|
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
|
|
|
RILPIVIRINE HCL 25 MG TABLET [109909]
|
Facility
|
IP
|
$59.33
|
|
|
Service Code
|
NDC 7006984830
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$44.50 |
| Rate for Payer: Adventist Health Commercial |
$11.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38.21
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.17
|
| Rate for Payer: Heritage Provider Network Senior |
$40.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.83
|
| Rate for Payer: Multiplan Commercial |
$44.50
|
|
|
RILPIVIRINE HCL 25 MG TABLET [109909]
|
Facility
|
OP
|
$59.33
|
|
|
Service Code
|
NDC 7006984830
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$50.43 |
| Rate for Payer: Adventist Health Commercial |
$11.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.68
|
| Rate for Payer: Blue Shield of California Commercial |
$36.19
|
| Rate for Payer: Blue Shield of California EPN |
$28.95
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$38.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.73
|
| Rate for Payer: Heritage Provider Network Senior |
$36.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$28.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$41.53
|
| Rate for Payer: Multiplan Commercial |
$44.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$23.73
|
| Rate for Payer: TriValley Medical Group Senior |
$23.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.43
|
| Rate for Payer: Vantage Medical Group Senior |
$50.43
|
|
|
RILPIVIRINE HCL 25 MG TABLET [109909]
|
Facility
|
OP
|
$59.33
|
|
|
Service Code
|
NDC 5967627801
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$50.43 |
| Rate for Payer: Adventist Health Commercial |
$11.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.68
|
| Rate for Payer: Blue Shield of California Commercial |
$36.19
|
| Rate for Payer: Blue Shield of California EPN |
$28.95
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$38.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.73
|
| Rate for Payer: Heritage Provider Network Senior |
$36.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$28.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$41.53
|
| Rate for Payer: Multiplan Commercial |
$44.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$23.73
|
| Rate for Payer: TriValley Medical Group Senior |
$23.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.43
|
| Rate for Payer: Vantage Medical Group Senior |
$50.43
|
|
|
RILPIVIRINE HCL 25 MG TABLET [109909]
|
Facility
|
IP
|
$59.33
|
|
|
Service Code
|
NDC 5967627801
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$44.50 |
| Rate for Payer: Adventist Health Commercial |
$11.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38.21
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.17
|
| Rate for Payer: Heritage Provider Network Senior |
$40.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.83
|
| Rate for Payer: Multiplan Commercial |
$44.50
|
|
|
RILUZOLE 50 MG TABLET [16124]
|
Facility
|
OP
|
$0.80
|
|
|
Service Code
|
NDC 6787728660
|
| 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 Non-Gatekeeper |
$0.49
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$0.40
|
| 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 |
$0.36
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 6846238160
|
| 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: Aetna of CA Non-Gatekeeper |
$1.02
|
| Rate for Payer: Cash Price |
$0.71
|
| 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 Foundation Hospitals 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
|
IP
|
$0.80
|
|
|
Service Code
|
NDC 6787728660
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.52
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.54
|
| Rate for Payer: Heritage Provider Network Senior |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.60
|
|
|
RILUZOLE 50 MG TABLET [16124]
|
Facility
|
OP
|
$1.58
|
|
|
Service Code
|
NDC 6846238160
|
| 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 Non-Gatekeeper |
$0.98
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$0.79
|
| 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 |
$0.71
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$0.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
|
|
RILUZOLE 50 MG TABLET [16124]
|
Facility
|
IP
|
$1.58
|
|
|
Service Code
|
NDC 6275653886
|
| 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: Aetna of CA Non-Gatekeeper |
$1.02
|
| Rate for Payer: Cash Price |
$0.71
|
| 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 Foundation Hospitals 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 6275653886
|
| 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 Non-Gatekeeper |
$0.98
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$0.79
|
| 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 |
$0.71
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$0.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 Non-Gatekeeper |
$470.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.90
|
| 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 |
$342.94
|
| Rate for Payer: Cash Price |
$342.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$350.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$487.74
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.29
|
| 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) Medicare Advantage |
$13.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$363.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$137.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.81
|
| 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 |
$16.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.62
|
| Rate for Payer: Vantage Medical Group Senior |
$14.62
|
|
|
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: Aetna of CA Non-Gatekeeper |
$490.79
|
| Rate for Payer: Cash Price |
$342.94
|
| 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 Foundation Hospitals 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
|
|
|
RIMEGEPANT 75 MG DISINTEGRATING TABLET [227435]
|
Facility
|
OP
|
$161.29
|
|
|
Service Code
|
NDC 7261830002
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$29.19 |
| Max. Negotiated Rate |
$137.10 |
| Rate for Payer: Adventist Health Commercial |
$32.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$99.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$137.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$120.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$80.68
|
| Rate for Payer: Blue Shield of California Commercial |
$98.39
|
| Rate for Payer: Blue Shield of California EPN |
$78.71
|
| Rate for Payer: Cash Price |
$72.58
|
| Rate for Payer: Cigna of CA HMO/PPO |
$104.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$137.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$137.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$99.84
|
| Rate for Payer: Heritage Provider Network Senior |
$99.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$76.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$112.90
|
| Rate for Payer: Multiplan Commercial |
$120.97
|
| Rate for Payer: TriValley Medical Group Commercial |
$64.52
|
| Rate for Payer: TriValley Medical Group Senior |
$64.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$80.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$80.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$137.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$137.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.10
|
|
|
RIMEGEPANT 75 MG DISINTEGRATING TABLET [227435]
|
Facility
|
IP
|
$161.29
|
|
|
Service Code
|
NDC 7261830002
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$29.19 |
| Max. Negotiated Rate |
$120.97 |
| Rate for Payer: Adventist Health Commercial |
$32.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$103.87
|
| Rate for Payer: Cash Price |
$72.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$109.19
|
| Rate for Payer: Heritage Provider Network Senior |
$109.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.32
|
| Rate for Payer: Multiplan Commercial |
$120.97
|
|
|
RINGER'S INTRAVENOUS SOLUTION [11295]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 0264778000
|
| 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 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: Anthem Blue Cross of CA HMO/PPO |
$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: 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
|
|
RINGER'S INTRAVENOUS SOLUTION [11295]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 0264778000
|
| 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 Non-Gatekeeper |
$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 Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
RIOCIGUAT 0.5 MG TABLET [203879]
|
Facility
|
OP
|
$197.42
|
|
|
Service Code
|
NDC 5041925091
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.73 |
| Max. Negotiated Rate |
$167.81 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$167.81
|
| Rate for Payer: Adventist Health Commercial |
$39.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$122.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$108.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$148.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.75
|
| Rate for Payer: Blue Shield of California Commercial |
$120.43
|
| Rate for Payer: Blue Shield of California EPN |
$96.34
|
| Rate for Payer: Cash Price |
$88.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$128.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$167.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$167.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$122.20
|
| Rate for Payer: Heritage Provider Network Senior |
$122.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$94.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$138.19
|
| Rate for Payer: Multiplan Commercial |
$148.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$78.97
|
| Rate for Payer: TriValley Medical Group Senior |
$78.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$98.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$98.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.81
|
| Rate for Payer: Vantage Medical Group Senior |
$167.81
|
|
|
RIOCIGUAT 0.5 MG TABLET [203879]
|
Facility
|
IP
|
$197.42
|
|
|
Service Code
|
NDC 5041925001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.73 |
| Max. Negotiated Rate |
$148.06 |
| Rate for Payer: Adventist Health Commercial |
$39.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$127.14
|
| Rate for Payer: Cash Price |
$88.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$133.65
|
| Rate for Payer: Heritage Provider Network Senior |
$133.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.35
|
| Rate for Payer: Multiplan Commercial |
$148.06
|
|
|
RIOCIGUAT 0.5 MG TABLET [203879]
|
Facility
|
IP
|
$197.42
|
|
|
Service Code
|
NDC 5041925091
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.73 |
| Max. Negotiated Rate |
$148.06 |
| Rate for Payer: Adventist Health Commercial |
$39.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$127.14
|
| Rate for Payer: Cash Price |
$88.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$133.65
|
| Rate for Payer: Heritage Provider Network Senior |
$133.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.35
|
| Rate for Payer: Multiplan Commercial |
$148.06
|
|
|
RIOCIGUAT 0.5 MG TABLET [203879]
|
Facility
|
OP
|
$197.42
|
|
|
Service Code
|
NDC 5041925001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.73 |
| Max. Negotiated Rate |
$167.81 |
| Rate for Payer: Adventist Health Commercial |
$39.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$122.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$108.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$148.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.75
|
| Rate for Payer: Blue Shield of California Commercial |
$120.43
|
| Rate for Payer: Blue Shield of California EPN |
$96.34
|
| Rate for Payer: Cash Price |
$88.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$128.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$167.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$167.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$122.20
|
| Rate for Payer: Heritage Provider Network Senior |
$122.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$94.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$138.19
|
| Rate for Payer: Multiplan Commercial |
$148.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$78.97
|
| Rate for Payer: TriValley Medical Group Senior |
$78.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$98.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$98.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$167.81
|
| Rate for Payer: Vantage Medical Group Senior |
$167.81
|
|
|
RIOCIGUAT 1 MG TABLET [203880]
|
Facility
|
OP
|
$197.42
|
|
|
Service Code
|
NDC 5041925101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.73 |
| Max. Negotiated Rate |
$167.81 |
| Rate for Payer: Adventist Health Commercial |
$39.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$122.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$108.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$148.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.75
|
| Rate for Payer: Blue Shield of California Commercial |
$120.43
|
| Rate for Payer: Blue Shield of California EPN |
$96.34
|
| Rate for Payer: Cash Price |
$88.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$128.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$167.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$167.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$122.20
|
| Rate for Payer: Heritage Provider Network Senior |
$122.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$94.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$138.19
|
| Rate for Payer: Multiplan Commercial |
$148.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$78.97
|
| Rate for Payer: TriValley Medical Group Senior |
$78.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$98.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$98.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$167.81
|
| Rate for Payer: Vantage Medical Group Senior |
$167.81
|
|
|
RIOCIGUAT 1 MG TABLET [203880]
|
Facility
|
OP
|
$197.42
|
|
|
Service Code
|
NDC 5041925191
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.73 |
| Max. Negotiated Rate |
$167.81 |
| Rate for Payer: Adventist Health Commercial |
$39.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$122.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$108.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$148.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.75
|
| Rate for Payer: Blue Shield of California Commercial |
$120.43
|
| Rate for Payer: Blue Shield of California EPN |
$96.34
|
| Rate for Payer: Cash Price |
$88.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$128.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$167.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$167.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$122.20
|
| Rate for Payer: Heritage Provider Network Senior |
$122.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$94.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$138.19
|
| Rate for Payer: Multiplan Commercial |
$148.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$78.97
|
| Rate for Payer: TriValley Medical Group Senior |
$78.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$98.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$98.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$167.81
|
| Rate for Payer: Vantage Medical Group Senior |
$167.81
|
|
|
RIOCIGUAT 1 MG TABLET [203880]
|
Facility
|
IP
|
$197.42
|
|
|
Service Code
|
NDC 5041925191
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.73 |
| Max. Negotiated Rate |
$148.06 |
| Rate for Payer: Adventist Health Commercial |
$39.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$127.14
|
| Rate for Payer: Cash Price |
$88.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$133.65
|
| Rate for Payer: Heritage Provider Network Senior |
$133.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.35
|
| Rate for Payer: Multiplan Commercial |
$148.06
|
|
|
RIOCIGUAT 1 MG TABLET [203880]
|
Facility
|
IP
|
$197.42
|
|
|
Service Code
|
NDC 5041925101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.73 |
| Max. Negotiated Rate |
$148.06 |
| Rate for Payer: Adventist Health Commercial |
$39.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$127.14
|
| Rate for Payer: Cash Price |
$88.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$133.65
|
| Rate for Payer: Heritage Provider Network Senior |
$133.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.35
|
| Rate for Payer: Multiplan Commercial |
$148.06
|
|
