|
RIFABUTIN 150 MG CAPSULE [11290]
|
Facility
|
IP
|
$16.79
|
|
|
Service Code
|
NDC 5976213501
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$15.11 |
| Rate for Payer: Adventist Health Commercial |
$3.36
|
| Rate for Payer: Blue Shield of California Commercial |
$13.47
|
| Rate for Payer: Blue Shield of California EPN |
$8.46
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: Central Health Plan Commercial |
$13.43
|
| Rate for Payer: Cigna of CA HMO |
$11.75
|
| Rate for Payer: Cigna of CA PPO |
$11.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.72
|
| Rate for Payer: EPIC Health Plan Senior |
$6.72
|
| Rate for Payer: Galaxy Health WC |
$14.27
|
| Rate for Payer: Global Benefits Group Commercial |
$10.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.36
|
| Rate for Payer: Multiplan Commercial |
$12.59
|
| Rate for Payer: Networks By Design Commercial |
$10.91
|
| Rate for Payer: Prime Health Services Commercial |
$14.27
|
|
|
RIFABUTIN 150 MG CAPSULE [11290]
|
Facility
|
IP
|
$15.12
|
|
|
Service Code
|
NDC 7095404110
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$13.61 |
| Rate for Payer: Adventist Health Commercial |
$3.02
|
| Rate for Payer: Blue Shield of California Commercial |
$12.13
|
| Rate for Payer: Blue Shield of California EPN |
$7.62
|
| Rate for Payer: Cash Price |
$6.80
|
| Rate for Payer: Central Health Plan Commercial |
$12.10
|
| Rate for Payer: Cigna of CA HMO |
$10.58
|
| Rate for Payer: Cigna of CA PPO |
$10.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.05
|
| Rate for Payer: EPIC Health Plan Senior |
$6.05
|
| Rate for Payer: Galaxy Health WC |
$12.85
|
| Rate for Payer: Global Benefits Group Commercial |
$9.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.02
|
| Rate for Payer: Multiplan Commercial |
$11.34
|
| Rate for Payer: Networks By Design Commercial |
$9.83
|
| Rate for Payer: Prime Health Services Commercial |
$12.85
|
|
|
RIFABUTIN 150 MG CAPSULE [11290]
|
Facility
|
OP
|
$16.79
|
|
|
Service Code
|
NDC 5976213501
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$15.11 |
| Rate for Payer: Adventist Health Commercial |
$3.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.77
|
| Rate for Payer: Blue Shield of California Commercial |
$10.64
|
| Rate for Payer: Blue Shield of California EPN |
$6.70
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: Central Health Plan Commercial |
$13.43
|
| Rate for Payer: Cigna of CA HMO |
$11.75
|
| Rate for Payer: Cigna of CA PPO |
$11.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.72
|
| Rate for Payer: EPIC Health Plan Senior |
$6.72
|
| Rate for Payer: Galaxy Health WC |
$14.27
|
| Rate for Payer: Global Benefits Group Commercial |
$10.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.75
|
| Rate for Payer: Multiplan Commercial |
$12.59
|
| Rate for Payer: Networks By Design Commercial |
$10.91
|
| Rate for Payer: Prime Health Services Commercial |
$14.27
|
| Rate for Payer: Riverside University Health System MISP |
$6.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.39
|
| Rate for Payer: United Healthcare All Other HMO |
$8.39
|
| Rate for Payer: United Healthcare HMO Rider |
$8.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.27
|
| Rate for Payer: Vantage Medical Group Senior |
$14.27
|
|
|
RIFAMPIN 150 MG CAPSULE [11292]
|
Facility
|
IP
|
$3.82
|
|
|
Service Code
|
NDC 6068757511
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.44 |
| Rate for Payer: Adventist Health Commercial |
$0.76
|
| Rate for Payer: Blue Shield of California Commercial |
$3.06
|
| Rate for Payer: Blue Shield of California EPN |
$1.93
|
| Rate for Payer: Cash Price |
$1.72
|
| Rate for Payer: Central Health Plan Commercial |
$3.06
|
| Rate for Payer: Cigna of CA HMO |
$2.67
|
| Rate for Payer: Cigna of CA PPO |
$2.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.53
|
| Rate for Payer: EPIC Health Plan Senior |
$1.53
|
| Rate for Payer: Galaxy Health WC |
$3.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$2.87
|
| Rate for Payer: Networks By Design Commercial |
$2.48
|
| Rate for Payer: Prime Health Services Commercial |
$3.25
|
|
|
RIFAMPIN 150 MG CAPSULE [11292]
|
Facility
|
OP
|
$3.82
|
|
|
Service Code
|
NDC 6068757521
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.44 |
| Rate for Payer: Adventist Health Commercial |
$0.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.22
|
| Rate for Payer: Blue Shield of California Commercial |
$2.42
|
| Rate for Payer: Blue Shield of California EPN |
$1.52
|
| Rate for Payer: Cash Price |
$1.72
|
| Rate for Payer: Central Health Plan Commercial |
$3.06
|
| Rate for Payer: Cigna of CA HMO |
$2.67
|
| Rate for Payer: Cigna of CA PPO |
$2.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.53
|
| Rate for Payer: EPIC Health Plan Senior |
$1.53
|
| Rate for Payer: Galaxy Health WC |
$3.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.67
|
| Rate for Payer: Multiplan Commercial |
$2.87
|
| Rate for Payer: Networks By Design Commercial |
$2.48
|
| Rate for Payer: Prime Health Services Commercial |
$3.25
|
| Rate for Payer: Riverside University Health System MISP |
$1.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.91
|
| Rate for Payer: United Healthcare All Other HMO |
$1.91
|
| Rate for Payer: United Healthcare HMO Rider |
$1.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.25
|
| Rate for Payer: Vantage Medical Group Senior |
$3.25
|
|
|
RIFAMPIN 150 MG CAPSULE [11292]
|
Facility
|
IP
|
$3.82
|
|
|
Service Code
|
NDC 6068757521
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.44 |
| Rate for Payer: Adventist Health Commercial |
$0.76
|
| Rate for Payer: Blue Shield of California Commercial |
$3.06
|
| Rate for Payer: Blue Shield of California EPN |
$1.93
|
| Rate for Payer: Cash Price |
$1.72
|
| Rate for Payer: Central Health Plan Commercial |
$3.06
|
| Rate for Payer: Cigna of CA HMO |
$2.67
|
| Rate for Payer: Cigna of CA PPO |
$2.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.53
|
| Rate for Payer: EPIC Health Plan Senior |
$1.53
|
| Rate for Payer: Galaxy Health WC |
$3.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$2.87
|
| Rate for Payer: Networks By Design Commercial |
$2.48
|
| Rate for Payer: Prime Health Services Commercial |
$3.25
|
|
|
RIFAMPIN 150 MG CAPSULE [11292]
|
Facility
|
OP
|
$3.82
|
|
|
Service Code
|
NDC 6068757511
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.44 |
| Rate for Payer: Adventist Health Commercial |
$0.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.22
|
| Rate for Payer: Blue Shield of California Commercial |
$2.42
|
| Rate for Payer: Blue Shield of California EPN |
$1.52
|
| Rate for Payer: Cash Price |
$1.72
|
| Rate for Payer: Central Health Plan Commercial |
$3.06
|
| Rate for Payer: Cigna of CA HMO |
$2.67
|
| Rate for Payer: Cigna of CA PPO |
$2.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.53
|
| Rate for Payer: EPIC Health Plan Senior |
$1.53
|
| Rate for Payer: Galaxy Health WC |
$3.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.67
|
| Rate for Payer: Multiplan Commercial |
$2.87
|
| Rate for Payer: Networks By Design Commercial |
$2.48
|
| Rate for Payer: Prime Health Services Commercial |
$3.25
|
| Rate for Payer: Riverside University Health System MISP |
$1.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.91
|
| Rate for Payer: United Healthcare All Other HMO |
$1.91
|
| Rate for Payer: United Healthcare HMO Rider |
$1.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.25
|
| Rate for Payer: Vantage Medical Group Senior |
$3.25
|
|
|
RIFAMPIN 300 MG CAPSULE [11293]
|
Facility
|
IP
|
$2.23
|
|
|
Service Code
|
NDC 6068758611
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.01 |
| Rate for Payer: Adventist Health Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California Commercial |
$1.79
|
| Rate for Payer: Blue Shield of California EPN |
$1.12
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Central Health Plan Commercial |
$1.78
|
| Rate for Payer: Cigna of CA HMO |
$1.56
|
| Rate for Payer: Cigna of CA PPO |
$1.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.89
|
| Rate for Payer: EPIC Health Plan Senior |
$0.89
|
| Rate for Payer: Galaxy Health WC |
$1.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.67
|
| Rate for Payer: Networks By Design Commercial |
$1.45
|
| Rate for Payer: Prime Health Services Commercial |
$1.90
|
|
|
RIFAMPIN 300 MG CAPSULE [11293]
|
Facility
|
OP
|
$2.23
|
|
|
Service Code
|
NDC 6068758611
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.01 |
| Rate for Payer: Adventist Health Commercial |
$0.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1.41
|
| Rate for Payer: Blue Shield of California EPN |
$0.89
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Central Health Plan Commercial |
$1.78
|
| Rate for Payer: Cigna of CA HMO |
$1.56
|
| Rate for Payer: Cigna of CA PPO |
$1.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.89
|
| Rate for Payer: EPIC Health Plan Senior |
$0.89
|
| Rate for Payer: Galaxy Health WC |
$1.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$1.67
|
| Rate for Payer: Networks By Design Commercial |
$1.45
|
| Rate for Payer: Prime Health Services Commercial |
$1.90
|
| Rate for Payer: Riverside University Health System MISP |
$0.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.11
|
| Rate for Payer: United Healthcare All Other HMO |
$1.11
|
| Rate for Payer: United Healthcare HMO Rider |
$1.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1.90
|
|
|
RIFAMPIN 300 MG CAPSULE [11293]
|
Facility
|
IP
|
$4.41
|
|
|
Service Code
|
NDC 6818065907
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$3.97 |
| Rate for Payer: Adventist Health Commercial |
$0.88
|
| Rate for Payer: Blue Shield of California Commercial |
$3.54
|
| Rate for Payer: Blue Shield of California EPN |
$2.22
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Central Health Plan Commercial |
$3.53
|
| Rate for Payer: Cigna of CA HMO |
$3.09
|
| Rate for Payer: Cigna of CA PPO |
$3.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.76
|
| Rate for Payer: EPIC Health Plan Senior |
$1.76
|
| Rate for Payer: Galaxy Health WC |
$3.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.88
|
| Rate for Payer: Multiplan Commercial |
$3.31
|
| 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
|
$4.41
|
|
|
Service Code
|
NDC 6818065906
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$3.97 |
| Rate for Payer: Adventist Health Commercial |
$0.88
|
| Rate for Payer: Blue Shield of California Commercial |
$3.54
|
| Rate for Payer: Blue Shield of California EPN |
$2.22
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Central Health Plan Commercial |
$3.53
|
| Rate for Payer: Cigna of CA HMO |
$3.09
|
| Rate for Payer: Cigna of CA PPO |
$3.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.76
|
| Rate for Payer: EPIC Health Plan Senior |
$1.76
|
| Rate for Payer: Galaxy Health WC |
$3.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.88
|
| Rate for Payer: Multiplan Commercial |
$3.31
|
| 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
|
$4.41
|
|
|
Service Code
|
NDC 6818065907
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$3.97 |
| Rate for Payer: Adventist Health Commercial |
$0.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.57
|
| Rate for Payer: Blue Shield of California Commercial |
$2.80
|
| Rate for Payer: Blue Shield of California EPN |
$1.76
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Central Health Plan Commercial |
$3.53
|
| Rate for Payer: Cigna of CA HMO |
$3.09
|
| Rate for Payer: Cigna of CA PPO |
$3.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.76
|
| Rate for Payer: EPIC Health Plan Senior |
$1.76
|
| Rate for Payer: Galaxy Health WC |
$3.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.09
|
| Rate for Payer: Multiplan Commercial |
$3.31
|
| Rate for Payer: Networks By Design Commercial |
$2.87
|
| Rate for Payer: Prime Health Services Commercial |
$3.75
|
| Rate for Payer: Riverside University Health System MISP |
$1.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.21
|
| Rate for Payer: United Healthcare All Other HMO |
$2.21
|
| Rate for Payer: United Healthcare HMO Rider |
$2.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.75
|
| Rate for Payer: Vantage Medical Group Senior |
$3.75
|
|
|
RIFAMPIN 300 MG CAPSULE [11293]
|
Facility
|
OP
|
$4.41
|
|
|
Service Code
|
NDC 6818065906
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$3.97 |
| Rate for Payer: Adventist Health Commercial |
$0.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.57
|
| Rate for Payer: Blue Shield of California Commercial |
$2.80
|
| Rate for Payer: Blue Shield of California EPN |
$1.76
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Central Health Plan Commercial |
$3.53
|
| Rate for Payer: Cigna of CA HMO |
$3.09
|
| Rate for Payer: Cigna of CA PPO |
$3.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.76
|
| Rate for Payer: EPIC Health Plan Senior |
$1.76
|
| Rate for Payer: Galaxy Health WC |
$3.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.09
|
| Rate for Payer: Multiplan Commercial |
$3.31
|
| Rate for Payer: Networks By Design Commercial |
$2.87
|
| Rate for Payer: Prime Health Services Commercial |
$3.75
|
| Rate for Payer: Riverside University Health System MISP |
$1.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.21
|
| Rate for Payer: United Healthcare All Other HMO |
$2.21
|
| Rate for Payer: United Healthcare HMO Rider |
$2.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.75
|
| Rate for Payer: Vantage Medical Group Senior |
$3.75
|
|
|
RIFAMPIN 300 MG CAPSULE [11293]
|
Facility
|
OP
|
$2.23
|
|
|
Service Code
|
NDC 6068758601
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.01 |
| Rate for Payer: Adventist Health Commercial |
$0.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1.41
|
| Rate for Payer: Blue Shield of California EPN |
$0.89
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Central Health Plan Commercial |
$1.78
|
| Rate for Payer: Cigna of CA HMO |
$1.56
|
| Rate for Payer: Cigna of CA PPO |
$1.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.89
|
| Rate for Payer: EPIC Health Plan Senior |
$0.89
|
| Rate for Payer: Galaxy Health WC |
$1.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$1.67
|
| Rate for Payer: Networks By Design Commercial |
$1.45
|
| Rate for Payer: Prime Health Services Commercial |
$1.90
|
| Rate for Payer: Riverside University Health System MISP |
$0.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.11
|
| Rate for Payer: United Healthcare All Other HMO |
$1.11
|
| Rate for Payer: United Healthcare HMO Rider |
$1.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1.90
|
|
|
RIFAMPIN 300 MG CAPSULE [11293]
|
Facility
|
IP
|
$2.23
|
|
|
Service Code
|
NDC 6068758601
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.01 |
| Rate for Payer: Adventist Health Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California Commercial |
$1.79
|
| Rate for Payer: Blue Shield of California EPN |
$1.12
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Central Health Plan Commercial |
$1.78
|
| Rate for Payer: Cigna of CA HMO |
$1.56
|
| Rate for Payer: Cigna of CA PPO |
$1.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.89
|
| Rate for Payer: EPIC Health Plan Senior |
$0.89
|
| Rate for Payer: Galaxy Health WC |
$1.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.67
|
| Rate for Payer: Networks By Design Commercial |
$1.45
|
| Rate for Payer: Prime Health Services Commercial |
$1.90
|
|
|
RIFAMPIN 600 MG INTRAVENOUS SOLUTION [11291]
|
Facility
|
OP
|
$184.92
|
|
|
Service Code
|
HCPCS J2804
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$166.43 |
| Rate for Payer: Adventist Health Commercial |
$36.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.86
|
| 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 |
$138.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.64
|
| Rate for Payer: Blue Shield of California Commercial |
$117.24
|
| Rate for Payer: Blue Shield of California EPN |
$73.78
|
| Rate for Payer: Cash Price |
$83.21
|
| Rate for Payer: Cash Price |
$83.21
|
| Rate for Payer: Central Health Plan Commercial |
$147.94
|
| Rate for Payer: Cigna of CA HMO |
$129.44
|
| Rate for Payer: Cigna of CA PPO |
$129.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$157.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$157.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$157.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$129.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.97
|
| Rate for Payer: EPIC Health Plan Senior |
$73.97
|
| Rate for Payer: Galaxy Health WC |
$157.18
|
| Rate for Payer: Global Benefits Group Commercial |
$110.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$166.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$117.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$109.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$129.44
|
| Rate for Payer: Multiplan Commercial |
$138.69
|
| Rate for Payer: Networks By Design Commercial |
$92.46
|
| Rate for Payer: Prime Health Services Commercial |
$157.18
|
| Rate for Payer: Riverside University Health System MISP |
$73.97
|
| 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 |
$69.40
|
| Rate for Payer: United Healthcare All Other HMO |
$67.55
|
| Rate for Payer: United Healthcare HMO Rider |
$66.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.56
|
| 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
|
HCPCS J2804
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.98 |
| Max. Negotiated Rate |
$166.43 |
| Rate for Payer: Adventist Health Commercial |
$36.98
|
| Rate for Payer: Blue Shield of California Commercial |
$148.31
|
| Rate for Payer: Blue Shield of California EPN |
$93.20
|
| Rate for Payer: Cash Price |
$83.21
|
| Rate for Payer: Central Health Plan Commercial |
$147.94
|
| Rate for Payer: Cigna of CA HMO |
$129.44
|
| Rate for Payer: Cigna of CA PPO |
$129.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$129.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.97
|
| Rate for Payer: EPIC Health Plan Senior |
$73.97
|
| Rate for Payer: Galaxy Health WC |
$157.18
|
| Rate for Payer: Global Benefits Group Commercial |
$110.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$166.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$117.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$109.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.98
|
| Rate for Payer: Multiplan Commercial |
$138.69
|
| Rate for Payer: Networks By Design Commercial |
$92.46
|
| Rate for Payer: Prime Health Services Commercial |
$157.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$69.40
|
| Rate for Payer: United Healthcare All Other HMO |
$67.55
|
| Rate for Payer: United Healthcare HMO Rider |
$66.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.56
|
|
|
RIFAMPIN ORAL SUSPENSION COMPOUND 10 MG/ML [4080331]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 9994080331
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
RIFAMPIN ORAL SUSPENSION COMPOUND 10 MG/ML [4080331]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 9994080331
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Riverside University Health System MISP |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
RIFAPENTINE 150 MG TABLET [23365]
|
Facility
|
OP
|
$6.08
|
|
|
Service Code
|
NDC 0088210201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$5.47 |
| Rate for Payer: Adventist Health Commercial |
$1.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.54
|
| Rate for Payer: Blue Shield of California Commercial |
$3.85
|
| Rate for Payer: Blue Shield of California EPN |
$2.43
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Central Health Plan Commercial |
$4.86
|
| Rate for Payer: Cigna of CA HMO |
$4.26
|
| Rate for Payer: Cigna of CA PPO |
$4.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.43
|
| Rate for Payer: EPIC Health Plan Senior |
$2.43
|
| Rate for Payer: Galaxy Health WC |
$5.17
|
| Rate for Payer: Global Benefits Group Commercial |
$3.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.26
|
| Rate for Payer: Multiplan Commercial |
$4.56
|
| Rate for Payer: Networks By Design Commercial |
$3.95
|
| Rate for Payer: Prime Health Services Commercial |
$5.17
|
| Rate for Payer: Riverside University Health System MISP |
$2.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.04
|
| Rate for Payer: United Healthcare All Other HMO |
$3.04
|
| Rate for Payer: United Healthcare HMO Rider |
$3.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.17
|
| Rate for Payer: Vantage Medical Group Senior |
$5.17
|
|
|
RIFAPENTINE 150 MG TABLET [23365]
|
Facility
|
IP
|
$6.08
|
|
|
Service Code
|
NDC 0088210201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$5.47 |
| Rate for Payer: Adventist Health Commercial |
$1.22
|
| Rate for Payer: Blue Shield of California Commercial |
$4.88
|
| Rate for Payer: Blue Shield of California EPN |
$3.06
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Central Health Plan Commercial |
$4.86
|
| Rate for Payer: Cigna of CA HMO |
$4.26
|
| Rate for Payer: Cigna of CA PPO |
$4.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.43
|
| Rate for Payer: EPIC Health Plan Senior |
$2.43
|
| Rate for Payer: Galaxy Health WC |
$5.17
|
| Rate for Payer: Global Benefits Group Commercial |
$3.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.22
|
| Rate for Payer: Multiplan Commercial |
$4.56
|
| Rate for Payer: Networks By Design Commercial |
$3.95
|
| Rate for Payer: Prime Health Services Commercial |
$5.17
|
|
|
RIFAXIMIN 200 MG TABLET [39063]
|
Facility
|
OP
|
$14.28
|
|
|
Service Code
|
NDC 6564930103
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$12.85 |
| Rate for Payer: Adventist Health Commercial |
$2.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.31
|
| Rate for Payer: Blue Shield of California Commercial |
$9.05
|
| Rate for Payer: Blue Shield of California EPN |
$5.70
|
| Rate for Payer: Cash Price |
$6.43
|
| Rate for Payer: Central Health Plan Commercial |
$11.42
|
| Rate for Payer: Cigna of CA HMO |
$10.00
|
| Rate for Payer: Cigna of CA PPO |
$10.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.71
|
| Rate for Payer: EPIC Health Plan Senior |
$5.71
|
| Rate for Payer: Galaxy Health WC |
$12.14
|
| Rate for Payer: Global Benefits Group Commercial |
$8.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$10.71
|
| Rate for Payer: Networks By Design Commercial |
$9.28
|
| Rate for Payer: Prime Health Services Commercial |
$12.14
|
| Rate for Payer: Riverside University Health System MISP |
$5.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.14
|
| Rate for Payer: United Healthcare All Other HMO |
$7.14
|
| Rate for Payer: United Healthcare HMO Rider |
$7.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.14
|
| Rate for Payer: Vantage Medical Group Senior |
$12.14
|
|
|
RIFAXIMIN 200 MG TABLET [39063]
|
Facility
|
IP
|
$14.28
|
|
|
Service Code
|
NDC 6564930103
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$12.85 |
| Rate for Payer: Adventist Health Commercial |
$2.86
|
| Rate for Payer: Blue Shield of California Commercial |
$11.45
|
| Rate for Payer: Blue Shield of California EPN |
$7.20
|
| Rate for Payer: Cash Price |
$6.43
|
| Rate for Payer: Central Health Plan Commercial |
$11.42
|
| Rate for Payer: Cigna of CA HMO |
$10.00
|
| Rate for Payer: Cigna of CA PPO |
$10.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.71
|
| Rate for Payer: EPIC Health Plan Senior |
$5.71
|
| Rate for Payer: Galaxy Health WC |
$12.14
|
| Rate for Payer: Global Benefits Group Commercial |
$8.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.86
|
| Rate for Payer: Multiplan Commercial |
$10.71
|
| Rate for Payer: Networks By Design Commercial |
$9.28
|
| Rate for Payer: Prime Health Services Commercial |
$12.14
|
|
|
RIFAXIMIN 550 MG TABLET [104604]
|
Facility
|
IP
|
$73.42
|
|
|
Service Code
|
NDC 6564930303
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.68 |
| Max. Negotiated Rate |
$66.08 |
| Rate for Payer: Adventist Health Commercial |
$14.68
|
| Rate for Payer: Blue Shield of California Commercial |
$58.88
|
| Rate for Payer: Blue Shield of California EPN |
$37.00
|
| Rate for Payer: Cash Price |
$33.04
|
| Rate for Payer: Central Health Plan Commercial |
$58.74
|
| Rate for Payer: Cigna of CA HMO |
$51.39
|
| Rate for Payer: Cigna of CA PPO |
$51.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$51.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.37
|
| Rate for Payer: EPIC Health Plan Senior |
$29.37
|
| Rate for Payer: Galaxy Health WC |
$62.41
|
| Rate for Payer: Global Benefits Group Commercial |
$44.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$66.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$46.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$43.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.68
|
| Rate for Payer: Multiplan Commercial |
$55.06
|
| Rate for Payer: Networks By Design Commercial |
$47.72
|
| Rate for Payer: Prime Health Services Commercial |
$62.41
|
|
|
RIFAXIMIN 550 MG TABLET [104604]
|
Facility
|
OP
|
$73.42
|
|
|
Service Code
|
NDC 6564930302
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.68 |
| Max. Negotiated Rate |
$66.08 |
| Rate for Payer: Adventist Health Commercial |
$14.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$44.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$62.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$55.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$35.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.71
|
| Rate for Payer: Blue Shield of California Commercial |
$46.55
|
| Rate for Payer: Blue Shield of California EPN |
$29.29
|
| Rate for Payer: Cash Price |
$33.04
|
| Rate for Payer: Central Health Plan Commercial |
$58.74
|
| Rate for Payer: Cigna of CA HMO |
$51.39
|
| Rate for Payer: Cigna of CA PPO |
$51.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$51.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.37
|
| Rate for Payer: EPIC Health Plan Senior |
$29.37
|
| Rate for Payer: Galaxy Health WC |
$62.41
|
| Rate for Payer: Global Benefits Group Commercial |
$44.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$66.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$46.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$43.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$51.39
|
| Rate for Payer: Multiplan Commercial |
$55.06
|
| Rate for Payer: Networks By Design Commercial |
$47.72
|
| Rate for Payer: Prime Health Services Commercial |
$62.41
|
| Rate for Payer: Riverside University Health System MISP |
$29.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.71
|
| Rate for Payer: United Healthcare All Other HMO |
$36.71
|
| Rate for Payer: United Healthcare HMO Rider |
$36.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$62.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.41
|
| Rate for Payer: Vantage Medical Group Senior |
$62.41
|
|
