|
RIFAMPIN ORAL SUSPENSION COMPOUND 10 MG/ML [4080331]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 9994080331
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
RIFAMPIN ORAL SUSPENSION COMPOUND 10 MG/ML [4080331]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 9994080331
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
RIFAPENTINE 150 MG TABLET [23365]
|
Facility
|
IP
|
$6.08
|
|
|
Service Code
|
NDC 0088210201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$5.17 |
| Rate for Payer: Adventist Health Commercial |
$1.22
|
| Rate for Payer: Blue Shield of California Commercial |
$3.08
|
| Rate for Payer: Blue Shield of California Commercial |
$4.68
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cigna of CA HMO |
$4.26
|
| Rate for Payer: Cigna of CA PPO |
$4.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.43
|
| Rate for Payer: EPIC Health Plan Senior |
$2.43
|
| Rate for Payer: Galaxy Health WC |
$5.17
|
| Rate for Payer: Global Benefits Group Commercial |
$3.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.46
|
| Rate for Payer: Multiplan Commercial |
$4.86
|
| Rate for Payer: Networks By Design Commercial |
$3.95
|
| Rate for Payer: Prime Health Services Commercial |
$5.17
|
|
|
RIFAPENTINE 150 MG TABLET [23365]
|
Facility
|
OP
|
$6.08
|
|
|
Service Code
|
NDC 0088210201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$5.17 |
| Rate for Payer: Adventist Health Commercial |
$1.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.90
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cigna of CA HMO |
$4.26
|
| Rate for Payer: Cigna of CA PPO |
$4.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.43
|
| Rate for Payer: EPIC Health Plan Senior |
$2.43
|
| Rate for Payer: Galaxy Health WC |
$5.17
|
| Rate for Payer: Global Benefits Group Commercial |
$3.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.26
|
| Rate for Payer: Multiplan Commercial |
$4.86
|
| Rate for Payer: Networks By Design Commercial |
$3.95
|
| Rate for Payer: Prime Health Services Commercial |
$5.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.04
|
| Rate for Payer: United Healthcare All Other HMO |
$3.04
|
| Rate for Payer: United Healthcare HMO Rider |
$3.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.17
|
| Rate for Payer: Vantage Medical Group Senior |
$5.17
|
|
|
RIFAXIMIN 200 MG TABLET [39063]
|
Facility
|
OP
|
$14.28
|
|
|
Service Code
|
NDC 6564930103
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$12.14 |
| Rate for Payer: Adventist Health Commercial |
$2.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.16
|
| Rate for Payer: Cash Price |
$6.43
|
| Rate for Payer: Cigna of CA HMO |
$10.00
|
| Rate for Payer: Cigna of CA PPO |
$10.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.71
|
| Rate for Payer: EPIC Health Plan Senior |
$5.71
|
| Rate for Payer: Galaxy Health WC |
$12.14
|
| Rate for Payer: Global Benefits Group Commercial |
$8.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$11.42
|
| Rate for Payer: Networks By Design Commercial |
$9.28
|
| Rate for Payer: Prime Health Services Commercial |
$12.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.14
|
| Rate for Payer: United Healthcare All Other HMO |
$7.14
|
| Rate for Payer: United Healthcare HMO Rider |
$7.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.14
|
| Rate for Payer: Vantage Medical Group Senior |
$12.14
|
|
|
RIFAXIMIN 200 MG TABLET [39063]
|
Facility
|
IP
|
$14.28
|
|
|
Service Code
|
NDC 6564930103
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$12.14 |
| Rate for Payer: Adventist Health Commercial |
$2.86
|
| Rate for Payer: Blue Shield of California Commercial |
$10.98
|
| Rate for Payer: Blue Shield of California Commercial |
$7.24
|
| Rate for Payer: Cash Price |
$6.43
|
| Rate for Payer: Cigna of CA HMO |
$10.00
|
| Rate for Payer: Cigna of CA PPO |
$10.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.71
|
| Rate for Payer: EPIC Health Plan Senior |
$5.71
|
| Rate for Payer: Galaxy Health WC |
$12.14
|
| Rate for Payer: Global Benefits Group Commercial |
$8.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.43
|
| Rate for Payer: Multiplan Commercial |
$11.42
|
| Rate for Payer: Networks By Design Commercial |
$9.28
|
| Rate for Payer: Prime Health Services Commercial |
$12.14
|
|
|
RIFAXIMIN 550 MG TABLET [104604]
|
Facility
|
OP
|
$73.42
|
|
|
Service Code
|
NDC 6564930302
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.68 |
| Max. Negotiated Rate |
$62.41 |
| Rate for Payer: Adventist Health Commercial |
$14.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$62.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$55.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.11
|
| Rate for Payer: Cash Price |
$33.04
|
| Rate for Payer: Cigna of CA HMO |
$51.39
|
| Rate for Payer: Cigna of CA PPO |
$51.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$51.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.37
|
| Rate for Payer: EPIC Health Plan Senior |
$29.37
|
| Rate for Payer: Galaxy Health WC |
$62.41
|
| Rate for Payer: Global Benefits Group Commercial |
$44.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$46.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$43.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51.39
|
| Rate for Payer: Multiplan Commercial |
$58.74
|
| Rate for Payer: Networks By Design Commercial |
$47.72
|
| Rate for Payer: Prime Health Services Commercial |
$62.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.71
|
| Rate for Payer: United Healthcare All Other HMO |
$36.71
|
| Rate for Payer: United Healthcare HMO Rider |
$36.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$62.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.41
|
| Rate for Payer: Vantage Medical Group Senior |
$62.41
|
|
|
RIFAXIMIN 550 MG TABLET [104604]
|
Facility
|
IP
|
$73.42
|
|
|
Service Code
|
NDC 6564930302
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.68 |
| Max. Negotiated Rate |
$62.41 |
| Rate for Payer: Adventist Health Commercial |
$14.68
|
| Rate for Payer: Blue Shield of California Commercial |
$37.22
|
| Rate for Payer: Blue Shield of California Commercial |
$56.46
|
| Rate for Payer: Cash Price |
$33.04
|
| Rate for Payer: Cigna of CA HMO |
$51.39
|
| Rate for Payer: Cigna of CA PPO |
$51.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$51.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.37
|
| Rate for Payer: EPIC Health Plan Senior |
$29.37
|
| Rate for Payer: Galaxy Health WC |
$62.41
|
| Rate for Payer: Global Benefits Group Commercial |
$44.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$46.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$43.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.62
|
| Rate for Payer: Multiplan Commercial |
$58.74
|
| Rate for Payer: Networks By Design Commercial |
$47.72
|
| Rate for Payer: Prime Health Services Commercial |
$62.41
|
|
|
RIFAXIMIN 550 MG TABLET [104604]
|
Facility
|
OP
|
$73.42
|
|
|
Service Code
|
NDC 6564930303
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.68 |
| Max. Negotiated Rate |
$62.41 |
| Rate for Payer: Adventist Health Commercial |
$14.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$62.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$55.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.11
|
| Rate for Payer: Cash Price |
$33.04
|
| Rate for Payer: Cigna of CA HMO |
$51.39
|
| Rate for Payer: Cigna of CA PPO |
$51.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$51.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.37
|
| Rate for Payer: EPIC Health Plan Senior |
$29.37
|
| Rate for Payer: Galaxy Health WC |
$62.41
|
| Rate for Payer: Global Benefits Group Commercial |
$44.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$46.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$43.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51.39
|
| Rate for Payer: Multiplan Commercial |
$58.74
|
| Rate for Payer: Networks By Design Commercial |
$47.72
|
| Rate for Payer: Prime Health Services Commercial |
$62.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.71
|
| Rate for Payer: United Healthcare All Other HMO |
$36.71
|
| Rate for Payer: United Healthcare HMO Rider |
$36.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$62.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.41
|
| Rate for Payer: Vantage Medical Group Senior |
$62.41
|
|
|
RIFAXIMIN 550 MG TABLET [104604]
|
Facility
|
IP
|
$73.42
|
|
|
Service Code
|
NDC 6564930303
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.68 |
| Max. Negotiated Rate |
$62.41 |
| Rate for Payer: Adventist Health Commercial |
$14.68
|
| Rate for Payer: Blue Shield of California Commercial |
$37.22
|
| Rate for Payer: Blue Shield of California Commercial |
$56.46
|
| Rate for Payer: Cash Price |
$33.04
|
| Rate for Payer: Cigna of CA HMO |
$51.39
|
| Rate for Payer: Cigna of CA PPO |
$51.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$51.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.37
|
| Rate for Payer: EPIC Health Plan Senior |
$29.37
|
| Rate for Payer: Galaxy Health WC |
$62.41
|
| Rate for Payer: Global Benefits Group Commercial |
$44.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$46.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$43.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.62
|
| Rate for Payer: Multiplan Commercial |
$58.74
|
| Rate for Payer: Networks By Design Commercial |
$47.72
|
| Rate for Payer: Prime Health Services Commercial |
$62.41
|
|
|
RIFAXIMIN ORAL SUSPENSION COMPOUND 20 MG/ML [4080332]
|
Facility
|
OP
|
$1.32
|
|
|
Service Code
|
NDC 9994080332
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.12 |
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.85
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cigna of CA HMO |
$0.92
|
| Rate for Payer: Cigna of CA PPO |
$0.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.53
|
| Rate for Payer: EPIC Health Plan Senior |
$0.53
|
| Rate for Payer: Galaxy Health WC |
$1.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.92
|
| Rate for Payer: Multiplan Commercial |
$1.06
|
| Rate for Payer: Networks By Design Commercial |
$0.86
|
| Rate for Payer: Prime Health Services Commercial |
$1.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.66
|
| Rate for Payer: United Healthcare All Other HMO |
$0.66
|
| Rate for Payer: United Healthcare HMO Rider |
$0.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1.12
|
|
|
RIFAXIMIN ORAL SUSPENSION COMPOUND 20 MG/ML [4080332]
|
Facility
|
IP
|
$1.32
|
|
|
Service Code
|
NDC 9994080332
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.12 |
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.67
|
| Rate for Payer: Blue Shield of California Commercial |
$1.02
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cigna of CA HMO |
$0.92
|
| Rate for Payer: Cigna of CA PPO |
$0.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.53
|
| Rate for Payer: EPIC Health Plan Senior |
$0.53
|
| Rate for Payer: Galaxy Health WC |
$1.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.78
|
| 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 |
$1.12
|
|
|
RILPIVIRINE HCL 25 MG TABLET [109909]
|
Facility
|
IP
|
$59.33
|
|
|
Service Code
|
NDC 5967627801
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.87 |
| Max. Negotiated Rate |
$50.43 |
| Rate for Payer: Adventist Health Commercial |
$11.87
|
| Rate for Payer: Blue Shield of California Commercial |
$30.08
|
| Rate for Payer: Blue Shield of California Commercial |
$45.62
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna of CA HMO |
$41.53
|
| Rate for Payer: Cigna of CA PPO |
$41.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.73
|
| Rate for Payer: EPIC Health Plan Senior |
$23.73
|
| Rate for Payer: Galaxy Health WC |
$50.43
|
| Rate for Payer: Global Benefits Group Commercial |
$35.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.24
|
| Rate for Payer: Multiplan Commercial |
$47.46
|
| Rate for Payer: Networks By Design Commercial |
$38.56
|
| Rate for Payer: Prime Health Services Commercial |
$50.43
|
|
|
RILPIVIRINE HCL 25 MG TABLET [109909]
|
Facility
|
OP
|
$59.33
|
|
|
Service Code
|
NDC 7006984830
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.87 |
| Max. Negotiated Rate |
$50.43 |
| Rate for Payer: Adventist Health Commercial |
$11.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.07
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna of CA HMO |
$41.53
|
| Rate for Payer: Cigna of CA PPO |
$41.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.73
|
| Rate for Payer: EPIC Health Plan Senior |
$23.73
|
| Rate for Payer: Galaxy Health WC |
$50.43
|
| Rate for Payer: Global Benefits Group Commercial |
$35.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.53
|
| Rate for Payer: Multiplan Commercial |
$47.46
|
| Rate for Payer: Networks By Design Commercial |
$38.56
|
| Rate for Payer: Prime Health Services Commercial |
$50.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.66
|
| Rate for Payer: United Healthcare All Other HMO |
$29.66
|
| Rate for Payer: United Healthcare HMO Rider |
$29.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.43
|
| Rate for Payer: Vantage Medical Group Senior |
$50.43
|
|
|
RILPIVIRINE HCL 25 MG TABLET [109909]
|
Facility
|
OP
|
$59.33
|
|
|
Service Code
|
NDC 5967627801
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.87 |
| Max. Negotiated Rate |
$50.43 |
| Rate for Payer: Adventist Health Commercial |
$11.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.07
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna of CA HMO |
$41.53
|
| Rate for Payer: Cigna of CA PPO |
$41.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.73
|
| Rate for Payer: EPIC Health Plan Senior |
$23.73
|
| Rate for Payer: Galaxy Health WC |
$50.43
|
| Rate for Payer: Global Benefits Group Commercial |
$35.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.53
|
| Rate for Payer: Multiplan Commercial |
$47.46
|
| Rate for Payer: Networks By Design Commercial |
$38.56
|
| Rate for Payer: Prime Health Services Commercial |
$50.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.66
|
| Rate for Payer: United Healthcare All Other HMO |
$29.66
|
| Rate for Payer: United Healthcare HMO Rider |
$29.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.43
|
| Rate for Payer: Vantage Medical Group Senior |
$50.43
|
|
|
RILPIVIRINE HCL 25 MG TABLET [109909]
|
Facility
|
IP
|
$59.33
|
|
|
Service Code
|
NDC 7006984830
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.87 |
| Max. Negotiated Rate |
$50.43 |
| Rate for Payer: Adventist Health Commercial |
$11.87
|
| Rate for Payer: Blue Shield of California Commercial |
$30.08
|
| Rate for Payer: Blue Shield of California Commercial |
$45.62
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna of CA HMO |
$41.53
|
| Rate for Payer: Cigna of CA PPO |
$41.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.73
|
| Rate for Payer: EPIC Health Plan Senior |
$23.73
|
| Rate for Payer: Galaxy Health WC |
$50.43
|
| Rate for Payer: Global Benefits Group Commercial |
$35.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.24
|
| Rate for Payer: Multiplan Commercial |
$47.46
|
| Rate for Payer: Networks By Design Commercial |
$38.56
|
| Rate for Payer: Prime Health Services Commercial |
$50.43
|
|
|
RILUZOLE 50 MG TABLET [16124]
|
Facility
|
OP
|
$1.58
|
|
|
Service Code
|
NDC 6846238160
|
| 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 |
$1.01
|
| 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 Medi-Cal |
$1.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.11
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.93
|
| 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
|
|
|
RILUZOLE 50 MG TABLET [16124]
|
Facility
|
OP
|
$0.80
|
|
|
Service Code
|
NDC 6787728660
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.51
|
| 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 Medi-Cal |
$0.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Senior |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.68
|
| Rate for Payer: Global Benefits Group Commercial |
$0.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.56
|
| 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: 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
|
IP
|
$1.58
|
|
|
Service Code
|
NDC 6275653886
|
| 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: Blue Shield of California Commercial |
$0.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1.22
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.11
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.93
|
| 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 6787728660
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California Commercial |
$0.62
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Senior |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.68
|
| Rate for Payer: Global Benefits Group Commercial |
$0.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.47
|
| 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
|
$1.58
|
|
|
Service Code
|
NDC 6275653886
|
| 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 |
$1.01
|
| 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 Medi-Cal |
$1.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.11
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.93
|
| 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
|
|
|
RILUZOLE 50 MG TABLET [16124]
|
Facility
|
IP
|
$1.58
|
|
|
Service Code
|
NDC 6846238160
|
| 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: Blue Shield of California Commercial |
$0.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1.22
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.11
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.93
|
| 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
|
|
|
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 |
$13.29 |
| Max. Negotiated Rate |
$647.78 |
| Rate for Payer: Adventist Health Commercial |
$152.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$81.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.02
|
| Rate for Payer: Blue Shield of California Commercial |
$14.94
|
| Rate for Payer: Cash Price |
$342.94
|
| Rate for Payer: Cash Price |
$342.94
|
| 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 |
$16.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$533.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.93
|
| Rate for Payer: EPIC Health Plan Senior |
$14.62
|
| Rate for Payer: Galaxy Health WC |
$647.78
|
| Rate for Payer: Global Benefits Group Commercial |
$457.26
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$483.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.81
|
| 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 |
$13.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.62
|
| Rate for Payer: Vantage Medical Group Senior |
$14.62
|
|
|
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 |
$386.38
|
| Rate for Payer: Blue Shield of California Commercial |
$586.05
|
| Rate for Payer: Cash Price |
$342.94
|
| Rate for Payer: Cigna of CA HMO |
$533.47
|
| Rate for Payer: Cigna of CA PPO |
$533.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$483.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$449.64
|
| 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
|
|
|
RIMEGEPANT 75 MG DISINTEGRATING TABLET [227435]
|
Facility
|
OP
|
$161.29
|
|
|
Service Code
|
NDC 7261830002
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$32.26 |
| Max. Negotiated Rate |
$137.10 |
| Rate for Payer: Adventist Health Commercial |
$32.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$105.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$137.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$120.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.50
|
| Rate for Payer: Cash Price |
$72.58
|
| Rate for Payer: Cigna of CA HMO |
$112.90
|
| Rate for Payer: Cigna of CA PPO |
$112.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$137.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$137.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$112.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.52
|
| Rate for Payer: EPIC Health Plan Senior |
$64.52
|
| Rate for Payer: Galaxy Health WC |
$137.10
|
| Rate for Payer: Global Benefits Group Commercial |
$96.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$102.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$112.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$112.90
|
| Rate for Payer: Multiplan Commercial |
$129.03
|
| Rate for Payer: Networks By Design Commercial |
$104.84
|
| Rate for Payer: Prime Health Services Commercial |
$137.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$96.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$96.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$80.64
|
| Rate for Payer: United Healthcare All Other HMO |
$80.64
|
| Rate for Payer: United Healthcare HMO Rider |
$80.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$80.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$137.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$137.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.10
|
|
