|
RIVAROXABAN 15 MG TABLET [153877]
|
Facility
|
OP
|
$21.70
|
|
|
Service Code
|
NDC 50458-578-10
|
| Hospital Charge Code |
1712515
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$18.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.93
|
| Rate for Payer: Blue Distinction Transplant |
$13.02
|
| Rate for Payer: Blue Shield of California Commercial |
$15.99
|
| Rate for Payer: Blue Shield of California EPN |
$12.67
|
| Rate for Payer: Cash Price |
$9.77
|
| Rate for Payer: Cigna of CA HMO |
$15.19
|
| Rate for Payer: Cigna of CA PPO |
$15.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.44
|
| Rate for Payer: Dignity Health Media |
$18.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.68
|
| Rate for Payer: Galaxy Health WC |
$18.44
|
| Rate for Payer: Global Benefits Group Commercial |
$13.02
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.21
|
| Rate for Payer: Multiplan Commercial |
$17.36
|
| Rate for Payer: Networks By Design Commercial |
$14.10
|
| Rate for Payer: Prime Health Services Commercial |
$18.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.85
|
| Rate for Payer: United Healthcare All Other HMO |
$10.85
|
| Rate for Payer: United Healthcare HMO Rider |
$10.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.44
|
| Rate for Payer: Vantage Medical Group Senior |
$18.44
|
|
|
RIVAROXABAN 20 MG TABLET [153878]
|
Facility
|
OP
|
$21.70
|
|
|
Service Code
|
NDC 50458-579-10
|
| Hospital Charge Code |
1712516
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$18.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.93
|
| Rate for Payer: Blue Distinction Transplant |
$13.02
|
| Rate for Payer: Blue Shield of California Commercial |
$15.99
|
| Rate for Payer: Blue Shield of California EPN |
$12.67
|
| Rate for Payer: Cash Price |
$9.77
|
| Rate for Payer: Cigna of CA HMO |
$15.19
|
| Rate for Payer: Cigna of CA PPO |
$15.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.44
|
| Rate for Payer: Dignity Health Media |
$18.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.68
|
| Rate for Payer: Galaxy Health WC |
$18.44
|
| Rate for Payer: Global Benefits Group Commercial |
$13.02
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.21
|
| Rate for Payer: Multiplan Commercial |
$17.36
|
| Rate for Payer: Networks By Design Commercial |
$14.10
|
| Rate for Payer: Prime Health Services Commercial |
$18.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.85
|
| Rate for Payer: United Healthcare All Other HMO |
$10.85
|
| Rate for Payer: United Healthcare HMO Rider |
$10.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.44
|
| Rate for Payer: Vantage Medical Group Senior |
$18.44
|
|
|
RIVAROXABAN 20 MG TABLET [153878]
|
Facility
|
IP
|
$21.70
|
|
|
Service Code
|
NDC 50458-579-30
|
| Hospital Charge Code |
1712516
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$18.44 |
| Rate for Payer: Blue Shield of California Commercial |
$15.45
|
| Rate for Payer: Blue Shield of California EPN |
$11.11
|
| Rate for Payer: Cash Price |
$9.77
|
| Rate for Payer: Cigna of CA HMO |
$15.19
|
| Rate for Payer: Cigna of CA PPO |
$15.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.68
|
| Rate for Payer: Galaxy Health WC |
$18.44
|
| Rate for Payer: Global Benefits Group Commercial |
$13.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.21
|
| Rate for Payer: Multiplan Commercial |
$17.36
|
| Rate for Payer: Networks By Design Commercial |
$14.10
|
| Rate for Payer: Prime Health Services Commercial |
$18.44
|
|
|
RIVAROXABAN 20 MG TABLET [153878]
|
Facility
|
OP
|
$21.70
|
|
|
Service Code
|
NDC 50458-579-30
|
| Hospital Charge Code |
1712516
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$18.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.93
|
| Rate for Payer: Blue Distinction Transplant |
$13.02
|
| Rate for Payer: Blue Shield of California Commercial |
$15.99
|
| Rate for Payer: Blue Shield of California EPN |
$12.67
|
| Rate for Payer: Cash Price |
$9.77
|
| Rate for Payer: Cigna of CA HMO |
$15.19
|
| Rate for Payer: Cigna of CA PPO |
$15.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.44
|
| Rate for Payer: Dignity Health Media |
$18.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.68
|
| Rate for Payer: Galaxy Health WC |
$18.44
|
| Rate for Payer: Global Benefits Group Commercial |
$13.02
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.21
|
| Rate for Payer: Multiplan Commercial |
$17.36
|
| Rate for Payer: Networks By Design Commercial |
$14.10
|
| Rate for Payer: Prime Health Services Commercial |
$18.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.85
|
| Rate for Payer: United Healthcare All Other HMO |
$10.85
|
| Rate for Payer: United Healthcare HMO Rider |
$10.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.44
|
| Rate for Payer: Vantage Medical Group Senior |
$18.44
|
|
|
RIVAROXABAN 20 MG TABLET [153878]
|
Facility
|
IP
|
$21.70
|
|
|
Service Code
|
NDC 50458-579-10
|
| Hospital Charge Code |
1712516
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$18.44 |
| Rate for Payer: Blue Shield of California Commercial |
$15.45
|
| Rate for Payer: Blue Shield of California EPN |
$11.11
|
| Rate for Payer: Cash Price |
$9.77
|
| Rate for Payer: Cigna of CA HMO |
$15.19
|
| Rate for Payer: Cigna of CA PPO |
$15.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.68
|
| Rate for Payer: Galaxy Health WC |
$18.44
|
| Rate for Payer: Global Benefits Group Commercial |
$13.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.21
|
| Rate for Payer: Multiplan Commercial |
$17.36
|
| Rate for Payer: Networks By Design Commercial |
$14.10
|
| Rate for Payer: Prime Health Services Commercial |
$18.44
|
|
|
RIVAROXABAN 2.5 MG TABLET [222768]
|
Facility
|
OP
|
$10.85
|
|
|
Service Code
|
NDC 50458-577-60
|
| Hospital Charge Code |
ERX222768
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$9.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.46
|
| Rate for Payer: Blue Distinction Transplant |
$6.51
|
| Rate for Payer: Blue Shield of California Commercial |
$8.00
|
| Rate for Payer: Blue Shield of California EPN |
$6.34
|
| Rate for Payer: Cash Price |
$4.88
|
| Rate for Payer: Cigna of CA HMO |
$7.60
|
| Rate for Payer: Cigna of CA PPO |
$7.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.22
|
| Rate for Payer: Dignity Health Media |
$9.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.34
|
| Rate for Payer: Galaxy Health WC |
$9.22
|
| Rate for Payer: Global Benefits Group Commercial |
$6.51
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.60
|
| Rate for Payer: Multiplan Commercial |
$8.68
|
| Rate for Payer: Networks By Design Commercial |
$7.05
|
| Rate for Payer: Prime Health Services Commercial |
$9.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.42
|
| Rate for Payer: United Healthcare All Other HMO |
$5.42
|
| Rate for Payer: United Healthcare HMO Rider |
$5.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.22
|
| Rate for Payer: Vantage Medical Group Senior |
$9.22
|
|
|
RIVAROXABAN 2.5 MG TABLET [222768]
|
Facility
|
IP
|
$10.85
|
|
|
Service Code
|
NDC 50458-577-60
|
| Hospital Charge Code |
ERX222768
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$9.22 |
| Rate for Payer: Blue Shield of California Commercial |
$7.73
|
| Rate for Payer: Blue Shield of California EPN |
$5.56
|
| Rate for Payer: Cash Price |
$4.88
|
| Rate for Payer: Cigna of CA HMO |
$7.60
|
| Rate for Payer: Cigna of CA PPO |
$7.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.34
|
| Rate for Payer: Galaxy Health WC |
$9.22
|
| Rate for Payer: Global Benefits Group Commercial |
$6.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.60
|
| Rate for Payer: Multiplan Commercial |
$8.68
|
| Rate for Payer: Networks By Design Commercial |
$7.05
|
| Rate for Payer: Prime Health Services Commercial |
$9.22
|
|
|
RIVASTIGMINE 1.5 MG CAPSULE [28278]
|
Facility
|
OP
|
$1.25
|
|
|
Service Code
|
NDC 51991-793-06
|
| Hospital Charge Code |
1711861
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.74
|
| Rate for Payer: Blue Distinction Transplant |
$0.75
|
| Rate for Payer: Blue Shield of California Commercial |
$0.92
|
| Rate for Payer: Blue Shield of California EPN |
$0.73
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: Cigna of CA HMO |
$0.88
|
| Rate for Payer: Cigna of CA PPO |
$0.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.06
|
| Rate for Payer: Dignity Health Media |
$1.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.50
|
| Rate for Payer: Galaxy Health WC |
$1.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.75
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$1.00
|
| Rate for Payer: Networks By Design Commercial |
$0.81
|
| Rate for Payer: Prime Health Services Commercial |
$1.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.63
|
| Rate for Payer: United Healthcare All Other HMO |
$0.63
|
| Rate for Payer: United Healthcare HMO Rider |
$0.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.06
|
| Rate for Payer: Vantage Medical Group Senior |
$1.06
|
|
|
RIVASTIGMINE 1.5 MG CAPSULE [28278]
|
Facility
|
IP
|
$1.25
|
|
|
Service Code
|
NDC 51991-793-06
|
| Hospital Charge Code |
1711861
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.06 |
| Rate for Payer: Blue Shield of California Commercial |
$0.89
|
| Rate for Payer: Blue Shield of California EPN |
$0.64
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: Cigna of CA HMO |
$0.88
|
| Rate for Payer: Cigna of CA PPO |
$0.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
| Rate for Payer: Galaxy Health WC |
$1.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$1.00
|
| Rate for Payer: Networks By Design Commercial |
$0.81
|
| Rate for Payer: Prime Health Services Commercial |
$1.06
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
|
OP
|
$5.10
|
|
|
Service Code
|
NDC 70710-1196-1
|
| Hospital Charge Code |
1712347
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$4.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.04
|
| Rate for Payer: Blue Distinction Transplant |
$3.06
|
| Rate for Payer: Blue Shield of California Commercial |
$3.76
|
| Rate for Payer: Blue Shield of California EPN |
$2.98
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna of CA HMO |
$3.57
|
| Rate for Payer: Cigna of CA PPO |
$3.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.34
|
| Rate for Payer: Dignity Health Media |
$4.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.04
|
| Rate for Payer: Galaxy Health WC |
$4.34
|
| Rate for Payer: Global Benefits Group Commercial |
$3.06
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.22
|
| Rate for Payer: Multiplan Commercial |
$4.08
|
| Rate for Payer: Networks By Design Commercial |
$3.32
|
| Rate for Payer: Prime Health Services Commercial |
$4.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.55
|
| Rate for Payer: United Healthcare All Other HMO |
$2.55
|
| Rate for Payer: United Healthcare HMO Rider |
$2.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Vantage Medical Group Senior |
$4.34
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
|
IP
|
$16.22
|
|
|
Service Code
|
NDC 0781-7304-31
|
| Hospital Charge Code |
1712347
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$13.79 |
| Rate for Payer: Blue Shield of California Commercial |
$11.55
|
| Rate for Payer: Blue Shield of California EPN |
$8.30
|
| Rate for Payer: Cash Price |
$7.30
|
| Rate for Payer: Cigna of CA HMO |
$11.35
|
| Rate for Payer: Cigna of CA PPO |
$11.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.49
|
| Rate for Payer: Galaxy Health WC |
$13.79
|
| Rate for Payer: Global Benefits Group Commercial |
$9.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.89
|
| Rate for Payer: Multiplan Commercial |
$12.98
|
| Rate for Payer: Networks By Design Commercial |
$10.54
|
| Rate for Payer: Prime Health Services Commercial |
$13.79
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
|
IP
|
$5.10
|
|
|
Service Code
|
NDC 70710-1196-1
|
| Hospital Charge Code |
1712347
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$4.34 |
| Rate for Payer: Blue Shield of California Commercial |
$3.63
|
| Rate for Payer: Blue Shield of California EPN |
$2.61
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna of CA HMO |
$3.57
|
| Rate for Payer: Cigna of CA PPO |
$3.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.04
|
| Rate for Payer: Galaxy Health WC |
$4.34
|
| Rate for Payer: Global Benefits Group Commercial |
$3.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.22
|
| Rate for Payer: Multiplan Commercial |
$4.08
|
| Rate for Payer: Networks By Design Commercial |
$3.32
|
| Rate for Payer: Prime Health Services Commercial |
$4.34
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 0378-9070-16
|
| Hospital Charge Code |
1712347
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Blue Shield of California Commercial |
$1.42
|
| Rate for Payer: Blue Shield of California EPN |
$1.02
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.30
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
|
OP
|
$5.10
|
|
|
Service Code
|
NDC 70710-1196-7
|
| Hospital Charge Code |
1712347
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$4.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.04
|
| Rate for Payer: Blue Distinction Transplant |
$3.06
|
| Rate for Payer: Blue Shield of California Commercial |
$3.76
|
| Rate for Payer: Blue Shield of California EPN |
$2.98
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna of CA HMO |
$3.57
|
| Rate for Payer: Cigna of CA PPO |
$3.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.34
|
| Rate for Payer: Dignity Health Media |
$4.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.04
|
| Rate for Payer: Galaxy Health WC |
$4.34
|
| Rate for Payer: Global Benefits Group Commercial |
$3.06
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.22
|
| Rate for Payer: Multiplan Commercial |
$4.08
|
| Rate for Payer: Networks By Design Commercial |
$3.32
|
| Rate for Payer: Prime Health Services Commercial |
$4.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.55
|
| Rate for Payer: United Healthcare All Other HMO |
$2.55
|
| Rate for Payer: United Healthcare HMO Rider |
$2.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Vantage Medical Group Senior |
$4.34
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
NDC 0378-9070-16
|
| Hospital Charge Code |
1712347
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.19
|
| Rate for Payer: Blue Distinction Transplant |
$1.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1.47
|
| Rate for Payer: Blue Shield of California EPN |
$1.17
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.70
|
| Rate for Payer: Dignity Health Media |
$1.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.30
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.20
|
| 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 |
$1.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1.70
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 0378-9070-93
|
| Hospital Charge Code |
1712347
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Blue Shield of California Commercial |
$1.42
|
| Rate for Payer: Blue Shield of California EPN |
$1.02
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.30
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
|
IP
|
$16.22
|
|
|
Service Code
|
NDC 0781-7304-58
|
| Hospital Charge Code |
1712347
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$13.79 |
| Rate for Payer: Blue Shield of California Commercial |
$11.55
|
| Rate for Payer: Blue Shield of California EPN |
$8.30
|
| Rate for Payer: Cash Price |
$7.30
|
| Rate for Payer: Cigna of CA HMO |
$11.35
|
| Rate for Payer: Cigna of CA PPO |
$11.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.49
|
| Rate for Payer: Galaxy Health WC |
$13.79
|
| Rate for Payer: Global Benefits Group Commercial |
$9.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.89
|
| Rate for Payer: Multiplan Commercial |
$12.98
|
| Rate for Payer: Networks By Design Commercial |
$10.54
|
| Rate for Payer: Prime Health Services Commercial |
$13.79
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
|
OP
|
$16.22
|
|
|
Service Code
|
NDC 0781-7304-58
|
| Hospital Charge Code |
1712347
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$13.79 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.66
|
| Rate for Payer: Blue Distinction Transplant |
$9.73
|
| Rate for Payer: Blue Shield of California Commercial |
$11.95
|
| Rate for Payer: Blue Shield of California EPN |
$9.47
|
| Rate for Payer: Cash Price |
$7.30
|
| Rate for Payer: Cigna of CA HMO |
$11.35
|
| Rate for Payer: Cigna of CA PPO |
$11.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.79
|
| Rate for Payer: Dignity Health Media |
$13.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.49
|
| Rate for Payer: Galaxy Health WC |
$13.79
|
| Rate for Payer: Global Benefits Group Commercial |
$9.73
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.89
|
| Rate for Payer: Multiplan Commercial |
$12.98
|
| Rate for Payer: Networks By Design Commercial |
$10.54
|
| Rate for Payer: Prime Health Services Commercial |
$13.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.11
|
| Rate for Payer: United Healthcare All Other HMO |
$8.11
|
| Rate for Payer: United Healthcare HMO Rider |
$8.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.79
|
| Rate for Payer: Vantage Medical Group Senior |
$13.79
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
|
IP
|
$5.10
|
|
|
Service Code
|
NDC 70710-1196-7
|
| Hospital Charge Code |
1712347
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$4.34 |
| Rate for Payer: Blue Shield of California Commercial |
$3.63
|
| Rate for Payer: Blue Shield of California EPN |
$2.61
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna of CA HMO |
$3.57
|
| Rate for Payer: Cigna of CA PPO |
$3.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.04
|
| Rate for Payer: Galaxy Health WC |
$4.34
|
| Rate for Payer: Global Benefits Group Commercial |
$3.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.22
|
| Rate for Payer: Multiplan Commercial |
$4.08
|
| Rate for Payer: Networks By Design Commercial |
$3.32
|
| Rate for Payer: Prime Health Services Commercial |
$4.34
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
NDC 0378-9070-93
|
| Hospital Charge Code |
1712347
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.19
|
| Rate for Payer: Blue Distinction Transplant |
$1.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1.47
|
| Rate for Payer: Blue Shield of California EPN |
$1.17
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.70
|
| Rate for Payer: Dignity Health Media |
$1.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.30
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.20
|
| 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 |
$1.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1.70
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
|
OP
|
$16.22
|
|
|
Service Code
|
NDC 0781-7304-31
|
| Hospital Charge Code |
1712347
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$13.79 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.66
|
| Rate for Payer: Blue Distinction Transplant |
$9.73
|
| Rate for Payer: Blue Shield of California Commercial |
$11.95
|
| Rate for Payer: Blue Shield of California EPN |
$9.47
|
| Rate for Payer: Cash Price |
$7.30
|
| Rate for Payer: Cigna of CA HMO |
$11.35
|
| Rate for Payer: Cigna of CA PPO |
$11.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.79
|
| Rate for Payer: Dignity Health Media |
$13.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.49
|
| Rate for Payer: Galaxy Health WC |
$13.79
|
| Rate for Payer: Global Benefits Group Commercial |
$9.73
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.89
|
| Rate for Payer: Multiplan Commercial |
$12.98
|
| Rate for Payer: Networks By Design Commercial |
$10.54
|
| Rate for Payer: Prime Health Services Commercial |
$13.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.11
|
| Rate for Payer: United Healthcare All Other HMO |
$8.11
|
| Rate for Payer: United Healthcare HMO Rider |
$8.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.79
|
| Rate for Payer: Vantage Medical Group Senior |
$13.79
|
|
|
RIZATRIPTAN 10 MG DISINTEGRATING TABLET [27630]
|
Facility
|
OP
|
$1.95
|
|
|
Service Code
|
NDC 68462-468-06
|
| Hospital Charge Code |
ERX27630
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$1.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: Blue Distinction Transplant |
$1.17
|
| Rate for Payer: Blue Shield of California Commercial |
$1.44
|
| Rate for Payer: Blue Shield of California EPN |
$1.14
|
| Rate for Payer: Cash Price |
$0.88
|
| Rate for Payer: Cigna of CA HMO |
$1.36
|
| Rate for Payer: Cigna of CA PPO |
$1.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.66
|
| Rate for Payer: Dignity Health Media |
$1.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.78
|
| Rate for Payer: Galaxy Health WC |
$1.66
|
| Rate for Payer: Global Benefits Group Commercial |
$1.17
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.47
|
| Rate for Payer: Multiplan Commercial |
$1.56
|
| Rate for Payer: Networks By Design Commercial |
$1.27
|
| Rate for Payer: Prime Health Services Commercial |
$1.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.98
|
| Rate for Payer: United Healthcare All Other HMO |
$0.98
|
| Rate for Payer: United Healthcare HMO Rider |
$0.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.66
|
| Rate for Payer: Vantage Medical Group Senior |
$1.66
|
|
|
RIZATRIPTAN 10 MG DISINTEGRATING TABLET [27630]
|
Facility
|
IP
|
$1.95
|
|
|
Service Code
|
NDC 68462-468-06
|
| Hospital Charge Code |
ERX27630
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$1.66 |
| Rate for Payer: Blue Shield of California Commercial |
$1.39
|
| Rate for Payer: Blue Shield of California EPN |
$1.00
|
| Rate for Payer: Cash Price |
$0.88
|
| Rate for Payer: Cigna of CA HMO |
$1.36
|
| Rate for Payer: Cigna of CA PPO |
$1.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.78
|
| Rate for Payer: Galaxy Health WC |
$1.66
|
| Rate for Payer: Global Benefits Group Commercial |
$1.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.47
|
| Rate for Payer: Multiplan Commercial |
$1.56
|
| Rate for Payer: Networks By Design Commercial |
$1.27
|
| Rate for Payer: Prime Health Services Commercial |
$1.66
|
|
|
RIZATRIPTAN 10 MG TABLET [23377]
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
NDC 0093-7472-19
|
| Hospital Charge Code |
1712228
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.53 |
| Rate for Payer: Blue Shield of California Commercial |
$1.28
|
| Rate for Payer: Blue Shield of California EPN |
$0.92
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cigna of CA HMO |
$1.26
|
| Rate for Payer: Cigna of CA PPO |
$1.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$1.53
|
| Rate for Payer: Global Benefits Group Commercial |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$1.44
|
| Rate for Payer: Networks By Design Commercial |
$1.17
|
| Rate for Payer: Prime Health Services Commercial |
$1.53
|
|
|
RIZATRIPTAN 10 MG TABLET [23377]
|
Facility
|
IP
|
$1.19
|
|
|
Service Code
|
NDC 57237-088-63
|
| Hospital Charge Code |
1712228
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.01 |
| Rate for Payer: Blue Shield of California Commercial |
$0.85
|
| Rate for Payer: Blue Shield of California EPN |
$0.61
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cigna of CA HMO |
$0.83
|
| Rate for Payer: Cigna of CA PPO |
$0.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.95
|
| Rate for Payer: Networks By Design Commercial |
$0.77
|
| Rate for Payer: Prime Health Services Commercial |
$1.01
|
|
