|
RILUZOLE 50 MG TABLET [16124]
|
Facility
|
IP
|
$1.58
|
|
|
Service Code
|
NDC 68462-381-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.19 |
| Rate for Payer: Adventist Health Commercial |
$0.32
|
| Rate for Payer: Cash Price |
$0.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.07
|
| Rate for Payer: Heritage Provider Network Senior |
$1.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.19
|
|
|
RILUZOLE 50 MG TABLET [16124]
|
Facility
|
OP
|
$0.80
|
|
|
Service Code
|
NDC 67877-286-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.60
|
| Rate for Payer: Blue Shield of California Commercial |
$0.49
|
| Rate for Payer: Blue Shield of California EPN |
$0.39
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.68
|
| Rate for Payer: Dignity Health Senior |
$0.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.50
|
| Rate for Payer: Heritage Provider Network Senior |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$0.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.32
|
| Rate for Payer: TriValley Medical Group Senior |
$0.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.68
|
| Rate for Payer: Vantage Medical Group Senior |
$0.68
|
|
|
RILUZOLE 50 MG TABLET [16124]
|
Facility
|
IP
|
$1.58
|
|
|
Service Code
|
NDC 62756-538-86
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.19 |
| Rate for Payer: Adventist Health Commercial |
$0.32
|
| Rate for Payer: Cash Price |
$0.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.07
|
| Rate for Payer: Heritage Provider Network Senior |
$1.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.19
|
|
|
RILUZOLE 50 MG TABLET [16124]
|
Facility
|
OP
|
$1.58
|
|
|
Service Code
|
NDC 62756-538-86
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Adventist Health Commercial |
$0.32
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.96
|
| Rate for Payer: Blue Shield of California EPN |
$0.77
|
| Rate for Payer: Cash Price |
$0.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.34
|
| Rate for Payer: Dignity Health Senior |
$1.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.98
|
| Rate for Payer: Heritage Provider Network Senior |
$0.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.11
|
| Rate for Payer: Multiplan Commercial |
$1.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.63
|
| Rate for Payer: TriValley Medical Group Senior |
$0.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1.34
|
|
|
RIMABOTULINUMTOXINB 2,500 UNIT/0.5 ML INTRAMUSCULAR SOLUTION [108078]
|
Facility
|
OP
|
$762.10
|
|
|
Service Code
|
HCPCS J0587
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.70 |
| Max. Negotiated Rate |
$571.58 |
| Rate for Payer: Adventist Health Commercial |
$152.42
|
| Rate for Payer: Aetna of CA Gatekeeper |
$407.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$523.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.89
|
| Rate for Payer: Blue Shield of California Commercial |
$12.70
|
| Rate for Payer: Blue Shield of California EPN |
$12.70
|
| Rate for Payer: Cash Price |
$419.15
|
| Rate for Payer: Cash Price |
$419.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$350.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.68
|
| Rate for Payer: Dignity Health Senior |
$14.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$487.74
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$352.85
|
| Rate for Payer: Heritage Provider Network Senior |
$352.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$363.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.81
|
| Rate for Payer: Multiplan Commercial |
$571.58
|
| Rate for Payer: TriValley Medical Group Commercial |
$304.84
|
| Rate for Payer: TriValley Medical Group Senior |
$304.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$275.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$252.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.68
|
| Rate for Payer: Vantage Medical Group Senior |
$14.68
|
|
|
RIMABOTULINUMTOXINB 2,500 UNIT/0.5 ML INTRAMUSCULAR SOLUTION [108078]
|
Facility
|
IP
|
$762.10
|
|
|
Service Code
|
HCPCS J0587
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$137.94 |
| Max. Negotiated Rate |
$571.58 |
| Rate for Payer: Adventist Health Commercial |
$152.42
|
| Rate for Payer: Cash Price |
$419.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$350.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$352.85
|
| Rate for Payer: Heritage Provider Network Senior |
$352.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.53
|
| Rate for Payer: Multiplan Commercial |
$571.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$275.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$252.33
|
|
|
RINGER'S INTRAVENOUS SOLUTION [11295]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 0264-7780-00
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
RINGER'S INTRAVENOUS SOLUTION [11295]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 0264-7780-00
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.00
|
| Rate for Payer: TriValley Medical Group Senior |
$0.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
RIOCIGUAT 0.5 MG TABLET [203879]
|
Facility
|
IP
|
$188.14
|
|
|
Service Code
|
NDC 50419-250-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$34.05 |
| Max. Negotiated Rate |
$141.10 |
| Rate for Payer: Adventist Health Commercial |
$37.63
|
| Rate for Payer: Cash Price |
$103.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$127.37
|
| Rate for Payer: Heritage Provider Network Senior |
$127.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.03
|
| Rate for Payer: Multiplan Commercial |
$141.10
|
|
|
RIOCIGUAT 0.5 MG TABLET [203879]
|
Facility
|
OP
|
$188.14
|
|
|
Service Code
|
NDC 50419-250-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$34.05 |
| Max. Negotiated Rate |
$159.92 |
| Rate for Payer: Adventist Health Commercial |
$37.63
|
| Rate for Payer: Aetna of CA Gatekeeper |
$100.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$129.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$159.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$141.10
|
| Rate for Payer: Blue Shield of California Commercial |
$114.77
|
| Rate for Payer: Blue Shield of California EPN |
$91.81
|
| Rate for Payer: Cash Price |
$103.47
|
| Rate for Payer: Cigna of CA HMO/PPO |
$122.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$159.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.92
|
| Rate for Payer: Dignity Health Senior |
$159.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$116.46
|
| Rate for Payer: Heritage Provider Network Senior |
$116.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$89.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$131.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$131.70
|
| Rate for Payer: Multiplan Commercial |
$141.10
|
| Rate for Payer: TriValley Medical Group Commercial |
$75.26
|
| Rate for Payer: TriValley Medical Group Senior |
$75.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$94.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$94.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$159.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.92
|
| Rate for Payer: Vantage Medical Group Senior |
$159.92
|
|
|
RIOCIGUAT 0.5 MG TABLET [203879]
|
Facility
|
IP
|
$188.14
|
|
|
Service Code
|
NDC 50419-250-91
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$34.05 |
| Max. Negotiated Rate |
$141.10 |
| Rate for Payer: Adventist Health Commercial |
$37.63
|
| Rate for Payer: Cash Price |
$103.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$127.37
|
| Rate for Payer: Heritage Provider Network Senior |
$127.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.03
|
| Rate for Payer: Multiplan Commercial |
$141.10
|
|
|
RIOCIGUAT 0.5 MG TABLET [203879]
|
Facility
|
OP
|
$188.14
|
|
|
Service Code
|
NDC 50419-250-91
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$34.05 |
| Max. Negotiated Rate |
$159.92 |
| Rate for Payer: Adventist Health Commercial |
$37.63
|
| Rate for Payer: Aetna of CA Gatekeeper |
$100.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$129.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$159.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$141.10
|
| Rate for Payer: Blue Shield of California Commercial |
$114.77
|
| Rate for Payer: Blue Shield of California EPN |
$91.81
|
| Rate for Payer: Cash Price |
$103.47
|
| Rate for Payer: Cigna of CA HMO/PPO |
$122.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$159.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.92
|
| Rate for Payer: Dignity Health Senior |
$159.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$116.46
|
| Rate for Payer: Heritage Provider Network Senior |
$116.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$89.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$131.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$131.70
|
| Rate for Payer: Multiplan Commercial |
$141.10
|
| Rate for Payer: TriValley Medical Group Commercial |
$75.26
|
| Rate for Payer: TriValley Medical Group Senior |
$75.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$94.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$94.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$159.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.92
|
| Rate for Payer: Vantage Medical Group Senior |
$159.92
|
|
|
RIOCIGUAT 1 MG TABLET [203880]
|
Facility
|
OP
|
$188.14
|
|
|
Service Code
|
NDC 50419-251-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$34.05 |
| Max. Negotiated Rate |
$159.92 |
| Rate for Payer: Adventist Health Commercial |
$37.63
|
| Rate for Payer: Aetna of CA Gatekeeper |
$100.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$129.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$159.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$141.10
|
| Rate for Payer: Blue Shield of California Commercial |
$114.77
|
| Rate for Payer: Blue Shield of California EPN |
$91.81
|
| Rate for Payer: Cash Price |
$103.47
|
| Rate for Payer: Cigna of CA HMO/PPO |
$122.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$159.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.92
|
| Rate for Payer: Dignity Health Senior |
$159.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$116.46
|
| Rate for Payer: Heritage Provider Network Senior |
$116.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$89.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$131.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$131.70
|
| Rate for Payer: Multiplan Commercial |
$141.10
|
| Rate for Payer: TriValley Medical Group Commercial |
$75.26
|
| Rate for Payer: TriValley Medical Group Senior |
$75.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$94.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$94.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$159.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.92
|
| Rate for Payer: Vantage Medical Group Senior |
$159.92
|
|
|
RIOCIGUAT 1 MG TABLET [203880]
|
Facility
|
IP
|
$188.14
|
|
|
Service Code
|
NDC 50419-251-91
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$34.05 |
| Max. Negotiated Rate |
$141.10 |
| Rate for Payer: Adventist Health Commercial |
$37.63
|
| Rate for Payer: Cash Price |
$103.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$127.37
|
| Rate for Payer: Heritage Provider Network Senior |
$127.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.03
|
| Rate for Payer: Multiplan Commercial |
$141.10
|
|
|
RIOCIGUAT 1 MG TABLET [203880]
|
Facility
|
OP
|
$188.14
|
|
|
Service Code
|
NDC 50419-251-91
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$34.05 |
| Max. Negotiated Rate |
$159.92 |
| Rate for Payer: Adventist Health Commercial |
$37.63
|
| Rate for Payer: Aetna of CA Gatekeeper |
$100.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$129.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$159.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$141.10
|
| Rate for Payer: Blue Shield of California Commercial |
$114.77
|
| Rate for Payer: Blue Shield of California EPN |
$91.81
|
| Rate for Payer: Cash Price |
$103.47
|
| Rate for Payer: Cigna of CA HMO/PPO |
$122.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$159.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.92
|
| Rate for Payer: Dignity Health Senior |
$159.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$116.46
|
| Rate for Payer: Heritage Provider Network Senior |
$116.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$89.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$131.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$131.70
|
| Rate for Payer: Multiplan Commercial |
$141.10
|
| Rate for Payer: TriValley Medical Group Commercial |
$75.26
|
| Rate for Payer: TriValley Medical Group Senior |
$75.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$94.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$94.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$159.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.92
|
| Rate for Payer: Vantage Medical Group Senior |
$159.92
|
|
|
RIOCIGUAT 1 MG TABLET [203880]
|
Facility
|
IP
|
$188.14
|
|
|
Service Code
|
NDC 50419-251-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$34.05 |
| Max. Negotiated Rate |
$141.10 |
| Rate for Payer: Adventist Health Commercial |
$37.63
|
| Rate for Payer: Cash Price |
$103.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$127.37
|
| Rate for Payer: Heritage Provider Network Senior |
$127.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.03
|
| Rate for Payer: Multiplan Commercial |
$141.10
|
|
|
RIOCIGUAT 2.5 MG TABLET [203883]
|
Facility
|
IP
|
$188.14
|
|
|
Service Code
|
NDC 50419-254-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$34.05 |
| Max. Negotiated Rate |
$141.10 |
| Rate for Payer: Adventist Health Commercial |
$37.63
|
| Rate for Payer: Cash Price |
$103.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$127.37
|
| Rate for Payer: Heritage Provider Network Senior |
$127.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.03
|
| Rate for Payer: Multiplan Commercial |
$141.10
|
|
|
RIOCIGUAT 2.5 MG TABLET [203883]
|
Facility
|
OP
|
$188.14
|
|
|
Service Code
|
NDC 50419-254-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$34.05 |
| Max. Negotiated Rate |
$159.92 |
| Rate for Payer: Adventist Health Commercial |
$37.63
|
| Rate for Payer: Aetna of CA Gatekeeper |
$100.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$129.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$159.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$141.10
|
| Rate for Payer: Blue Shield of California Commercial |
$114.77
|
| Rate for Payer: Blue Shield of California EPN |
$91.81
|
| Rate for Payer: Cash Price |
$103.47
|
| Rate for Payer: Cigna of CA HMO/PPO |
$122.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$159.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.92
|
| Rate for Payer: Dignity Health Senior |
$159.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$116.46
|
| Rate for Payer: Heritage Provider Network Senior |
$116.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$89.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$131.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$131.70
|
| Rate for Payer: Multiplan Commercial |
$141.10
|
| Rate for Payer: TriValley Medical Group Commercial |
$75.26
|
| Rate for Payer: TriValley Medical Group Senior |
$75.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$94.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$94.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$159.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.92
|
| Rate for Payer: Vantage Medical Group Senior |
$159.92
|
|
|
RIOCIGUAT 2.5 MG TABLET [203883]
|
Facility
|
OP
|
$188.14
|
|
|
Service Code
|
NDC 50419-254-91
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$34.05 |
| Max. Negotiated Rate |
$159.92 |
| Rate for Payer: Adventist Health Commercial |
$37.63
|
| Rate for Payer: Aetna of CA Gatekeeper |
$100.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$129.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$159.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$141.10
|
| Rate for Payer: Blue Shield of California Commercial |
$114.77
|
| Rate for Payer: Blue Shield of California EPN |
$91.81
|
| Rate for Payer: Cash Price |
$103.47
|
| Rate for Payer: Cigna of CA HMO/PPO |
$122.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$159.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.92
|
| Rate for Payer: Dignity Health Senior |
$159.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$116.46
|
| Rate for Payer: Heritage Provider Network Senior |
$116.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$89.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$131.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$131.70
|
| Rate for Payer: Multiplan Commercial |
$141.10
|
| Rate for Payer: TriValley Medical Group Commercial |
$75.26
|
| Rate for Payer: TriValley Medical Group Senior |
$75.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$94.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$94.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$159.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.92
|
| Rate for Payer: Vantage Medical Group Senior |
$159.92
|
|
|
RIOCIGUAT 2.5 MG TABLET [203883]
|
Facility
|
IP
|
$188.14
|
|
|
Service Code
|
NDC 50419-254-91
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$34.05 |
| Max. Negotiated Rate |
$141.10 |
| Rate for Payer: Adventist Health Commercial |
$37.63
|
| Rate for Payer: Cash Price |
$103.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$127.37
|
| Rate for Payer: Heritage Provider Network Senior |
$127.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.03
|
| Rate for Payer: Multiplan Commercial |
$141.10
|
|
|
RIPRETINIB 50 MG TABLET [228115]
|
Facility
|
IP
|
$591.60
|
|
|
Service Code
|
NDC 73207-101-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$107.08 |
| Max. Negotiated Rate |
$443.70 |
| Rate for Payer: Adventist Health Commercial |
$118.32
|
| Rate for Payer: Cash Price |
$325.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$319.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$400.51
|
| Rate for Payer: Heritage Provider Network Senior |
$400.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.90
|
| Rate for Payer: Multiplan Commercial |
$443.70
|
|
|
RIPRETINIB 50 MG TABLET [228115]
|
Facility
|
OP
|
$591.60
|
|
|
Service Code
|
NDC 73207-101-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$107.08 |
| Max. Negotiated Rate |
$502.86 |
| Rate for Payer: Adventist Health Commercial |
$118.32
|
| Rate for Payer: Aetna of CA Gatekeeper |
$316.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$406.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$502.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$325.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$443.70
|
| Rate for Payer: Blue Shield of California Commercial |
$360.88
|
| Rate for Payer: Blue Shield of California EPN |
$288.70
|
| Rate for Payer: Cash Price |
$325.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$384.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$502.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$502.86
|
| Rate for Payer: Dignity Health Senior |
$502.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$378.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$366.20
|
| Rate for Payer: Heritage Provider Network Senior |
$366.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$282.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$414.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$414.12
|
| Rate for Payer: Multiplan Commercial |
$443.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$236.64
|
| Rate for Payer: TriValley Medical Group Senior |
$236.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$295.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$295.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$502.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$502.86
|
| Rate for Payer: Vantage Medical Group Senior |
$502.86
|
|
|
RISEDRONATE 35 MG TABLET [32895]
|
Facility
|
IP
|
$102.29
|
|
|
Service Code
|
NDC 0430-0472-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$18.51 |
| Max. Negotiated Rate |
$76.72 |
| Rate for Payer: Adventist Health Commercial |
$20.46
|
| Rate for Payer: Cash Price |
$56.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$69.25
|
| Rate for Payer: Heritage Provider Network Senior |
$69.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.57
|
| Rate for Payer: Multiplan Commercial |
$76.72
|
|
|
RISEDRONATE 35 MG TABLET [32895]
|
Facility
|
OP
|
$102.29
|
|
|
Service Code
|
NDC 0430-0472-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$18.51 |
| Max. Negotiated Rate |
$86.95 |
| Rate for Payer: Adventist Health Commercial |
$20.46
|
| Rate for Payer: Aetna of CA Gatekeeper |
$54.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$70.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$86.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.72
|
| Rate for Payer: Blue Shield of California Commercial |
$62.40
|
| Rate for Payer: Blue Shield of California EPN |
$49.92
|
| Rate for Payer: Cash Price |
$56.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$66.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$86.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$86.95
|
| Rate for Payer: Dignity Health Senior |
$86.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.32
|
| Rate for Payer: Heritage Provider Network Senior |
$63.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$48.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$71.60
|
| Rate for Payer: Multiplan Commercial |
$76.72
|
| Rate for Payer: TriValley Medical Group Commercial |
$40.92
|
| Rate for Payer: TriValley Medical Group Senior |
$40.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$51.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$51.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$86.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$86.95
|
| Rate for Payer: Vantage Medical Group Senior |
$86.95
|
|
|
RISPERIDONE 0.25 MG TABLET [25519]
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
NDC 68084-270-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Senior |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
|
