|
RIMABOTULINUMTOXINB 2,500 UNIT/0.5 ML INTRAMUSCULAR SOLUTION [108078]
|
Facility
|
OP
|
$762.10
|
|
|
Service Code
|
HCPCS J0587
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.57 |
| Max. Negotiated Rate |
$685.89 |
| Rate for Payer: Adventist Health Commercial |
$152.42
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$462.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.57
|
| Rate for Payer: Blue Shield of California Commercial |
$16.43
|
| Rate for Payer: Blue Shield of California EPN |
$14.94
|
| Rate for Payer: Cash Price |
$419.15
|
| Rate for Payer: Cash Price |
$419.15
|
| Rate for Payer: Central Health Plan Commercial |
$609.68
|
| Rate for Payer: Cigna of CA HMO |
$533.47
|
| Rate for Payer: Cigna of CA PPO |
$533.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.01
|
| Rate for Payer: EPIC Health Plan Senior |
$13.34
|
| Rate for Payer: Galaxy Health WC |
$647.78
|
| Rate for Payer: Global Benefits Group Commercial |
$457.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$685.89
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.34
|
| Rate for Payer: InnovAge PACE Commercial |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$508.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.88
|
| Rate for Payer: Multiplan Commercial |
$571.58
|
| Rate for Payer: Networks By Design Commercial |
$381.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.34
|
| Rate for Payer: Prime Health Services Commercial |
$647.78
|
| Rate for Payer: Prime Health Services Medicare |
$14.14
|
| Rate for Payer: Riverside University Health System MISP |
$14.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$457.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$457.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$286.02
|
| Rate for Payer: United Healthcare All Other HMO |
$278.40
|
| Rate for Payer: United Healthcare HMO Rider |
$272.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$249.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.68
|
| Rate for Payer: Vantage Medical Group Senior |
$14.68
|
|
|
RIMABOTULINUMTOXINB 2,500 UNIT/0.5 ML INTRAMUSCULAR SOLUTION [108078]
|
Facility
|
IP
|
$762.10
|
|
|
Service Code
|
HCPCS J0587
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$152.42 |
| Max. Negotiated Rate |
$685.89 |
| Rate for Payer: Adventist Health Commercial |
$152.42
|
| Rate for Payer: Blue Shield of California Commercial |
$589.10
|
| Rate for Payer: Blue Shield of California EPN |
$384.10
|
| Rate for Payer: Cash Price |
$419.15
|
| Rate for Payer: Central Health Plan Commercial |
$609.68
|
| Rate for Payer: Cigna of CA HMO |
$533.47
|
| Rate for Payer: Cigna of CA PPO |
$533.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$304.84
|
| Rate for Payer: EPIC Health Plan Senior |
$304.84
|
| Rate for Payer: Galaxy Health WC |
$647.78
|
| Rate for Payer: Global Benefits Group Commercial |
$457.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$685.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$508.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$290.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$471.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.42
|
| Rate for Payer: Multiplan Commercial |
$571.58
|
| Rate for Payer: Networks By Design Commercial |
$381.05
|
| Rate for Payer: Prime Health Services Commercial |
$647.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$286.02
|
| Rate for Payer: United Healthcare All Other HMO |
$278.40
|
| Rate for Payer: United Healthcare HMO Rider |
$272.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$249.59
|
|
|
RINGER'S INTRAVENOUS SOLUTION [11295]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 0264-7780-00
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
RINGER'S INTRAVENOUS SOLUTION [11295]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 0264-7780-00
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: InnovAge PACE Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
RIOCIGUAT 0.5 MG TABLET [203879]
|
Facility
|
OP
|
$188.14
|
|
|
Service Code
|
NDC 50419-250-91
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$37.63 |
| Max. Negotiated Rate |
$169.33 |
| Rate for Payer: Adventist Health Commercial |
$37.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$114.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$159.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$141.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$91.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.49
|
| Rate for Payer: Blue Shield of California Commercial |
$114.95
|
| Rate for Payer: Blue Shield of California EPN |
$75.07
|
| Rate for Payer: Cash Price |
$103.47
|
| Rate for Payer: Central Health Plan Commercial |
$150.51
|
| Rate for Payer: Cigna of CA HMO |
$131.70
|
| Rate for Payer: Cigna of CA PPO |
$131.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$159.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$159.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.26
|
| Rate for Payer: EPIC Health Plan Senior |
$75.26
|
| Rate for Payer: Galaxy Health WC |
$159.92
|
| Rate for Payer: Global Benefits Group Commercial |
$112.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$169.33
|
| Rate for Payer: InnovAge PACE Commercial |
$94.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$125.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$131.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$131.70
|
| Rate for Payer: Multiplan Commercial |
$141.10
|
| Rate for Payer: Networks By Design Commercial |
$122.29
|
| Rate for Payer: Prime Health Services Commercial |
$159.92
|
| Rate for Payer: Riverside University Health System MISP |
$75.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$112.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$112.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.07
|
| Rate for Payer: United Healthcare All Other HMO |
$94.07
|
| Rate for Payer: United Healthcare HMO Rider |
$94.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$159.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.92
|
| Rate for Payer: Vantage Medical Group Senior |
$159.92
|
|
|
RIOCIGUAT 0.5 MG TABLET [203879]
|
Facility
|
IP
|
$188.14
|
|
|
Service Code
|
NDC 50419-250-91
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$37.63 |
| Max. Negotiated Rate |
$169.33 |
| Rate for Payer: Adventist Health Commercial |
$37.63
|
| Rate for Payer: Blue Shield of California Commercial |
$145.43
|
| Rate for Payer: Blue Shield of California EPN |
$94.82
|
| Rate for Payer: Cash Price |
$103.47
|
| Rate for Payer: Central Health Plan Commercial |
$150.51
|
| Rate for Payer: Cigna of CA HMO |
$131.70
|
| Rate for Payer: Cigna of CA PPO |
$131.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.26
|
| Rate for Payer: EPIC Health Plan Senior |
$75.26
|
| Rate for Payer: Galaxy Health WC |
$159.92
|
| Rate for Payer: Global Benefits Group Commercial |
$112.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$169.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$125.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.63
|
| Rate for Payer: Multiplan Commercial |
$141.10
|
| Rate for Payer: Networks By Design Commercial |
$122.29
|
| Rate for Payer: Prime Health Services Commercial |
$159.92
|
|
|
RIOCIGUAT 0.5 MG TABLET [203879]
|
Facility
|
IP
|
$188.14
|
|
|
Service Code
|
NDC 50419-250-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$37.63 |
| Max. Negotiated Rate |
$169.33 |
| Rate for Payer: Adventist Health Commercial |
$37.63
|
| Rate for Payer: Blue Shield of California Commercial |
$145.43
|
| Rate for Payer: Blue Shield of California EPN |
$94.82
|
| Rate for Payer: Cash Price |
$103.47
|
| Rate for Payer: Central Health Plan Commercial |
$150.51
|
| Rate for Payer: Cigna of CA HMO |
$131.70
|
| Rate for Payer: Cigna of CA PPO |
$131.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.26
|
| Rate for Payer: EPIC Health Plan Senior |
$75.26
|
| Rate for Payer: Galaxy Health WC |
$159.92
|
| Rate for Payer: Global Benefits Group Commercial |
$112.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$169.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$125.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.63
|
| Rate for Payer: Multiplan Commercial |
$141.10
|
| Rate for Payer: Networks By Design Commercial |
$122.29
|
| Rate for Payer: Prime Health Services Commercial |
$159.92
|
|
|
RIOCIGUAT 0.5 MG TABLET [203879]
|
Facility
|
OP
|
$188.14
|
|
|
Service Code
|
NDC 50419-250-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$37.63 |
| Max. Negotiated Rate |
$169.33 |
| Rate for Payer: Adventist Health Commercial |
$37.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$114.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$159.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$141.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$91.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.49
|
| Rate for Payer: Blue Shield of California Commercial |
$114.95
|
| Rate for Payer: Blue Shield of California EPN |
$75.07
|
| Rate for Payer: Cash Price |
$103.47
|
| Rate for Payer: Central Health Plan Commercial |
$150.51
|
| Rate for Payer: Cigna of CA HMO |
$131.70
|
| Rate for Payer: Cigna of CA PPO |
$131.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$159.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$159.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.26
|
| Rate for Payer: EPIC Health Plan Senior |
$75.26
|
| Rate for Payer: Galaxy Health WC |
$159.92
|
| Rate for Payer: Global Benefits Group Commercial |
$112.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$169.33
|
| Rate for Payer: InnovAge PACE Commercial |
$94.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$125.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$131.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$131.70
|
| Rate for Payer: Multiplan Commercial |
$141.10
|
| Rate for Payer: Networks By Design Commercial |
$122.29
|
| Rate for Payer: Prime Health Services Commercial |
$159.92
|
| Rate for Payer: Riverside University Health System MISP |
$75.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$112.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$112.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.07
|
| Rate for Payer: United Healthcare All Other HMO |
$94.07
|
| Rate for Payer: United Healthcare HMO Rider |
$94.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$159.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.92
|
| Rate for Payer: Vantage Medical Group Senior |
$159.92
|
|
|
RIOCIGUAT 1 MG TABLET [203880]
|
Facility
|
OP
|
$188.14
|
|
|
Service Code
|
NDC 50419-251-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$37.63 |
| Max. Negotiated Rate |
$169.33 |
| Rate for Payer: Adventist Health Commercial |
$37.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$114.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$159.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$141.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$91.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.49
|
| Rate for Payer: Blue Shield of California Commercial |
$114.95
|
| Rate for Payer: Blue Shield of California EPN |
$75.07
|
| Rate for Payer: Cash Price |
$103.47
|
| Rate for Payer: Central Health Plan Commercial |
$150.51
|
| Rate for Payer: Cigna of CA HMO |
$131.70
|
| Rate for Payer: Cigna of CA PPO |
$131.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$159.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$159.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.26
|
| Rate for Payer: EPIC Health Plan Senior |
$75.26
|
| Rate for Payer: Galaxy Health WC |
$159.92
|
| Rate for Payer: Global Benefits Group Commercial |
$112.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$169.33
|
| Rate for Payer: InnovAge PACE Commercial |
$94.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$125.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$131.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$131.70
|
| Rate for Payer: Multiplan Commercial |
$141.10
|
| Rate for Payer: Networks By Design Commercial |
$122.29
|
| Rate for Payer: Prime Health Services Commercial |
$159.92
|
| Rate for Payer: Riverside University Health System MISP |
$75.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$112.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$112.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.07
|
| Rate for Payer: United Healthcare All Other HMO |
$94.07
|
| Rate for Payer: United Healthcare HMO Rider |
$94.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$159.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.92
|
| Rate for Payer: Vantage Medical Group Senior |
$159.92
|
|
|
RIOCIGUAT 1 MG TABLET [203880]
|
Facility
|
OP
|
$188.14
|
|
|
Service Code
|
NDC 50419-251-91
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$37.63 |
| Max. Negotiated Rate |
$169.33 |
| Rate for Payer: Adventist Health Commercial |
$37.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$114.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$159.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$141.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$91.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.49
|
| Rate for Payer: Blue Shield of California Commercial |
$114.95
|
| Rate for Payer: Blue Shield of California EPN |
$75.07
|
| Rate for Payer: Cash Price |
$103.47
|
| Rate for Payer: Central Health Plan Commercial |
$150.51
|
| Rate for Payer: Cigna of CA HMO |
$131.70
|
| Rate for Payer: Cigna of CA PPO |
$131.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$159.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$159.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.26
|
| Rate for Payer: EPIC Health Plan Senior |
$75.26
|
| Rate for Payer: Galaxy Health WC |
$159.92
|
| Rate for Payer: Global Benefits Group Commercial |
$112.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$169.33
|
| Rate for Payer: InnovAge PACE Commercial |
$94.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$125.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$131.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$131.70
|
| Rate for Payer: Multiplan Commercial |
$141.10
|
| Rate for Payer: Networks By Design Commercial |
$122.29
|
| Rate for Payer: Prime Health Services Commercial |
$159.92
|
| Rate for Payer: Riverside University Health System MISP |
$75.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$112.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$112.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.07
|
| Rate for Payer: United Healthcare All Other HMO |
$94.07
|
| Rate for Payer: United Healthcare HMO Rider |
$94.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$159.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.92
|
| Rate for Payer: Vantage Medical Group Senior |
$159.92
|
|
|
RIOCIGUAT 1 MG TABLET [203880]
|
Facility
|
IP
|
$188.14
|
|
|
Service Code
|
NDC 50419-251-91
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$37.63 |
| Max. Negotiated Rate |
$169.33 |
| Rate for Payer: Adventist Health Commercial |
$37.63
|
| Rate for Payer: Blue Shield of California Commercial |
$145.43
|
| Rate for Payer: Blue Shield of California EPN |
$94.82
|
| Rate for Payer: Cash Price |
$103.47
|
| Rate for Payer: Central Health Plan Commercial |
$150.51
|
| Rate for Payer: Cigna of CA HMO |
$131.70
|
| Rate for Payer: Cigna of CA PPO |
$131.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.26
|
| Rate for Payer: EPIC Health Plan Senior |
$75.26
|
| Rate for Payer: Galaxy Health WC |
$159.92
|
| Rate for Payer: Global Benefits Group Commercial |
$112.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$169.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$125.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.63
|
| Rate for Payer: Multiplan Commercial |
$141.10
|
| Rate for Payer: Networks By Design Commercial |
$122.29
|
| Rate for Payer: Prime Health Services Commercial |
$159.92
|
|
|
RIOCIGUAT 1 MG TABLET [203880]
|
Facility
|
IP
|
$188.14
|
|
|
Service Code
|
NDC 50419-251-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$37.63 |
| Max. Negotiated Rate |
$169.33 |
| Rate for Payer: Adventist Health Commercial |
$37.63
|
| Rate for Payer: Blue Shield of California Commercial |
$145.43
|
| Rate for Payer: Blue Shield of California EPN |
$94.82
|
| Rate for Payer: Cash Price |
$103.47
|
| Rate for Payer: Central Health Plan Commercial |
$150.51
|
| Rate for Payer: Cigna of CA HMO |
$131.70
|
| Rate for Payer: Cigna of CA PPO |
$131.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.26
|
| Rate for Payer: EPIC Health Plan Senior |
$75.26
|
| Rate for Payer: Galaxy Health WC |
$159.92
|
| Rate for Payer: Global Benefits Group Commercial |
$112.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$169.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$125.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.63
|
| Rate for Payer: Multiplan Commercial |
$141.10
|
| Rate for Payer: Networks By Design Commercial |
$122.29
|
| Rate for Payer: Prime Health Services Commercial |
$159.92
|
|
|
RIOCIGUAT 2.5 MG TABLET [203883]
|
Facility
|
IP
|
$188.14
|
|
|
Service Code
|
NDC 50419-254-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$37.63 |
| Max. Negotiated Rate |
$169.33 |
| Rate for Payer: Adventist Health Commercial |
$37.63
|
| Rate for Payer: Blue Shield of California Commercial |
$145.43
|
| Rate for Payer: Blue Shield of California EPN |
$94.82
|
| Rate for Payer: Cash Price |
$103.47
|
| Rate for Payer: Central Health Plan Commercial |
$150.51
|
| Rate for Payer: Cigna of CA HMO |
$131.70
|
| Rate for Payer: Cigna of CA PPO |
$131.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.26
|
| Rate for Payer: EPIC Health Plan Senior |
$75.26
|
| Rate for Payer: Galaxy Health WC |
$159.92
|
| Rate for Payer: Global Benefits Group Commercial |
$112.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$169.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$125.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.63
|
| Rate for Payer: Multiplan Commercial |
$141.10
|
| Rate for Payer: Networks By Design Commercial |
$122.29
|
| Rate for Payer: Prime Health Services Commercial |
$159.92
|
|
|
RIOCIGUAT 2.5 MG TABLET [203883]
|
Facility
|
IP
|
$188.14
|
|
|
Service Code
|
NDC 50419-254-91
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$37.63 |
| Max. Negotiated Rate |
$169.33 |
| Rate for Payer: Adventist Health Commercial |
$37.63
|
| Rate for Payer: Blue Shield of California Commercial |
$145.43
|
| Rate for Payer: Blue Shield of California EPN |
$94.82
|
| Rate for Payer: Cash Price |
$103.47
|
| Rate for Payer: Central Health Plan Commercial |
$150.51
|
| Rate for Payer: Cigna of CA HMO |
$131.70
|
| Rate for Payer: Cigna of CA PPO |
$131.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.26
|
| Rate for Payer: EPIC Health Plan Senior |
$75.26
|
| Rate for Payer: Galaxy Health WC |
$159.92
|
| Rate for Payer: Global Benefits Group Commercial |
$112.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$169.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$125.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.63
|
| Rate for Payer: Multiplan Commercial |
$141.10
|
| Rate for Payer: Networks By Design Commercial |
$122.29
|
| Rate for Payer: Prime Health Services Commercial |
$159.92
|
|
|
RIOCIGUAT 2.5 MG TABLET [203883]
|
Facility
|
OP
|
$188.14
|
|
|
Service Code
|
NDC 50419-254-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$37.63 |
| Max. Negotiated Rate |
$169.33 |
| Rate for Payer: Adventist Health Commercial |
$37.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$114.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$159.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$141.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$91.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.49
|
| Rate for Payer: Blue Shield of California Commercial |
$114.95
|
| Rate for Payer: Blue Shield of California EPN |
$75.07
|
| Rate for Payer: Cash Price |
$103.47
|
| Rate for Payer: Central Health Plan Commercial |
$150.51
|
| Rate for Payer: Cigna of CA HMO |
$131.70
|
| Rate for Payer: Cigna of CA PPO |
$131.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$159.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$159.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.26
|
| Rate for Payer: EPIC Health Plan Senior |
$75.26
|
| Rate for Payer: Galaxy Health WC |
$159.92
|
| Rate for Payer: Global Benefits Group Commercial |
$112.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$169.33
|
| Rate for Payer: InnovAge PACE Commercial |
$94.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$125.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$131.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$131.70
|
| Rate for Payer: Multiplan Commercial |
$141.10
|
| Rate for Payer: Networks By Design Commercial |
$122.29
|
| Rate for Payer: Prime Health Services Commercial |
$159.92
|
| Rate for Payer: Riverside University Health System MISP |
$75.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$112.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$112.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.07
|
| Rate for Payer: United Healthcare All Other HMO |
$94.07
|
| Rate for Payer: United Healthcare HMO Rider |
$94.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$159.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.92
|
| Rate for Payer: Vantage Medical Group Senior |
$159.92
|
|
|
RIOCIGUAT 2.5 MG TABLET [203883]
|
Facility
|
OP
|
$188.14
|
|
|
Service Code
|
NDC 50419-254-91
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$37.63 |
| Max. Negotiated Rate |
$169.33 |
| Rate for Payer: Adventist Health Commercial |
$37.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$114.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$159.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$141.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$91.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.49
|
| Rate for Payer: Blue Shield of California Commercial |
$114.95
|
| Rate for Payer: Blue Shield of California EPN |
$75.07
|
| Rate for Payer: Cash Price |
$103.47
|
| Rate for Payer: Central Health Plan Commercial |
$150.51
|
| Rate for Payer: Cigna of CA HMO |
$131.70
|
| Rate for Payer: Cigna of CA PPO |
$131.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$159.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$159.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.26
|
| Rate for Payer: EPIC Health Plan Senior |
$75.26
|
| Rate for Payer: Galaxy Health WC |
$159.92
|
| Rate for Payer: Global Benefits Group Commercial |
$112.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$169.33
|
| Rate for Payer: InnovAge PACE Commercial |
$94.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$125.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$131.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$131.70
|
| Rate for Payer: Multiplan Commercial |
$141.10
|
| Rate for Payer: Networks By Design Commercial |
$122.29
|
| Rate for Payer: Prime Health Services Commercial |
$159.92
|
| Rate for Payer: Riverside University Health System MISP |
$75.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$112.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$112.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.07
|
| Rate for Payer: United Healthcare All Other HMO |
$94.07
|
| Rate for Payer: United Healthcare HMO Rider |
$94.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$159.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.92
|
| Rate for Payer: Vantage Medical Group Senior |
$159.92
|
|
|
RIPRETINIB 50 MG TABLET [228115]
|
Facility
|
OP
|
$591.60
|
|
|
Service Code
|
NDC 73207-101-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$118.32 |
| Max. Negotiated Rate |
$532.44 |
| Rate for Payer: Adventist Health Commercial |
$118.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$359.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$502.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$325.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$443.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$286.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.45
|
| Rate for Payer: Blue Shield of California Commercial |
$361.47
|
| Rate for Payer: Blue Shield of California EPN |
$236.05
|
| Rate for Payer: Cash Price |
$325.38
|
| Rate for Payer: Central Health Plan Commercial |
$473.28
|
| Rate for Payer: Cigna of CA HMO |
$414.12
|
| Rate for Payer: Cigna of CA PPO |
$414.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$502.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$502.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$502.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.64
|
| Rate for Payer: EPIC Health Plan Senior |
$236.64
|
| Rate for Payer: Galaxy Health WC |
$502.86
|
| Rate for Payer: Global Benefits Group Commercial |
$354.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$532.44
|
| Rate for Payer: InnovAge PACE Commercial |
$295.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$394.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$225.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$366.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$414.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$414.12
|
| Rate for Payer: Multiplan Commercial |
$443.70
|
| Rate for Payer: Networks By Design Commercial |
$384.54
|
| Rate for Payer: Prime Health Services Commercial |
$502.86
|
| Rate for Payer: Riverside University Health System MISP |
$236.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$354.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$354.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$295.80
|
| Rate for Payer: United Healthcare All Other HMO |
$295.80
|
| Rate for Payer: United Healthcare HMO Rider |
$295.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$295.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$502.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$502.86
|
| Rate for Payer: Vantage Medical Group Senior |
$502.86
|
|
|
RIPRETINIB 50 MG TABLET [228115]
|
Facility
|
IP
|
$591.60
|
|
|
Service Code
|
NDC 73207-101-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$118.32 |
| Max. Negotiated Rate |
$532.44 |
| Rate for Payer: Adventist Health Commercial |
$118.32
|
| Rate for Payer: Blue Shield of California Commercial |
$457.31
|
| Rate for Payer: Blue Shield of California EPN |
$298.17
|
| Rate for Payer: Cash Price |
$325.38
|
| Rate for Payer: Central Health Plan Commercial |
$473.28
|
| Rate for Payer: Cigna of CA HMO |
$414.12
|
| Rate for Payer: Cigna of CA PPO |
$414.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.64
|
| Rate for Payer: EPIC Health Plan Senior |
$236.64
|
| Rate for Payer: Galaxy Health WC |
$502.86
|
| Rate for Payer: Global Benefits Group Commercial |
$354.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$532.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$394.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$225.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$366.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.32
|
| Rate for Payer: Multiplan Commercial |
$443.70
|
| Rate for Payer: Networks By Design Commercial |
$384.54
|
| Rate for Payer: Prime Health Services Commercial |
$502.86
|
|
|
RISEDRONATE 35 MG TABLET [32895]
|
Facility
|
IP
|
$102.29
|
|
|
Service Code
|
NDC 0430-0472-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$92.06 |
| Rate for Payer: Adventist Health Commercial |
$20.46
|
| Rate for Payer: Blue Shield of California Commercial |
$79.07
|
| Rate for Payer: Blue Shield of California EPN |
$51.55
|
| Rate for Payer: Cash Price |
$56.26
|
| Rate for Payer: Central Health Plan Commercial |
$81.83
|
| Rate for Payer: Cigna of CA HMO |
$71.60
|
| Rate for Payer: Cigna of CA PPO |
$71.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.92
|
| Rate for Payer: EPIC Health Plan Senior |
$40.92
|
| Rate for Payer: Galaxy Health WC |
$86.95
|
| Rate for Payer: Global Benefits Group Commercial |
$61.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$92.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$63.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.46
|
| Rate for Payer: Multiplan Commercial |
$76.72
|
| Rate for Payer: Networks By Design Commercial |
$66.49
|
| Rate for Payer: Prime Health Services Commercial |
$86.95
|
|
|
RISEDRONATE 35 MG TABLET [32895]
|
Facility
|
OP
|
$102.29
|
|
|
Service Code
|
NDC 0430-0472-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$92.06 |
| Rate for Payer: Adventist Health Commercial |
$20.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$86.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$49.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.07
|
| Rate for Payer: Blue Shield of California Commercial |
$62.50
|
| Rate for Payer: Blue Shield of California EPN |
$40.81
|
| Rate for Payer: Cash Price |
$56.26
|
| Rate for Payer: Central Health Plan Commercial |
$81.83
|
| Rate for Payer: Cigna of CA HMO |
$71.60
|
| Rate for Payer: Cigna of CA PPO |
$71.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$86.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$86.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$86.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.92
|
| Rate for Payer: EPIC Health Plan Senior |
$40.92
|
| Rate for Payer: Galaxy Health WC |
$86.95
|
| Rate for Payer: Global Benefits Group Commercial |
$61.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$92.06
|
| Rate for Payer: InnovAge PACE Commercial |
$51.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$63.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$71.60
|
| Rate for Payer: Multiplan Commercial |
$76.72
|
| Rate for Payer: Networks By Design Commercial |
$66.49
|
| Rate for Payer: Prime Health Services Commercial |
$86.95
|
| Rate for Payer: Riverside University Health System MISP |
$40.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$61.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$61.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$51.15
|
| Rate for Payer: United Healthcare All Other HMO |
$51.15
|
| Rate for Payer: United Healthcare HMO Rider |
$51.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$86.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$86.95
|
| Rate for Payer: Vantage Medical Group Senior |
$86.95
|
|
|
RISPERIDONE 0.25 MG TABLET [25519]
|
Facility
|
OP
|
$0.27
|
|
|
Service Code
|
NDC 68084-270-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Senior |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.24
|
| Rate for Payer: InnovAge PACE Commercial |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
| Rate for Payer: Riverside University Health System MISP |
$0.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO |
$0.14
|
| Rate for Payer: United Healthcare HMO Rider |
$0.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Vantage Medical Group Senior |
$0.23
|
|
|
RISPERIDONE 0.25 MG TABLET [25519]
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
NDC 68084-270-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Senior |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
|
|
RISPERIDONE 0.25 MG TABLET [25519]
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
NDC 68084-270-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Senior |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
|
|
RISPERIDONE 0.25 MG TABLET [25519]
|
Facility
|
OP
|
$0.27
|
|
|
Service Code
|
NDC 68084-270-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Senior |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.24
|
| Rate for Payer: InnovAge PACE Commercial |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
| Rate for Payer: Riverside University Health System MISP |
$0.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO |
$0.14
|
| Rate for Payer: United Healthcare HMO Rider |
$0.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Vantage Medical Group Senior |
$0.23
|
|
|
RISPERIDONE 0.5 MG DISINTEGRATING TABLET [35686]
|
Facility
|
OP
|
$1.99
|
|
|
Service Code
|
NDC 59746-010-32
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.79 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.17
|
| Rate for Payer: Blue Shield of California Commercial |
$1.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.79
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: Central Health Plan Commercial |
$1.59
|
| Rate for Payer: Cigna of CA HMO |
$1.39
|
| Rate for Payer: Cigna of CA PPO |
$1.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Senior |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.69
|
| Rate for Payer: Global Benefits Group Commercial |
$1.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.79
|
| Rate for Payer: InnovAge PACE Commercial |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.39
|
| Rate for Payer: Multiplan Commercial |
$1.49
|
| Rate for Payer: Networks By Design Commercial |
$1.29
|
| Rate for Payer: Prime Health Services Commercial |
$1.69
|
| Rate for Payer: Riverside University Health System MISP |
$0.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1.69
|
|
