|
RIFAMPIN 300 MG CAPSULE [11293]
|
Facility
|
OP
|
$2.23
|
|
|
Service Code
|
NDC 60687-586-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.01 |
| Rate for Payer: Adventist Health Commercial |
$0.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.31
|
| Rate for Payer: Blue Shield of California Commercial |
$1.36
|
| Rate for Payer: Blue Shield of California EPN |
$0.89
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: Central Health Plan Commercial |
$1.78
|
| Rate for Payer: Cigna of CA HMO |
$1.56
|
| Rate for Payer: Cigna of CA PPO |
$1.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.89
|
| Rate for Payer: EPIC Health Plan Senior |
$0.89
|
| Rate for Payer: Galaxy Health WC |
$1.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.01
|
| Rate for Payer: InnovAge PACE Commercial |
$1.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$1.67
|
| Rate for Payer: Networks By Design Commercial |
$1.45
|
| Rate for Payer: Prime Health Services Commercial |
$1.90
|
| Rate for Payer: Riverside University Health System MISP |
$0.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.11
|
| Rate for Payer: United Healthcare All Other HMO |
$1.11
|
| Rate for Payer: United Healthcare HMO Rider |
$1.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1.90
|
|
|
RIFAMPIN 300 MG CAPSULE [11293]
|
Facility
|
IP
|
$4.41
|
|
|
Service Code
|
NDC 68180-659-06
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$3.97 |
| Rate for Payer: Adventist Health Commercial |
$0.88
|
| Rate for Payer: Blue Shield of California Commercial |
$3.41
|
| Rate for Payer: Blue Shield of California EPN |
$2.22
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Central Health Plan Commercial |
$3.53
|
| Rate for Payer: Cigna of CA HMO |
$3.09
|
| Rate for Payer: Cigna of CA PPO |
$3.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.76
|
| Rate for Payer: EPIC Health Plan Senior |
$1.76
|
| Rate for Payer: Galaxy Health WC |
$3.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.88
|
| Rate for Payer: Multiplan Commercial |
$3.31
|
| Rate for Payer: Networks By Design Commercial |
$2.87
|
| Rate for Payer: Prime Health Services Commercial |
$3.75
|
|
|
RIFAMPIN 300 MG CAPSULE [11293]
|
Facility
|
OP
|
$4.41
|
|
|
Service Code
|
NDC 68180-659-06
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$3.97 |
| Rate for Payer: Adventist Health Commercial |
$0.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.59
|
| Rate for Payer: Blue Shield of California Commercial |
$2.69
|
| Rate for Payer: Blue Shield of California EPN |
$1.76
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Central Health Plan Commercial |
$3.53
|
| Rate for Payer: Cigna of CA HMO |
$3.09
|
| Rate for Payer: Cigna of CA PPO |
$3.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.76
|
| Rate for Payer: EPIC Health Plan Senior |
$1.76
|
| Rate for Payer: Galaxy Health WC |
$3.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.97
|
| Rate for Payer: InnovAge PACE Commercial |
$2.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.09
|
| Rate for Payer: Multiplan Commercial |
$3.31
|
| Rate for Payer: Networks By Design Commercial |
$2.87
|
| Rate for Payer: Prime Health Services Commercial |
$3.75
|
| Rate for Payer: Riverside University Health System MISP |
$1.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.21
|
| Rate for Payer: United Healthcare All Other HMO |
$2.21
|
| Rate for Payer: United Healthcare HMO Rider |
$2.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.75
|
| Rate for Payer: Vantage Medical Group Senior |
$3.75
|
|
|
RIFAMPIN 600 MG INTRAVENOUS SOLUTION [11291]
|
Facility
|
OP
|
$184.92
|
|
|
Service Code
|
HCPCS J2804
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$166.43 |
| Rate for Payer: Adventist Health Commercial |
$36.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$112.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$157.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$138.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$112.99
|
| Rate for Payer: Blue Shield of California EPN |
$73.78
|
| Rate for Payer: Cash Price |
$101.71
|
| Rate for Payer: Cash Price |
$101.71
|
| Rate for Payer: Central Health Plan Commercial |
$147.94
|
| Rate for Payer: Cigna of CA HMO |
$129.44
|
| Rate for Payer: Cigna of CA PPO |
$129.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$157.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$157.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$157.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.97
|
| Rate for Payer: EPIC Health Plan Senior |
$73.97
|
| Rate for Payer: Galaxy Health WC |
$157.18
|
| Rate for Payer: Global Benefits Group Commercial |
$110.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$166.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.14
|
| Rate for Payer: InnovAge PACE Commercial |
$92.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$123.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$114.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$129.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$129.44
|
| Rate for Payer: Multiplan Commercial |
$138.69
|
| Rate for Payer: Networks By Design Commercial |
$92.46
|
| Rate for Payer: Prime Health Services Commercial |
$157.18
|
| Rate for Payer: Riverside University Health System MISP |
$73.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$69.40
|
| Rate for Payer: United Healthcare All Other HMO |
$67.55
|
| Rate for Payer: United Healthcare HMO Rider |
$66.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$157.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$157.18
|
| Rate for Payer: Vantage Medical Group Senior |
$157.18
|
|
|
RIFAMPIN 600 MG INTRAVENOUS SOLUTION [11291]
|
Facility
|
IP
|
$184.92
|
|
|
Service Code
|
HCPCS J2804
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.98 |
| Max. Negotiated Rate |
$166.43 |
| Rate for Payer: Adventist Health Commercial |
$36.98
|
| Rate for Payer: Blue Shield of California Commercial |
$142.94
|
| Rate for Payer: Blue Shield of California EPN |
$93.20
|
| Rate for Payer: Cash Price |
$101.71
|
| Rate for Payer: Central Health Plan Commercial |
$147.94
|
| Rate for Payer: Cigna of CA HMO |
$129.44
|
| Rate for Payer: Cigna of CA PPO |
$129.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.97
|
| Rate for Payer: EPIC Health Plan Senior |
$73.97
|
| Rate for Payer: Galaxy Health WC |
$157.18
|
| Rate for Payer: Global Benefits Group Commercial |
$110.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$166.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$123.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$114.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.98
|
| Rate for Payer: Multiplan Commercial |
$138.69
|
| Rate for Payer: Networks By Design Commercial |
$92.46
|
| Rate for Payer: Prime Health Services Commercial |
$157.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$69.40
|
| Rate for Payer: United Healthcare All Other HMO |
$67.55
|
| Rate for Payer: United Healthcare HMO Rider |
$66.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.56
|
|
|
RIFAMPIN ORAL SUSPENSION COMPOUND 10 MG/ML [4080331]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 9994-0803-31
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
RIFAMPIN ORAL SUSPENSION COMPOUND 10 MG/ML [4080331]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 9994-0803-31
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.04
|
| Rate for Payer: InnovAge PACE Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Riverside University Health System MISP |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
RIFAPENTINE 150 MG TABLET [23365]
|
Facility
|
OP
|
$5.96
|
|
|
Service Code
|
NDC 0088-2102-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Adventist Health Commercial |
$1.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.50
|
| Rate for Payer: Blue Shield of California Commercial |
$3.64
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Cash Price |
$3.28
|
| Rate for Payer: Central Health Plan Commercial |
$4.77
|
| Rate for Payer: Cigna of CA HMO |
$4.17
|
| Rate for Payer: Cigna of CA PPO |
$4.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.38
|
| Rate for Payer: EPIC Health Plan Senior |
$2.38
|
| Rate for Payer: Galaxy Health WC |
$5.07
|
| Rate for Payer: Global Benefits Group Commercial |
$3.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.36
|
| Rate for Payer: InnovAge PACE Commercial |
$2.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.17
|
| Rate for Payer: Multiplan Commercial |
$4.47
|
| Rate for Payer: Networks By Design Commercial |
$3.87
|
| Rate for Payer: Prime Health Services Commercial |
$5.07
|
| Rate for Payer: Riverside University Health System MISP |
$2.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.98
|
| Rate for Payer: United Healthcare All Other HMO |
$2.98
|
| Rate for Payer: United Healthcare HMO Rider |
$2.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.07
|
| Rate for Payer: Vantage Medical Group Senior |
$5.07
|
|
|
RIFAPENTINE 150 MG TABLET [23365]
|
Facility
|
IP
|
$5.96
|
|
|
Service Code
|
NDC 0088-2102-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Adventist Health Commercial |
$1.19
|
| Rate for Payer: Blue Shield of California Commercial |
$4.61
|
| Rate for Payer: Blue Shield of California EPN |
$3.00
|
| Rate for Payer: Cash Price |
$3.28
|
| Rate for Payer: Central Health Plan Commercial |
$4.77
|
| Rate for Payer: Cigna of CA HMO |
$4.17
|
| Rate for Payer: Cigna of CA PPO |
$4.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.38
|
| Rate for Payer: EPIC Health Plan Senior |
$2.38
|
| Rate for Payer: Galaxy Health WC |
$5.07
|
| Rate for Payer: Global Benefits Group Commercial |
$3.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.19
|
| Rate for Payer: Multiplan Commercial |
$4.47
|
| Rate for Payer: Networks By Design Commercial |
$3.87
|
| Rate for Payer: Prime Health Services Commercial |
$5.07
|
|
|
RIFAXIMIN 200 MG TABLET [39063]
|
Facility
|
OP
|
$13.47
|
|
|
Service Code
|
NDC 65649-301-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.69 |
| Max. Negotiated Rate |
$12.12 |
| Rate for Payer: Adventist Health Commercial |
$2.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.91
|
| Rate for Payer: Blue Shield of California Commercial |
$8.23
|
| Rate for Payer: Blue Shield of California EPN |
$5.37
|
| Rate for Payer: Cash Price |
$7.41
|
| Rate for Payer: Central Health Plan Commercial |
$10.78
|
| Rate for Payer: Cigna of CA HMO |
$9.43
|
| Rate for Payer: Cigna of CA PPO |
$9.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.39
|
| Rate for Payer: EPIC Health Plan Senior |
$5.39
|
| Rate for Payer: Galaxy Health WC |
$11.45
|
| Rate for Payer: Global Benefits Group Commercial |
$8.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.12
|
| Rate for Payer: InnovAge PACE Commercial |
$6.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.43
|
| Rate for Payer: Multiplan Commercial |
$10.10
|
| Rate for Payer: Networks By Design Commercial |
$8.76
|
| Rate for Payer: Prime Health Services Commercial |
$11.45
|
| Rate for Payer: Riverside University Health System MISP |
$5.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.74
|
| Rate for Payer: United Healthcare All Other HMO |
$6.74
|
| Rate for Payer: United Healthcare HMO Rider |
$6.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.45
|
| Rate for Payer: Vantage Medical Group Senior |
$11.45
|
|
|
RIFAXIMIN 200 MG TABLET [39063]
|
Facility
|
IP
|
$13.47
|
|
|
Service Code
|
NDC 65649-301-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.69 |
| Max. Negotiated Rate |
$12.12 |
| Rate for Payer: Adventist Health Commercial |
$2.69
|
| Rate for Payer: Blue Shield of California Commercial |
$10.41
|
| Rate for Payer: Blue Shield of California EPN |
$6.79
|
| Rate for Payer: Cash Price |
$7.41
|
| Rate for Payer: Central Health Plan Commercial |
$10.78
|
| Rate for Payer: Cigna of CA HMO |
$9.43
|
| Rate for Payer: Cigna of CA PPO |
$9.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.39
|
| Rate for Payer: EPIC Health Plan Senior |
$5.39
|
| Rate for Payer: Galaxy Health WC |
$11.45
|
| Rate for Payer: Global Benefits Group Commercial |
$8.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.69
|
| Rate for Payer: Multiplan Commercial |
$10.10
|
| Rate for Payer: Networks By Design Commercial |
$8.76
|
| Rate for Payer: Prime Health Services Commercial |
$11.45
|
|
|
RIFAXIMIN 550 MG TABLET [104604]
|
Facility
|
OP
|
$69.26
|
|
|
Service Code
|
NDC 65649-303-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.85 |
| Max. Negotiated Rate |
$62.33 |
| Rate for Payer: Adventist Health Commercial |
$13.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$58.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$33.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.68
|
| Rate for Payer: Blue Shield of California Commercial |
$42.32
|
| Rate for Payer: Blue Shield of California EPN |
$27.63
|
| Rate for Payer: Cash Price |
$38.10
|
| Rate for Payer: Central Health Plan Commercial |
$55.41
|
| Rate for Payer: Cigna of CA HMO |
$48.48
|
| Rate for Payer: Cigna of CA PPO |
$48.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$58.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.70
|
| Rate for Payer: EPIC Health Plan Senior |
$27.70
|
| Rate for Payer: Galaxy Health WC |
$58.87
|
| Rate for Payer: Global Benefits Group Commercial |
$41.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$62.33
|
| Rate for Payer: InnovAge PACE Commercial |
$34.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48.48
|
| Rate for Payer: Multiplan Commercial |
$51.95
|
| Rate for Payer: Networks By Design Commercial |
$45.02
|
| Rate for Payer: Prime Health Services Commercial |
$58.87
|
| Rate for Payer: Riverside University Health System MISP |
$27.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$41.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$41.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.63
|
| Rate for Payer: United Healthcare All Other HMO |
$34.63
|
| Rate for Payer: United Healthcare HMO Rider |
$34.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$58.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.87
|
| Rate for Payer: Vantage Medical Group Senior |
$58.87
|
|
|
RIFAXIMIN 550 MG TABLET [104604]
|
Facility
|
IP
|
$69.26
|
|
|
Service Code
|
NDC 65649-303-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.85 |
| Max. Negotiated Rate |
$62.33 |
| Rate for Payer: Adventist Health Commercial |
$13.85
|
| Rate for Payer: Blue Shield of California Commercial |
$53.54
|
| Rate for Payer: Blue Shield of California EPN |
$34.91
|
| Rate for Payer: Cash Price |
$38.10
|
| Rate for Payer: Central Health Plan Commercial |
$55.41
|
| Rate for Payer: Cigna of CA HMO |
$48.48
|
| Rate for Payer: Cigna of CA PPO |
$48.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.70
|
| Rate for Payer: EPIC Health Plan Senior |
$27.70
|
| Rate for Payer: Galaxy Health WC |
$58.87
|
| Rate for Payer: Global Benefits Group Commercial |
$41.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$62.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.85
|
| Rate for Payer: Multiplan Commercial |
$51.95
|
| Rate for Payer: Networks By Design Commercial |
$45.02
|
| Rate for Payer: Prime Health Services Commercial |
$58.87
|
|
|
RIFAXIMIN 550 MG TABLET [104604]
|
Facility
|
IP
|
$69.26
|
|
|
Service Code
|
NDC 65649-303-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.85 |
| Max. Negotiated Rate |
$62.33 |
| Rate for Payer: Adventist Health Commercial |
$13.85
|
| Rate for Payer: Blue Shield of California Commercial |
$53.54
|
| Rate for Payer: Blue Shield of California EPN |
$34.91
|
| Rate for Payer: Cash Price |
$38.10
|
| Rate for Payer: Central Health Plan Commercial |
$55.41
|
| Rate for Payer: Cigna of CA HMO |
$48.48
|
| Rate for Payer: Cigna of CA PPO |
$48.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.70
|
| Rate for Payer: EPIC Health Plan Senior |
$27.70
|
| Rate for Payer: Galaxy Health WC |
$58.87
|
| Rate for Payer: Global Benefits Group Commercial |
$41.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$62.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.85
|
| Rate for Payer: Multiplan Commercial |
$51.95
|
| Rate for Payer: Networks By Design Commercial |
$45.02
|
| Rate for Payer: Prime Health Services Commercial |
$58.87
|
|
|
RIFAXIMIN 550 MG TABLET [104604]
|
Facility
|
OP
|
$69.26
|
|
|
Service Code
|
NDC 65649-303-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.85 |
| Max. Negotiated Rate |
$62.33 |
| Rate for Payer: Adventist Health Commercial |
$13.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$58.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$33.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.68
|
| Rate for Payer: Blue Shield of California Commercial |
$42.32
|
| Rate for Payer: Blue Shield of California EPN |
$27.63
|
| Rate for Payer: Cash Price |
$38.10
|
| Rate for Payer: Central Health Plan Commercial |
$55.41
|
| Rate for Payer: Cigna of CA HMO |
$48.48
|
| Rate for Payer: Cigna of CA PPO |
$48.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$58.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.70
|
| Rate for Payer: EPIC Health Plan Senior |
$27.70
|
| Rate for Payer: Galaxy Health WC |
$58.87
|
| Rate for Payer: Global Benefits Group Commercial |
$41.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$62.33
|
| Rate for Payer: InnovAge PACE Commercial |
$34.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48.48
|
| Rate for Payer: Multiplan Commercial |
$51.95
|
| Rate for Payer: Networks By Design Commercial |
$45.02
|
| Rate for Payer: Prime Health Services Commercial |
$58.87
|
| Rate for Payer: Riverside University Health System MISP |
$27.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$41.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$41.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.63
|
| Rate for Payer: United Healthcare All Other HMO |
$34.63
|
| Rate for Payer: United Healthcare HMO Rider |
$34.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$58.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.87
|
| Rate for Payer: Vantage Medical Group Senior |
$58.87
|
|
|
RIFAXIMIN ORAL SUSPENSION COMPOUND 20 MG/ML [4080332]
|
Facility
|
IP
|
$1.32
|
|
|
Service Code
|
NDC 9994-0803-32
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.19 |
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.67
|
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: Central Health Plan Commercial |
$1.06
|
| Rate for Payer: Cigna of CA HMO |
$0.92
|
| Rate for Payer: Cigna of CA PPO |
$0.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.53
|
| Rate for Payer: EPIC Health Plan Senior |
$0.53
|
| Rate for Payer: Galaxy Health WC |
$1.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.99
|
| Rate for Payer: Networks By Design Commercial |
$0.86
|
| Rate for Payer: Prime Health Services Commercial |
$1.12
|
|
|
RIFAXIMIN ORAL SUSPENSION COMPOUND 20 MG/ML [4080332]
|
Facility
|
OP
|
$1.32
|
|
|
Service Code
|
NDC 9994-0803-32
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.19 |
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.78
|
| Rate for Payer: Blue Shield of California Commercial |
$0.81
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: Central Health Plan Commercial |
$1.06
|
| Rate for Payer: Cigna of CA HMO |
$0.92
|
| Rate for Payer: Cigna of CA PPO |
$0.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.53
|
| Rate for Payer: EPIC Health Plan Senior |
$0.53
|
| Rate for Payer: Galaxy Health WC |
$1.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.19
|
| Rate for Payer: InnovAge PACE Commercial |
$0.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.92
|
| Rate for Payer: Multiplan Commercial |
$0.99
|
| Rate for Payer: Networks By Design Commercial |
$0.86
|
| Rate for Payer: Prime Health Services Commercial |
$1.12
|
| Rate for Payer: Riverside University Health System MISP |
$0.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.66
|
| Rate for Payer: United Healthcare All Other HMO |
$0.66
|
| Rate for Payer: United Healthcare HMO Rider |
$0.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1.12
|
|
|
RILPIVIRINE HCL 25 MG TABLET [109909]
|
Facility
|
IP
|
$59.33
|
|
|
Service Code
|
NDC 59676-278-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.87 |
| Max. Negotiated Rate |
$53.40 |
| Rate for Payer: Adventist Health Commercial |
$11.87
|
| Rate for Payer: Blue Shield of California Commercial |
$45.86
|
| Rate for Payer: Blue Shield of California EPN |
$29.90
|
| Rate for Payer: Cash Price |
$32.63
|
| Rate for Payer: Central Health Plan Commercial |
$47.46
|
| Rate for Payer: Cigna of CA HMO |
$41.53
|
| Rate for Payer: Cigna of CA PPO |
$41.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.73
|
| Rate for Payer: EPIC Health Plan Senior |
$23.73
|
| Rate for Payer: Galaxy Health WC |
$50.43
|
| Rate for Payer: Global Benefits Group Commercial |
$35.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.87
|
| Rate for Payer: Multiplan Commercial |
$44.50
|
| Rate for Payer: Networks By Design Commercial |
$38.56
|
| Rate for Payer: Prime Health Services Commercial |
$50.43
|
|
|
RILPIVIRINE HCL 25 MG TABLET [109909]
|
Facility
|
OP
|
$59.33
|
|
|
Service Code
|
NDC 59676-278-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.87 |
| Max. Negotiated Rate |
$53.40 |
| Rate for Payer: Adventist Health Commercial |
$11.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.84
|
| Rate for Payer: Blue Shield of California Commercial |
$36.25
|
| Rate for Payer: Blue Shield of California EPN |
$23.67
|
| Rate for Payer: Cash Price |
$32.63
|
| Rate for Payer: Central Health Plan Commercial |
$47.46
|
| Rate for Payer: Cigna of CA HMO |
$41.53
|
| Rate for Payer: Cigna of CA PPO |
$41.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.73
|
| Rate for Payer: EPIC Health Plan Senior |
$23.73
|
| Rate for Payer: Galaxy Health WC |
$50.43
|
| Rate for Payer: Global Benefits Group Commercial |
$35.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.40
|
| Rate for Payer: InnovAge PACE Commercial |
$29.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.53
|
| Rate for Payer: Multiplan Commercial |
$44.50
|
| Rate for Payer: Networks By Design Commercial |
$38.56
|
| Rate for Payer: Prime Health Services Commercial |
$50.43
|
| Rate for Payer: Riverside University Health System MISP |
$23.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.66
|
| Rate for Payer: United Healthcare All Other HMO |
$29.66
|
| Rate for Payer: United Healthcare HMO Rider |
$29.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.43
|
| Rate for Payer: Vantage Medical Group Senior |
$50.43
|
|
|
RILUZOLE 50 MG TABLET [16124]
|
Facility
|
OP
|
$1.58
|
|
|
Service Code
|
NDC 62756-538-86
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.42 |
| Rate for Payer: Adventist Health Commercial |
$0.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.93
|
| Rate for Payer: Blue Shield of California Commercial |
$0.97
|
| Rate for Payer: Blue Shield of California EPN |
$0.63
|
| Rate for Payer: Cash Price |
$0.87
|
| Rate for Payer: Central Health Plan Commercial |
$1.26
|
| Rate for Payer: Cigna of CA HMO |
$1.11
|
| Rate for Payer: Cigna of CA PPO |
$1.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.63
|
| Rate for Payer: EPIC Health Plan Senior |
$0.63
|
| Rate for Payer: Galaxy Health WC |
$1.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.42
|
| Rate for Payer: InnovAge PACE Commercial |
$0.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.11
|
| Rate for Payer: Multiplan Commercial |
$1.19
|
| Rate for Payer: Networks By Design Commercial |
$1.03
|
| Rate for Payer: Prime Health Services Commercial |
$1.34
|
| Rate for Payer: Riverside University Health System MISP |
$0.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.79
|
| Rate for Payer: United Healthcare All Other HMO |
$0.79
|
| Rate for Payer: United Healthcare HMO Rider |
$0.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1.34
|
|
|
RILUZOLE 50 MG TABLET [16124]
|
Facility
|
IP
|
$1.58
|
|
|
Service Code
|
NDC 68462-381-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.42 |
| Rate for Payer: Adventist Health Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.80
|
| Rate for Payer: Cash Price |
$0.87
|
| Rate for Payer: Central Health Plan Commercial |
$1.26
|
| Rate for Payer: Cigna of CA HMO |
$1.11
|
| Rate for Payer: Cigna of CA PPO |
$1.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.63
|
| Rate for Payer: EPIC Health Plan Senior |
$0.63
|
| Rate for Payer: Galaxy Health WC |
$1.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$1.19
|
| Rate for Payer: Networks By Design Commercial |
$1.03
|
| Rate for Payer: Prime Health Services Commercial |
$1.34
|
|
|
RILUZOLE 50 MG TABLET [16124]
|
Facility
|
IP
|
$1.58
|
|
|
Service Code
|
NDC 62756-538-86
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.42 |
| Rate for Payer: Adventist Health Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.80
|
| Rate for Payer: Cash Price |
$0.87
|
| Rate for Payer: Central Health Plan Commercial |
$1.26
|
| Rate for Payer: Cigna of CA HMO |
$1.11
|
| Rate for Payer: Cigna of CA PPO |
$1.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.63
|
| Rate for Payer: EPIC Health Plan Senior |
$0.63
|
| Rate for Payer: Galaxy Health WC |
$1.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$1.19
|
| Rate for Payer: Networks By Design Commercial |
$1.03
|
| Rate for Payer: Prime Health Services Commercial |
$1.34
|
|
|
RILUZOLE 50 MG TABLET [16124]
|
Facility
|
OP
|
$0.80
|
|
|
Service Code
|
NDC 67877-286-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.72 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.47
|
| Rate for Payer: Blue Shield of California Commercial |
$0.49
|
| Rate for Payer: Blue Shield of California EPN |
$0.32
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Central Health Plan Commercial |
$0.64
|
| Rate for Payer: Cigna of CA HMO |
$0.56
|
| Rate for Payer: Cigna of CA PPO |
$0.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Senior |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.68
|
| Rate for Payer: Global Benefits Group Commercial |
$0.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.72
|
| Rate for Payer: InnovAge PACE Commercial |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$0.60
|
| Rate for Payer: Networks By Design Commercial |
$0.52
|
| Rate for Payer: Prime Health Services Commercial |
$0.68
|
| Rate for Payer: Riverside University Health System MISP |
$0.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO |
$0.40
|
| Rate for Payer: United Healthcare HMO Rider |
$0.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.68
|
| Rate for Payer: Vantage Medical Group Senior |
$0.68
|
|
|
RILUZOLE 50 MG TABLET [16124]
|
Facility
|
IP
|
$0.80
|
|
|
Service Code
|
NDC 67877-286-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.72 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.62
|
| Rate for Payer: Blue Shield of California EPN |
$0.40
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Central Health Plan Commercial |
$0.64
|
| Rate for Payer: Cigna of CA HMO |
$0.56
|
| Rate for Payer: Cigna of CA PPO |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Senior |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.68
|
| Rate for Payer: Global Benefits Group Commercial |
$0.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.60
|
| Rate for Payer: Networks By Design Commercial |
$0.52
|
| Rate for Payer: Prime Health Services Commercial |
$0.68
|
|
|
RILUZOLE 50 MG TABLET [16124]
|
Facility
|
OP
|
$1.58
|
|
|
Service Code
|
NDC 68462-381-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.42 |
| Rate for Payer: Adventist Health Commercial |
$0.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.93
|
| Rate for Payer: Blue Shield of California Commercial |
$0.97
|
| Rate for Payer: Blue Shield of California EPN |
$0.63
|
| Rate for Payer: Cash Price |
$0.87
|
| Rate for Payer: Central Health Plan Commercial |
$1.26
|
| Rate for Payer: Cigna of CA HMO |
$1.11
|
| Rate for Payer: Cigna of CA PPO |
$1.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.63
|
| Rate for Payer: EPIC Health Plan Senior |
$0.63
|
| Rate for Payer: Galaxy Health WC |
$1.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.42
|
| Rate for Payer: InnovAge PACE Commercial |
$0.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.11
|
| Rate for Payer: Multiplan Commercial |
$1.19
|
| Rate for Payer: Networks By Design Commercial |
$1.03
|
| Rate for Payer: Prime Health Services Commercial |
$1.34
|
| Rate for Payer: Riverside University Health System MISP |
$0.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.79
|
| Rate for Payer: United Healthcare All Other HMO |
$0.79
|
| Rate for Payer: United Healthcare HMO Rider |
$0.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1.34
|
|
