|
RILUZOLE 50 MG TABLET [16124]
|
Facility
|
IP
|
$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: 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
|
|
|
RILUZOLE 50 MG TABLET [16124]
|
Facility
|
IP
|
$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: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California EPN |
$0.41
|
| 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: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.68
|
| Rate for Payer: Global Benefits Group Commercial |
$0.48
|
| 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
|
|
|
RIMABOTULINUMTOXINB 2,500 UNIT/0.5 ML INTRAMUSCULAR SOLUTION [108078]
|
Facility
|
IP
|
$747.14
|
|
|
Service Code
|
CPT J0587
|
| Hospital Charge Code |
NDG108078
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$179.31 |
| Max. Negotiated Rate |
$635.07 |
| Rate for Payer: Blue Shield of California Commercial |
$531.96
|
| Rate for Payer: Blue Shield of California EPN |
$382.54
|
| Rate for Payer: Cash Price |
$336.21
|
| Rate for Payer: Cigna of CA HMO |
$523.00
|
| Rate for Payer: Cigna of CA PPO |
$523.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$298.86
|
| Rate for Payer: Galaxy Health WC |
$635.07
|
| Rate for Payer: Global Benefits Group Commercial |
$448.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$498.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$284.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.31
|
| Rate for Payer: Multiplan Commercial |
$597.71
|
| Rate for Payer: Networks By Design Commercial |
$373.57
|
| Rate for Payer: Prime Health Services Commercial |
$635.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$282.12
|
| Rate for Payer: United Healthcare All Other HMO |
$275.55
|
| Rate for Payer: United Healthcare HMO Rider |
$269.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.56
|
|
|
RIMABOTULINUMTOXINB 2,500 UNIT/0.5 ML INTRAMUSCULAR SOLUTION [108078]
|
Facility
|
OP
|
$747.14
|
|
|
Service Code
|
CPT J0587
|
| Hospital Charge Code |
NDG108078
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.03 |
| Max. Negotiated Rate |
$635.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$81.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.37
|
| Rate for Payer: Blue Distinction Transplant |
$448.28
|
| Rate for Payer: Blue Shield of California Commercial |
$550.64
|
| Rate for Payer: Blue Shield of California EPN |
$13.94
|
| Rate for Payer: Cash Price |
$336.21
|
| Rate for Payer: Cash Price |
$336.21
|
| Rate for Payer: Cigna of CA HMO |
$523.00
|
| Rate for Payer: Cigna of CA PPO |
$523.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.54
|
| Rate for Payer: Dignity Health Media |
$13.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.59
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.03
|
| Rate for Payer: Galaxy Health WC |
$635.07
|
| Rate for Payer: Global Benefits Group Commercial |
$448.28
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$560.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.36
|
| Rate for Payer: Heritage Provider Network Transplant |
$21.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$21.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$498.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.45
|
| Rate for Payer: Multiplan Commercial |
$597.71
|
| Rate for Payer: Networks By Design Commercial |
$373.57
|
| Rate for Payer: Prime Health Services Commercial |
$635.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$448.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$448.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$373.57
|
| Rate for Payer: United Healthcare All Other HMO |
$373.57
|
| Rate for Payer: United Healthcare HMO Rider |
$373.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$373.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Vantage Medical Group Senior |
$13.03
|
|
|
RINGER'S INTRAVENOUS SOLUTION [11295]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 0264-7780-00
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
RINGER'S INTRAVENOUS SOLUTION [11295]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 0264-7780-00
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| 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: Blue Distinction Transplant |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$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 Media |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
RIOCIGUAT 0.5 MG TABLET [203879]
|
Facility
|
IP
|
$164.16
|
|
|
Service Code
|
NDC 50419-250-01
|
| Hospital Charge Code |
ERX203879
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.40 |
| Max. Negotiated Rate |
$139.54 |
| Rate for Payer: Blue Shield of California Commercial |
$116.88
|
| Rate for Payer: Blue Shield of California EPN |
$84.05
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Cigna of CA HMO |
$114.91
|
| Rate for Payer: Cigna of CA PPO |
$114.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.66
|
| Rate for Payer: Galaxy Health WC |
$139.54
|
| Rate for Payer: Global Benefits Group Commercial |
$98.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.40
|
| Rate for Payer: Multiplan Commercial |
$131.33
|
| Rate for Payer: Networks By Design Commercial |
$106.70
|
| Rate for Payer: Prime Health Services Commercial |
$139.54
|
|
|
RIOCIGUAT 0.5 MG TABLET [203879]
|
Facility
|
OP
|
$164.16
|
|
|
Service Code
|
NDC 50419-250-01
|
| Hospital Charge Code |
ERX203879
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.40 |
| Max. Negotiated Rate |
$139.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$107.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$139.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$90.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.81
|
| Rate for Payer: Blue Distinction Transplant |
$98.50
|
| Rate for Payer: Blue Shield of California Commercial |
$120.99
|
| Rate for Payer: Blue Shield of California EPN |
$95.87
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Cigna of CA HMO |
$114.91
|
| Rate for Payer: Cigna of CA PPO |
$114.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$139.54
|
| Rate for Payer: Dignity Health Media |
$139.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$139.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$65.66
|
| Rate for Payer: Galaxy Health WC |
$139.54
|
| Rate for Payer: Global Benefits Group Commercial |
$98.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$123.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.40
|
| Rate for Payer: Multiplan Commercial |
$131.33
|
| Rate for Payer: Networks By Design Commercial |
$106.70
|
| Rate for Payer: Prime Health Services Commercial |
$139.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$98.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$98.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.08
|
| Rate for Payer: United Healthcare All Other HMO |
$82.08
|
| Rate for Payer: United Healthcare HMO Rider |
$82.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$139.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$139.54
|
| Rate for Payer: Vantage Medical Group Senior |
$139.54
|
|
|
RIOCIGUAT 0.5 MG TABLET [203879]
|
Facility
|
IP
|
$164.16
|
|
|
Service Code
|
NDC 50419-250-91
|
| Hospital Charge Code |
ERX203879
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.40 |
| Max. Negotiated Rate |
$139.54 |
| Rate for Payer: Blue Shield of California Commercial |
$116.88
|
| Rate for Payer: Blue Shield of California EPN |
$84.05
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Cigna of CA HMO |
$114.91
|
| Rate for Payer: Cigna of CA PPO |
$114.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.66
|
| Rate for Payer: Galaxy Health WC |
$139.54
|
| Rate for Payer: Global Benefits Group Commercial |
$98.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.40
|
| Rate for Payer: Multiplan Commercial |
$131.33
|
| Rate for Payer: Networks By Design Commercial |
$106.70
|
| Rate for Payer: Prime Health Services Commercial |
$139.54
|
|
|
RIOCIGUAT 0.5 MG TABLET [203879]
|
Facility
|
OP
|
$164.16
|
|
|
Service Code
|
NDC 50419-250-91
|
| Hospital Charge Code |
ERX203879
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.40 |
| Max. Negotiated Rate |
$139.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$107.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$139.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$90.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.81
|
| Rate for Payer: Blue Distinction Transplant |
$98.50
|
| Rate for Payer: Blue Shield of California Commercial |
$120.99
|
| Rate for Payer: Blue Shield of California EPN |
$95.87
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Cigna of CA HMO |
$114.91
|
| Rate for Payer: Cigna of CA PPO |
$114.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$139.54
|
| Rate for Payer: Dignity Health Media |
$139.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$139.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$65.66
|
| Rate for Payer: Galaxy Health WC |
$139.54
|
| Rate for Payer: Global Benefits Group Commercial |
$98.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$123.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.40
|
| Rate for Payer: Multiplan Commercial |
$131.33
|
| Rate for Payer: Networks By Design Commercial |
$106.70
|
| Rate for Payer: Prime Health Services Commercial |
$139.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$98.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$98.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.08
|
| Rate for Payer: United Healthcare All Other HMO |
$82.08
|
| Rate for Payer: United Healthcare HMO Rider |
$82.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$139.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$139.54
|
| Rate for Payer: Vantage Medical Group Senior |
$139.54
|
|
|
RIOCIGUAT 1 MG TABLET [203880]
|
Facility
|
OP
|
$164.16
|
|
|
Service Code
|
NDC 50419-251-01
|
| Hospital Charge Code |
ERX203880
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.40 |
| Max. Negotiated Rate |
$139.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$107.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$139.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$90.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.81
|
| Rate for Payer: Blue Distinction Transplant |
$98.50
|
| Rate for Payer: Blue Shield of California Commercial |
$120.99
|
| Rate for Payer: Blue Shield of California EPN |
$95.87
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Cigna of CA HMO |
$114.91
|
| Rate for Payer: Cigna of CA PPO |
$114.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$139.54
|
| Rate for Payer: Dignity Health Media |
$139.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$139.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$65.66
|
| Rate for Payer: Galaxy Health WC |
$139.54
|
| Rate for Payer: Global Benefits Group Commercial |
$98.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$123.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.40
|
| Rate for Payer: Multiplan Commercial |
$131.33
|
| Rate for Payer: Networks By Design Commercial |
$106.70
|
| Rate for Payer: Prime Health Services Commercial |
$139.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$98.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$98.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.08
|
| Rate for Payer: United Healthcare All Other HMO |
$82.08
|
| Rate for Payer: United Healthcare HMO Rider |
$82.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$139.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$139.54
|
| Rate for Payer: Vantage Medical Group Senior |
$139.54
|
|
|
RIOCIGUAT 1 MG TABLET [203880]
|
Facility
|
IP
|
$164.16
|
|
|
Service Code
|
NDC 50419-251-91
|
| Hospital Charge Code |
ERX203880
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.40 |
| Max. Negotiated Rate |
$139.54 |
| Rate for Payer: Blue Shield of California Commercial |
$116.88
|
| Rate for Payer: Blue Shield of California EPN |
$84.05
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Cigna of CA HMO |
$114.91
|
| Rate for Payer: Cigna of CA PPO |
$114.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.66
|
| Rate for Payer: Galaxy Health WC |
$139.54
|
| Rate for Payer: Global Benefits Group Commercial |
$98.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.40
|
| Rate for Payer: Multiplan Commercial |
$131.33
|
| Rate for Payer: Networks By Design Commercial |
$106.70
|
| Rate for Payer: Prime Health Services Commercial |
$139.54
|
|
|
RIOCIGUAT 1 MG TABLET [203880]
|
Facility
|
OP
|
$164.16
|
|
|
Service Code
|
NDC 50419-251-91
|
| Hospital Charge Code |
ERX203880
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.40 |
| Max. Negotiated Rate |
$139.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$107.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$139.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$90.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.81
|
| Rate for Payer: Blue Distinction Transplant |
$98.50
|
| Rate for Payer: Blue Shield of California Commercial |
$120.99
|
| Rate for Payer: Blue Shield of California EPN |
$95.87
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Cigna of CA HMO |
$114.91
|
| Rate for Payer: Cigna of CA PPO |
$114.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$139.54
|
| Rate for Payer: Dignity Health Media |
$139.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$139.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$65.66
|
| Rate for Payer: Galaxy Health WC |
$139.54
|
| Rate for Payer: Global Benefits Group Commercial |
$98.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$123.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.40
|
| Rate for Payer: Multiplan Commercial |
$131.33
|
| Rate for Payer: Networks By Design Commercial |
$106.70
|
| Rate for Payer: Prime Health Services Commercial |
$139.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$98.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$98.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.08
|
| Rate for Payer: United Healthcare All Other HMO |
$82.08
|
| Rate for Payer: United Healthcare HMO Rider |
$82.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$139.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$139.54
|
| Rate for Payer: Vantage Medical Group Senior |
$139.54
|
|
|
RIOCIGUAT 1 MG TABLET [203880]
|
Facility
|
IP
|
$164.16
|
|
|
Service Code
|
NDC 50419-251-01
|
| Hospital Charge Code |
ERX203880
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.40 |
| Max. Negotiated Rate |
$139.54 |
| Rate for Payer: Blue Shield of California Commercial |
$116.88
|
| Rate for Payer: Blue Shield of California EPN |
$84.05
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Cigna of CA HMO |
$114.91
|
| Rate for Payer: Cigna of CA PPO |
$114.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.66
|
| Rate for Payer: Galaxy Health WC |
$139.54
|
| Rate for Payer: Global Benefits Group Commercial |
$98.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.40
|
| Rate for Payer: Multiplan Commercial |
$131.33
|
| Rate for Payer: Networks By Design Commercial |
$106.70
|
| Rate for Payer: Prime Health Services Commercial |
$139.54
|
|
|
RIOCIGUAT 2.5 MG TABLET [203883]
|
Facility
|
IP
|
$164.16
|
|
|
Service Code
|
NDC 50419-254-91
|
| Hospital Charge Code |
ERX203883
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.40 |
| Max. Negotiated Rate |
$139.54 |
| Rate for Payer: Blue Shield of California Commercial |
$116.88
|
| Rate for Payer: Blue Shield of California EPN |
$84.05
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Cigna of CA HMO |
$114.91
|
| Rate for Payer: Cigna of CA PPO |
$114.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.66
|
| Rate for Payer: Galaxy Health WC |
$139.54
|
| Rate for Payer: Global Benefits Group Commercial |
$98.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.40
|
| Rate for Payer: Multiplan Commercial |
$131.33
|
| Rate for Payer: Networks By Design Commercial |
$106.70
|
| Rate for Payer: Prime Health Services Commercial |
$139.54
|
|
|
RIOCIGUAT 2.5 MG TABLET [203883]
|
Facility
|
OP
|
$164.16
|
|
|
Service Code
|
NDC 50419-254-91
|
| Hospital Charge Code |
ERX203883
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.40 |
| Max. Negotiated Rate |
$139.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$107.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$139.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$90.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.81
|
| Rate for Payer: Blue Distinction Transplant |
$98.50
|
| Rate for Payer: Blue Shield of California Commercial |
$120.99
|
| Rate for Payer: Blue Shield of California EPN |
$95.87
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Cigna of CA HMO |
$114.91
|
| Rate for Payer: Cigna of CA PPO |
$114.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$139.54
|
| Rate for Payer: Dignity Health Media |
$139.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$139.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$65.66
|
| Rate for Payer: Galaxy Health WC |
$139.54
|
| Rate for Payer: Global Benefits Group Commercial |
$98.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$123.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.40
|
| Rate for Payer: Multiplan Commercial |
$131.33
|
| Rate for Payer: Networks By Design Commercial |
$106.70
|
| Rate for Payer: Prime Health Services Commercial |
$139.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$98.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$98.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.08
|
| Rate for Payer: United Healthcare All Other HMO |
$82.08
|
| Rate for Payer: United Healthcare HMO Rider |
$82.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$139.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$139.54
|
| Rate for Payer: Vantage Medical Group Senior |
$139.54
|
|
|
RIOCIGUAT 2.5 MG TABLET [203883]
|
Facility
|
OP
|
$164.16
|
|
|
Service Code
|
NDC 50419-254-01
|
| Hospital Charge Code |
ERX203883
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.40 |
| Max. Negotiated Rate |
$139.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$107.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$139.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$90.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.81
|
| Rate for Payer: Blue Distinction Transplant |
$98.50
|
| Rate for Payer: Blue Shield of California Commercial |
$120.99
|
| Rate for Payer: Blue Shield of California EPN |
$95.87
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Cigna of CA HMO |
$114.91
|
| Rate for Payer: Cigna of CA PPO |
$114.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$139.54
|
| Rate for Payer: Dignity Health Media |
$139.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$139.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$65.66
|
| Rate for Payer: Galaxy Health WC |
$139.54
|
| Rate for Payer: Global Benefits Group Commercial |
$98.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$123.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.40
|
| Rate for Payer: Multiplan Commercial |
$131.33
|
| Rate for Payer: Networks By Design Commercial |
$106.70
|
| Rate for Payer: Prime Health Services Commercial |
$139.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$98.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$98.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.08
|
| Rate for Payer: United Healthcare All Other HMO |
$82.08
|
| Rate for Payer: United Healthcare HMO Rider |
$82.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$139.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$139.54
|
| Rate for Payer: Vantage Medical Group Senior |
$139.54
|
|
|
RIOCIGUAT 2.5 MG TABLET [203883]
|
Facility
|
IP
|
$164.16
|
|
|
Service Code
|
NDC 50419-254-01
|
| Hospital Charge Code |
ERX203883
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.40 |
| Max. Negotiated Rate |
$139.54 |
| Rate for Payer: Blue Shield of California Commercial |
$116.88
|
| Rate for Payer: Blue Shield of California EPN |
$84.05
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Cigna of CA HMO |
$114.91
|
| Rate for Payer: Cigna of CA PPO |
$114.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.66
|
| Rate for Payer: Galaxy Health WC |
$139.54
|
| Rate for Payer: Global Benefits Group Commercial |
$98.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.40
|
| Rate for Payer: Multiplan Commercial |
$131.33
|
| Rate for Payer: Networks By Design Commercial |
$106.70
|
| Rate for Payer: Prime Health Services Commercial |
$139.54
|
|
|
RIPRETINIB 50 MG TABLET [228115]
|
Facility
|
OP
|
$521.40
|
|
|
Service Code
|
NDC 73207-101-30
|
| Hospital Charge Code |
ERX228115
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$125.14 |
| Max. Negotiated Rate |
$443.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$341.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$443.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$286.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$310.65
|
| Rate for Payer: Blue Distinction Transplant |
$312.84
|
| Rate for Payer: Blue Shield of California Commercial |
$384.27
|
| Rate for Payer: Blue Shield of California EPN |
$304.50
|
| Rate for Payer: Cash Price |
$234.63
|
| Rate for Payer: Cigna of CA HMO |
$364.98
|
| Rate for Payer: Cigna of CA PPO |
$364.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$443.19
|
| Rate for Payer: Dignity Health Media |
$443.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$443.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$208.56
|
| Rate for Payer: Galaxy Health WC |
$443.19
|
| Rate for Payer: Global Benefits Group Commercial |
$312.84
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$391.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$347.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.14
|
| Rate for Payer: Multiplan Commercial |
$417.12
|
| Rate for Payer: Networks By Design Commercial |
$338.91
|
| Rate for Payer: Prime Health Services Commercial |
$443.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$312.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$312.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$260.70
|
| Rate for Payer: United Healthcare All Other HMO |
$260.70
|
| Rate for Payer: United Healthcare HMO Rider |
$260.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$260.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$443.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$443.19
|
| Rate for Payer: Vantage Medical Group Senior |
$443.19
|
|
|
RIPRETINIB 50 MG TABLET [228115]
|
Facility
|
IP
|
$521.40
|
|
|
Service Code
|
NDC 73207-101-30
|
| Hospital Charge Code |
ERX228115
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$125.14 |
| Max. Negotiated Rate |
$443.19 |
| Rate for Payer: Blue Shield of California Commercial |
$371.24
|
| Rate for Payer: Blue Shield of California EPN |
$266.96
|
| Rate for Payer: Cash Price |
$234.63
|
| Rate for Payer: Cigna of CA HMO |
$364.98
|
| Rate for Payer: Cigna of CA PPO |
$364.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.56
|
| Rate for Payer: Galaxy Health WC |
$443.19
|
| Rate for Payer: Global Benefits Group Commercial |
$312.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$347.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.14
|
| Rate for Payer: Multiplan Commercial |
$417.12
|
| Rate for Payer: Networks By Design Commercial |
$338.91
|
| Rate for Payer: Prime Health Services Commercial |
$443.19
|
|
|
RISANKIZUMAB-RZAA 60 MG/ML INTRAVENOUS SOLUTION [234679]
|
Facility
|
OP
|
$1,140.22
|
|
|
Service Code
|
CPT J2327
|
| Hospital Charge Code |
NDG234679
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.36 |
| Max. Negotiated Rate |
$969.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$96.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.47
|
| Rate for Payer: Blue Distinction Transplant |
$684.13
|
| Rate for Payer: Blue Shield of California Commercial |
$840.34
|
| Rate for Payer: Blue Shield of California EPN |
$665.89
|
| Rate for Payer: Cash Price |
$513.10
|
| Rate for Payer: Cash Price |
$513.10
|
| Rate for Payer: Cigna of CA HMO |
$798.15
|
| Rate for Payer: Cigna of CA PPO |
$798.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.20
|
| Rate for Payer: Dignity Health Media |
$16.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$15.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.36
|
| Rate for Payer: Galaxy Health WC |
$969.19
|
| Rate for Payer: Global Benefits Group Commercial |
$684.13
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$855.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.20
|
| Rate for Payer: Heritage Provider Network Transplant |
$25.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$24.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$760.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$273.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.59
|
| Rate for Payer: Multiplan Commercial |
$912.18
|
| Rate for Payer: Networks By Design Commercial |
$570.11
|
| Rate for Payer: Prime Health Services Commercial |
$969.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$684.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$684.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$570.11
|
| Rate for Payer: United Healthcare All Other HMO |
$570.11
|
| Rate for Payer: United Healthcare HMO Rider |
$570.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.90
|
| Rate for Payer: Vantage Medical Group Senior |
$16.90
|
|
|
RISANKIZUMAB-RZAA 60 MG/ML INTRAVENOUS SOLUTION [234679]
|
Facility
|
IP
|
$1,140.22
|
|
|
Service Code
|
CPT J2327
|
| Hospital Charge Code |
NDG234679
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$273.65 |
| Max. Negotiated Rate |
$969.19 |
| Rate for Payer: Blue Shield of California Commercial |
$811.84
|
| Rate for Payer: Blue Shield of California EPN |
$583.79
|
| Rate for Payer: Cash Price |
$513.10
|
| Rate for Payer: Cigna of CA HMO |
$798.15
|
| Rate for Payer: Cigna of CA PPO |
$798.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$456.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$456.09
|
| Rate for Payer: Galaxy Health WC |
$969.19
|
| Rate for Payer: Global Benefits Group Commercial |
$684.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$760.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$434.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$273.65
|
| Rate for Payer: Multiplan Commercial |
$912.18
|
| Rate for Payer: Networks By Design Commercial |
$570.11
|
| Rate for Payer: Prime Health Services Commercial |
$969.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$430.55
|
| Rate for Payer: United Healthcare All Other HMO |
$420.51
|
| Rate for Payer: United Healthcare HMO Rider |
$411.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$376.27
|
|
|
RISEDRONATE 35 MG TABLET [32895]
|
Facility
|
IP
|
$102.29
|
|
|
Service Code
|
NDC 0430-0472-03
|
| Hospital Charge Code |
1711871
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$24.55 |
| Max. Negotiated Rate |
$86.95 |
| Rate for Payer: Blue Shield of California Commercial |
$72.83
|
| Rate for Payer: Blue Shield of California EPN |
$52.37
|
| 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: EPIC Health Plan Commercial |
$40.92
|
| Rate for Payer: Galaxy Health WC |
$86.95
|
| Rate for Payer: Global Benefits Group Commercial |
$61.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.55
|
| Rate for Payer: Multiplan Commercial |
$81.83
|
| Rate for Payer: Networks By Design Commercial |
$66.49
|
| Rate for Payer: Prime Health Services Commercial |
$86.95
|
|
|
RISEDRONATE 35 MG TABLET [32895]
|
Facility
|
OP
|
$102.29
|
|
|
Service Code
|
NDC 0430-0472-03
|
| Hospital Charge Code |
1711871
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$24.55 |
| Max. Negotiated Rate |
$86.95 |
| 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 |
$56.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.94
|
| Rate for Payer: Blue Distinction Transplant |
$61.37
|
| Rate for Payer: Blue Shield of California Commercial |
$75.39
|
| Rate for Payer: Blue Shield of California EPN |
$59.74
|
| 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 Media |
$86.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$86.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$40.92
|
| Rate for Payer: Galaxy Health WC |
$86.95
|
| Rate for Payer: Global Benefits Group Commercial |
$61.37
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$76.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.97
|
| Rate for Payer: 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
|
| 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 |
$51.14
|
| Rate for Payer: United Healthcare All Other HMO |
$51.14
|
| Rate for Payer: United Healthcare HMO Rider |
$51.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$86.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$86.95
|
| Rate for Payer: Vantage Medical Group Senior |
$86.95
|
|
|
RISPERIDONE 0.25 MG TABLET [25519]
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
NDC 68084-270-11
|
| Hospital Charge Code |
1712235
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
|
