|
RISPERIDONE 2 MG DISINTEGRATING TABLET [35688]
|
Facility
|
OP
|
$7.97
|
|
|
Service Code
|
NDC 4988440191
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$7.17 |
| Rate for Payer: Adventist Health Commercial |
$1.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.64
|
| Rate for Payer: Blue Shield of California Commercial |
$5.05
|
| Rate for Payer: Blue Shield of California EPN |
$3.18
|
| Rate for Payer: Cash Price |
$3.59
|
| Rate for Payer: Central Health Plan Commercial |
$6.38
|
| Rate for Payer: Cigna of CA HMO |
$5.58
|
| Rate for Payer: Cigna of CA PPO |
$5.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.19
|
| Rate for Payer: EPIC Health Plan Senior |
$3.19
|
| Rate for Payer: Galaxy Health WC |
$6.77
|
| Rate for Payer: Global Benefits Group Commercial |
$4.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.58
|
| Rate for Payer: Multiplan Commercial |
$5.98
|
| Rate for Payer: Networks By Design Commercial |
$5.18
|
| Rate for Payer: Prime Health Services Commercial |
$6.77
|
| Rate for Payer: Riverside University Health System MISP |
$3.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.98
|
| Rate for Payer: United Healthcare All Other HMO |
$3.98
|
| Rate for Payer: United Healthcare HMO Rider |
$3.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.77
|
| Rate for Payer: Vantage Medical Group Senior |
$6.77
|
|
|
RISPERIDONE 2 MG DISINTEGRATING TABLET [35688]
|
Facility
|
IP
|
$4.01
|
|
|
Service Code
|
NDC 5974603022
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.61 |
| Rate for Payer: Adventist Health Commercial |
$0.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3.22
|
| Rate for Payer: Blue Shield of California EPN |
$2.02
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Central Health Plan Commercial |
$3.21
|
| Rate for Payer: Cigna of CA HMO |
$2.81
|
| Rate for Payer: Cigna of CA PPO |
$2.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1.60
|
| Rate for Payer: Galaxy Health WC |
$3.41
|
| Rate for Payer: Global Benefits Group Commercial |
$2.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$3.01
|
| Rate for Payer: Networks By Design Commercial |
$2.61
|
| Rate for Payer: Prime Health Services Commercial |
$3.41
|
|
|
RISPERIDONE 2 MG DISINTEGRATING TABLET [35688]
|
Facility
|
IP
|
$7.97
|
|
|
Service Code
|
NDC 4988440191
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$7.17 |
| Rate for Payer: Adventist Health Commercial |
$1.59
|
| Rate for Payer: Blue Shield of California Commercial |
$6.39
|
| Rate for Payer: Blue Shield of California EPN |
$4.02
|
| Rate for Payer: Cash Price |
$3.59
|
| Rate for Payer: Central Health Plan Commercial |
$6.38
|
| Rate for Payer: Cigna of CA HMO |
$5.58
|
| Rate for Payer: Cigna of CA PPO |
$5.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.19
|
| Rate for Payer: EPIC Health Plan Senior |
$3.19
|
| Rate for Payer: Galaxy Health WC |
$6.77
|
| Rate for Payer: Global Benefits Group Commercial |
$4.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: Multiplan Commercial |
$5.98
|
| Rate for Payer: Networks By Design Commercial |
$5.18
|
| Rate for Payer: Prime Health Services Commercial |
$6.77
|
|
|
RISPERIDONE 2 MG TABLET [18311]
|
Facility
|
IP
|
$0.26
|
|
|
Service Code
|
NDC 4354734206
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Central Health Plan Commercial |
$0.21
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.15
|
| 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 |
$0.17
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
|
|
RISPERIDONE 2 MG TABLET [18311]
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
NDC 4354734206
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| 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 |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| 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 |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Central Health Plan Commercial |
$0.21
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.17
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
| Rate for Payer: Riverside University Health System MISP |
$0.10
|
| 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 |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Vantage Medical Group Senior |
$0.22
|
|
|
RISPERIDONE 3 MG TABLET [18312]
|
Facility
|
OP
|
$0.61
|
|
|
Service Code
|
NDC 6808427401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.35
|
| Rate for Payer: Blue Shield of California Commercial |
$0.39
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.52
|
| Rate for Payer: Riverside University Health System MISP |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO |
$0.31
|
| Rate for Payer: United Healthcare HMO Rider |
$0.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.52
|
| Rate for Payer: Vantage Medical Group Senior |
$0.52
|
|
|
RISPERIDONE 3 MG TABLET [18312]
|
Facility
|
IP
|
$0.61
|
|
|
Service Code
|
NDC 6808427411
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.49
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.52
|
|
|
RISPERIDONE 3 MG TABLET [18312]
|
Facility
|
OP
|
$0.61
|
|
|
Service Code
|
NDC 6808427411
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.35
|
| Rate for Payer: Blue Shield of California Commercial |
$0.39
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.52
|
| Rate for Payer: Riverside University Health System MISP |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO |
$0.31
|
| Rate for Payer: United Healthcare HMO Rider |
$0.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.52
|
| Rate for Payer: Vantage Medical Group Senior |
$0.52
|
|
|
RISPERIDONE 3 MG TABLET [18312]
|
Facility
|
IP
|
$0.61
|
|
|
Service Code
|
NDC 6808427401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.49
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.52
|
|
|
RISPERIDONE 4 MG TABLET [18310]
|
Facility
|
IP
|
$0.61
|
|
|
Service Code
|
NDC 6808427711
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.49
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.52
|
|
|
RISPERIDONE 4 MG TABLET [18310]
|
Facility
|
OP
|
$0.61
|
|
|
Service Code
|
NDC 6808427711
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.35
|
| Rate for Payer: Blue Shield of California Commercial |
$0.39
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.52
|
| Rate for Payer: Riverside University Health System MISP |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO |
$0.31
|
| Rate for Payer: United Healthcare HMO Rider |
$0.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.52
|
| Rate for Payer: Vantage Medical Group Senior |
$0.52
|
|
|
RISPERIDONE 4 MG TABLET [18310]
|
Facility
|
IP
|
$0.61
|
|
|
Service Code
|
NDC 6808427701
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.49
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.52
|
|
|
RISPERIDONE 4 MG TABLET [18310]
|
Facility
|
OP
|
$0.61
|
|
|
Service Code
|
NDC 6808427701
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.35
|
| Rate for Payer: Blue Shield of California Commercial |
$0.39
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.52
|
| Rate for Payer: Riverside University Health System MISP |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO |
$0.31
|
| Rate for Payer: United Healthcare HMO Rider |
$0.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.52
|
| Rate for Payer: Vantage Medical Group Senior |
$0.52
|
|
|
RITLECITINIB 50 MG CAPSULE [238783]
|
Facility
|
IP
|
$187.89
|
|
|
Service Code
|
NDC 0069033428
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$37.58 |
| Max. Negotiated Rate |
$169.10 |
| Rate for Payer: Adventist Health Commercial |
$37.58
|
| Rate for Payer: Blue Shield of California Commercial |
$150.69
|
| Rate for Payer: Blue Shield of California EPN |
$94.70
|
| Rate for Payer: Cash Price |
$84.55
|
| Rate for Payer: Central Health Plan Commercial |
$150.31
|
| Rate for Payer: Cigna of CA HMO |
$131.52
|
| Rate for Payer: Cigna of CA PPO |
$131.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$131.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.16
|
| Rate for Payer: EPIC Health Plan Senior |
$75.16
|
| Rate for Payer: Galaxy Health WC |
$159.71
|
| Rate for Payer: Global Benefits Group Commercial |
$112.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$169.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$119.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$110.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.58
|
| Rate for Payer: Multiplan Commercial |
$140.92
|
| Rate for Payer: Networks By Design Commercial |
$122.13
|
| Rate for Payer: Prime Health Services Commercial |
$159.71
|
|
|
RITLECITINIB 50 MG CAPSULE [238783]
|
Facility
|
OP
|
$187.89
|
|
|
Service Code
|
NDC 0069033428
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$37.58 |
| Max. Negotiated Rate |
$169.10 |
| Rate for Payer: Adventist Health Commercial |
$37.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$114.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$159.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$140.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$90.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$109.30
|
| Rate for Payer: Blue Shield of California Commercial |
$119.12
|
| Rate for Payer: Blue Shield of California EPN |
$74.97
|
| Rate for Payer: Cash Price |
$84.55
|
| Rate for Payer: Central Health Plan Commercial |
$150.31
|
| Rate for Payer: Cigna of CA HMO |
$131.52
|
| Rate for Payer: Cigna of CA PPO |
$131.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$159.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$159.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$131.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.16
|
| Rate for Payer: EPIC Health Plan Senior |
$75.16
|
| Rate for Payer: Galaxy Health WC |
$159.71
|
| Rate for Payer: Global Benefits Group Commercial |
$112.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$169.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$119.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$68.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$110.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$131.52
|
| Rate for Payer: Multiplan Commercial |
$140.92
|
| Rate for Payer: Networks By Design Commercial |
$122.13
|
| Rate for Payer: Prime Health Services Commercial |
$159.71
|
| Rate for Payer: Riverside University Health System MISP |
$75.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$112.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$112.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.94
|
| Rate for Payer: United Healthcare All Other HMO |
$93.94
|
| Rate for Payer: United Healthcare HMO Rider |
$93.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$93.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$159.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.71
|
| Rate for Payer: Vantage Medical Group Senior |
$159.71
|
|
|
RITONAVIR 100 MG TABLET [100995]
|
Facility
|
OP
|
$3.20
|
|
|
Service Code
|
NDC 6586268730
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.88 |
| Rate for Payer: Adventist Health Commercial |
$0.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.86
|
| Rate for Payer: Blue Shield of California Commercial |
$2.03
|
| Rate for Payer: Blue Shield of California EPN |
$1.28
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Central Health Plan Commercial |
$2.56
|
| Rate for Payer: Cigna of CA HMO |
$2.24
|
| Rate for Payer: Cigna of CA PPO |
$2.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: EPIC Health Plan Senior |
$1.28
|
| Rate for Payer: Galaxy Health WC |
$2.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.24
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$2.08
|
| Rate for Payer: Prime Health Services Commercial |
$2.72
|
| Rate for Payer: Riverside University Health System MISP |
$1.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1.60
|
| Rate for Payer: United Healthcare HMO Rider |
$1.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.72
|
| Rate for Payer: Vantage Medical Group Senior |
$2.72
|
|
|
RITONAVIR 100 MG TABLET [100995]
|
Facility
|
OP
|
$6.40
|
|
|
Service Code
|
NDC 0054040713
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$5.76 |
| Rate for Payer: Adventist Health Commercial |
$1.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.72
|
| Rate for Payer: Blue Shield of California Commercial |
$4.06
|
| Rate for Payer: Blue Shield of California EPN |
$2.55
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: Central Health Plan Commercial |
$5.12
|
| Rate for Payer: Cigna of CA HMO |
$4.48
|
| Rate for Payer: Cigna of CA PPO |
$4.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.56
|
| Rate for Payer: EPIC Health Plan Senior |
$2.56
|
| Rate for Payer: Galaxy Health WC |
$5.44
|
| Rate for Payer: Global Benefits Group Commercial |
$3.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.48
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Networks By Design Commercial |
$4.16
|
| Rate for Payer: Prime Health Services Commercial |
$5.44
|
| Rate for Payer: Riverside University Health System MISP |
$2.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.20
|
| Rate for Payer: United Healthcare All Other HMO |
$3.20
|
| Rate for Payer: United Healthcare HMO Rider |
$3.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.44
|
| Rate for Payer: Vantage Medical Group Senior |
$5.44
|
|
|
RITONAVIR 100 MG TABLET [100995]
|
Facility
|
IP
|
$3.20
|
|
|
Service Code
|
NDC 3172259730
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.88 |
| Rate for Payer: Adventist Health Commercial |
$0.64
|
| Rate for Payer: Blue Shield of California Commercial |
$2.57
|
| Rate for Payer: Blue Shield of California EPN |
$1.61
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Central Health Plan Commercial |
$2.56
|
| Rate for Payer: Cigna of CA HMO |
$2.24
|
| Rate for Payer: Cigna of CA PPO |
$2.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: EPIC Health Plan Senior |
$1.28
|
| Rate for Payer: Galaxy Health WC |
$2.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$2.08
|
| Rate for Payer: Prime Health Services Commercial |
$2.72
|
|
|
RITONAVIR 100 MG TABLET [100995]
|
Facility
|
IP
|
$3.20
|
|
|
Service Code
|
NDC 6586268730
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.88 |
| Rate for Payer: Adventist Health Commercial |
$0.64
|
| Rate for Payer: Blue Shield of California Commercial |
$2.57
|
| Rate for Payer: Blue Shield of California EPN |
$1.61
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Central Health Plan Commercial |
$2.56
|
| Rate for Payer: Cigna of CA HMO |
$2.24
|
| Rate for Payer: Cigna of CA PPO |
$2.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: EPIC Health Plan Senior |
$1.28
|
| Rate for Payer: Galaxy Health WC |
$2.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$2.08
|
| Rate for Payer: Prime Health Services Commercial |
$2.72
|
|
|
RITONAVIR 100 MG TABLET [100995]
|
Facility
|
OP
|
$3.20
|
|
|
Service Code
|
NDC 3172259730
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.88 |
| Rate for Payer: Adventist Health Commercial |
$0.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.86
|
| Rate for Payer: Blue Shield of California Commercial |
$2.03
|
| Rate for Payer: Blue Shield of California EPN |
$1.28
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Central Health Plan Commercial |
$2.56
|
| Rate for Payer: Cigna of CA HMO |
$2.24
|
| Rate for Payer: Cigna of CA PPO |
$2.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: EPIC Health Plan Senior |
$1.28
|
| Rate for Payer: Galaxy Health WC |
$2.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.24
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$2.08
|
| Rate for Payer: Prime Health Services Commercial |
$2.72
|
| Rate for Payer: Riverside University Health System MISP |
$1.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1.60
|
| Rate for Payer: United Healthcare HMO Rider |
$1.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.72
|
| Rate for Payer: Vantage Medical Group Senior |
$2.72
|
|
|
RITONAVIR 100 MG TABLET [100995]
|
Facility
|
IP
|
$6.40
|
|
|
Service Code
|
NDC 0054040713
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$5.76 |
| Rate for Payer: Adventist Health Commercial |
$1.28
|
| Rate for Payer: Blue Shield of California Commercial |
$5.13
|
| Rate for Payer: Blue Shield of California EPN |
$3.23
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: Central Health Plan Commercial |
$5.12
|
| Rate for Payer: Cigna of CA HMO |
$4.48
|
| Rate for Payer: Cigna of CA PPO |
$4.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.56
|
| Rate for Payer: EPIC Health Plan Senior |
$2.56
|
| Rate for Payer: Galaxy Health WC |
$5.44
|
| Rate for Payer: Global Benefits Group Commercial |
$3.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Networks By Design Commercial |
$4.16
|
| Rate for Payer: Prime Health Services Commercial |
$5.44
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS [22149]
|
Facility
|
OP
|
$112.74
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.55 |
| Max. Negotiated Rate |
$232.11 |
| Rate for Payer: Adventist Health Commercial |
$22.55
|
| Rate for Payer: Adventist Health Medi-Cal |
$73.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$150.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$109.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$186.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$232.11
|
| Rate for Payer: Blue Shield of California Commercial |
$124.01
|
| Rate for Payer: Blue Shield of California EPN |
$112.74
|
| Rate for Payer: Cash Price |
$50.73
|
| Rate for Payer: Cash Price |
$50.73
|
| Rate for Payer: Central Health Plan Commercial |
$90.19
|
| Rate for Payer: Cigna of CA HMO |
$78.92
|
| Rate for Payer: Cigna of CA PPO |
$78.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$91.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$80.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$80.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$78.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.91
|
| Rate for Payer: EPIC Health Plan Senior |
$80.61
|
| Rate for Payer: Galaxy Health WC |
$95.83
|
| Rate for Payer: Global Benefits Group Commercial |
$67.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.47
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$120.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$73.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$73.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$142.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$102.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$98.20
|
| Rate for Payer: Multiplan Commercial |
$84.56
|
| Rate for Payer: Networks By Design Commercial |
$56.37
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$73.28
|
| Rate for Payer: Prime Health Services Commercial |
$95.83
|
| Rate for Payer: Prime Health Services Medicare |
$77.68
|
| Rate for Payer: Riverside University Health System MISP |
$80.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.31
|
| Rate for Payer: United Healthcare All Other HMO |
$41.18
|
| Rate for Payer: United Healthcare HMO Rider |
$40.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.92
|
| Rate for Payer: Upland Medical Group Pediatric |
$73.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$91.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$80.61
|
| Rate for Payer: Vantage Medical Group Senior |
$80.61
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS [22149]
|
Facility
|
IP
|
$112.74
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.55 |
| Max. Negotiated Rate |
$101.47 |
| Rate for Payer: Adventist Health Commercial |
$22.55
|
| Rate for Payer: Blue Shield of California Commercial |
$90.42
|
| Rate for Payer: Blue Shield of California EPN |
$56.82
|
| Rate for Payer: Cash Price |
$50.73
|
| Rate for Payer: Central Health Plan Commercial |
$90.19
|
| Rate for Payer: Cigna of CA HMO |
$78.92
|
| Rate for Payer: Cigna of CA PPO |
$78.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$78.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.10
|
| Rate for Payer: EPIC Health Plan Senior |
$45.10
|
| Rate for Payer: Galaxy Health WC |
$95.83
|
| Rate for Payer: Global Benefits Group Commercial |
$67.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.55
|
| Rate for Payer: Multiplan Commercial |
$84.56
|
| Rate for Payer: Networks By Design Commercial |
$56.37
|
| Rate for Payer: Prime Health Services Commercial |
$95.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.31
|
| Rate for Payer: United Healthcare All Other HMO |
$41.18
|
| Rate for Payer: United Healthcare HMO Rider |
$40.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.92
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS NON-ONCOLOGY [4081336]
|
Facility
|
IP
|
$112.74
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.55 |
| Max. Negotiated Rate |
$101.47 |
| Rate for Payer: Adventist Health Commercial |
$22.55
|
| Rate for Payer: Blue Shield of California Commercial |
$90.42
|
| Rate for Payer: Blue Shield of California EPN |
$56.82
|
| Rate for Payer: Cash Price |
$50.73
|
| Rate for Payer: Central Health Plan Commercial |
$90.19
|
| Rate for Payer: Cigna of CA HMO |
$78.92
|
| Rate for Payer: Cigna of CA PPO |
$78.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$78.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.10
|
| Rate for Payer: EPIC Health Plan Senior |
$45.10
|
| Rate for Payer: Galaxy Health WC |
$95.83
|
| Rate for Payer: Global Benefits Group Commercial |
$67.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.55
|
| Rate for Payer: Multiplan Commercial |
$84.56
|
| Rate for Payer: Networks By Design Commercial |
$56.37
|
| Rate for Payer: Prime Health Services Commercial |
$95.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.31
|
| Rate for Payer: United Healthcare All Other HMO |
$41.18
|
| Rate for Payer: United Healthcare HMO Rider |
$40.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.92
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS NON-ONCOLOGY [4081336]
|
Facility
|
OP
|
$112.74
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.55 |
| Max. Negotiated Rate |
$232.11 |
| Rate for Payer: Adventist Health Commercial |
$22.55
|
| Rate for Payer: Adventist Health Medi-Cal |
$73.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$150.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$109.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$186.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$232.11
|
| Rate for Payer: Blue Shield of California Commercial |
$124.01
|
| Rate for Payer: Blue Shield of California EPN |
$112.74
|
| Rate for Payer: Cash Price |
$50.73
|
| Rate for Payer: Cash Price |
$50.73
|
| Rate for Payer: Central Health Plan Commercial |
$90.19
|
| Rate for Payer: Cigna of CA HMO |
$78.92
|
| Rate for Payer: Cigna of CA PPO |
$78.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$91.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$80.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$80.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$78.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.91
|
| Rate for Payer: EPIC Health Plan Senior |
$80.61
|
| Rate for Payer: Galaxy Health WC |
$95.83
|
| Rate for Payer: Global Benefits Group Commercial |
$67.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.47
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$120.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$73.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$73.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$142.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$102.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$98.20
|
| Rate for Payer: Multiplan Commercial |
$84.56
|
| Rate for Payer: Networks By Design Commercial |
$56.37
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$73.28
|
| Rate for Payer: Prime Health Services Commercial |
$95.83
|
| Rate for Payer: Prime Health Services Medicare |
$77.68
|
| Rate for Payer: Riverside University Health System MISP |
$80.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.31
|
| Rate for Payer: United Healthcare All Other HMO |
$41.18
|
| Rate for Payer: United Healthcare HMO Rider |
$40.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.92
|
| Rate for Payer: Upland Medical Group Pediatric |
$73.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$91.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$80.61
|
| Rate for Payer: Vantage Medical Group Senior |
$80.61
|
|
