|
RIFAMPIN 300 MG CAPSULE [11293]
|
Facility
|
IP
|
$1.31
|
|
|
Service Code
|
NDC 60687-586-11
|
| Hospital Charge Code |
1710623
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.11 |
| Rate for Payer: Blue Shield of California Commercial |
$0.93
|
| Rate for Payer: Blue Shield of California EPN |
$0.67
|
| 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: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$1.05
|
| Rate for Payer: Networks By Design Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.11
|
|
|
RIFAMPIN 300 MG CAPSULE [11293]
|
Facility
|
IP
|
$4.41
|
|
|
Service Code
|
NDC 68180-659-06
|
| Hospital Charge Code |
1710623
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Blue Shield of California Commercial |
$3.14
|
| Rate for Payer: Blue Shield of California EPN |
$2.26
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cigna of CA HMO |
$3.09
|
| Rate for Payer: Cigna of CA PPO |
$3.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.76
|
| Rate for Payer: Galaxy Health WC |
$3.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Multiplan Commercial |
$3.53
|
| Rate for Payer: Networks By Design Commercial |
$2.87
|
| Rate for Payer: Prime Health Services Commercial |
$3.75
|
|
|
RIFAMPIN 300 MG CAPSULE [11293]
|
Facility
|
OP
|
$1.31
|
|
|
Service Code
|
NDC 60687-586-01
|
| Hospital Charge Code |
1710623
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.78
|
| Rate for Payer: Blue Distinction Transplant |
$0.79
|
| Rate for Payer: Blue Shield of California Commercial |
$0.97
|
| Rate for Payer: Blue Shield of California EPN |
$0.77
|
| 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 |
$1.11
|
| Rate for Payer: Dignity Health Media |
$1.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.79
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$1.05
|
| Rate for Payer: Networks By Design Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.11
|
| 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 |
$1.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.11
|
| Rate for Payer: Vantage Medical Group Senior |
$1.11
|
|
|
RIFAMPIN 300 MG CAPSULE [11293]
|
Facility
|
IP
|
$4.41
|
|
|
Service Code
|
NDC 68180-659-07
|
| Hospital Charge Code |
1710623
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Blue Shield of California Commercial |
$3.14
|
| Rate for Payer: Blue Shield of California EPN |
$2.26
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cigna of CA HMO |
$3.09
|
| Rate for Payer: Cigna of CA PPO |
$3.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.76
|
| Rate for Payer: Galaxy Health WC |
$3.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Multiplan Commercial |
$3.53
|
| Rate for Payer: Networks By Design Commercial |
$2.87
|
| Rate for Payer: Prime Health Services Commercial |
$3.75
|
|
|
RIFAMPIN 300 MG CAPSULE [11293]
|
Facility
|
IP
|
$1.31
|
|
|
Service Code
|
NDC 60687-586-01
|
| Hospital Charge Code |
1710623
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.11 |
| Rate for Payer: Blue Shield of California Commercial |
$0.93
|
| Rate for Payer: Blue Shield of California EPN |
$0.67
|
| 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: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$1.05
|
| Rate for Payer: Networks By Design Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.11
|
|
|
RIFAMPIN 600 MG INTRAVENOUS SOLUTION [11291]
|
Facility
|
OP
|
$184.92
|
|
|
Service Code
|
NDC 67457-445-60
|
| Hospital Charge Code |
1753334
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.38 |
| Max. Negotiated Rate |
$157.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$121.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$157.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$101.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.18
|
| Rate for Payer: Blue Distinction Transplant |
$110.95
|
| Rate for Payer: Blue Shield of California Commercial |
$136.29
|
| Rate for Payer: Blue Shield of California EPN |
$107.99
|
| Rate for Payer: Cash Price |
$83.21
|
| Rate for Payer: Cigna of CA HMO |
$118.35
|
| Rate for Payer: Cigna of CA PPO |
$136.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$157.18
|
| Rate for Payer: Dignity Health Media |
$157.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$157.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$73.97
|
| Rate for Payer: Galaxy Health WC |
$157.18
|
| Rate for Payer: Global Benefits Group Commercial |
$110.95
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$138.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$123.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.38
|
| Rate for Payer: Multiplan Commercial |
$147.94
|
| Rate for Payer: Networks By Design Commercial |
$120.20
|
| Rate for Payer: Prime Health Services Commercial |
$157.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$92.46
|
| Rate for Payer: United Healthcare All Other HMO |
$92.46
|
| Rate for Payer: United Healthcare HMO Rider |
$92.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$157.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$157.18
|
| Rate for Payer: Vantage Medical Group Senior |
$157.18
|
|
|
RIFAMPIN 600 MG INTRAVENOUS SOLUTION [11291]
|
Facility
|
IP
|
$184.92
|
|
|
Service Code
|
NDC 67457-445-60
|
| Hospital Charge Code |
1753334
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.38 |
| Max. Negotiated Rate |
$157.18 |
| Rate for Payer: Blue Shield of California Commercial |
$131.66
|
| Rate for Payer: Blue Shield of California EPN |
$94.68
|
| Rate for Payer: Cash Price |
$83.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.97
|
| Rate for Payer: Galaxy Health WC |
$157.18
|
| Rate for Payer: Global Benefits Group Commercial |
$110.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$123.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.38
|
| Rate for Payer: Multiplan Commercial |
$147.94
|
| Rate for Payer: Networks By Design Commercial |
$120.20
|
| Rate for Payer: Prime Health Services Commercial |
$157.18
|
|
|
RIFAMPIN ORAL SUSPENSION COMPOUND 10 MG/ML [4080331]
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
NDC 9994-0803-31
|
| Hospital Charge Code |
1715511
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
|
|
RIFAMPIN ORAL SUSPENSION COMPOUND 10 MG/ML [4080331]
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 9994-0803-31
|
| Hospital Charge Code |
1715511
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| 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: Blue Distinction Transplant |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.04
|
| Rate for Payer: Dignity Health Media |
$0.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.04
|
|
|
RIFAPENTINE 150 MG TABLET [23365]
|
Facility
|
OP
|
$5.54
|
|
|
Service Code
|
NDC 0088-2102-01
|
| Hospital Charge Code |
ERX23365
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$4.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.30
|
| Rate for Payer: Blue Distinction Transplant |
$3.32
|
| Rate for Payer: Blue Shield of California Commercial |
$4.08
|
| Rate for Payer: Blue Shield of California EPN |
$3.24
|
| Rate for Payer: Cash Price |
$2.49
|
| Rate for Payer: Cigna of CA HMO |
$3.88
|
| Rate for Payer: Cigna of CA PPO |
$3.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.71
|
| Rate for Payer: Dignity Health Media |
$4.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.22
|
| Rate for Payer: Galaxy Health WC |
$4.71
|
| Rate for Payer: Global Benefits Group Commercial |
$3.32
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.33
|
| Rate for Payer: Multiplan Commercial |
$4.43
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Prime Health Services Commercial |
$4.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.77
|
| Rate for Payer: United Healthcare All Other HMO |
$2.77
|
| Rate for Payer: United Healthcare HMO Rider |
$2.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.71
|
| Rate for Payer: Vantage Medical Group Senior |
$4.71
|
|
|
RIFAPENTINE 150 MG TABLET [23365]
|
Facility
|
IP
|
$5.54
|
|
|
Service Code
|
NDC 0088-2102-01
|
| Hospital Charge Code |
ERX23365
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$4.71 |
| Rate for Payer: Blue Shield of California Commercial |
$3.94
|
| Rate for Payer: Blue Shield of California EPN |
$2.84
|
| Rate for Payer: Cash Price |
$2.49
|
| Rate for Payer: Cigna of CA HMO |
$3.88
|
| Rate for Payer: Cigna of CA PPO |
$3.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.22
|
| Rate for Payer: Galaxy Health WC |
$4.71
|
| Rate for Payer: Global Benefits Group Commercial |
$3.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.33
|
| Rate for Payer: Multiplan Commercial |
$4.43
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Prime Health Services Commercial |
$4.71
|
|
|
RIFAXIMIN 200 MG TABLET [39063]
|
Facility
|
OP
|
$12.29
|
|
|
Service Code
|
NDC 65649-301-03
|
| Hospital Charge Code |
1710937
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.32
|
| Rate for Payer: Blue Distinction Transplant |
$7.37
|
| Rate for Payer: Blue Shield of California Commercial |
$9.06
|
| Rate for Payer: Blue Shield of California EPN |
$7.18
|
| Rate for Payer: Cash Price |
$5.53
|
| Rate for Payer: Cigna of CA HMO |
$8.60
|
| Rate for Payer: Cigna of CA PPO |
$8.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.45
|
| Rate for Payer: Dignity Health Media |
$10.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.92
|
| Rate for Payer: Galaxy Health WC |
$10.45
|
| Rate for Payer: Global Benefits Group Commercial |
$7.37
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.95
|
| Rate for Payer: Multiplan Commercial |
$9.83
|
| Rate for Payer: Networks By Design Commercial |
$7.99
|
| Rate for Payer: Prime Health Services Commercial |
$10.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.14
|
| Rate for Payer: United Healthcare All Other HMO |
$6.14
|
| Rate for Payer: United Healthcare HMO Rider |
$6.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.45
|
| Rate for Payer: Vantage Medical Group Senior |
$10.45
|
|
|
RIFAXIMIN 200 MG TABLET [39063]
|
Facility
|
IP
|
$12.29
|
|
|
Service Code
|
NDC 65649-301-03
|
| Hospital Charge Code |
1710937
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Blue Shield of California Commercial |
$8.75
|
| Rate for Payer: Blue Shield of California EPN |
$6.29
|
| Rate for Payer: Cash Price |
$5.53
|
| Rate for Payer: Cigna of CA HMO |
$8.60
|
| Rate for Payer: Cigna of CA PPO |
$8.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.92
|
| Rate for Payer: Galaxy Health WC |
$10.45
|
| Rate for Payer: Global Benefits Group Commercial |
$7.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.95
|
| Rate for Payer: Multiplan Commercial |
$9.83
|
| Rate for Payer: Networks By Design Commercial |
$7.99
|
| Rate for Payer: Prime Health Services Commercial |
$10.45
|
|
|
RIFAXIMIN 550 MG TABLET [104604]
|
Facility
|
OP
|
$63.20
|
|
|
Service Code
|
NDC 65649-303-03
|
| Hospital Charge Code |
1712455
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$15.17 |
| Max. Negotiated Rate |
$53.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$41.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$53.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.65
|
| Rate for Payer: Blue Distinction Transplant |
$37.92
|
| Rate for Payer: Blue Shield of California Commercial |
$46.58
|
| Rate for Payer: Blue Shield of California EPN |
$36.91
|
| Rate for Payer: Cash Price |
$28.44
|
| Rate for Payer: Cigna of CA HMO |
$44.24
|
| Rate for Payer: Cigna of CA PPO |
$44.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.72
|
| Rate for Payer: Dignity Health Media |
$53.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.28
|
| Rate for Payer: Galaxy Health WC |
$53.72
|
| Rate for Payer: Global Benefits Group Commercial |
$37.92
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$47.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.17
|
| Rate for Payer: Multiplan Commercial |
$50.56
|
| Rate for Payer: Networks By Design Commercial |
$41.08
|
| Rate for Payer: Prime Health Services Commercial |
$53.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.60
|
| Rate for Payer: United Healthcare All Other HMO |
$31.60
|
| Rate for Payer: United Healthcare HMO Rider |
$31.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$53.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.72
|
| Rate for Payer: Vantage Medical Group Senior |
$53.72
|
|
|
RIFAXIMIN 550 MG TABLET [104604]
|
Facility
|
IP
|
$63.20
|
|
|
Service Code
|
NDC 65649-303-03
|
| Hospital Charge Code |
1712455
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$15.17 |
| Max. Negotiated Rate |
$53.72 |
| Rate for Payer: Blue Shield of California Commercial |
$45.00
|
| Rate for Payer: Blue Shield of California EPN |
$32.36
|
| Rate for Payer: Cash Price |
$28.44
|
| Rate for Payer: Cigna of CA HMO |
$44.24
|
| Rate for Payer: Cigna of CA PPO |
$44.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.28
|
| Rate for Payer: Galaxy Health WC |
$53.72
|
| Rate for Payer: Global Benefits Group Commercial |
$37.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.17
|
| Rate for Payer: Multiplan Commercial |
$50.56
|
| Rate for Payer: Networks By Design Commercial |
$41.08
|
| Rate for Payer: Prime Health Services Commercial |
$53.72
|
|
|
RIFAXIMIN 550 MG TABLET [104604]
|
Facility
|
IP
|
$63.20
|
|
|
Service Code
|
NDC 65649-303-02
|
| Hospital Charge Code |
1712455
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$15.17 |
| Max. Negotiated Rate |
$53.72 |
| Rate for Payer: Blue Shield of California Commercial |
$45.00
|
| Rate for Payer: Blue Shield of California EPN |
$32.36
|
| Rate for Payer: Cash Price |
$28.44
|
| Rate for Payer: Cigna of CA HMO |
$44.24
|
| Rate for Payer: Cigna of CA PPO |
$44.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.28
|
| Rate for Payer: Galaxy Health WC |
$53.72
|
| Rate for Payer: Global Benefits Group Commercial |
$37.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.17
|
| Rate for Payer: Multiplan Commercial |
$50.56
|
| Rate for Payer: Networks By Design Commercial |
$41.08
|
| Rate for Payer: Prime Health Services Commercial |
$53.72
|
|
|
RIFAXIMIN 550 MG TABLET [104604]
|
Facility
|
OP
|
$63.20
|
|
|
Service Code
|
NDC 65649-303-02
|
| Hospital Charge Code |
1712455
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$15.17 |
| Max. Negotiated Rate |
$53.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$41.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$53.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.65
|
| Rate for Payer: Blue Distinction Transplant |
$37.92
|
| Rate for Payer: Blue Shield of California Commercial |
$46.58
|
| Rate for Payer: Blue Shield of California EPN |
$36.91
|
| Rate for Payer: Cash Price |
$28.44
|
| Rate for Payer: Cigna of CA HMO |
$44.24
|
| Rate for Payer: Cigna of CA PPO |
$44.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.72
|
| Rate for Payer: Dignity Health Media |
$53.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.28
|
| Rate for Payer: Galaxy Health WC |
$53.72
|
| Rate for Payer: Global Benefits Group Commercial |
$37.92
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$47.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.17
|
| Rate for Payer: Multiplan Commercial |
$50.56
|
| Rate for Payer: Networks By Design Commercial |
$41.08
|
| Rate for Payer: Prime Health Services Commercial |
$53.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.60
|
| Rate for Payer: United Healthcare All Other HMO |
$31.60
|
| Rate for Payer: United Healthcare HMO Rider |
$31.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$53.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.72
|
| Rate for Payer: Vantage Medical Group Senior |
$53.72
|
|
|
RIFAXIMIN ORAL SUSPENSION COMPOUND 20 MG/ML [4080332]
|
Facility
|
IP
|
$1.33
|
|
|
Service Code
|
NDC 9994-0803-32
|
| Hospital Charge Code |
1715270
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.13 |
| Rate for Payer: Blue Shield of California Commercial |
$0.95
|
| Rate for Payer: Blue Shield of California EPN |
$0.68
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna of CA HMO |
$0.93
|
| Rate for Payer: Cigna of CA PPO |
$0.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.53
|
| Rate for Payer: Galaxy Health WC |
$1.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$1.06
|
| Rate for Payer: Networks By Design Commercial |
$0.86
|
| Rate for Payer: Prime Health Services Commercial |
$1.13
|
|
|
RIFAXIMIN ORAL SUSPENSION COMPOUND 20 MG/ML [4080332]
|
Facility
|
OP
|
$1.33
|
|
|
Service Code
|
NDC 9994-0803-32
|
| Hospital Charge Code |
1715270
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.79
|
| Rate for Payer: Blue Distinction Transplant |
$0.80
|
| Rate for Payer: Blue Shield of California Commercial |
$0.98
|
| Rate for Payer: Blue Shield of California EPN |
$0.78
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna of CA HMO |
$0.93
|
| Rate for Payer: Cigna of CA PPO |
$0.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.13
|
| Rate for Payer: Dignity Health Media |
$1.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.53
|
| Rate for Payer: Galaxy Health WC |
$1.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$1.06
|
| Rate for Payer: Networks By Design Commercial |
$0.86
|
| Rate for Payer: Prime Health Services Commercial |
$1.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.67
|
| Rate for Payer: United Healthcare All Other HMO |
$0.67
|
| Rate for Payer: United Healthcare HMO Rider |
$0.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.13
|
| Rate for Payer: Vantage Medical Group Senior |
$1.13
|
|
|
RILPIVIRINE HCL 25 MG TABLET [109909]
|
Facility
|
OP
|
$54.01
|
|
|
Service Code
|
NDC 59676-278-01
|
| Hospital Charge Code |
1712619
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$45.91 |
| Rate for Payer: Aetna of CA HMO/PPO |
$35.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.18
|
| Rate for Payer: Blue Distinction Transplant |
$32.41
|
| Rate for Payer: Blue Shield of California Commercial |
$39.81
|
| Rate for Payer: Blue Shield of California EPN |
$31.54
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna of CA HMO |
$37.81
|
| Rate for Payer: Cigna of CA PPO |
$37.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.91
|
| Rate for Payer: Dignity Health Media |
$45.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.60
|
| Rate for Payer: Galaxy Health WC |
$45.91
|
| Rate for Payer: Global Benefits Group Commercial |
$32.41
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$40.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.96
|
| Rate for Payer: Multiplan Commercial |
$43.21
|
| Rate for Payer: Networks By Design Commercial |
$35.11
|
| Rate for Payer: Prime Health Services Commercial |
$45.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27.00
|
| Rate for Payer: United Healthcare HMO Rider |
$27.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.91
|
| Rate for Payer: Vantage Medical Group Senior |
$45.91
|
|
|
RILPIVIRINE HCL 25 MG TABLET [109909]
|
Facility
|
IP
|
$54.01
|
|
|
Service Code
|
NDC 59676-278-01
|
| Hospital Charge Code |
1712619
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$45.91 |
| Rate for Payer: Blue Shield of California Commercial |
$38.46
|
| Rate for Payer: Blue Shield of California EPN |
$27.65
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna of CA HMO |
$37.81
|
| Rate for Payer: Cigna of CA PPO |
$37.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: Galaxy Health WC |
$45.91
|
| Rate for Payer: Global Benefits Group Commercial |
$32.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.96
|
| Rate for Payer: Multiplan Commercial |
$43.21
|
| Rate for Payer: Networks By Design Commercial |
$35.11
|
| Rate for Payer: Prime Health Services Commercial |
$45.91
|
|
|
RILUZOLE 50 MG TABLET [16124]
|
Facility
|
OP
|
$0.80
|
|
|
Service Code
|
NDC 67877-286-60
|
| Hospital Charge Code |
1712269
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.52
|
| Rate for Payer: 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 |
$0.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.48
|
| Rate for Payer: Blue Distinction Transplant |
$0.48
|
| Rate for Payer: Blue Shield of California Commercial |
$0.59
|
| Rate for Payer: Blue Shield of California EPN |
$0.47
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cigna of CA HMO |
$0.56
|
| Rate for Payer: Cigna of CA PPO |
$0.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.68
|
| Rate for Payer: Dignity Health Media |
$0.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.68
|
| Rate for Payer: Global Benefits Group Commercial |
$0.48
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.64
|
| Rate for Payer: Networks By Design Commercial |
$0.52
|
| Rate for Payer: Prime Health Services Commercial |
$0.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO |
$0.40
|
| Rate for Payer: United Healthcare HMO Rider |
$0.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.68
|
| Rate for Payer: Vantage Medical Group Senior |
$0.68
|
|
|
RILUZOLE 50 MG TABLET [16124]
|
Facility
|
OP
|
$1.58
|
|
|
Service Code
|
NDC 62756-538-86
|
| Hospital Charge Code |
1712269
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.04
|
| Rate for Payer: 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 |
$0.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.94
|
| Rate for Payer: Blue Distinction Transplant |
$0.95
|
| Rate for Payer: Blue Shield of California Commercial |
$1.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.92
|
| Rate for Payer: Cash Price |
$0.71
|
| Rate for Payer: Cigna of CA HMO |
$1.11
|
| Rate for Payer: Cigna of CA PPO |
$1.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.34
|
| Rate for Payer: Dignity Health Media |
$1.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.63
|
| Rate for Payer: Galaxy Health WC |
$1.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.95
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
| Rate for Payer: Networks By Design Commercial |
$1.03
|
| Rate for Payer: Prime Health Services Commercial |
$1.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.79
|
| Rate for Payer: United Healthcare All Other HMO |
$0.79
|
| Rate for Payer: United Healthcare HMO Rider |
$0.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1.34
|
|
|
RILUZOLE 50 MG TABLET [16124]
|
Facility
|
OP
|
$1.58
|
|
|
Service Code
|
NDC 68462-381-60
|
| Hospital Charge Code |
1712269
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: 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 |
$0.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.94
|
| Rate for Payer: Blue Distinction Transplant |
$0.95
|
| Rate for Payer: Blue Shield of California Commercial |
$1.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.92
|
| Rate for Payer: Cash Price |
$0.71
|
| Rate for Payer: Cigna of CA HMO |
$1.11
|
| Rate for Payer: Cigna of CA PPO |
$1.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.34
|
| Rate for Payer: Dignity Health Media |
$1.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.63
|
| Rate for Payer: Galaxy Health WC |
$1.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.95
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
| Rate for Payer: Networks By Design Commercial |
$1.03
|
| Rate for Payer: Prime Health Services Commercial |
$1.34
|
| Rate for Payer: 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 62756-538-86
|
| Hospital Charge Code |
1712269
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Blue Shield of California Commercial |
$1.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.81
|
| Rate for Payer: Cash Price |
$0.71
|
| Rate for Payer: Cigna of CA HMO |
$1.11
|
| Rate for Payer: Cigna of CA PPO |
$1.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.63
|
| Rate for Payer: Galaxy Health WC |
$1.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
| Rate for Payer: Networks By Design Commercial |
$1.03
|
| Rate for Payer: Prime Health Services Commercial |
$1.34
|
|
