|
RIFAMPIN 150 MG CAPSULE [11292]
|
Facility
|
OP
|
$3.82
|
|
|
Service Code
|
NDC 6068757521
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Adventist Health Commercial |
$0.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.91
|
| Rate for Payer: Blue Shield of California Commercial |
$2.33
|
| Rate for Payer: Blue Shield of California EPN |
$1.86
|
| Rate for Payer: Cash Price |
$1.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.36
|
| Rate for Payer: Heritage Provider Network Senior |
$2.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.67
|
| Rate for Payer: Multiplan Commercial |
$2.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.53
|
| Rate for Payer: TriValley Medical Group Senior |
$1.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.25
|
| Rate for Payer: Vantage Medical Group Senior |
$3.25
|
|
|
RIFAMPIN 150 MG CAPSULE [11292]
|
Facility
|
IP
|
$3.82
|
|
|
Service Code
|
NDC 6068757511
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Adventist Health Commercial |
$0.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.46
|
| Rate for Payer: Cash Price |
$1.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.59
|
| Rate for Payer: Heritage Provider Network Senior |
$2.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$2.87
|
|
|
RIFAMPIN 150 MG CAPSULE [11292]
|
Facility
|
OP
|
$3.82
|
|
|
Service Code
|
NDC 6068757511
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Adventist Health Commercial |
$0.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.91
|
| Rate for Payer: Blue Shield of California Commercial |
$2.33
|
| Rate for Payer: Blue Shield of California EPN |
$1.86
|
| Rate for Payer: Cash Price |
$1.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.36
|
| Rate for Payer: Heritage Provider Network Senior |
$2.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.67
|
| Rate for Payer: Multiplan Commercial |
$2.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.53
|
| Rate for Payer: TriValley Medical Group Senior |
$1.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.25
|
| Rate for Payer: Vantage Medical Group Senior |
$3.25
|
|
|
RIFAMPIN 150 MG CAPSULE [11292]
|
Facility
|
IP
|
$3.82
|
|
|
Service Code
|
NDC 6068757521
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Adventist Health Commercial |
$0.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.46
|
| Rate for Payer: Cash Price |
$1.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.59
|
| Rate for Payer: Heritage Provider Network Senior |
$2.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$2.87
|
|
|
RIFAMPIN 300 MG CAPSULE [11293]
|
Facility
|
OP
|
$2.23
|
|
|
Service Code
|
NDC 6068758601
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Adventist Health Commercial |
$0.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.12
|
| Rate for Payer: Blue Shield of California Commercial |
$1.36
|
| Rate for Payer: Blue Shield of California EPN |
$1.09
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.38
|
| Rate for Payer: Heritage Provider Network Senior |
$1.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$1.67
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.89
|
| Rate for Payer: TriValley Medical Group Senior |
$0.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1.90
|
|
|
RIFAMPIN 300 MG CAPSULE [11293]
|
Facility
|
OP
|
$4.41
|
|
|
Service Code
|
NDC 6818065906
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Adventist Health Commercial |
$0.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.21
|
| Rate for Payer: Blue Shield of California Commercial |
$2.69
|
| Rate for Payer: Blue Shield of California EPN |
$2.15
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.73
|
| Rate for Payer: Heritage Provider Network Senior |
$2.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.09
|
| Rate for Payer: Multiplan Commercial |
$3.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.76
|
| Rate for Payer: TriValley Medical Group Senior |
$1.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.75
|
| Rate for Payer: Vantage Medical Group Senior |
$3.75
|
|
|
RIFAMPIN 300 MG CAPSULE [11293]
|
Facility
|
IP
|
$2.23
|
|
|
Service Code
|
NDC 6068758611
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Adventist Health Commercial |
$0.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.44
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.51
|
| Rate for Payer: Heritage Provider Network Senior |
$1.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$1.67
|
|
|
RIFAMPIN 300 MG CAPSULE [11293]
|
Facility
|
IP
|
$4.41
|
|
|
Service Code
|
NDC 6818065906
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.31 |
| Rate for Payer: Adventist Health Commercial |
$0.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.84
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.99
|
| Rate for Payer: Heritage Provider Network Senior |
$2.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.10
|
| Rate for Payer: Multiplan Commercial |
$3.31
|
|
|
RIFAMPIN 300 MG CAPSULE [11293]
|
Facility
|
IP
|
$2.23
|
|
|
Service Code
|
NDC 6068758601
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Adventist Health Commercial |
$0.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.44
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.51
|
| Rate for Payer: Heritage Provider Network Senior |
$1.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$1.67
|
|
|
RIFAMPIN 300 MG CAPSULE [11293]
|
Facility
|
OP
|
$2.23
|
|
|
Service Code
|
NDC 6068758611
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Adventist Health Commercial |
$0.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.12
|
| Rate for Payer: Blue Shield of California Commercial |
$1.36
|
| Rate for Payer: Blue Shield of California EPN |
$1.09
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.38
|
| Rate for Payer: Heritage Provider Network Senior |
$1.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$1.67
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.89
|
| Rate for Payer: TriValley Medical Group Senior |
$0.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1.90
|
|
|
RIFAMPIN 300 MG CAPSULE [11293]
|
Facility
|
IP
|
$4.41
|
|
|
Service Code
|
NDC 6818065907
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.31 |
| Rate for Payer: Adventist Health Commercial |
$0.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.84
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.99
|
| Rate for Payer: Heritage Provider Network Senior |
$2.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.10
|
| Rate for Payer: Multiplan Commercial |
$3.31
|
|
|
RIFAMPIN 300 MG CAPSULE [11293]
|
Facility
|
OP
|
$4.41
|
|
|
Service Code
|
NDC 6818065907
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.73
|
| Rate for Payer: Adventist Health Commercial |
$0.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.21
|
| Rate for Payer: Blue Shield of California Commercial |
$2.69
|
| Rate for Payer: Blue Shield of California EPN |
$2.15
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.73
|
| Rate for Payer: Heritage Provider Network Senior |
$2.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.09
|
| Rate for Payer: Multiplan Commercial |
$3.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.76
|
| Rate for Payer: TriValley Medical Group Senior |
$1.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.75
|
| Rate for Payer: Vantage Medical Group Senior |
$3.75
|
|
|
RIFAMPIN 600 MG INTRAVENOUS SOLUTION [11291]
|
Facility
|
OP
|
$184.92
|
|
|
Service Code
|
HCPCS J2804
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$157.18 |
| Rate for Payer: Adventist Health Commercial |
$36.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$114.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$157.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$138.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.63
|
| Rate for Payer: Blue Shield of California Commercial |
$112.80
|
| Rate for Payer: Blue Shield of California EPN |
$90.24
|
| Rate for Payer: Cash Price |
$83.21
|
| Rate for Payer: Cash Price |
$83.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$85.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$157.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$157.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$157.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.62
|
| Rate for Payer: Heritage Provider Network Senior |
$85.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$88.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$129.44
|
| Rate for Payer: Multiplan Commercial |
$138.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$73.97
|
| Rate for Payer: TriValley Medical Group Senior |
$73.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$66.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$61.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$157.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$157.18
|
| Rate for Payer: Vantage Medical Group Senior |
$157.18
|
|
|
RIFAMPIN 600 MG INTRAVENOUS SOLUTION [11291]
|
Facility
|
IP
|
$184.92
|
|
|
Service Code
|
HCPCS J2804
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.47 |
| Max. Negotiated Rate |
$138.69 |
| Rate for Payer: Adventist Health Commercial |
$36.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$119.09
|
| Rate for Payer: Cash Price |
$83.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$85.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.62
|
| Rate for Payer: Heritage Provider Network Senior |
$85.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.23
|
| Rate for Payer: Multiplan Commercial |
$138.69
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$66.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$61.23
|
|
|
RIFAMPIN ORAL SUSPENSION COMPOUND 10 MG/ML [4080331]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 9994080331
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Senior |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
|
|
RIFAMPIN ORAL SUSPENSION COMPOUND 10 MG/ML [4080331]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 9994080331
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Senior |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
RIFAPENTINE 150 MG TABLET [23365]
|
Facility
|
IP
|
$6.08
|
|
|
Service Code
|
NDC 0088210201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$4.56 |
| Rate for Payer: Adventist Health Commercial |
$1.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.92
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.12
|
| Rate for Payer: Heritage Provider Network Senior |
$4.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.52
|
| Rate for Payer: Multiplan Commercial |
$4.56
|
|
|
RIFAPENTINE 150 MG TABLET [23365]
|
Facility
|
OP
|
$6.08
|
|
|
Service Code
|
NDC 0088210201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$5.17 |
| Rate for Payer: Adventist Health Commercial |
$1.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.04
|
| Rate for Payer: Blue Shield of California Commercial |
$3.71
|
| Rate for Payer: Blue Shield of California EPN |
$2.97
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.76
|
| Rate for Payer: Heritage Provider Network Senior |
$3.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.26
|
| Rate for Payer: Multiplan Commercial |
$4.56
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.43
|
| Rate for Payer: TriValley Medical Group Senior |
$2.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.17
|
| Rate for Payer: Vantage Medical Group Senior |
$5.17
|
|
|
RIFAXIMIN 200 MG TABLET [39063]
|
Facility
|
IP
|
$14.28
|
|
|
Service Code
|
NDC 6564930103
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$10.71 |
| Rate for Payer: Adventist Health Commercial |
$2.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.20
|
| Rate for Payer: Cash Price |
$6.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.67
|
| Rate for Payer: Heritage Provider Network Senior |
$9.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.57
|
| Rate for Payer: Multiplan Commercial |
$10.71
|
|
|
RIFAXIMIN 200 MG TABLET [39063]
|
Facility
|
OP
|
$14.28
|
|
|
Service Code
|
NDC 6564930103
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$12.14 |
| Rate for Payer: Adventist Health Commercial |
$2.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.14
|
| Rate for Payer: Blue Shield of California Commercial |
$8.71
|
| Rate for Payer: Blue Shield of California EPN |
$6.97
|
| Rate for Payer: Cash Price |
$6.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.84
|
| Rate for Payer: Heritage Provider Network Senior |
$8.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$10.71
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.71
|
| Rate for Payer: TriValley Medical Group Senior |
$5.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.14
|
| Rate for Payer: Vantage Medical Group Senior |
$12.14
|
|
|
RIFAXIMIN 550 MG TABLET [104604]
|
Facility
|
IP
|
$73.42
|
|
|
Service Code
|
NDC 6564930303
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.29 |
| Max. Negotiated Rate |
$55.06 |
| Rate for Payer: Adventist Health Commercial |
$14.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$47.28
|
| Rate for Payer: Cash Price |
$33.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$49.71
|
| Rate for Payer: Heritage Provider Network Senior |
$49.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.36
|
| Rate for Payer: Multiplan Commercial |
$55.06
|
|
|
RIFAXIMIN 550 MG TABLET [104604]
|
Facility
|
OP
|
$73.42
|
|
|
Service Code
|
NDC 6564930303
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.29 |
| Max. Negotiated Rate |
$62.41 |
| Rate for Payer: Adventist Health Commercial |
$14.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$45.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$62.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$55.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.72
|
| Rate for Payer: Blue Shield of California Commercial |
$44.79
|
| Rate for Payer: Blue Shield of California EPN |
$35.83
|
| Rate for Payer: Cash Price |
$33.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$47.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.45
|
| Rate for Payer: Heritage Provider Network Senior |
$45.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$35.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$51.39
|
| Rate for Payer: Multiplan Commercial |
$55.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$29.37
|
| Rate for Payer: TriValley Medical Group Senior |
$29.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$62.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.41
|
| Rate for Payer: Vantage Medical Group Senior |
$62.41
|
|
|
RIFAXIMIN 550 MG TABLET [104604]
|
Facility
|
IP
|
$73.42
|
|
|
Service Code
|
NDC 6564930302
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.29 |
| Max. Negotiated Rate |
$55.06 |
| Rate for Payer: Adventist Health Commercial |
$14.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$47.28
|
| Rate for Payer: Cash Price |
$33.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$49.71
|
| Rate for Payer: Heritage Provider Network Senior |
$49.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.36
|
| Rate for Payer: Multiplan Commercial |
$55.06
|
|
|
RIFAXIMIN 550 MG TABLET [104604]
|
Facility
|
OP
|
$73.42
|
|
|
Service Code
|
NDC 6564930302
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.29 |
| Max. Negotiated Rate |
$62.41 |
| Rate for Payer: Adventist Health Commercial |
$14.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$45.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$62.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$55.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.72
|
| Rate for Payer: Blue Shield of California Commercial |
$44.79
|
| Rate for Payer: Blue Shield of California EPN |
$35.83
|
| Rate for Payer: Cash Price |
$33.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$47.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.45
|
| Rate for Payer: Heritage Provider Network Senior |
$45.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$35.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$51.39
|
| Rate for Payer: Multiplan Commercial |
$55.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$29.37
|
| Rate for Payer: TriValley Medical Group Senior |
$29.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$62.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.41
|
| Rate for Payer: Vantage Medical Group Senior |
$62.41
|
|
|
RIFAXIMIN ORAL SUSPENSION COMPOUND 20 MG/ML [4080332]
|
Facility
|
IP
|
$1.32
|
|
|
Service Code
|
NDC 9994080332
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.85
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.89
|
| Rate for Payer: Heritage Provider Network Senior |
$0.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Multiplan Commercial |
$0.99
|
|
