|
RIVAROXABAN 15 MG TABLET [153877]
|
Facility
IP
|
$21.70
|
|
|
Service Code
|
NDC 50458-578-10
|
| Hospital Charge Code |
1712515
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$19.53 |
| Rate for Payer: Blue Shield of California Commercial |
$16.28
|
| Rate for Payer: Blue Shield of California EPN |
$11.59
|
| Rate for Payer: Cash Price |
$9.77
|
| Rate for Payer: Central Health Plan Commercial |
$17.36
|
| Rate for Payer: Cigna of CA HMO |
$15.19
|
| Rate for Payer: Cigna of CA PPO |
$15.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.68
|
| Rate for Payer: Galaxy Health WC |
$18.44
|
| Rate for Payer: Global Benefits Group Commercial |
$13.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.34
|
| Rate for Payer: Multiplan Commercial |
$16.28
|
| Rate for Payer: Networks By Design Commercial |
$14.10
|
| Rate for Payer: Prime Health Services Commercial |
$18.44
|
|
|
RIVAROXABAN 15 MG TABLET [153877]
|
Facility
OP
|
$21.70
|
|
|
Service Code
|
NDC 50458-578-10
|
| Hospital Charge Code |
1712515
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$19.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.94
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.82
|
| Rate for Payer: BCBS Transplant Transplant |
$13.02
|
| Rate for Payer: Blue Shield of California Commercial |
$13.65
|
| Rate for Payer: Blue Shield of California EPN |
$10.61
|
| Rate for Payer: Cash Price |
$9.77
|
| Rate for Payer: Central Health Plan Commercial |
$17.36
|
| Rate for Payer: Cigna of CA HMO |
$15.19
|
| Rate for Payer: Cigna of CA PPO |
$15.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.68
|
| Rate for Payer: Galaxy Health WC |
$18.44
|
| Rate for Payer: Global Benefits Group Commercial |
$13.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.53
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$16.28
|
| Rate for Payer: IEHP medi-cal |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.34
|
| Rate for Payer: Multiplan Commercial |
$16.28
|
| Rate for Payer: Networks By Design Commercial |
$14.10
|
| Rate for Payer: Prime Health Services Commercial |
$18.44
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$13.02
|
| Rate for Payer: Riverside University Health MISP |
$8.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.85
|
| Rate for Payer: United Healthcare All Other HMO |
$10.85
|
| Rate for Payer: United Healthcare HMO Rider |
$10.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.44
|
| Rate for Payer: Vantage Medical Group Senior |
$18.44
|
|
|
RIVAROXABAN 15 MG TABLET [153877]
|
Facility
IP
|
$21.70
|
|
|
Service Code
|
NDC 50458-578-01
|
| Hospital Charge Code |
1712515
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$19.53 |
| Rate for Payer: Blue Shield of California Commercial |
$16.28
|
| Rate for Payer: Blue Shield of California EPN |
$11.59
|
| Rate for Payer: Cash Price |
$9.77
|
| Rate for Payer: Central Health Plan Commercial |
$17.36
|
| Rate for Payer: Cigna of CA HMO |
$15.19
|
| Rate for Payer: Cigna of CA PPO |
$15.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.68
|
| Rate for Payer: Galaxy Health WC |
$18.44
|
| Rate for Payer: Global Benefits Group Commercial |
$13.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.34
|
| Rate for Payer: Multiplan Commercial |
$16.28
|
| Rate for Payer: Networks By Design Commercial |
$14.10
|
| Rate for Payer: Prime Health Services Commercial |
$18.44
|
|
|
RIVAROXABAN 20 MG TABLET [153878]
|
Facility
IP
|
$21.70
|
|
|
Service Code
|
NDC 50458-579-30
|
| Hospital Charge Code |
1712516
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$19.53 |
| Rate for Payer: Blue Shield of California Commercial |
$16.28
|
| Rate for Payer: Blue Shield of California EPN |
$11.59
|
| Rate for Payer: Cash Price |
$9.77
|
| Rate for Payer: Central Health Plan Commercial |
$17.36
|
| Rate for Payer: Cigna of CA HMO |
$15.19
|
| Rate for Payer: Cigna of CA PPO |
$15.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.68
|
| Rate for Payer: Galaxy Health WC |
$18.44
|
| Rate for Payer: Global Benefits Group Commercial |
$13.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.34
|
| Rate for Payer: Multiplan Commercial |
$16.28
|
| Rate for Payer: Networks By Design Commercial |
$14.10
|
| Rate for Payer: Prime Health Services Commercial |
$18.44
|
|
|
RIVAROXABAN 20 MG TABLET [153878]
|
Facility
OP
|
$21.70
|
|
|
Service Code
|
NDC 50458-579-30
|
| Hospital Charge Code |
1712516
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$19.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.94
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.82
|
| Rate for Payer: BCBS Transplant Transplant |
$13.02
|
| Rate for Payer: Blue Shield of California Commercial |
$13.65
|
| Rate for Payer: Blue Shield of California EPN |
$10.61
|
| Rate for Payer: Cash Price |
$9.77
|
| Rate for Payer: Central Health Plan Commercial |
$17.36
|
| Rate for Payer: Cigna of CA HMO |
$15.19
|
| Rate for Payer: Cigna of CA PPO |
$15.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.68
|
| Rate for Payer: Galaxy Health WC |
$18.44
|
| Rate for Payer: Global Benefits Group Commercial |
$13.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.53
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$16.28
|
| Rate for Payer: IEHP medi-cal |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.34
|
| Rate for Payer: Multiplan Commercial |
$16.28
|
| Rate for Payer: Networks By Design Commercial |
$14.10
|
| Rate for Payer: Prime Health Services Commercial |
$18.44
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$13.02
|
| Rate for Payer: Riverside University Health MISP |
$8.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.85
|
| Rate for Payer: United Healthcare All Other HMO |
$10.85
|
| Rate for Payer: United Healthcare HMO Rider |
$10.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.44
|
| Rate for Payer: Vantage Medical Group Senior |
$18.44
|
|
|
RIVAROXABAN 20 MG TABLET [153878]
|
Facility
IP
|
$21.70
|
|
|
Service Code
|
NDC 50458-579-10
|
| Hospital Charge Code |
1712516
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$19.53 |
| Rate for Payer: Blue Shield of California Commercial |
$16.28
|
| Rate for Payer: Blue Shield of California EPN |
$11.59
|
| Rate for Payer: Cash Price |
$9.77
|
| Rate for Payer: Central Health Plan Commercial |
$17.36
|
| Rate for Payer: Cigna of CA HMO |
$15.19
|
| Rate for Payer: Cigna of CA PPO |
$15.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.68
|
| Rate for Payer: Galaxy Health WC |
$18.44
|
| Rate for Payer: Global Benefits Group Commercial |
$13.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.34
|
| Rate for Payer: Multiplan Commercial |
$16.28
|
| Rate for Payer: Networks By Design Commercial |
$14.10
|
| Rate for Payer: Prime Health Services Commercial |
$18.44
|
|
|
RIVAROXABAN 20 MG TABLET [153878]
|
Facility
OP
|
$21.70
|
|
|
Service Code
|
NDC 50458-579-10
|
| Hospital Charge Code |
1712516
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$19.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.94
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.82
|
| Rate for Payer: BCBS Transplant Transplant |
$13.02
|
| Rate for Payer: Blue Shield of California Commercial |
$13.65
|
| Rate for Payer: Blue Shield of California EPN |
$10.61
|
| Rate for Payer: Cash Price |
$9.77
|
| Rate for Payer: Central Health Plan Commercial |
$17.36
|
| Rate for Payer: Cigna of CA HMO |
$15.19
|
| Rate for Payer: Cigna of CA PPO |
$15.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.68
|
| Rate for Payer: Galaxy Health WC |
$18.44
|
| Rate for Payer: Global Benefits Group Commercial |
$13.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.53
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$16.28
|
| Rate for Payer: IEHP medi-cal |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.34
|
| Rate for Payer: Multiplan Commercial |
$16.28
|
| Rate for Payer: Networks By Design Commercial |
$14.10
|
| Rate for Payer: Prime Health Services Commercial |
$18.44
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$13.02
|
| Rate for Payer: Riverside University Health MISP |
$8.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.85
|
| Rate for Payer: United Healthcare All Other HMO |
$10.85
|
| Rate for Payer: United Healthcare HMO Rider |
$10.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.44
|
| Rate for Payer: Vantage Medical Group Senior |
$18.44
|
|
|
RIVAROXABAN 2.5 MG TABLET [222768]
|
Facility
OP
|
$10.85
|
|
|
Service Code
|
NDC 50458-577-60
|
| Hospital Charge Code |
ERX222768
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$9.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.97
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.41
|
| Rate for Payer: BCBS Transplant Transplant |
$6.51
|
| Rate for Payer: Blue Shield of California Commercial |
$6.82
|
| Rate for Payer: Blue Shield of California EPN |
$5.31
|
| Rate for Payer: Cash Price |
$4.88
|
| Rate for Payer: Central Health Plan Commercial |
$8.68
|
| Rate for Payer: Cigna of CA HMO |
$7.60
|
| Rate for Payer: Cigna of CA PPO |
$7.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.34
|
| Rate for Payer: Galaxy Health WC |
$9.22
|
| Rate for Payer: Global Benefits Group Commercial |
$6.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.76
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.14
|
| Rate for Payer: IEHP medi-cal |
$3.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.17
|
| Rate for Payer: Multiplan Commercial |
$8.14
|
| Rate for Payer: Networks By Design Commercial |
$7.05
|
| Rate for Payer: Prime Health Services Commercial |
$9.22
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.51
|
| Rate for Payer: Riverside University Health MISP |
$4.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.42
|
| Rate for Payer: United Healthcare All Other HMO |
$5.42
|
| Rate for Payer: United Healthcare HMO Rider |
$5.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.22
|
| Rate for Payer: Vantage Medical Group Senior |
$9.22
|
|
|
RIVAROXABAN 2.5 MG TABLET [222768]
|
Facility
IP
|
$10.85
|
|
|
Service Code
|
NDC 50458-577-60
|
| Hospital Charge Code |
ERX222768
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$9.76 |
| Rate for Payer: Blue Shield of California Commercial |
$8.14
|
| Rate for Payer: Blue Shield of California EPN |
$5.79
|
| Rate for Payer: Cash Price |
$4.88
|
| Rate for Payer: Central Health Plan Commercial |
$8.68
|
| Rate for Payer: Cigna of CA HMO |
$7.60
|
| Rate for Payer: Cigna of CA PPO |
$7.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.34
|
| Rate for Payer: Galaxy Health WC |
$9.22
|
| Rate for Payer: Global Benefits Group Commercial |
$6.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.17
|
| Rate for Payer: Multiplan Commercial |
$8.14
|
| Rate for Payer: Networks By Design Commercial |
$7.05
|
| Rate for Payer: Prime Health Services Commercial |
$9.22
|
|
|
RIVASTIGMINE 1.5 MG CAPSULE [28278]
|
Facility
IP
|
$1.25
|
|
|
Service Code
|
NDC 51991-793-06
|
| Hospital Charge Code |
1711861
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.12 |
| Rate for Payer: Blue Shield of California Commercial |
$0.94
|
| Rate for Payer: Blue Shield of California EPN |
$0.67
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: Central Health Plan Commercial |
$1.00
|
| Rate for Payer: Cigna of CA HMO |
$0.88
|
| Rate for Payer: Cigna of CA PPO |
$0.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
| Rate for Payer: Galaxy Health WC |
$1.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.94
|
| Rate for Payer: Networks By Design Commercial |
$0.81
|
| Rate for Payer: Prime Health Services Commercial |
$1.06
|
|
|
RIVASTIGMINE 1.5 MG CAPSULE [28278]
|
Facility
OP
|
$1.25
|
|
|
Service Code
|
NDC 51991-793-06
|
| Hospital Charge Code |
1711861
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.74
|
| Rate for Payer: BCBS Transplant Transplant |
$0.75
|
| Rate for Payer: Blue Shield of California Commercial |
$0.79
|
| Rate for Payer: Blue Shield of California EPN |
$0.61
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: Central Health Plan Commercial |
$1.00
|
| Rate for Payer: Cigna of CA HMO |
$0.88
|
| Rate for Payer: Cigna of CA PPO |
$0.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.50
|
| Rate for Payer: Galaxy Health WC |
$1.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.12
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.94
|
| Rate for Payer: IEHP medi-cal |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.94
|
| Rate for Payer: Networks By Design Commercial |
$0.81
|
| Rate for Payer: Prime Health Services Commercial |
$1.06
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.75
|
| Rate for Payer: Riverside University Health MISP |
$0.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.63
|
| Rate for Payer: United Healthcare All Other HMO |
$0.63
|
| Rate for Payer: United Healthcare HMO Rider |
$0.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.06
|
| Rate for Payer: Vantage Medical Group Senior |
$1.06
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
OP
|
$5.10
|
|
|
Service Code
|
NDC 70710-1196-1
|
| Hospital Charge Code |
1712347
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.01
|
| Rate for Payer: BCBS Transplant Transplant |
$3.06
|
| Rate for Payer: Blue Shield of California Commercial |
$3.21
|
| Rate for Payer: Blue Shield of California EPN |
$2.49
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Central Health Plan Commercial |
$4.08
|
| Rate for Payer: Cigna of CA HMO |
$3.57
|
| Rate for Payer: Cigna of CA PPO |
$3.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.04
|
| Rate for Payer: Galaxy Health WC |
$4.34
|
| Rate for Payer: Global Benefits Group Commercial |
$3.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.59
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.82
|
| Rate for Payer: IEHP medi-cal |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: Multiplan Commercial |
$3.82
|
| Rate for Payer: Networks By Design Commercial |
$3.32
|
| Rate for Payer: Prime Health Services Commercial |
$4.34
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.06
|
| Rate for Payer: Riverside University Health MISP |
$2.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.55
|
| Rate for Payer: United Healthcare All Other HMO |
$2.55
|
| Rate for Payer: United Healthcare HMO Rider |
$2.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Vantage Medical Group Senior |
$4.34
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
OP
|
$5.10
|
|
|
Service Code
|
NDC 70710-1196-7
|
| Hospital Charge Code |
1712347
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.01
|
| Rate for Payer: BCBS Transplant Transplant |
$3.06
|
| Rate for Payer: Blue Shield of California Commercial |
$3.21
|
| Rate for Payer: Blue Shield of California EPN |
$2.49
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Central Health Plan Commercial |
$4.08
|
| Rate for Payer: Cigna of CA HMO |
$3.57
|
| Rate for Payer: Cigna of CA PPO |
$3.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.04
|
| Rate for Payer: Galaxy Health WC |
$4.34
|
| Rate for Payer: Global Benefits Group Commercial |
$3.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.59
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.82
|
| Rate for Payer: IEHP medi-cal |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: Multiplan Commercial |
$3.82
|
| Rate for Payer: Networks By Design Commercial |
$3.32
|
| Rate for Payer: Prime Health Services Commercial |
$4.34
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.06
|
| Rate for Payer: Riverside University Health MISP |
$2.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.55
|
| Rate for Payer: United Healthcare All Other HMO |
$2.55
|
| Rate for Payer: United Healthcare HMO Rider |
$2.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Vantage Medical Group Senior |
$4.34
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
IP
|
$5.10
|
|
|
Service Code
|
NDC 70710-1196-1
|
| Hospital Charge Code |
1712347
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Blue Shield of California Commercial |
$3.82
|
| Rate for Payer: Blue Shield of California EPN |
$2.72
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Central Health Plan Commercial |
$4.08
|
| Rate for Payer: Cigna of CA HMO |
$3.57
|
| Rate for Payer: Cigna of CA PPO |
$3.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.04
|
| Rate for Payer: Galaxy Health WC |
$4.34
|
| Rate for Payer: Global Benefits Group Commercial |
$3.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: Multiplan Commercial |
$3.82
|
| Rate for Payer: Networks By Design Commercial |
$3.32
|
| Rate for Payer: Prime Health Services Commercial |
$4.34
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
IP
|
$2.00
|
|
|
Service Code
|
NDC 0378-9070-93
|
| Hospital Charge Code |
1712347
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Blue Shield of California Commercial |
$1.50
|
| Rate for Payer: Blue Shield of California EPN |
$1.07
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$1.60
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: Networks By Design Commercial |
$1.30
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
IP
|
$16.22
|
|
|
Service Code
|
NDC 0781-7304-58
|
| Hospital Charge Code |
1712347
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$14.60 |
| Rate for Payer: Blue Shield of California Commercial |
$12.16
|
| Rate for Payer: Blue Shield of California EPN |
$8.66
|
| Rate for Payer: Cash Price |
$7.30
|
| Rate for Payer: Central Health Plan Commercial |
$12.98
|
| Rate for Payer: Cigna of CA HMO |
$11.35
|
| Rate for Payer: Cigna of CA PPO |
$11.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.49
|
| Rate for Payer: Galaxy Health WC |
$13.79
|
| Rate for Payer: Global Benefits Group Commercial |
$9.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.24
|
| Rate for Payer: Multiplan Commercial |
$12.16
|
| Rate for Payer: Networks By Design Commercial |
$10.54
|
| Rate for Payer: Prime Health Services Commercial |
$13.79
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
OP
|
$16.22
|
|
|
Service Code
|
NDC 0781-7304-31
|
| Hospital Charge Code |
1712347
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$14.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.85
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.79
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.58
|
| Rate for Payer: BCBS Transplant Transplant |
$9.73
|
| Rate for Payer: Blue Shield of California Commercial |
$10.20
|
| Rate for Payer: Blue Shield of California EPN |
$7.93
|
| Rate for Payer: Cash Price |
$7.30
|
| Rate for Payer: Central Health Plan Commercial |
$12.98
|
| Rate for Payer: Cigna of CA HMO |
$11.35
|
| Rate for Payer: Cigna of CA PPO |
$11.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.49
|
| Rate for Payer: Galaxy Health WC |
$13.79
|
| Rate for Payer: Global Benefits Group Commercial |
$9.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.16
|
| Rate for Payer: IEHP medi-cal |
$5.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.24
|
| Rate for Payer: Multiplan Commercial |
$12.16
|
| Rate for Payer: Networks By Design Commercial |
$10.54
|
| Rate for Payer: Prime Health Services Commercial |
$13.79
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.73
|
| Rate for Payer: Riverside University Health MISP |
$6.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.11
|
| Rate for Payer: United Healthcare All Other HMO |
$8.11
|
| Rate for Payer: United Healthcare HMO Rider |
$8.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.79
|
| Rate for Payer: Vantage Medical Group Senior |
$13.79
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
IP
|
$16.22
|
|
|
Service Code
|
NDC 0781-7304-31
|
| Hospital Charge Code |
1712347
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$14.60 |
| Rate for Payer: Blue Shield of California Commercial |
$12.16
|
| Rate for Payer: Blue Shield of California EPN |
$8.66
|
| Rate for Payer: Cash Price |
$7.30
|
| Rate for Payer: Central Health Plan Commercial |
$12.98
|
| Rate for Payer: Cigna of CA HMO |
$11.35
|
| Rate for Payer: Cigna of CA PPO |
$11.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.49
|
| Rate for Payer: Galaxy Health WC |
$13.79
|
| Rate for Payer: Global Benefits Group Commercial |
$9.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.24
|
| Rate for Payer: Multiplan Commercial |
$12.16
|
| Rate for Payer: Networks By Design Commercial |
$10.54
|
| Rate for Payer: Prime Health Services Commercial |
$13.79
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
OP
|
$2.00
|
|
|
Service Code
|
NDC 0378-9070-93
|
| Hospital Charge Code |
1712347
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.18
|
| Rate for Payer: BCBS Transplant Transplant |
$1.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.98
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$1.60
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.50
|
| Rate for Payer: IEHP medi-cal |
$0.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: Networks By Design Commercial |
$1.30
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.20
|
| Rate for Payer: Riverside University Health MISP |
$0.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.20
|
| 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 Medi-Cal |
$1.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1.70
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
IP
|
$5.10
|
|
|
Service Code
|
NDC 70710-1196-7
|
| Hospital Charge Code |
1712347
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Blue Shield of California Commercial |
$3.82
|
| Rate for Payer: Blue Shield of California EPN |
$2.72
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Central Health Plan Commercial |
$4.08
|
| Rate for Payer: Cigna of CA HMO |
$3.57
|
| Rate for Payer: Cigna of CA PPO |
$3.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.04
|
| Rate for Payer: Galaxy Health WC |
$4.34
|
| Rate for Payer: Global Benefits Group Commercial |
$3.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: Multiplan Commercial |
$3.82
|
| Rate for Payer: Networks By Design Commercial |
$3.32
|
| Rate for Payer: Prime Health Services Commercial |
$4.34
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
OP
|
$2.00
|
|
|
Service Code
|
NDC 0378-9070-16
|
| Hospital Charge Code |
1712347
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.18
|
| Rate for Payer: BCBS Transplant Transplant |
$1.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.98
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$1.60
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.50
|
| Rate for Payer: IEHP medi-cal |
$0.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: Networks By Design Commercial |
$1.30
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.20
|
| Rate for Payer: Riverside University Health MISP |
$0.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.20
|
| 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 Medi-Cal |
$1.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1.70
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
IP
|
$2.00
|
|
|
Service Code
|
NDC 0378-9070-16
|
| Hospital Charge Code |
1712347
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Blue Shield of California Commercial |
$1.50
|
| Rate for Payer: Blue Shield of California EPN |
$1.07
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$1.60
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: Networks By Design Commercial |
$1.30
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
OP
|
$16.22
|
|
|
Service Code
|
NDC 0781-7304-58
|
| Hospital Charge Code |
1712347
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$14.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.85
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.79
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.58
|
| Rate for Payer: BCBS Transplant Transplant |
$9.73
|
| Rate for Payer: Blue Shield of California Commercial |
$10.20
|
| Rate for Payer: Blue Shield of California EPN |
$7.93
|
| Rate for Payer: Cash Price |
$7.30
|
| Rate for Payer: Central Health Plan Commercial |
$12.98
|
| Rate for Payer: Cigna of CA HMO |
$11.35
|
| Rate for Payer: Cigna of CA PPO |
$11.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.49
|
| Rate for Payer: Galaxy Health WC |
$13.79
|
| Rate for Payer: Global Benefits Group Commercial |
$9.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.16
|
| Rate for Payer: IEHP medi-cal |
$5.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.24
|
| Rate for Payer: Multiplan Commercial |
$12.16
|
| Rate for Payer: Networks By Design Commercial |
$10.54
|
| Rate for Payer: Prime Health Services Commercial |
$13.79
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.73
|
| Rate for Payer: Riverside University Health MISP |
$6.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.11
|
| Rate for Payer: United Healthcare All Other HMO |
$8.11
|
| Rate for Payer: United Healthcare HMO Rider |
$8.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.79
|
| Rate for Payer: Vantage Medical Group Senior |
$13.79
|
|
|
RIZATRIPTAN 10 MG DISINTEGRATING TABLET [27630]
|
Facility
OP
|
$1.95
|
|
|
Service Code
|
NDC 68462-468-06
|
| Hospital Charge Code |
ERX27630
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.15
|
| Rate for Payer: BCBS Transplant Transplant |
$1.17
|
| Rate for Payer: Blue Shield of California Commercial |
$1.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.95
|
| Rate for Payer: Cash Price |
$0.88
|
| Rate for Payer: Central Health Plan Commercial |
$1.56
|
| Rate for Payer: Cigna of CA HMO |
$1.36
|
| Rate for Payer: Cigna of CA PPO |
$1.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.78
|
| Rate for Payer: Galaxy Health WC |
$1.66
|
| Rate for Payer: Global Benefits Group Commercial |
$1.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.76
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.46
|
| Rate for Payer: IEHP medi-cal |
$0.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$1.46
|
| Rate for Payer: Networks By Design Commercial |
$1.27
|
| Rate for Payer: Prime Health Services Commercial |
$1.66
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.17
|
| Rate for Payer: Riverside University Health MISP |
$0.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.98
|
| Rate for Payer: United Healthcare All Other HMO |
$0.98
|
| Rate for Payer: United Healthcare HMO Rider |
$0.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.66
|
| Rate for Payer: Vantage Medical Group Senior |
$1.66
|
|
|
RIZATRIPTAN 10 MG DISINTEGRATING TABLET [27630]
|
Facility
IP
|
$1.95
|
|
|
Service Code
|
NDC 68462-468-06
|
| Hospital Charge Code |
ERX27630
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.76 |
| Rate for Payer: Blue Shield of California Commercial |
$1.46
|
| Rate for Payer: Blue Shield of California EPN |
$1.04
|
| Rate for Payer: Cash Price |
$0.88
|
| Rate for Payer: Central Health Plan Commercial |
$1.56
|
| Rate for Payer: Cigna of CA HMO |
$1.36
|
| Rate for Payer: Cigna of CA PPO |
$1.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.78
|
| Rate for Payer: Galaxy Health WC |
$1.66
|
| Rate for Payer: Global Benefits Group Commercial |
$1.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$1.46
|
| Rate for Payer: Networks By Design Commercial |
$1.27
|
| Rate for Payer: Prime Health Services Commercial |
$1.66
|
|
