|
RISPERIDONE 1 MG TABLET [18313]
|
Facility
|
IP
|
$0.50
|
|
|
Service Code
|
NDC 68084-272-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.39
|
| Rate for Payer: Blue Shield of California EPN |
$0.25
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Central Health Plan Commercial |
$0.40
|
| Rate for Payer: Cigna of CA HMO |
$0.35
|
| Rate for Payer: Cigna of CA PPO |
$0.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.43
|
| Rate for Payer: Global Benefits Group Commercial |
$0.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.38
|
| Rate for Payer: Networks By Design Commercial |
$0.33
|
| Rate for Payer: Prime Health Services Commercial |
$0.43
|
|
|
RISPERIDONE 1 MG TABLET [18313]
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
NDC 68382-114-14
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.14
|
| Rate for Payer: InnovAge PACE Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Riverside University Health System MISP |
$0.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
RISPERIDONE 1 MG TABLET [18313]
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
NDC 43547-341-06
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Central Health Plan Commercial |
$0.19
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.22
|
| Rate for Payer: InnovAge PACE Commercial |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
| Rate for Payer: Riverside University Health System MISP |
$0.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO |
$0.12
|
| Rate for Payer: United Healthcare HMO Rider |
$0.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
RISPERIDONE 1 MG TABLET [18313]
|
Facility
|
IP
|
$0.16
|
|
|
Service Code
|
NDC 68382-114-14
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
|
RISPERIDONE 2 MG DISINTEGRATING TABLET [35688]
|
Facility
|
IP
|
$4.01
|
|
|
Service Code
|
NDC 59746-030-22
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.61 |
| Rate for Payer: Adventist Health Commercial |
$0.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.02
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Central Health Plan Commercial |
$3.21
|
| Rate for Payer: Cigna of CA HMO |
$2.81
|
| Rate for Payer: Cigna of CA PPO |
$2.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1.60
|
| Rate for Payer: Galaxy Health WC |
$3.41
|
| Rate for Payer: Global Benefits Group Commercial |
$2.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$3.01
|
| Rate for Payer: Networks By Design Commercial |
$2.61
|
| Rate for Payer: Prime Health Services Commercial |
$3.41
|
|
|
RISPERIDONE 2 MG DISINTEGRATING TABLET [35688]
|
Facility
|
OP
|
$4.01
|
|
|
Service Code
|
NDC 59746-030-22
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.61 |
| Rate for Payer: Adventist Health Commercial |
$0.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.36
|
| Rate for Payer: Blue Shield of California Commercial |
$2.45
|
| Rate for Payer: Blue Shield of California EPN |
$1.60
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Central Health Plan Commercial |
$3.21
|
| Rate for Payer: Cigna of CA HMO |
$2.81
|
| Rate for Payer: Cigna of CA PPO |
$2.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1.60
|
| Rate for Payer: Galaxy Health WC |
$3.41
|
| Rate for Payer: Global Benefits Group Commercial |
$2.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.61
|
| Rate for Payer: InnovAge PACE Commercial |
$2.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.81
|
| Rate for Payer: Multiplan Commercial |
$3.01
|
| Rate for Payer: Networks By Design Commercial |
$2.61
|
| Rate for Payer: Prime Health Services Commercial |
$3.41
|
| Rate for Payer: Riverside University Health System MISP |
$1.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.41
|
| Rate for Payer: Vantage Medical Group Senior |
$3.41
|
|
|
RISPERIDONE 2 MG DISINTEGRATING TABLET [35688]
|
Facility
|
IP
|
$7.97
|
|
|
Service Code
|
NDC 49884-401-52
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$7.17 |
| Rate for Payer: Adventist Health Commercial |
$1.59
|
| Rate for Payer: Blue Shield of California Commercial |
$6.16
|
| Rate for Payer: Blue Shield of California EPN |
$4.02
|
| Rate for Payer: Cash Price |
$4.38
|
| Rate for Payer: Central Health Plan Commercial |
$6.38
|
| Rate for Payer: Cigna of CA HMO |
$5.58
|
| Rate for Payer: Cigna of CA PPO |
$5.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.19
|
| Rate for Payer: EPIC Health Plan Senior |
$3.19
|
| Rate for Payer: Galaxy Health WC |
$6.77
|
| Rate for Payer: Global Benefits Group Commercial |
$4.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: Multiplan Commercial |
$5.98
|
| Rate for Payer: Networks By Design Commercial |
$5.18
|
| Rate for Payer: Prime Health Services Commercial |
$6.77
|
|
|
RISPERIDONE 2 MG DISINTEGRATING TABLET [35688]
|
Facility
|
OP
|
$7.97
|
|
|
Service Code
|
NDC 49884-401-52
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$7.17 |
| Rate for Payer: Adventist Health Commercial |
$1.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.68
|
| Rate for Payer: Blue Shield of California Commercial |
$4.87
|
| Rate for Payer: Blue Shield of California EPN |
$3.18
|
| Rate for Payer: Cash Price |
$4.38
|
| Rate for Payer: Central Health Plan Commercial |
$6.38
|
| Rate for Payer: Cigna of CA HMO |
$5.58
|
| Rate for Payer: Cigna of CA PPO |
$5.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.19
|
| Rate for Payer: EPIC Health Plan Senior |
$3.19
|
| Rate for Payer: Galaxy Health WC |
$6.77
|
| Rate for Payer: Global Benefits Group Commercial |
$4.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.17
|
| Rate for Payer: InnovAge PACE Commercial |
$3.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.58
|
| Rate for Payer: Multiplan Commercial |
$5.98
|
| Rate for Payer: Networks By Design Commercial |
$5.18
|
| Rate for Payer: Prime Health Services Commercial |
$6.77
|
| Rate for Payer: Riverside University Health System MISP |
$3.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.98
|
| Rate for Payer: United Healthcare All Other HMO |
$3.98
|
| Rate for Payer: United Healthcare HMO Rider |
$3.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.77
|
| Rate for Payer: Vantage Medical Group Senior |
$6.77
|
|
|
RISPERIDONE 2 MG DISINTEGRATING TABLET [35688]
|
Facility
|
IP
|
$7.97
|
|
|
Service Code
|
NDC 49884-401-91
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$7.17 |
| Rate for Payer: Adventist Health Commercial |
$1.59
|
| Rate for Payer: Blue Shield of California Commercial |
$6.16
|
| Rate for Payer: Blue Shield of California EPN |
$4.02
|
| Rate for Payer: Cash Price |
$4.38
|
| Rate for Payer: Central Health Plan Commercial |
$6.38
|
| Rate for Payer: Cigna of CA HMO |
$5.58
|
| Rate for Payer: Cigna of CA PPO |
$5.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.19
|
| Rate for Payer: EPIC Health Plan Senior |
$3.19
|
| Rate for Payer: Galaxy Health WC |
$6.77
|
| Rate for Payer: Global Benefits Group Commercial |
$4.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: Multiplan Commercial |
$5.98
|
| Rate for Payer: Networks By Design Commercial |
$5.18
|
| Rate for Payer: Prime Health Services Commercial |
$6.77
|
|
|
RISPERIDONE 2 MG DISINTEGRATING TABLET [35688]
|
Facility
|
OP
|
$7.97
|
|
|
Service Code
|
NDC 49884-401-91
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$7.17 |
| Rate for Payer: Adventist Health Commercial |
$1.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.68
|
| Rate for Payer: Blue Shield of California Commercial |
$4.87
|
| Rate for Payer: Blue Shield of California EPN |
$3.18
|
| Rate for Payer: Cash Price |
$4.38
|
| Rate for Payer: Central Health Plan Commercial |
$6.38
|
| Rate for Payer: Cigna of CA HMO |
$5.58
|
| Rate for Payer: Cigna of CA PPO |
$5.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.19
|
| Rate for Payer: EPIC Health Plan Senior |
$3.19
|
| Rate for Payer: Galaxy Health WC |
$6.77
|
| Rate for Payer: Global Benefits Group Commercial |
$4.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.17
|
| Rate for Payer: InnovAge PACE Commercial |
$3.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.58
|
| Rate for Payer: Multiplan Commercial |
$5.98
|
| Rate for Payer: Networks By Design Commercial |
$5.18
|
| Rate for Payer: Prime Health Services Commercial |
$6.77
|
| Rate for Payer: Riverside University Health System MISP |
$3.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.98
|
| Rate for Payer: United Healthcare All Other HMO |
$3.98
|
| Rate for Payer: United Healthcare HMO Rider |
$3.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.77
|
| Rate for Payer: Vantage Medical Group Senior |
$6.77
|
|
|
RISPERIDONE 3 MG TABLET [18312]
|
Facility
|
OP
|
$0.61
|
|
|
Service Code
|
NDC 68084-274-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Central Health Plan Commercial |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.55
|
| Rate for Payer: InnovAge PACE Commercial |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.52
|
| Rate for Payer: Riverside University Health System MISP |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO |
$0.31
|
| Rate for Payer: United Healthcare HMO Rider |
$0.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.52
|
| Rate for Payer: Vantage Medical Group Senior |
$0.52
|
|
|
RISPERIDONE 3 MG TABLET [18312]
|
Facility
|
IP
|
$0.61
|
|
|
Service Code
|
NDC 68084-274-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.47
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Central Health Plan Commercial |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.52
|
|
|
RISPERIDONE 3 MG TABLET [18312]
|
Facility
|
IP
|
$0.61
|
|
|
Service Code
|
NDC 68084-274-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.47
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Central Health Plan Commercial |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.52
|
|
|
RISPERIDONE 3 MG TABLET [18312]
|
Facility
|
OP
|
$0.61
|
|
|
Service Code
|
NDC 68084-274-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Central Health Plan Commercial |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.55
|
| Rate for Payer: InnovAge PACE Commercial |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.52
|
| Rate for Payer: Riverside University Health System MISP |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO |
$0.31
|
| Rate for Payer: United Healthcare HMO Rider |
$0.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.52
|
| Rate for Payer: Vantage Medical Group Senior |
$0.52
|
|
|
RISPERIDONE 4 MG TABLET [18310]
|
Facility
|
OP
|
$0.61
|
|
|
Service Code
|
NDC 68084-277-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Central Health Plan Commercial |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.55
|
| Rate for Payer: InnovAge PACE Commercial |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.52
|
| Rate for Payer: Riverside University Health System MISP |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO |
$0.31
|
| Rate for Payer: United Healthcare HMO Rider |
$0.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.52
|
| Rate for Payer: Vantage Medical Group Senior |
$0.52
|
|
|
RISPERIDONE 4 MG TABLET [18310]
|
Facility
|
IP
|
$0.61
|
|
|
Service Code
|
NDC 68084-277-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.47
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Central Health Plan Commercial |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.52
|
|
|
RISPERIDONE 4 MG TABLET [18310]
|
Facility
|
IP
|
$0.61
|
|
|
Service Code
|
NDC 68084-277-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.47
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Central Health Plan Commercial |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.52
|
|
|
RISPERIDONE 4 MG TABLET [18310]
|
Facility
|
OP
|
$0.61
|
|
|
Service Code
|
NDC 68084-277-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Central Health Plan Commercial |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.55
|
| Rate for Payer: InnovAge PACE Commercial |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.52
|
| Rate for Payer: Riverside University Health System MISP |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO |
$0.31
|
| Rate for Payer: United Healthcare HMO Rider |
$0.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.52
|
| Rate for Payer: Vantage Medical Group Senior |
$0.52
|
|
|
RITLECITINIB 50 MG CAPSULE [238783]
|
Facility
|
OP
|
$178.10
|
|
|
Service Code
|
NDC 0069-0334-28
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.62 |
| Max. Negotiated Rate |
$160.29 |
| Rate for Payer: Adventist Health Commercial |
$35.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$108.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$151.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$97.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$133.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$86.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$104.60
|
| Rate for Payer: Blue Shield of California Commercial |
$108.82
|
| Rate for Payer: Blue Shield of California EPN |
$71.06
|
| Rate for Payer: Cash Price |
$97.95
|
| Rate for Payer: Central Health Plan Commercial |
$142.48
|
| Rate for Payer: Cigna of CA HMO |
$124.67
|
| Rate for Payer: Cigna of CA PPO |
$124.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$151.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$151.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.24
|
| Rate for Payer: EPIC Health Plan Senior |
$71.24
|
| Rate for Payer: Galaxy Health WC |
$151.38
|
| Rate for Payer: Global Benefits Group Commercial |
$106.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$160.29
|
| Rate for Payer: InnovAge PACE Commercial |
$89.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$124.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$124.67
|
| Rate for Payer: Multiplan Commercial |
$133.57
|
| Rate for Payer: Networks By Design Commercial |
$115.77
|
| Rate for Payer: Prime Health Services Commercial |
$151.38
|
| Rate for Payer: Riverside University Health System MISP |
$71.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$89.05
|
| Rate for Payer: United Healthcare All Other HMO |
$89.05
|
| Rate for Payer: United Healthcare HMO Rider |
$89.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$151.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.38
|
| Rate for Payer: Vantage Medical Group Senior |
$151.38
|
|
|
RITLECITINIB 50 MG CAPSULE [238783]
|
Facility
|
IP
|
$178.10
|
|
|
Service Code
|
NDC 0069-0334-28
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.62 |
| Max. Negotiated Rate |
$160.29 |
| Rate for Payer: Adventist Health Commercial |
$35.62
|
| Rate for Payer: Blue Shield of California Commercial |
$137.67
|
| Rate for Payer: Blue Shield of California EPN |
$89.76
|
| Rate for Payer: Cash Price |
$97.95
|
| Rate for Payer: Central Health Plan Commercial |
$142.48
|
| Rate for Payer: Cigna of CA HMO |
$124.67
|
| Rate for Payer: Cigna of CA PPO |
$124.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.24
|
| Rate for Payer: EPIC Health Plan Senior |
$71.24
|
| Rate for Payer: Galaxy Health WC |
$151.38
|
| Rate for Payer: Global Benefits Group Commercial |
$106.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$160.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.62
|
| Rate for Payer: Multiplan Commercial |
$133.57
|
| Rate for Payer: Networks By Design Commercial |
$115.77
|
| Rate for Payer: Prime Health Services Commercial |
$151.38
|
|
|
RITONAVIR 100 MG TABLET [100995]
|
Facility
|
OP
|
$6.40
|
|
|
Service Code
|
NDC 0054-0407-13
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$5.76 |
| Rate for Payer: Adventist Health Commercial |
$1.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.76
|
| Rate for Payer: Blue Shield of California Commercial |
$3.91
|
| Rate for Payer: Blue Shield of California EPN |
$2.55
|
| Rate for Payer: Cash Price |
$3.52
|
| Rate for Payer: Central Health Plan Commercial |
$5.12
|
| Rate for Payer: Cigna of CA HMO |
$4.48
|
| Rate for Payer: Cigna of CA PPO |
$4.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.56
|
| Rate for Payer: EPIC Health Plan Senior |
$2.56
|
| Rate for Payer: Galaxy Health WC |
$5.44
|
| Rate for Payer: Global Benefits Group Commercial |
$3.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.76
|
| Rate for Payer: InnovAge PACE Commercial |
$3.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.48
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Networks By Design Commercial |
$4.16
|
| Rate for Payer: Prime Health Services Commercial |
$5.44
|
| Rate for Payer: Riverside University Health System MISP |
$2.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.20
|
| Rate for Payer: United Healthcare All Other HMO |
$3.20
|
| Rate for Payer: United Healthcare HMO Rider |
$3.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.44
|
| Rate for Payer: Vantage Medical Group Senior |
$5.44
|
|
|
RITONAVIR 100 MG TABLET [100995]
|
Facility
|
IP
|
$6.40
|
|
|
Service Code
|
NDC 0054-0407-13
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$5.76 |
| Rate for Payer: Adventist Health Commercial |
$1.28
|
| Rate for Payer: Blue Shield of California Commercial |
$4.95
|
| Rate for Payer: Blue Shield of California EPN |
$3.23
|
| Rate for Payer: Cash Price |
$3.52
|
| Rate for Payer: Central Health Plan Commercial |
$5.12
|
| Rate for Payer: Cigna of CA HMO |
$4.48
|
| Rate for Payer: Cigna of CA PPO |
$4.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.56
|
| Rate for Payer: EPIC Health Plan Senior |
$2.56
|
| Rate for Payer: Galaxy Health WC |
$5.44
|
| Rate for Payer: Global Benefits Group Commercial |
$3.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Networks By Design Commercial |
$4.16
|
| Rate for Payer: Prime Health Services Commercial |
$5.44
|
|
|
RITONAVIR 100 MG TABLET [100995]
|
Facility
|
IP
|
$3.20
|
|
|
Service Code
|
NDC 31722-597-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.88 |
| Rate for Payer: Adventist Health Commercial |
$0.64
|
| Rate for Payer: Blue Shield of California Commercial |
$2.47
|
| Rate for Payer: Blue Shield of California EPN |
$1.61
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Central Health Plan Commercial |
$2.56
|
| Rate for Payer: Cigna of CA HMO |
$2.24
|
| Rate for Payer: Cigna of CA PPO |
$2.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: EPIC Health Plan Senior |
$1.28
|
| Rate for Payer: Galaxy Health WC |
$2.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$2.08
|
| Rate for Payer: Prime Health Services Commercial |
$2.72
|
|
|
RITONAVIR 100 MG TABLET [100995]
|
Facility
|
IP
|
$3.20
|
|
|
Service Code
|
NDC 65862-687-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.88 |
| Rate for Payer: Adventist Health Commercial |
$0.64
|
| Rate for Payer: Blue Shield of California Commercial |
$2.47
|
| Rate for Payer: Blue Shield of California EPN |
$1.61
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Central Health Plan Commercial |
$2.56
|
| Rate for Payer: Cigna of CA HMO |
$2.24
|
| Rate for Payer: Cigna of CA PPO |
$2.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: EPIC Health Plan Senior |
$1.28
|
| Rate for Payer: Galaxy Health WC |
$2.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$2.08
|
| Rate for Payer: Prime Health Services Commercial |
$2.72
|
|
|
RITONAVIR 100 MG TABLET [100995]
|
Facility
|
OP
|
$3.20
|
|
|
Service Code
|
NDC 65862-687-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.88 |
| Rate for Payer: Adventist Health Commercial |
$0.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.96
|
| Rate for Payer: Blue Shield of California EPN |
$1.28
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Central Health Plan Commercial |
$2.56
|
| Rate for Payer: Cigna of CA HMO |
$2.24
|
| Rate for Payer: Cigna of CA PPO |
$2.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: EPIC Health Plan Senior |
$1.28
|
| Rate for Payer: Galaxy Health WC |
$2.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.88
|
| Rate for Payer: InnovAge PACE Commercial |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.24
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$2.08
|
| Rate for Payer: Prime Health Services Commercial |
$2.72
|
| Rate for Payer: Riverside University Health System MISP |
$1.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1.60
|
| Rate for Payer: United Healthcare HMO Rider |
$1.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.72
|
| Rate for Payer: Vantage Medical Group Senior |
$2.72
|
|
