|
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
|
|
|
RINGER'S INTRAVENOUS SOLUTION [11295]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 0264778000
|
| 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: 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
|
|
RINGER'S INTRAVENOUS SOLUTION [11295]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 0264778000
|
| 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 Commercial |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
|
|
RIOCIGUAT 0.5 MG TABLET [203879]
|
Facility
|
IP
|
$197.42
|
|
|
Service Code
|
NDC 5041925001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.48 |
| Max. Negotiated Rate |
$167.81 |
| Rate for Payer: Adventist Health Commercial |
$39.48
|
| Rate for Payer: Blue Shield of California Commercial |
$100.09
|
| Rate for Payer: Blue Shield of California Commercial |
$151.82
|
| Rate for Payer: Cash Price |
$88.84
|
| Rate for Payer: Cigna of CA HMO |
$138.19
|
| Rate for Payer: Cigna of CA PPO |
$138.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$138.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.97
|
| Rate for Payer: EPIC Health Plan Senior |
$78.97
|
| Rate for Payer: Galaxy Health WC |
$167.81
|
| Rate for Payer: Global Benefits Group Commercial |
$118.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$125.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$116.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.38
|
| Rate for Payer: Multiplan Commercial |
$157.94
|
| Rate for Payer: Networks By Design Commercial |
$128.32
|
| Rate for Payer: Prime Health Services Commercial |
$167.81
|
|
|
RIOCIGUAT 0.5 MG TABLET [203879]
|
Facility
|
OP
|
$197.42
|
|
|
Service Code
|
NDC 5041925091
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.48 |
| Max. Negotiated Rate |
$167.81 |
| Rate for Payer: Adventist Health Commercial |
$39.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$129.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$108.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$148.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$126.68
|
| Rate for Payer: Cash Price |
$88.84
|
| Rate for Payer: Cigna of CA HMO |
$138.19
|
| Rate for Payer: Cigna of CA PPO |
$138.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$167.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$167.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$138.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.97
|
| Rate for Payer: EPIC Health Plan Senior |
$78.97
|
| Rate for Payer: Galaxy Health WC |
$167.81
|
| Rate for Payer: Global Benefits Group Commercial |
$118.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$125.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$71.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$116.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$138.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$138.19
|
| Rate for Payer: Multiplan Commercial |
$157.94
|
| Rate for Payer: Networks By Design Commercial |
$128.32
|
| Rate for Payer: Prime Health Services Commercial |
$167.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$118.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$118.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$98.71
|
| Rate for Payer: United Healthcare All Other HMO |
$98.71
|
| Rate for Payer: United Healthcare HMO Rider |
$98.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$167.81
|
| Rate for Payer: Vantage Medical Group Senior |
$167.81
|
|
|
RIOCIGUAT 0.5 MG TABLET [203879]
|
Facility
|
IP
|
$197.42
|
|
|
Service Code
|
NDC 5041925091
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.48 |
| Max. Negotiated Rate |
$167.81 |
| Rate for Payer: Adventist Health Commercial |
$39.48
|
| Rate for Payer: Blue Shield of California Commercial |
$100.09
|
| Rate for Payer: Blue Shield of California Commercial |
$151.82
|
| Rate for Payer: Cash Price |
$88.84
|
| Rate for Payer: Cigna of CA HMO |
$138.19
|
| Rate for Payer: Cigna of CA PPO |
$138.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$138.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.97
|
| Rate for Payer: EPIC Health Plan Senior |
$78.97
|
| Rate for Payer: Galaxy Health WC |
$167.81
|
| Rate for Payer: Global Benefits Group Commercial |
$118.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$125.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$116.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.38
|
| Rate for Payer: Multiplan Commercial |
$157.94
|
| Rate for Payer: Networks By Design Commercial |
$128.32
|
| Rate for Payer: Prime Health Services Commercial |
$167.81
|
|
|
RIOCIGUAT 0.5 MG TABLET [203879]
|
Facility
|
OP
|
$197.42
|
|
|
Service Code
|
NDC 5041925001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.48 |
| Max. Negotiated Rate |
$167.81 |
| Rate for Payer: Adventist Health Commercial |
$39.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$129.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$108.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$148.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$126.68
|
| Rate for Payer: Cash Price |
$88.84
|
| Rate for Payer: Cigna of CA HMO |
$138.19
|
| Rate for Payer: Cigna of CA PPO |
$138.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$167.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$167.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$138.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.97
|
| Rate for Payer: EPIC Health Plan Senior |
$78.97
|
| Rate for Payer: Galaxy Health WC |
$167.81
|
| Rate for Payer: Global Benefits Group Commercial |
$118.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$125.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$71.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$116.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$138.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$138.19
|
| Rate for Payer: Multiplan Commercial |
$157.94
|
| Rate for Payer: Networks By Design Commercial |
$128.32
|
| Rate for Payer: Prime Health Services Commercial |
$167.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$118.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$118.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$98.71
|
| Rate for Payer: United Healthcare All Other HMO |
$98.71
|
| Rate for Payer: United Healthcare HMO Rider |
$98.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$167.81
|
| Rate for Payer: Vantage Medical Group Senior |
$167.81
|
|
|
RIOCIGUAT 1 MG TABLET [203880]
|
Facility
|
IP
|
$197.42
|
|
|
Service Code
|
NDC 5041925101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.48 |
| Max. Negotiated Rate |
$167.81 |
| Rate for Payer: Adventist Health Commercial |
$39.48
|
| Rate for Payer: Blue Shield of California Commercial |
$100.09
|
| Rate for Payer: Blue Shield of California Commercial |
$151.82
|
| Rate for Payer: Cash Price |
$88.84
|
| Rate for Payer: Cigna of CA HMO |
$138.19
|
| Rate for Payer: Cigna of CA PPO |
$138.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$138.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.97
|
| Rate for Payer: EPIC Health Plan Senior |
$78.97
|
| Rate for Payer: Galaxy Health WC |
$167.81
|
| Rate for Payer: Global Benefits Group Commercial |
$118.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$125.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$116.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.38
|
| Rate for Payer: Multiplan Commercial |
$157.94
|
| Rate for Payer: Networks By Design Commercial |
$128.32
|
| Rate for Payer: Prime Health Services Commercial |
$167.81
|
|
|
RIOCIGUAT 1 MG TABLET [203880]
|
Facility
|
IP
|
$197.42
|
|
|
Service Code
|
NDC 5041925191
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.48 |
| Max. Negotiated Rate |
$167.81 |
| Rate for Payer: Adventist Health Commercial |
$39.48
|
| Rate for Payer: Blue Shield of California Commercial |
$100.09
|
| Rate for Payer: Blue Shield of California Commercial |
$151.82
|
| Rate for Payer: Cash Price |
$88.84
|
| Rate for Payer: Cigna of CA HMO |
$138.19
|
| Rate for Payer: Cigna of CA PPO |
$138.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$138.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.97
|
| Rate for Payer: EPIC Health Plan Senior |
$78.97
|
| Rate for Payer: Galaxy Health WC |
$167.81
|
| Rate for Payer: Global Benefits Group Commercial |
$118.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$125.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$116.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.38
|
| Rate for Payer: Multiplan Commercial |
$157.94
|
| Rate for Payer: Networks By Design Commercial |
$128.32
|
| Rate for Payer: Prime Health Services Commercial |
$167.81
|
|
|
RIOCIGUAT 1 MG TABLET [203880]
|
Facility
|
OP
|
$197.42
|
|
|
Service Code
|
NDC 5041925191
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.48 |
| Max. Negotiated Rate |
$167.81 |
| Rate for Payer: Adventist Health Commercial |
$39.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$129.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$108.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$148.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$126.68
|
| Rate for Payer: Cash Price |
$88.84
|
| Rate for Payer: Cigna of CA HMO |
$138.19
|
| Rate for Payer: Cigna of CA PPO |
$138.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$167.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$167.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$138.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.97
|
| Rate for Payer: EPIC Health Plan Senior |
$78.97
|
| Rate for Payer: Galaxy Health WC |
$167.81
|
| Rate for Payer: Global Benefits Group Commercial |
$118.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$125.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$71.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$116.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$138.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$138.19
|
| Rate for Payer: Multiplan Commercial |
$157.94
|
| Rate for Payer: Networks By Design Commercial |
$128.32
|
| Rate for Payer: Prime Health Services Commercial |
$167.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$118.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$118.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$98.71
|
| Rate for Payer: United Healthcare All Other HMO |
$98.71
|
| Rate for Payer: United Healthcare HMO Rider |
$98.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$167.81
|
| Rate for Payer: Vantage Medical Group Senior |
$167.81
|
|
|
RIOCIGUAT 1 MG TABLET [203880]
|
Facility
|
OP
|
$197.42
|
|
|
Service Code
|
NDC 5041925101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.48 |
| Max. Negotiated Rate |
$167.81 |
| Rate for Payer: Adventist Health Commercial |
$39.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$129.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$108.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$148.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$126.68
|
| Rate for Payer: Cash Price |
$88.84
|
| Rate for Payer: Cigna of CA HMO |
$138.19
|
| Rate for Payer: Cigna of CA PPO |
$138.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$167.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$167.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$138.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.97
|
| Rate for Payer: EPIC Health Plan Senior |
$78.97
|
| Rate for Payer: Galaxy Health WC |
$167.81
|
| Rate for Payer: Global Benefits Group Commercial |
$118.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$125.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$71.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$116.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$138.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$138.19
|
| Rate for Payer: Multiplan Commercial |
$157.94
|
| Rate for Payer: Networks By Design Commercial |
$128.32
|
| Rate for Payer: Prime Health Services Commercial |
$167.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$118.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$118.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$98.71
|
| Rate for Payer: United Healthcare All Other HMO |
$98.71
|
| Rate for Payer: United Healthcare HMO Rider |
$98.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$167.81
|
| Rate for Payer: Vantage Medical Group Senior |
$167.81
|
|
|
RIOCIGUAT 2.5 MG TABLET [203883]
|
Facility
|
OP
|
$197.42
|
|
|
Service Code
|
NDC 5041925491
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.48 |
| Max. Negotiated Rate |
$167.81 |
| Rate for Payer: Adventist Health Commercial |
$39.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$129.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$108.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$148.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$126.68
|
| Rate for Payer: Cash Price |
$88.84
|
| Rate for Payer: Cigna of CA HMO |
$138.19
|
| Rate for Payer: Cigna of CA PPO |
$138.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$167.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$167.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$138.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.97
|
| Rate for Payer: EPIC Health Plan Senior |
$78.97
|
| Rate for Payer: Galaxy Health WC |
$167.81
|
| Rate for Payer: Global Benefits Group Commercial |
$118.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$125.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$71.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$116.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$138.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$138.19
|
| Rate for Payer: Multiplan Commercial |
$157.94
|
| Rate for Payer: Networks By Design Commercial |
$128.32
|
| Rate for Payer: Prime Health Services Commercial |
$167.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$118.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$118.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$98.71
|
| Rate for Payer: United Healthcare All Other HMO |
$98.71
|
| Rate for Payer: United Healthcare HMO Rider |
$98.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$167.81
|
| Rate for Payer: Vantage Medical Group Senior |
$167.81
|
|
|
RIOCIGUAT 2.5 MG TABLET [203883]
|
Facility
|
IP
|
$197.42
|
|
|
Service Code
|
NDC 5041925491
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.48 |
| Max. Negotiated Rate |
$167.81 |
| Rate for Payer: Adventist Health Commercial |
$39.48
|
| Rate for Payer: Blue Shield of California Commercial |
$100.09
|
| Rate for Payer: Blue Shield of California Commercial |
$151.82
|
| Rate for Payer: Cash Price |
$88.84
|
| Rate for Payer: Cigna of CA HMO |
$138.19
|
| Rate for Payer: Cigna of CA PPO |
$138.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$138.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.97
|
| Rate for Payer: EPIC Health Plan Senior |
$78.97
|
| Rate for Payer: Galaxy Health WC |
$167.81
|
| Rate for Payer: Global Benefits Group Commercial |
$118.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$125.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$116.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.38
|
| Rate for Payer: Multiplan Commercial |
$157.94
|
| Rate for Payer: Networks By Design Commercial |
$128.32
|
| Rate for Payer: Prime Health Services Commercial |
$167.81
|
|
|
RIOCIGUAT 2.5 MG TABLET [203883]
|
Facility
|
OP
|
$197.42
|
|
|
Service Code
|
NDC 5041925401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.48 |
| Max. Negotiated Rate |
$167.81 |
| Rate for Payer: Adventist Health Commercial |
$39.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$129.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$108.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$148.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$126.68
|
| Rate for Payer: Cash Price |
$88.84
|
| Rate for Payer: Cigna of CA HMO |
$138.19
|
| Rate for Payer: Cigna of CA PPO |
$138.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$167.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$167.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$138.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.97
|
| Rate for Payer: EPIC Health Plan Senior |
$78.97
|
| Rate for Payer: Galaxy Health WC |
$167.81
|
| Rate for Payer: Global Benefits Group Commercial |
$118.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$125.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$71.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$116.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$138.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$138.19
|
| Rate for Payer: Multiplan Commercial |
$157.94
|
| Rate for Payer: Networks By Design Commercial |
$128.32
|
| Rate for Payer: Prime Health Services Commercial |
$167.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$118.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$118.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$98.71
|
| Rate for Payer: United Healthcare All Other HMO |
$98.71
|
| Rate for Payer: United Healthcare HMO Rider |
$98.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$167.81
|
| Rate for Payer: Vantage Medical Group Senior |
$167.81
|
|
|
RIOCIGUAT 2.5 MG TABLET [203883]
|
Facility
|
IP
|
$197.42
|
|
|
Service Code
|
NDC 5041925401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.48 |
| Max. Negotiated Rate |
$167.81 |
| Rate for Payer: Adventist Health Commercial |
$39.48
|
| Rate for Payer: Blue Shield of California Commercial |
$100.09
|
| Rate for Payer: Blue Shield of California Commercial |
$151.82
|
| Rate for Payer: Cash Price |
$88.84
|
| Rate for Payer: Cigna of CA HMO |
$138.19
|
| Rate for Payer: Cigna of CA PPO |
$138.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$138.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.97
|
| Rate for Payer: EPIC Health Plan Senior |
$78.97
|
| Rate for Payer: Galaxy Health WC |
$167.81
|
| Rate for Payer: Global Benefits Group Commercial |
$118.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$125.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$116.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.38
|
| Rate for Payer: Multiplan Commercial |
$157.94
|
| Rate for Payer: Networks By Design Commercial |
$128.32
|
| Rate for Payer: Prime Health Services Commercial |
$167.81
|
|
|
RIPRETINIB 50 MG TABLET [228115]
|
Facility
|
OP
|
$621.60
|
|
|
Service Code
|
NDC 7320710130
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$124.32 |
| Max. Negotiated Rate |
$528.36 |
| Rate for Payer: Adventist Health Commercial |
$124.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$407.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$528.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$341.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$466.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$398.88
|
| Rate for Payer: Cash Price |
$279.72
|
| Rate for Payer: Cigna of CA HMO |
$435.12
|
| Rate for Payer: Cigna of CA PPO |
$435.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$528.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$528.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$435.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.64
|
| Rate for Payer: EPIC Health Plan Senior |
$248.64
|
| Rate for Payer: Galaxy Health WC |
$528.36
|
| Rate for Payer: Global Benefits Group Commercial |
$372.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$394.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$225.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$366.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$435.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$435.12
|
| Rate for Payer: Multiplan Commercial |
$497.28
|
| Rate for Payer: Networks By Design Commercial |
$404.04
|
| Rate for Payer: Prime Health Services Commercial |
$528.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$372.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$372.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$310.80
|
| Rate for Payer: United Healthcare All Other HMO |
$310.80
|
| Rate for Payer: United Healthcare HMO Rider |
$310.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$310.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$528.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.36
|
| Rate for Payer: Vantage Medical Group Senior |
$528.36
|
|
|
RIPRETINIB 50 MG TABLET [228115]
|
Facility
|
IP
|
$621.60
|
|
|
Service Code
|
NDC 7320710130
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$124.32 |
| Max. Negotiated Rate |
$528.36 |
| Rate for Payer: Adventist Health Commercial |
$124.32
|
| Rate for Payer: Blue Shield of California Commercial |
$315.15
|
| Rate for Payer: Blue Shield of California Commercial |
$478.01
|
| Rate for Payer: Cash Price |
$279.72
|
| Rate for Payer: Cigna of CA HMO |
$435.12
|
| Rate for Payer: Cigna of CA PPO |
$435.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$435.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.64
|
| Rate for Payer: EPIC Health Plan Senior |
$248.64
|
| Rate for Payer: Galaxy Health WC |
$528.36
|
| Rate for Payer: Global Benefits Group Commercial |
$372.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$394.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$366.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.18
|
| Rate for Payer: Multiplan Commercial |
$497.28
|
| Rate for Payer: Networks By Design Commercial |
$404.04
|
| Rate for Payer: Prime Health Services Commercial |
$528.36
|
|
|
RISEDRONATE 35 MG TABLET [32895]
|
Facility
|
OP
|
$102.29
|
|
|
Service Code
|
NDC 0430047203
|
| 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 |
$65.64
|
| Rate for Payer: Cash Price |
$46.03
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$64.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$60.35
|
| 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
|
|
|
RISEDRONATE 35 MG TABLET [32895]
|
Facility
|
IP
|
$102.29
|
|
|
Service Code
|
NDC 0430047203
|
| 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 |
$51.86
|
| Rate for Payer: Blue Shield of California Commercial |
$78.66
|
| Rate for Payer: Cash Price |
$46.03
|
| Rate for Payer: Cigna of CA HMO |
$71.60
|
| Rate for Payer: Cigna of CA PPO |
$71.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$64.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$60.35
|
| 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
|
|
|
RISPERIDONE 0.25 MG TABLET [25519]
|
Facility
|
OP
|
$0.27
|
|
|
Service Code
|
NDC 6808427001
|
| 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 |
$0.12
|
| 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 Medi-Cal |
$0.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.16
|
| 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 6808427011
|
| 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 |
$0.12
|
| 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 Medi-Cal |
$0.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.16
|
| 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 6808427011
|
| 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 |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.16
|
| 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
|
IP
|
$0.27
|
|
|
Service Code
|
NDC 6808427001
|
| 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 |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.16
|
| 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 0.5 MG DISINTEGRATING TABLET [35686]
|
Facility
|
IP
|
$4.20
|
|
|
Service Code
|
NDC 4988431191
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Blue Shield of California Commercial |
$2.13
|
| Rate for Payer: Blue Shield of California Commercial |
$3.23
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: Multiplan Commercial |
$3.36
|
| Rate for Payer: Networks By Design Commercial |
$2.73
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
|
|
RISPERIDONE 0.5 MG DISINTEGRATING TABLET [35686]
|
Facility
|
OP
|
$1.99
|
|
|
Service Code
|
NDC 5974601032
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.69 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.28
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO |
$1.39
|
| Rate for Payer: Cigna of CA PPO |
$1.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Senior |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.69
|
| Rate for Payer: Global Benefits Group Commercial |
$1.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.39
|
| Rate for Payer: Multiplan Commercial |
$1.59
|
| Rate for Payer: Networks By Design Commercial |
$1.29
|
| Rate for Payer: Prime Health Services Commercial |
$1.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1.69
|
|
