
|
| Rate for Payer: Prime Health Services Commercial |
$159.92
|
|
|
RIOCIGUAT 0.5 MG TABLET [203879]
|
Facility
|
OP
|
$188.14
|
|
|
Service Code
|
NDC 50419-250-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$37.63 |
| Max. Negotiated Rate |
$159.92 |
| Rate for Payer: Adventist Health Commercial |
$37.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$123.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$159.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$141.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.54
|
| Rate for Payer: Cash Price |
$103.47
|
| Rate for Payer: Cigna of CA HMO |
$131.70
|
| Rate for Payer: Cigna of CA PPO |
$131.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$159.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$159.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.26
|
| Rate for Payer: EPIC Health Plan Senior |
$75.26
|
| Rate for Payer: Galaxy Health WC |
$159.92
|
| Rate for Payer: Global Benefits Group Commercial |
$112.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$125.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$131.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$131.70
|
| Rate for Payer: Multiplan Commercial |
$150.51
|
| Rate for Payer: Networks By Design Commercial |
$122.29
|
| Rate for Payer: Prime Health Services Commercial |
$159.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$112.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$112.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.07
|
| Rate for Payer: United Healthcare All Other HMO |
$94.07
|
| Rate for Payer: United Healthcare HMO Rider |
$94.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$159.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.92
|
| Rate for Payer: Vantage Medical Group Senior |
$159.92
|
|
|
RIOCIGUAT 1 MG TABLET [203880]
|
Facility
|
IP
|
$188.14
|
|
|
Service Code
|
NDC 50419-251-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$37.63 |
| Max. Negotiated Rate |
$159.92 |
| Rate for Payer: Adventist Health Commercial |
$37.63
|
| Rate for Payer: Blue Shield of California Commercial |
$138.85
|
| Rate for Payer: Blue Shield of California EPN |
$91.44
|
| Rate for Payer: Cash Price |
$103.47
|
| Rate for Payer: Cigna of CA HMO |
$131.70
|
| Rate for Payer: Cigna of CA PPO |
$131.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.26
|
| Rate for Payer: EPIC Health Plan Senior |
$75.26
|
| Rate for Payer: Galaxy Health WC |
$159.92
|
| Rate for Payer: Global Benefits Group Commercial |
$112.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$125.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.15
|
| Rate for Payer: Multiplan Commercial |
$150.51
|
| Rate for Payer: Networks By Design Commercial |
$122.29
|
| Rate for Payer: Prime Health Services Commercial |
$159.92
|
|
|
RIOCIGUAT 1 MG TABLET [203880]
|
Facility
|
IP
|
$188.14
|
|
|
Service Code
|
NDC 50419-251-91
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$37.63 |
| Max. Negotiated Rate |
$159.92 |
| Rate for Payer: Adventist Health Commercial |
$37.63
|
| Rate for Payer: Blue Shield of California Commercial |
$138.85
|
| Rate for Payer: Blue Shield of California EPN |
$91.44
|
| Rate for Payer: Cash Price |
$103.47
|
| Rate for Payer: Cigna of CA HMO |
$131.70
|
| Rate for Payer: Cigna of CA PPO |
$131.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.26
|
| Rate for Payer: EPIC Health Plan Senior |
$75.26
|
| Rate for Payer: Galaxy Health WC |
$159.92
|
| Rate for Payer: Global Benefits Group Commercial |
$112.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$125.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.15
|
| Rate for Payer: Multiplan Commercial |
$150.51
|
| Rate for Payer: Networks By Design Commercial |
$122.29
|
| Rate for Payer: Prime Health Services Commercial |
$159.92
|
|
|
RIOCIGUAT 1 MG TABLET [203880]
|
Facility
|
OP
|
$188.14
|
|
|
Service Code
|
NDC 50419-251-91
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$37.63 |
| Max. Negotiated Rate |
$159.92 |
| Rate for Payer: Adventist Health Commercial |
$37.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$123.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$159.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$141.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.54
|
| Rate for Payer: Cash Price |
$103.47
|
| Rate for Payer: Cigna of CA HMO |
$131.70
|
| Rate for Payer: Cigna of CA PPO |
$131.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$159.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$159.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.26
|
| Rate for Payer: EPIC Health Plan Senior |
$75.26
|
| Rate for Payer: Galaxy Health WC |
$159.92
|
| Rate for Payer: Global Benefits Group Commercial |
$112.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$125.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$131.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$131.70
|
| Rate for Payer: Multiplan Commercial |
$150.51
|
| Rate for Payer: Networks By Design Commercial |
$122.29
|
| Rate for Payer: Prime Health Services Commercial |
$159.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$112.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$112.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.07
|
| Rate for Payer: United Healthcare All Other HMO |
$94.07
|
| Rate for Payer: United Healthcare HMO Rider |
$94.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$159.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.92
|
| Rate for Payer: Vantage Medical Group Senior |
$159.92
|
|
|
RIOCIGUAT 1 MG TABLET [203880]
|
Facility
|
OP
|
$188.14
|
|
|
Service Code
|
NDC 50419-251-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$37.63 |
| Max. Negotiated Rate |
$159.92 |
| Rate for Payer: Adventist Health Commercial |
$37.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$123.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$159.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$141.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.54
|
| Rate for Payer: Cash Price |
$103.47
|
| Rate for Payer: Cigna of CA HMO |
$131.70
|
| Rate for Payer: Cigna of CA PPO |
$131.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$159.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$159.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.26
|
| Rate for Payer: EPIC Health Plan Senior |
$75.26
|
| Rate for Payer: Galaxy Health WC |
$159.92
|
| Rate for Payer: Global Benefits Group Commercial |
$112.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$125.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$131.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$131.70
|
| Rate for Payer: Multiplan Commercial |
$150.51
|
| Rate for Payer: Networks By Design Commercial |
$122.29
|
| Rate for Payer: Prime Health Services Commercial |
$159.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$112.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$112.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.07
|
| Rate for Payer: United Healthcare All Other HMO |
$94.07
|
| Rate for Payer: United Healthcare HMO Rider |
$94.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$159.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.92
|
| Rate for Payer: Vantage Medical Group Senior |
$159.92
|
|
|
RIOCIGUAT 2.5 MG TABLET [203883]
|
Facility
|
OP
|
$188.14
|
|
|
Service Code
|
NDC 50419-254-91
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$37.63 |
| Max. Negotiated Rate |
$159.92 |
| Rate for Payer: Adventist Health Commercial |
$37.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$123.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$159.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$141.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.54
|
| Rate for Payer: Cash Price |
$103.47
|
| Rate for Payer: Cigna of CA HMO |
$131.70
|
| Rate for Payer: Cigna of CA PPO |
$131.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$159.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$159.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.26
|
| Rate for Payer: EPIC Health Plan Senior |
$75.26
|
| Rate for Payer: Galaxy Health WC |
$159.92
|
| Rate for Payer: Global Benefits Group Commercial |
$112.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$125.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$131.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$131.70
|
| Rate for Payer: Multiplan Commercial |
$150.51
|
| Rate for Payer: Networks By Design Commercial |
$122.29
|
| Rate for Payer: Prime Health Services Commercial |
$159.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$112.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$112.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.07
|
| Rate for Payer: United Healthcare All Other HMO |
$94.07
|
| Rate for Payer: United Healthcare HMO Rider |
$94.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$159.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.92
|
| Rate for Payer: Vantage Medical Group Senior |
$159.92
|
|
|
RIOCIGUAT 2.5 MG TABLET [203883]
|
Facility
|
IP
|
$188.14
|
|
|
Service Code
|
NDC 50419-254-91
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$37.63 |
| Max. Negotiated Rate |
$159.92 |
| Rate for Payer: Adventist Health Commercial |
$37.63
|
| Rate for Payer: Blue Shield of California Commercial |
$138.85
|
| Rate for Payer: Blue Shield of California EPN |
$91.44
|
| Rate for Payer: Cash Price |
$103.47
|
| Rate for Payer: Cigna of CA HMO |
$131.70
|
| Rate for Payer: Cigna of CA PPO |
$131.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.26
|
| Rate for Payer: EPIC Health Plan Senior |
$75.26
|
| Rate for Payer: Galaxy Health WC |
$159.92
|
| Rate for Payer: Global Benefits Group Commercial |
$112.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$125.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.15
|
| Rate for Payer: Multiplan Commercial |
$150.51
|
| Rate for Payer: Networks By Design Commercial |
$122.29
|
| Rate for Payer: Prime Health Services Commercial |
$159.92
|
|
|
RIOCIGUAT 2.5 MG TABLET [203883]
|
Facility
|
OP
|
$188.14
|
|
|
Service Code
|
NDC 50419-254-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$37.63 |
| Max. Negotiated Rate |
$159.92 |
| Rate for Payer: Adventist Health Commercial |
$37.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$123.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$159.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$141.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.54
|
| Rate for Payer: Cash Price |
$103.47
|
| Rate for Payer: Cigna of CA HMO |
$131.70
|
| Rate for Payer: Cigna of CA PPO |
$131.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$159.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$159.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.26
|
| Rate for Payer: EPIC Health Plan Senior |
$75.26
|
| Rate for Payer: Galaxy Health WC |
$159.92
|
| Rate for Payer: Global Benefits Group Commercial |
$112.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$125.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$131.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$131.70
|
| Rate for Payer: Multiplan Commercial |
$150.51
|
| Rate for Payer: Networks By Design Commercial |
$122.29
|
| Rate for Payer: Prime Health Services Commercial |
$159.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$112.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$112.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.07
|
| Rate for Payer: United Healthcare All Other HMO |
$94.07
|
| Rate for Payer: United Healthcare HMO Rider |
$94.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$159.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.92
|
| Rate for Payer: Vantage Medical Group Senior |
$159.92
|
|
|
RIOCIGUAT 2.5 MG TABLET [203883]
|
Facility
|
IP
|
$188.14
|
|
|
Service Code
|
NDC 50419-254-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$37.63 |
| Max. Negotiated Rate |
$159.92 |
| Rate for Payer: Adventist Health Commercial |
$37.63
|
| Rate for Payer: Blue Shield of California Commercial |
$138.85
|
| Rate for Payer: Blue Shield of California EPN |
$91.44
|
| Rate for Payer: Cash Price |
$103.47
|
| Rate for Payer: Cigna of CA HMO |
$131.70
|
| Rate for Payer: Cigna of CA PPO |
$131.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.26
|
| Rate for Payer: EPIC Health Plan Senior |
$75.26
|
| Rate for Payer: Galaxy Health WC |
$159.92
|
| Rate for Payer: Global Benefits Group Commercial |
$112.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$125.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.15
|
| Rate for Payer: Multiplan Commercial |
$150.51
|
| Rate for Payer: Networks By Design Commercial |
$122.29
|
| Rate for Payer: Prime Health Services Commercial |
$159.92
|
|
|
RIPRETINIB 50 MG TABLET [228115]
|
Facility
|
IP
|
$591.60
|
|
|
Service Code
|
NDC 73207-101-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$118.32 |
| Max. Negotiated Rate |
$502.86 |
| Rate for Payer: Adventist Health Commercial |
$118.32
|
| Rate for Payer: Blue Shield of California Commercial |
$436.60
|
| Rate for Payer: Blue Shield of California EPN |
$287.52
|
| Rate for Payer: Cash Price |
$325.38
|
| Rate for Payer: Cigna of CA HMO |
$414.12
|
| Rate for Payer: Cigna of CA PPO |
$414.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.64
|
| Rate for Payer: EPIC Health Plan Senior |
$236.64
|
| Rate for Payer: Galaxy Health WC |
$502.86
|
| Rate for Payer: Global Benefits Group Commercial |
$354.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$394.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$225.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$366.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.98
|
| Rate for Payer: Multiplan Commercial |
$473.28
|
| Rate for Payer: Networks By Design Commercial |
$384.54
|
| Rate for Payer: Prime Health Services Commercial |
$502.86
|
|
|
RIPRETINIB 50 MG TABLET [228115]
|
Facility
|
OP
|
$591.60
|
|
|
Service Code
|
NDC 73207-101-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$118.32 |
| Max. Negotiated Rate |
$502.86 |
| Rate for Payer: Adventist Health Commercial |
$118.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$388.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$502.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$325.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$443.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$363.30
|
| Rate for Payer: Cash Price |
$325.38
|
| Rate for Payer: Cigna of CA HMO |
$414.12
|
| Rate for Payer: Cigna of CA PPO |
$414.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$502.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$502.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$502.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.64
|
| Rate for Payer: EPIC Health Plan Senior |
$236.64
|
| Rate for Payer: Galaxy Health WC |
$502.86
|
| Rate for Payer: Global Benefits Group Commercial |
$354.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$394.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$225.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$366.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$414.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$414.12
|
| Rate for Payer: Multiplan Commercial |
$473.28
|
| Rate for Payer: Networks By Design Commercial |
$384.54
|
| Rate for Payer: Prime Health Services Commercial |
$502.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$354.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$354.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$295.80
|
| Rate for Payer: United Healthcare All Other HMO |
$295.80
|
| Rate for Payer: United Healthcare HMO Rider |
$295.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$295.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$502.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$502.86
|
| Rate for Payer: Vantage Medical Group Senior |
$502.86
|
|
|
RISEDRONATE 35 MG TABLET [32895]
|
Facility
|
IP
|
$102.29
|
|
|
Service Code
|
NDC 0430-0472-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$86.95 |
| Rate for Payer: Adventist Health Commercial |
$20.46
|
| Rate for Payer: Blue Shield of California Commercial |
$75.49
|
| Rate for Payer: Blue Shield of California EPN |
$49.71
|
| Rate for Payer: Cash Price |
$56.26
|
| Rate for Payer: Cigna of CA HMO |
$71.60
|
| Rate for Payer: Cigna of CA PPO |
$71.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.92
|
| Rate for Payer: EPIC Health Plan Senior |
$40.92
|
| Rate for Payer: Galaxy Health WC |
$86.95
|
| Rate for Payer: Global Benefits Group Commercial |
$61.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$63.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.55
|
| Rate for Payer: Multiplan Commercial |
$81.83
|
| Rate for Payer: Networks By Design Commercial |
$66.49
|
| Rate for Payer: Prime Health Services Commercial |
$86.95
|
|
|
RISEDRONATE 35 MG TABLET [32895]
|
Facility
|
OP
|
$102.29
|
|
|
Service Code
|
NDC 0430-0472-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$86.95 |
| Rate for Payer: Adventist Health Commercial |
$20.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$67.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$86.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.82
|
| Rate for Payer: Cash Price |
$56.26
|
| Rate for Payer: Cigna of CA HMO |
$71.60
|
| Rate for Payer: Cigna of CA PPO |
$71.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$86.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$86.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$86.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.92
|
| Rate for Payer: EPIC Health Plan Senior |
$40.92
|
| Rate for Payer: Galaxy Health WC |
$86.95
|
| Rate for Payer: Global Benefits Group Commercial |
$61.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$63.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$71.60
|
| Rate for Payer: Multiplan Commercial |
$81.83
|
| Rate for Payer: Networks By Design Commercial |
$66.49
|
| Rate for Payer: Prime Health Services Commercial |
$86.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$61.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$61.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$51.15
|
| Rate for Payer: United Healthcare All Other HMO |
$51.15
|
| Rate for Payer: United Healthcare HMO Rider |
$51.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$86.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$86.95
|
| Rate for Payer: Vantage Medical Group Senior |
$86.95
|
|
|
RISPERIDONE 0.25 MG TABLET [25519]
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
NDC 68084-270-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.15
|
| 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: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$0.17
|
| 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 0.25 MG TABLET [25519]
|
Facility
|
OP
|
$0.27
|
|
|
Service Code
|
NDC 68084-270-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Cash Price |
$0.15
|
| 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 Medi-Cal |
$0.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.19
|
| 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: 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 0.25 MG TABLET [25519]
|
Facility
|
OP
|
$0.27
|
|
|
Service Code
|
NDC 68084-270-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Cash Price |
$0.15
|
| 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 Medi-Cal |
$0.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.19
|
| 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: 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 0.25 MG TABLET [25519]
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
NDC 68084-270-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.15
|
| 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: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$0.17
|
| 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
|
|
