|
RIFAXIMIN 550 MG TABLET [104604]
|
Facility
IP
|
$63.20
|
|
|
Service Code
|
NDC 65649-303-03
|
| Hospital Charge Code |
1712455
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.64 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$47.40
|
| Rate for Payer: Blue Shield of California EPN |
$33.75
|
| Rate for Payer: Cash Price |
$28.44
|
| Rate for Payer: Cash Price |
$28.44
|
| Rate for Payer: Central Health Plan Commercial |
$50.56
|
| Rate for Payer: Cigna of CA HMO |
$44.24
|
| Rate for Payer: Cigna of CA PPO |
$44.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.28
|
| Rate for Payer: Galaxy Health WC |
$53.72
|
| Rate for Payer: Global Benefits Group Commercial |
$37.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$56.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.64
|
| Rate for Payer: Multiplan Commercial |
$47.40
|
| Rate for Payer: Networks By Design Commercial |
$41.08
|
| Rate for Payer: Prime Health Services Commercial |
$53.72
|
|
|
RIFAXIMIN 550 MG TABLET [104604]
|
Facility
OP
|
$63.20
|
|
|
Service Code
|
NDC 65649-303-03
|
| Hospital Charge Code |
1712455
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.64 |
| Max. Negotiated Rate |
$56.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$38.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$53.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$34.76
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$34.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$30.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.34
|
| Rate for Payer: BCBS Transplant Transplant |
$37.92
|
| Rate for Payer: Blue Shield of California Commercial |
$39.75
|
| Rate for Payer: Blue Shield of California EPN |
$30.90
|
| Rate for Payer: Cash Price |
$28.44
|
| Rate for Payer: Central Health Plan Commercial |
$50.56
|
| Rate for Payer: Cigna of CA HMO |
$44.24
|
| Rate for Payer: Cigna of CA PPO |
$44.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.28
|
| Rate for Payer: Galaxy Health WC |
$53.72
|
| Rate for Payer: Global Benefits Group Commercial |
$37.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$56.88
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$47.40
|
| Rate for Payer: IEHP medi-cal |
$22.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.64
|
| Rate for Payer: Multiplan Commercial |
$47.40
|
| Rate for Payer: Networks By Design Commercial |
$41.08
|
| Rate for Payer: Prime Health Services Commercial |
$53.72
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$37.92
|
| Rate for Payer: Riverside University Health MISP |
$25.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.60
|
| Rate for Payer: United Healthcare All Other HMO |
$31.60
|
| Rate for Payer: United Healthcare HMO Rider |
$31.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.72
|
| Rate for Payer: Vantage Medical Group Senior |
$53.72
|
|
|
RIFAXIMIN ORAL SUSPENSION COMPOUND 20 MG/ML [4080332]
|
Facility
OP
|
$1.33
|
|
|
Service Code
|
NDC 9994-0803-32
|
| Hospital Charge Code |
1715270
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.73
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.79
|
| Rate for Payer: BCBS Transplant Transplant |
$0.80
|
| Rate for Payer: Blue Shield of California Commercial |
$0.84
|
| Rate for Payer: Blue Shield of California EPN |
$0.65
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Central Health Plan Commercial |
$1.06
|
| Rate for Payer: Cigna of CA HMO |
$0.93
|
| Rate for Payer: Cigna of CA PPO |
$0.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.53
|
| Rate for Payer: Galaxy Health WC |
$1.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.00
|
| Rate for Payer: IEHP medi-cal |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$1.00
|
| Rate for Payer: Networks By Design Commercial |
$0.86
|
| Rate for Payer: Prime Health Services Commercial |
$1.13
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.80
|
| Rate for Payer: Riverside University Health MISP |
$0.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.67
|
| Rate for Payer: United Healthcare All Other HMO |
$0.67
|
| Rate for Payer: United Healthcare HMO Rider |
$0.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.13
|
| Rate for Payer: Vantage Medical Group Senior |
$1.13
|
|
|
RIFAXIMIN ORAL SUSPENSION COMPOUND 20 MG/ML [4080332]
|
Facility
IP
|
$1.33
|
|
|
Service Code
|
NDC 9994-0803-32
|
| Hospital Charge Code |
1715270
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.00
|
| Rate for Payer: Blue Shield of California EPN |
$0.71
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Central Health Plan Commercial |
$1.06
|
| Rate for Payer: Cigna of CA HMO |
$0.93
|
| Rate for Payer: Cigna of CA PPO |
$0.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.53
|
| Rate for Payer: Galaxy Health WC |
$1.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$1.00
|
| Rate for Payer: Networks By Design Commercial |
$0.86
|
| Rate for Payer: Prime Health Services Commercial |
$1.13
|
|
|
RILPIVIRINE HCL 25 MG TABLET [109909]
|
Facility
IP
|
$54.01
|
|
|
Service Code
|
NDC 59676-278-01
|
| Hospital Charge Code |
1712619
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$40.51
|
| Rate for Payer: Blue Shield of California EPN |
$28.84
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Central Health Plan Commercial |
$43.21
|
| Rate for Payer: Cigna of CA HMO |
$37.81
|
| Rate for Payer: Cigna of CA PPO |
$37.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: Galaxy Health WC |
$45.91
|
| Rate for Payer: Global Benefits Group Commercial |
$32.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Multiplan Commercial |
$40.51
|
| Rate for Payer: Networks By Design Commercial |
$35.11
|
| Rate for Payer: Prime Health Services Commercial |
$45.91
|
|
|
RILPIVIRINE HCL 25 MG TABLET [109909]
|
Facility
OP
|
$54.01
|
|
|
Service Code
|
NDC 59676-278-01
|
| Hospital Charge Code |
1712619
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$48.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$45.91
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$29.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$29.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.91
|
| Rate for Payer: BCBS Transplant Transplant |
$32.41
|
| Rate for Payer: Blue Shield of California Commercial |
$33.97
|
| Rate for Payer: Blue Shield of California EPN |
$26.41
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Central Health Plan Commercial |
$43.21
|
| Rate for Payer: Cigna of CA HMO |
$37.81
|
| Rate for Payer: Cigna of CA PPO |
$37.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.60
|
| Rate for Payer: Galaxy Health WC |
$45.91
|
| Rate for Payer: Global Benefits Group Commercial |
$32.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.61
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$40.51
|
| Rate for Payer: IEHP medi-cal |
$18.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Multiplan Commercial |
$40.51
|
| Rate for Payer: Networks By Design Commercial |
$35.11
|
| Rate for Payer: Prime Health Services Commercial |
$45.91
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$32.41
|
| Rate for Payer: Riverside University Health MISP |
$21.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27.00
|
| Rate for Payer: United Healthcare HMO Rider |
$27.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.91
|
| Rate for Payer: Vantage Medical Group Senior |
$45.91
|
|
|
RILUZOLE 50 MG TABLET [16124]
|
Facility
IP
|
$0.80
|
|
|
Service Code
|
NDC 67877-286-60
|
| Hospital Charge Code |
1712269
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.60
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Central Health Plan Commercial |
$0.64
|
| Rate for Payer: Cigna of CA HMO |
$0.56
|
| Rate for Payer: Cigna of CA PPO |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.68
|
| Rate for Payer: Global Benefits Group Commercial |
$0.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.60
|
| Rate for Payer: Networks By Design Commercial |
$0.52
|
| Rate for Payer: Prime Health Services Commercial |
$0.68
|
|
|
RILUZOLE 50 MG TABLET [16124]
|
Facility
OP
|
$1.58
|
|
|
Service Code
|
NDC 62756-538-86
|
| Hospital Charge Code |
1712269
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.96
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.93
|
| Rate for Payer: BCBS Transplant Transplant |
$0.95
|
| Rate for Payer: Blue Shield of California Commercial |
$0.99
|
| Rate for Payer: Blue Shield of California EPN |
$0.77
|
| Rate for Payer: Cash Price |
$0.71
|
| Rate for Payer: Central Health Plan Commercial |
$1.26
|
| Rate for Payer: Cigna of CA HMO |
$1.11
|
| Rate for Payer: Cigna of CA PPO |
$1.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.63
|
| Rate for Payer: Galaxy Health WC |
$1.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.42
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.18
|
| Rate for Payer: IEHP medi-cal |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$1.18
|
| Rate for Payer: Networks By Design Commercial |
$1.03
|
| Rate for Payer: Prime Health Services Commercial |
$1.34
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.95
|
| Rate for Payer: Riverside University Health MISP |
$0.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.79
|
| Rate for Payer: United Healthcare All Other HMO |
$0.79
|
| Rate for Payer: United Healthcare HMO Rider |
$0.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1.34
|
|
|
RILUZOLE 50 MG TABLET [16124]
|
Facility
IP
|
$1.58
|
|
|
Service Code
|
NDC 68462-381-60
|
| Hospital Charge Code |
1712269
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.84
|
| Rate for Payer: Cash Price |
$0.71
|
| Rate for Payer: Cash Price |
$0.71
|
| Rate for Payer: Central Health Plan Commercial |
$1.26
|
| Rate for Payer: Cigna of CA HMO |
$1.11
|
| Rate for Payer: Cigna of CA PPO |
$1.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.63
|
| Rate for Payer: Galaxy Health WC |
$1.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$1.18
|
| Rate for Payer: Networks By Design Commercial |
$1.03
|
| Rate for Payer: Prime Health Services Commercial |
$1.34
|
|
|
RILUZOLE 50 MG TABLET [16124]
|
Facility
OP
|
$0.80
|
|
|
Service Code
|
NDC 67877-286-60
|
| Hospital Charge Code |
1712269
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.47
|
| Rate for Payer: BCBS Transplant Transplant |
$0.48
|
| Rate for Payer: Blue Shield of California Commercial |
$0.50
|
| Rate for Payer: Blue Shield of California EPN |
$0.39
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Central Health Plan Commercial |
$0.64
|
| Rate for Payer: Cigna of CA HMO |
$0.56
|
| Rate for Payer: Cigna of CA PPO |
$0.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.68
|
| Rate for Payer: Global Benefits Group Commercial |
$0.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.72
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.60
|
| Rate for Payer: IEHP medi-cal |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.60
|
| Rate for Payer: Networks By Design Commercial |
$0.52
|
| Rate for Payer: Prime Health Services Commercial |
$0.68
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.48
|
| Rate for Payer: Riverside University Health MISP |
$0.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO |
$0.40
|
| Rate for Payer: United Healthcare HMO Rider |
$0.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.68
|
| Rate for Payer: Vantage Medical Group Senior |
$0.68
|
|
|
RILUZOLE 50 MG TABLET [16124]
|
Facility
OP
|
$1.58
|
|
|
Service Code
|
NDC 68462-381-60
|
| Hospital Charge Code |
1712269
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.96
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.93
|
| Rate for Payer: BCBS Transplant Transplant |
$0.95
|
| Rate for Payer: Blue Shield of California Commercial |
$0.99
|
| Rate for Payer: Blue Shield of California EPN |
$0.77
|
| Rate for Payer: Cash Price |
$0.71
|
| Rate for Payer: Central Health Plan Commercial |
$1.26
|
| Rate for Payer: Cigna of CA HMO |
$1.11
|
| Rate for Payer: Cigna of CA PPO |
$1.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.63
|
| Rate for Payer: Galaxy Health WC |
$1.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.42
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.18
|
| Rate for Payer: IEHP medi-cal |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$1.18
|
| Rate for Payer: Networks By Design Commercial |
$1.03
|
| Rate for Payer: Prime Health Services Commercial |
$1.34
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.95
|
| Rate for Payer: Riverside University Health MISP |
$0.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.79
|
| Rate for Payer: United Healthcare All Other HMO |
$0.79
|
| Rate for Payer: United Healthcare HMO Rider |
$0.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1.34
|
|
|
RILUZOLE 50 MG TABLET [16124]
|
Facility
IP
|
$1.58
|
|
|
Service Code
|
NDC 62756-538-86
|
| Hospital Charge Code |
1712269
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.84
|
| Rate for Payer: Cash Price |
$0.71
|
| Rate for Payer: Cash Price |
$0.71
|
| Rate for Payer: Central Health Plan Commercial |
$1.26
|
| Rate for Payer: Cigna of CA HMO |
$1.11
|
| Rate for Payer: Cigna of CA PPO |
$1.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.63
|
| Rate for Payer: Galaxy Health WC |
$1.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$1.18
|
| Rate for Payer: Networks By Design Commercial |
$1.03
|
| Rate for Payer: Prime Health Services Commercial |
$1.34
|
|
|
RIMABOTULINUMTOXINB 2,500 UNIT/0.5 ML INTRAMUSCULAR SOLUTION [108078]
|
Facility
OP
|
$747.14
|
|
|
Service Code
|
CPT J0587
|
| Hospital Charge Code |
NDG108078
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.03 |
| Max. Negotiated Rate |
$672.43 |
| Rate for Payer: Adventist Health Medi-Cal |
$13.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$80.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.68
|
| Rate for Payer: BCBS Transplant Transplant |
$448.28
|
| Rate for Payer: Blue Shield of California Commercial |
$15.33
|
| Rate for Payer: Blue Shield of California EPN |
$13.94
|
| Rate for Payer: Caremore Medicare Advantage |
$13.03
|
| Rate for Payer: Cash Price |
$336.21
|
| Rate for Payer: Cash Price |
$336.21
|
| Rate for Payer: Central Health Plan Commercial |
$597.71
|
| Rate for Payer: Cigna of CA HMO |
$523.00
|
| Rate for Payer: Cigna of CA PPO |
$523.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.59
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.03
|
| Rate for Payer: Galaxy Health WC |
$635.07
|
| Rate for Payer: Global Benefits Group Commercial |
$448.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$672.43
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$560.36
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.36
|
| Rate for Payer: IEHP medi-cal |
$21.49
|
| Rate for Payer: IEHP Medicare Advantage |
$13.03
|
| Rate for Payer: Innovage PACE Commercial |
$19.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$498.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.45
|
| Rate for Payer: Multiplan Commercial |
$560.36
|
| Rate for Payer: Networks By Design Commercial |
$373.57
|
| Rate for Payer: Prime Health Services Commercial |
$635.07
|
| Rate for Payer: Prime Health Services Medicare |
$13.81
|
| Rate for Payer: Riverside University Health MISP |
$14.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$448.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$448.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$373.57
|
| Rate for Payer: United Healthcare All Other HMO |
$373.57
|
| Rate for Payer: United Healthcare HMO Rider |
$373.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$373.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Vantage Medical Group Senior |
$13.03
|
|
|
RIMABOTULINUMTOXINB 2,500 UNIT/0.5 ML INTRAMUSCULAR SOLUTION [108078]
|
Facility
IP
|
$747.14
|
|
|
Service Code
|
CPT J0587
|
| Hospital Charge Code |
NDG108078
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$149.43 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$560.36
|
| Rate for Payer: Blue Shield of California EPN |
$398.97
|
| Rate for Payer: Cash Price |
$336.21
|
| Rate for Payer: Cash Price |
$336.21
|
| Rate for Payer: Central Health Plan Commercial |
$597.71
|
| Rate for Payer: Cigna of CA HMO |
$523.00
|
| Rate for Payer: Cigna of CA PPO |
$523.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$298.86
|
| Rate for Payer: Galaxy Health WC |
$635.07
|
| Rate for Payer: Global Benefits Group Commercial |
$448.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$672.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$498.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.43
|
| Rate for Payer: Multiplan Commercial |
$560.36
|
| Rate for Payer: Networks By Design Commercial |
$373.57
|
| Rate for Payer: Prime Health Services Commercial |
$635.07
|
|
|
RINGER'S INTRAVENOUS SOLUTION [11295]
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
NDC 0264-7780-00
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: BCBS Transplant Transplant |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.01
|
| Rate for Payer: IEHP medi-cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Riverside University Health MISP |
$0.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
RINGER'S INTRAVENOUS SOLUTION [11295]
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
NDC 0264-7780-00
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
RIOCIGUAT 0.5 MG TABLET [203879]
|
Facility
OP
|
$164.16
|
|
|
Service Code
|
NDC 50419-250-01
|
| Hospital Charge Code |
ERX203879
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$32.83 |
| Max. Negotiated Rate |
$147.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$99.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$139.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$90.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$90.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.99
|
| Rate for Payer: BCBS Transplant Transplant |
$98.50
|
| Rate for Payer: Blue Shield of California Commercial |
$103.26
|
| Rate for Payer: Blue Shield of California EPN |
$80.27
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Central Health Plan Commercial |
$131.33
|
| Rate for Payer: Cigna of CA HMO |
$114.91
|
| Rate for Payer: Cigna of CA PPO |
$114.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$139.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$65.66
|
| Rate for Payer: Galaxy Health WC |
$139.54
|
| Rate for Payer: Global Benefits Group Commercial |
$98.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$147.74
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$123.12
|
| Rate for Payer: IEHP medi-cal |
$57.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.83
|
| Rate for Payer: Multiplan Commercial |
$123.12
|
| Rate for Payer: Networks By Design Commercial |
$106.70
|
| Rate for Payer: Prime Health Services Commercial |
$139.54
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$98.50
|
| Rate for Payer: Riverside University Health MISP |
$65.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$98.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$98.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.08
|
| Rate for Payer: United Healthcare All Other HMO |
$82.08
|
| Rate for Payer: United Healthcare HMO Rider |
$82.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$139.54
|
| Rate for Payer: Vantage Medical Group Senior |
$139.54
|
|
|
RIOCIGUAT 0.5 MG TABLET [203879]
|
Facility
OP
|
$164.16
|
|
|
Service Code
|
NDC 50419-250-91
|
| Hospital Charge Code |
ERX203879
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$32.83 |
| Max. Negotiated Rate |
$147.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$99.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$139.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$90.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$90.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.99
|
| Rate for Payer: BCBS Transplant Transplant |
$98.50
|
| Rate for Payer: Blue Shield of California Commercial |
$103.26
|
| Rate for Payer: Blue Shield of California EPN |
$80.27
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Central Health Plan Commercial |
$131.33
|
| Rate for Payer: Cigna of CA HMO |
$114.91
|
| Rate for Payer: Cigna of CA PPO |
$114.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$139.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$65.66
|
| Rate for Payer: Galaxy Health WC |
$139.54
|
| Rate for Payer: Global Benefits Group Commercial |
$98.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$147.74
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$123.12
|
| Rate for Payer: IEHP medi-cal |
$57.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.83
|
| Rate for Payer: Multiplan Commercial |
$123.12
|
| Rate for Payer: Networks By Design Commercial |
$106.70
|
| Rate for Payer: Prime Health Services Commercial |
$139.54
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$98.50
|
| Rate for Payer: Riverside University Health MISP |
$65.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$98.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$98.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.08
|
| Rate for Payer: United Healthcare All Other HMO |
$82.08
|
| Rate for Payer: United Healthcare HMO Rider |
$82.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$139.54
|
| Rate for Payer: Vantage Medical Group Senior |
$139.54
|
|
|
RIOCIGUAT 0.5 MG TABLET [203879]
|
Facility
IP
|
$164.16
|
|
|
Service Code
|
NDC 50419-250-01
|
| Hospital Charge Code |
ERX203879
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$32.83 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$123.12
|
| Rate for Payer: Blue Shield of California EPN |
$87.66
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Central Health Plan Commercial |
$131.33
|
| Rate for Payer: Cigna of CA HMO |
$114.91
|
| Rate for Payer: Cigna of CA PPO |
$114.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.66
|
| Rate for Payer: Galaxy Health WC |
$139.54
|
| Rate for Payer: Global Benefits Group Commercial |
$98.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$147.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.83
|
| Rate for Payer: Multiplan Commercial |
$123.12
|
| Rate for Payer: Networks By Design Commercial |
$106.70
|
| Rate for Payer: Prime Health Services Commercial |
$139.54
|
|
|
RIOCIGUAT 0.5 MG TABLET [203879]
|
Facility
IP
|
$164.16
|
|
|
Service Code
|
NDC 50419-250-91
|
| Hospital Charge Code |
ERX203879
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$32.83 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$123.12
|
| Rate for Payer: Blue Shield of California EPN |
$87.66
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Central Health Plan Commercial |
$131.33
|
| Rate for Payer: Cigna of CA HMO |
$114.91
|
| Rate for Payer: Cigna of CA PPO |
$114.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.66
|
| Rate for Payer: Galaxy Health WC |
$139.54
|
| Rate for Payer: Global Benefits Group Commercial |
$98.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$147.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.83
|
| Rate for Payer: Multiplan Commercial |
$123.12
|
| Rate for Payer: Networks By Design Commercial |
$106.70
|
| Rate for Payer: Prime Health Services Commercial |
$139.54
|
|
|
RIOCIGUAT 1 MG TABLET [203880]
|
Facility
IP
|
$164.16
|
|
|
Service Code
|
NDC 50419-251-91
|
| Hospital Charge Code |
ERX203880
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$32.83 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$123.12
|
| Rate for Payer: Blue Shield of California EPN |
$87.66
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Central Health Plan Commercial |
$131.33
|
| Rate for Payer: Cigna of CA HMO |
$114.91
|
| Rate for Payer: Cigna of CA PPO |
$114.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.66
|
| Rate for Payer: Galaxy Health WC |
$139.54
|
| Rate for Payer: Global Benefits Group Commercial |
$98.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$147.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.83
|
| Rate for Payer: Multiplan Commercial |
$123.12
|
| Rate for Payer: Networks By Design Commercial |
$106.70
|
| Rate for Payer: Prime Health Services Commercial |
$139.54
|
|
|
RIOCIGUAT 1 MG TABLET [203880]
|
Facility
OP
|
$164.16
|
|
|
Service Code
|
NDC 50419-251-91
|
| Hospital Charge Code |
ERX203880
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$32.83 |
| Max. Negotiated Rate |
$147.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$99.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$139.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$90.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$90.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.99
|
| Rate for Payer: BCBS Transplant Transplant |
$98.50
|
| Rate for Payer: Blue Shield of California Commercial |
$103.26
|
| Rate for Payer: Blue Shield of California EPN |
$80.27
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Central Health Plan Commercial |
$131.33
|
| Rate for Payer: Cigna of CA HMO |
$114.91
|
| Rate for Payer: Cigna of CA PPO |
$114.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$139.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$65.66
|
| Rate for Payer: Galaxy Health WC |
$139.54
|
| Rate for Payer: Global Benefits Group Commercial |
$98.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$147.74
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$123.12
|
| Rate for Payer: IEHP medi-cal |
$57.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.83
|
| Rate for Payer: Multiplan Commercial |
$123.12
|
| Rate for Payer: Networks By Design Commercial |
$106.70
|
| Rate for Payer: Prime Health Services Commercial |
$139.54
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$98.50
|
| Rate for Payer: Riverside University Health MISP |
$65.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$98.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$98.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.08
|
| Rate for Payer: United Healthcare All Other HMO |
$82.08
|
| Rate for Payer: United Healthcare HMO Rider |
$82.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$139.54
|
| Rate for Payer: Vantage Medical Group Senior |
$139.54
|
|
|
RIOCIGUAT 1 MG TABLET [203880]
|
Facility
OP
|
$164.16
|
|
|
Service Code
|
NDC 50419-251-01
|
| Hospital Charge Code |
ERX203880
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$32.83 |
| Max. Negotiated Rate |
$147.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$99.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$139.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$90.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$90.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.99
|
| Rate for Payer: BCBS Transplant Transplant |
$98.50
|
| Rate for Payer: Blue Shield of California Commercial |
$103.26
|
| Rate for Payer: Blue Shield of California EPN |
$80.27
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Central Health Plan Commercial |
$131.33
|
| Rate for Payer: Cigna of CA HMO |
$114.91
|
| Rate for Payer: Cigna of CA PPO |
$114.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$139.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$65.66
|
| Rate for Payer: Galaxy Health WC |
$139.54
|
| Rate for Payer: Global Benefits Group Commercial |
$98.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$147.74
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$123.12
|
| Rate for Payer: IEHP medi-cal |
$57.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.83
|
| Rate for Payer: Multiplan Commercial |
$123.12
|
| Rate for Payer: Networks By Design Commercial |
$106.70
|
| Rate for Payer: Prime Health Services Commercial |
$139.54
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$98.50
|
| Rate for Payer: Riverside University Health MISP |
$65.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$98.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$98.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.08
|
| Rate for Payer: United Healthcare All Other HMO |
$82.08
|
| Rate for Payer: United Healthcare HMO Rider |
$82.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$139.54
|
| Rate for Payer: Vantage Medical Group Senior |
$139.54
|
|
|
RIOCIGUAT 1 MG TABLET [203880]
|
Facility
IP
|
$164.16
|
|
|
Service Code
|
NDC 50419-251-01
|
| Hospital Charge Code |
ERX203880
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$32.83 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$123.12
|
| Rate for Payer: Blue Shield of California EPN |
$87.66
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Central Health Plan Commercial |
$131.33
|
| Rate for Payer: Cigna of CA HMO |
$114.91
|
| Rate for Payer: Cigna of CA PPO |
$114.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.66
|
| Rate for Payer: Galaxy Health WC |
$139.54
|
| Rate for Payer: Global Benefits Group Commercial |
$98.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$147.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.83
|
| Rate for Payer: Multiplan Commercial |
$123.12
|
| Rate for Payer: Networks By Design Commercial |
$106.70
|
| Rate for Payer: Prime Health Services Commercial |
$139.54
|
|
|
RIOCIGUAT 2.5 MG TABLET [203883]
|
Facility
IP
|
$164.16
|
|
|
Service Code
|
NDC 50419-254-01
|
| Hospital Charge Code |
ERX203883
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$32.83 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$123.12
|
| Rate for Payer: Blue Shield of California EPN |
$87.66
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Central Health Plan Commercial |
$131.33
|
| Rate for Payer: Cigna of CA HMO |
$114.91
|
| Rate for Payer: Cigna of CA PPO |
$114.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.66
|
| Rate for Payer: Galaxy Health WC |
$139.54
|
| Rate for Payer: Global Benefits Group Commercial |
$98.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$147.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.83
|
| Rate for Payer: Multiplan Commercial |
$123.12
|
| Rate for Payer: Networks By Design Commercial |
$106.70
|
| Rate for Payer: Prime Health Services Commercial |
$139.54
|
|
