|
RIOCIGUAT 1 MG TABLET [203880]
|
Facility
|
IP
|
$197.42
|
|
|
Service Code
|
NDC 5041925191
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.48 |
| Max. Negotiated Rate |
$177.68 |
| Rate for Payer: Adventist Health Commercial |
$39.48
|
| Rate for Payer: Blue Shield of California Commercial |
$158.33
|
| Rate for Payer: Blue Shield of California EPN |
$99.50
|
| Rate for Payer: Cash Price |
$88.84
|
| Rate for Payer: Central Health Plan Commercial |
$157.94
|
| Rate for Payer: Cigna of CA HMO |
$138.19
|
| Rate for Payer: Cigna of CA PPO |
$138.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$138.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.97
|
| Rate for Payer: EPIC Health Plan Senior |
$78.97
|
| Rate for Payer: Galaxy Health WC |
$167.81
|
| Rate for Payer: Global Benefits Group Commercial |
$118.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$177.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$125.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$116.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.48
|
| Rate for Payer: Multiplan Commercial |
$148.06
|
| Rate for Payer: Networks By Design Commercial |
$128.32
|
| Rate for Payer: Prime Health Services Commercial |
$167.81
|
|
|
RIOCIGUAT 1 MG TABLET [203880]
|
Facility
|
OP
|
$197.42
|
|
|
Service Code
|
NDC 5041925191
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.48 |
| Max. Negotiated Rate |
$177.68 |
| Rate for Payer: Adventist Health Commercial |
$39.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$108.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$148.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.84
|
| Rate for Payer: Blue Shield of California Commercial |
$125.16
|
| Rate for Payer: Blue Shield of California EPN |
$78.77
|
| Rate for Payer: Cash Price |
$88.84
|
| Rate for Payer: Central Health Plan Commercial |
$157.94
|
| Rate for Payer: Cigna of CA HMO |
$138.19
|
| Rate for Payer: Cigna of CA PPO |
$138.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$167.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$167.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$138.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.97
|
| Rate for Payer: EPIC Health Plan Senior |
$78.97
|
| Rate for Payer: Galaxy Health WC |
$167.81
|
| Rate for Payer: Global Benefits Group Commercial |
$118.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$177.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$125.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$71.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$116.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$138.19
|
| Rate for Payer: Multiplan Commercial |
$148.06
|
| Rate for Payer: Networks By Design Commercial |
$128.32
|
| Rate for Payer: Prime Health Services Commercial |
$167.81
|
| Rate for Payer: Riverside University Health System MISP |
$78.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$118.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$118.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$98.71
|
| Rate for Payer: United Healthcare All Other HMO |
$98.71
|
| Rate for Payer: United Healthcare HMO Rider |
$98.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$167.81
|
| Rate for Payer: Vantage Medical Group Senior |
$167.81
|
|
|
RIOCIGUAT 1 MG TABLET [203880]
|
Facility
|
OP
|
$197.42
|
|
|
Service Code
|
NDC 5041925101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.48 |
| Max. Negotiated Rate |
$177.68 |
| Rate for Payer: Adventist Health Commercial |
$39.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$108.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$148.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.84
|
| Rate for Payer: Blue Shield of California Commercial |
$125.16
|
| Rate for Payer: Blue Shield of California EPN |
$78.77
|
| Rate for Payer: Cash Price |
$88.84
|
| Rate for Payer: Central Health Plan Commercial |
$157.94
|
| Rate for Payer: Cigna of CA HMO |
$138.19
|
| Rate for Payer: Cigna of CA PPO |
$138.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$167.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$167.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$138.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.97
|
| Rate for Payer: EPIC Health Plan Senior |
$78.97
|
| Rate for Payer: Galaxy Health WC |
$167.81
|
| Rate for Payer: Global Benefits Group Commercial |
$118.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$177.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$125.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$71.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$116.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$138.19
|
| Rate for Payer: Multiplan Commercial |
$148.06
|
| Rate for Payer: Networks By Design Commercial |
$128.32
|
| Rate for Payer: Prime Health Services Commercial |
$167.81
|
| Rate for Payer: Riverside University Health System MISP |
$78.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$118.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$118.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$98.71
|
| Rate for Payer: United Healthcare All Other HMO |
$98.71
|
| Rate for Payer: United Healthcare HMO Rider |
$98.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$167.81
|
| Rate for Payer: Vantage Medical Group Senior |
$167.81
|
|
|
RIOCIGUAT 2.5 MG TABLET [203883]
|
Facility
|
OP
|
$197.42
|
|
|
Service Code
|
NDC 5041925401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.48 |
| Max. Negotiated Rate |
$177.68 |
| Rate for Payer: Adventist Health Commercial |
$39.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$108.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$148.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.84
|
| Rate for Payer: Blue Shield of California Commercial |
$125.16
|
| Rate for Payer: Blue Shield of California EPN |
$78.77
|
| Rate for Payer: Cash Price |
$88.84
|
| Rate for Payer: Central Health Plan Commercial |
$157.94
|
| Rate for Payer: Cigna of CA HMO |
$138.19
|
| Rate for Payer: Cigna of CA PPO |
$138.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$167.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$167.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$138.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.97
|
| Rate for Payer: EPIC Health Plan Senior |
$78.97
|
| Rate for Payer: Galaxy Health WC |
$167.81
|
| Rate for Payer: Global Benefits Group Commercial |
$118.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$177.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$125.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$71.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$116.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$138.19
|
| Rate for Payer: Multiplan Commercial |
$148.06
|
| Rate for Payer: Networks By Design Commercial |
$128.32
|
| Rate for Payer: Prime Health Services Commercial |
$167.81
|
| Rate for Payer: Riverside University Health System MISP |
$78.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$118.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$118.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$98.71
|
| Rate for Payer: United Healthcare All Other HMO |
$98.71
|
| Rate for Payer: United Healthcare HMO Rider |
$98.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$167.81
|
| Rate for Payer: Vantage Medical Group Senior |
$167.81
|
|
|
RIOCIGUAT 2.5 MG TABLET [203883]
|
Facility
|
IP
|
$197.42
|
|
|
Service Code
|
NDC 5041925491
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.48 |
| Max. Negotiated Rate |
$177.68 |
| Rate for Payer: Adventist Health Commercial |
$39.48
|
| Rate for Payer: Blue Shield of California Commercial |
$158.33
|
| Rate for Payer: Blue Shield of California EPN |
$99.50
|
| Rate for Payer: Cash Price |
$88.84
|
| Rate for Payer: Central Health Plan Commercial |
$157.94
|
| Rate for Payer: Cigna of CA HMO |
$138.19
|
| Rate for Payer: Cigna of CA PPO |
$138.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$138.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.97
|
| Rate for Payer: EPIC Health Plan Senior |
$78.97
|
| Rate for Payer: Galaxy Health WC |
$167.81
|
| Rate for Payer: Global Benefits Group Commercial |
$118.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$177.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$125.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$116.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.48
|
| Rate for Payer: Multiplan Commercial |
$148.06
|
| Rate for Payer: Networks By Design Commercial |
$128.32
|
| Rate for Payer: Prime Health Services Commercial |
$167.81
|
|
|
RIOCIGUAT 2.5 MG TABLET [203883]
|
Facility
|
IP
|
$197.42
|
|
|
Service Code
|
NDC 5041925401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.48 |
| Max. Negotiated Rate |
$177.68 |
| Rate for Payer: Adventist Health Commercial |
$39.48
|
| Rate for Payer: Blue Shield of California Commercial |
$158.33
|
| Rate for Payer: Blue Shield of California EPN |
$99.50
|
| Rate for Payer: Cash Price |
$88.84
|
| Rate for Payer: Central Health Plan Commercial |
$157.94
|
| Rate for Payer: Cigna of CA HMO |
$138.19
|
| Rate for Payer: Cigna of CA PPO |
$138.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$138.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.97
|
| Rate for Payer: EPIC Health Plan Senior |
$78.97
|
| Rate for Payer: Galaxy Health WC |
$167.81
|
| Rate for Payer: Global Benefits Group Commercial |
$118.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$177.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$125.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$116.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.48
|
| Rate for Payer: Multiplan Commercial |
$148.06
|
| Rate for Payer: Networks By Design Commercial |
$128.32
|
| Rate for Payer: Prime Health Services Commercial |
$167.81
|
|
|
RIOCIGUAT 2.5 MG TABLET [203883]
|
Facility
|
OP
|
$197.42
|
|
|
Service Code
|
NDC 5041925491
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.48 |
| Max. Negotiated Rate |
$177.68 |
| Rate for Payer: Adventist Health Commercial |
$39.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$108.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$148.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.84
|
| Rate for Payer: Blue Shield of California Commercial |
$125.16
|
| Rate for Payer: Blue Shield of California EPN |
$78.77
|
| Rate for Payer: Cash Price |
$88.84
|
| Rate for Payer: Central Health Plan Commercial |
$157.94
|
| Rate for Payer: Cigna of CA HMO |
$138.19
|
| Rate for Payer: Cigna of CA PPO |
$138.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$167.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$167.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$138.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.97
|
| Rate for Payer: EPIC Health Plan Senior |
$78.97
|
| Rate for Payer: Galaxy Health WC |
$167.81
|
| Rate for Payer: Global Benefits Group Commercial |
$118.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$177.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$125.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$71.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$116.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$138.19
|
| Rate for Payer: Multiplan Commercial |
$148.06
|
| Rate for Payer: Networks By Design Commercial |
$128.32
|
| Rate for Payer: Prime Health Services Commercial |
$167.81
|
| Rate for Payer: Riverside University Health System MISP |
$78.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$118.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$118.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$98.71
|
| Rate for Payer: United Healthcare All Other HMO |
$98.71
|
| Rate for Payer: United Healthcare HMO Rider |
$98.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$167.81
|
| Rate for Payer: Vantage Medical Group Senior |
$167.81
|
|
|
RIPRETINIB 50 MG TABLET [228115]
|
Facility
|
OP
|
$621.60
|
|
|
Service Code
|
NDC 7320710130
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$124.32 |
| Max. Negotiated Rate |
$559.44 |
| Rate for Payer: Adventist Health Commercial |
$124.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$377.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$528.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$341.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$466.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$300.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$361.58
|
| Rate for Payer: Blue Shield of California Commercial |
$394.09
|
| Rate for Payer: Blue Shield of California EPN |
$248.02
|
| Rate for Payer: Cash Price |
$279.72
|
| Rate for Payer: Central Health Plan Commercial |
$497.28
|
| Rate for Payer: Cigna of CA HMO |
$435.12
|
| Rate for Payer: Cigna of CA PPO |
$435.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$528.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$528.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$435.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.64
|
| Rate for Payer: EPIC Health Plan Senior |
$248.64
|
| Rate for Payer: Galaxy Health WC |
$528.36
|
| Rate for Payer: Global Benefits Group Commercial |
$372.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$559.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$394.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$225.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$366.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$435.12
|
| Rate for Payer: Multiplan Commercial |
$466.20
|
| Rate for Payer: Networks By Design Commercial |
$404.04
|
| Rate for Payer: Prime Health Services Commercial |
$528.36
|
| Rate for Payer: Riverside University Health System MISP |
$248.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$372.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$372.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$310.80
|
| Rate for Payer: United Healthcare All Other HMO |
$310.80
|
| Rate for Payer: United Healthcare HMO Rider |
$310.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$310.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$528.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.36
|
| Rate for Payer: Vantage Medical Group Senior |
$528.36
|
|
|
RIPRETINIB 50 MG TABLET [228115]
|
Facility
|
IP
|
$621.60
|
|
|
Service Code
|
NDC 7320710130
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$124.32 |
| Max. Negotiated Rate |
$559.44 |
| Rate for Payer: Adventist Health Commercial |
$124.32
|
| Rate for Payer: Blue Shield of California Commercial |
$498.52
|
| Rate for Payer: Blue Shield of California EPN |
$313.29
|
| Rate for Payer: Cash Price |
$279.72
|
| Rate for Payer: Central Health Plan Commercial |
$497.28
|
| Rate for Payer: Cigna of CA HMO |
$435.12
|
| Rate for Payer: Cigna of CA PPO |
$435.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$435.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.64
|
| Rate for Payer: EPIC Health Plan Senior |
$248.64
|
| Rate for Payer: Galaxy Health WC |
$528.36
|
| Rate for Payer: Global Benefits Group Commercial |
$372.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$559.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$394.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$366.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.32
|
| Rate for Payer: Multiplan Commercial |
$466.20
|
| Rate for Payer: Networks By Design Commercial |
$404.04
|
| Rate for Payer: Prime Health Services Commercial |
$528.36
|
|
|
RISEDRONATE 35 MG TABLET [32895]
|
Facility
|
IP
|
$102.29
|
|
|
Service Code
|
NDC 0430047203
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$92.06 |
| Rate for Payer: Adventist Health Commercial |
$20.46
|
| Rate for Payer: Blue Shield of California Commercial |
$82.04
|
| Rate for Payer: Blue Shield of California EPN |
$51.55
|
| Rate for Payer: Cash Price |
$46.03
|
| Rate for Payer: Central Health Plan Commercial |
$81.83
|
| Rate for Payer: Cigna of CA HMO |
$71.60
|
| Rate for Payer: Cigna of CA PPO |
$71.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$71.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.92
|
| Rate for Payer: EPIC Health Plan Senior |
$40.92
|
| Rate for Payer: Galaxy Health WC |
$86.95
|
| Rate for Payer: Global Benefits Group Commercial |
$61.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$92.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$64.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$60.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.46
|
| Rate for Payer: Multiplan Commercial |
$76.72
|
| 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 0430047203
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$92.06 |
| Rate for Payer: Adventist Health Commercial |
$20.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$86.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$49.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.50
|
| Rate for Payer: Blue Shield of California Commercial |
$64.85
|
| Rate for Payer: Blue Shield of California EPN |
$40.81
|
| Rate for Payer: Cash Price |
$46.03
|
| Rate for Payer: Central Health Plan Commercial |
$81.83
|
| Rate for Payer: Cigna of CA HMO |
$71.60
|
| Rate for Payer: Cigna of CA PPO |
$71.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$86.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$86.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$86.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$71.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.92
|
| Rate for Payer: EPIC Health Plan Senior |
$40.92
|
| Rate for Payer: Galaxy Health WC |
$86.95
|
| Rate for Payer: Global Benefits Group Commercial |
$61.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$92.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$64.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$60.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$71.60
|
| Rate for Payer: Multiplan Commercial |
$76.72
|
| Rate for Payer: Networks By Design Commercial |
$66.49
|
| Rate for Payer: Prime Health Services Commercial |
$86.95
|
| Rate for Payer: Riverside University Health System MISP |
$40.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$61.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$61.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$51.15
|
| Rate for Payer: United Healthcare All Other HMO |
$51.15
|
| Rate for Payer: United Healthcare HMO Rider |
$51.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$86.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$86.95
|
| Rate for Payer: Vantage Medical Group Senior |
$86.95
|
|
|
RISPERIDONE 0.25 MG TABLET [25519]
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
NDC 6808427001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Central Health Plan Commercial |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Senior |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
|
|
RISPERIDONE 0.25 MG TABLET [25519]
|
Facility
|
OP
|
$0.27
|
|
|
Service Code
|
NDC 6808427011
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Central Health Plan Commercial |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Senior |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
| Rate for Payer: Riverside University Health System MISP |
$0.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO |
$0.14
|
| Rate for Payer: United Healthcare HMO Rider |
$0.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Vantage Medical Group Senior |
$0.23
|
|
|
RISPERIDONE 0.25 MG TABLET [25519]
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
NDC 6808427011
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Central Health Plan Commercial |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Senior |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
|
|
RISPERIDONE 0.25 MG TABLET [25519]
|
Facility
|
OP
|
$0.27
|
|
|
Service Code
|
NDC 6808427001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Central Health Plan Commercial |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Senior |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
| Rate for Payer: Riverside University Health System MISP |
$0.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO |
$0.14
|
| Rate for Payer: United Healthcare HMO Rider |
$0.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Vantage Medical Group Senior |
$0.23
|
|
|
RISPERIDONE 0.5 MG DISINTEGRATING TABLET [35686]
|
Facility
|
OP
|
$4.20
|
|
|
Service Code
|
NDC 4988431152
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$3.78 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.44
|
| Rate for Payer: Blue Shield of California Commercial |
$2.66
|
| Rate for Payer: Blue Shield of California EPN |
$1.68
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Central Health Plan Commercial |
$3.36
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.94
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: Networks By Design Commercial |
$2.73
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
| Rate for Payer: Riverside University Health System MISP |
$1.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.10
|
| Rate for Payer: United Healthcare All Other HMO |
$2.10
|
| Rate for Payer: United Healthcare HMO Rider |
$2.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.57
|
| Rate for Payer: Vantage Medical Group Senior |
$3.57
|
|
|
RISPERIDONE 0.5 MG DISINTEGRATING TABLET [35686]
|
Facility
|
IP
|
$4.20
|
|
|
Service Code
|
NDC 4988431191
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$3.78 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Blue Shield of California Commercial |
$3.37
|
| Rate for Payer: Blue Shield of California EPN |
$2.12
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Central Health Plan Commercial |
$3.36
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: Networks By Design Commercial |
$2.73
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
|
|
RISPERIDONE 0.5 MG DISINTEGRATING TABLET [35686]
|
Facility
|
OP
|
$1.99
|
|
|
Service Code
|
NDC 5974601032
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.79 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.79
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$1.59
|
| Rate for Payer: Cigna of CA HMO |
$1.39
|
| Rate for Payer: Cigna of CA PPO |
$1.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Senior |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.69
|
| Rate for Payer: Global Benefits Group Commercial |
$1.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.39
|
| Rate for Payer: Multiplan Commercial |
$1.49
|
| Rate for Payer: Networks By Design Commercial |
$1.29
|
| Rate for Payer: Prime Health Services Commercial |
$1.69
|
| Rate for Payer: Riverside University Health System MISP |
$0.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1.69
|
|
|
RISPERIDONE 0.5 MG DISINTEGRATING TABLET [35686]
|
Facility
|
IP
|
$4.20
|
|
|
Service Code
|
NDC 4988431152
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$3.78 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Blue Shield of California Commercial |
$3.37
|
| Rate for Payer: Blue Shield of California EPN |
$2.12
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Central Health Plan Commercial |
$3.36
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: Networks By Design Commercial |
$2.73
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
|
|
RISPERIDONE 0.5 MG DISINTEGRATING TABLET [35686]
|
Facility
|
OP
|
$4.20
|
|
|
Service Code
|
NDC 4988431191
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$3.78 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.44
|
| Rate for Payer: Blue Shield of California Commercial |
$2.66
|
| Rate for Payer: Blue Shield of California EPN |
$1.68
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Central Health Plan Commercial |
$3.36
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.94
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: Networks By Design Commercial |
$2.73
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
| Rate for Payer: Riverside University Health System MISP |
$1.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.10
|
| Rate for Payer: United Healthcare All Other HMO |
$2.10
|
| Rate for Payer: United Healthcare HMO Rider |
$2.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.57
|
| Rate for Payer: Vantage Medical Group Senior |
$3.57
|
|
|
RISPERIDONE 0.5 MG DISINTEGRATING TABLET [35686]
|
Facility
|
IP
|
$1.99
|
|
|
Service Code
|
NDC 5974601032
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.79 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1.60
|
| Rate for Payer: Blue Shield of California EPN |
$1.00
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$1.59
|
| Rate for Payer: Cigna of CA HMO |
$1.39
|
| Rate for Payer: Cigna of CA PPO |
$1.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Senior |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.69
|
| Rate for Payer: Global Benefits Group Commercial |
$1.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.49
|
| Rate for Payer: Networks By Design Commercial |
$1.29
|
| Rate for Payer: Prime Health Services Commercial |
$1.69
|
|
|
RISPERIDONE 0.5 MG TABLET [25520]
|
Facility
|
OP
|
$0.15
|
|
|
Service Code
|
NDC 6838211314
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Central Health Plan Commercial |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.13
|
| Rate for Payer: Riverside University Health System MISP |
$0.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Vantage Medical Group Senior |
$0.13
|
|
|
RISPERIDONE 0.5 MG TABLET [25520]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 4354734006
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Central Health Plan Commercial |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
|
|
RISPERIDONE 0.5 MG TABLET [25520]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 4354734006
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Central Health Plan Commercial |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
| Rate for Payer: Riverside University Health System MISP |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
|
|
RISPERIDONE 0.5 MG TABLET [25520]
|
Facility
|
IP
|
$0.15
|
|
|
Service Code
|
NDC 6838211314
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Central Health Plan Commercial |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.13
|
|
