|
RIOCIGUAT 2.5 MG TABLET [203883]
|
Facility
|
OP
|
$197.42
|
|
|
Service Code
|
NDC 5041925491
|
| 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 2.5 MG TABLET [203883]
|
Facility
|
IP
|
$197.42
|
|
|
Service Code
|
NDC 5041925491
|
| 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 2.5 MG TABLET [203883]
|
Facility
|
IP
|
$197.42
|
|
|
Service Code
|
NDC 5041925401
|
| 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 2.5 MG TABLET [203883]
|
Facility
|
OP
|
$197.42
|
|
|
Service Code
|
NDC 5041925401
|
| 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
|
|
|
RIPRETINIB 50 MG TABLET [228115]
|
Facility
|
IP
|
$621.60
|
|
|
Service Code
|
NDC 7320710130
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$112.51 |
| Max. Negotiated Rate |
$466.20 |
| Rate for Payer: Adventist Health Commercial |
$124.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$400.31
|
| Rate for Payer: Cash Price |
$279.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$335.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$420.82
|
| Rate for Payer: Heritage Provider Network Senior |
$420.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$112.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.40
|
| Rate for Payer: Multiplan Commercial |
$466.20
|
|
|
RIPRETINIB 50 MG TABLET [228115]
|
Facility
|
OP
|
$621.60
|
|
|
Service Code
|
NDC 7320710130
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$112.51 |
| Max. Negotiated Rate |
$528.36 |
| Rate for Payer: Adventist Health Commercial |
$124.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$384.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$528.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$341.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$466.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$310.92
|
| Rate for Payer: Blue Shield of California Commercial |
$379.18
|
| Rate for Payer: Blue Shield of California EPN |
$303.34
|
| Rate for Payer: Cash Price |
$279.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$404.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$528.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$528.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$384.77
|
| Rate for Payer: Heritage Provider Network Senior |
$384.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$296.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$112.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$435.12
|
| Rate for Payer: Multiplan Commercial |
$466.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$248.64
|
| Rate for Payer: TriValley Medical Group Senior |
$248.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$310.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$310.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$528.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.36
|
| Rate for Payer: Vantage Medical Group Senior |
$528.36
|
|
|
RISEDRONATE 35 MG TABLET [32895]
|
Facility
|
OP
|
$102.29
|
|
|
Service Code
|
NDC 0430047203
|
| 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 Non-Gatekeeper |
$63.22
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$51.17
|
| 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 |
$46.03
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$48.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
|
|
RISEDRONATE 35 MG TABLET [32895]
|
Facility
|
IP
|
$102.29
|
|
|
Service Code
|
NDC 0430047203
|
| 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: Aetna of CA Non-Gatekeeper |
$65.87
|
| Rate for Payer: Cash Price |
$46.03
|
| 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 Foundation Hospitals Medi-Cal |
$18.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.57
|
| Rate for Payer: Multiplan Commercial |
$76.72
|
|
|
RISPERIDONE 0.25 MG TABLET [25519]
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
NDC 6808427001
|
| 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: Aetna of CA Non-Gatekeeper |
$0.17
|
| Rate for Payer: Cash Price |
$0.12
|
| 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 Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
|
|
RISPERIDONE 0.25 MG TABLET [25519]
|
Facility
|
OP
|
$0.27
|
|
|
Service Code
|
NDC 6808427011
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Senior |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Vantage Medical Group Senior |
$0.23
|
|
|
RISPERIDONE 0.25 MG TABLET [25519]
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
NDC 6808427011
|
| 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: Aetna of CA Non-Gatekeeper |
$0.17
|
| Rate for Payer: Cash Price |
$0.12
|
| 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 Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
|
|
RISPERIDONE 0.25 MG TABLET [25519]
|
Facility
|
OP
|
$0.27
|
|
|
Service Code
|
NDC 6808427001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.17
|
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Senior |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Vantage Medical Group Senior |
$0.23
|
|
|
RISPERIDONE 0.5 MG DISINTEGRATING TABLET [35686]
|
Facility
|
OP
|
$4.20
|
|
|
Service Code
|
NDC 4988431191
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.10
|
| Rate for Payer: Blue Shield of California Commercial |
$2.56
|
| Rate for Payer: Blue Shield of California EPN |
$2.05
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.60
|
| Rate for Payer: Heritage Provider Network Senior |
$2.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.94
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.68
|
| Rate for Payer: TriValley Medical Group Senior |
$1.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.57
|
| Rate for Payer: Vantage Medical Group Senior |
$3.57
|
|
|
RISPERIDONE 0.5 MG DISINTEGRATING TABLET [35686]
|
Facility
|
OP
|
$1.99
|
|
|
Service Code
|
NDC 5974601032
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.69 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.97
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.23
|
| Rate for Payer: Heritage Provider Network Senior |
$1.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.39
|
| Rate for Payer: Multiplan Commercial |
$1.49
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.80
|
| Rate for Payer: TriValley Medical Group Senior |
$0.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1.69
|
|
|
RISPERIDONE 0.5 MG DISINTEGRATING TABLET [35686]
|
Facility
|
IP
|
$4.20
|
|
|
Service Code
|
NDC 4988431191
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.15 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.70
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.84
|
| Rate for Payer: Heritage Provider Network Senior |
$2.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.05
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
|
|
RISPERIDONE 0.5 MG DISINTEGRATING TABLET [35686]
|
Facility
|
IP
|
$1.99
|
|
|
Service Code
|
NDC 5974601032
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.49 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.28
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.35
|
| Rate for Payer: Heritage Provider Network Senior |
$1.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$1.49
|
|
|
RISPERIDONE 0.5 MG DISINTEGRATING TABLET [35686]
|
Facility
|
IP
|
$4.20
|
|
|
Service Code
|
NDC 4988431152
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.15 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.70
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.84
|
| Rate for Payer: Heritage Provider Network Senior |
$2.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.05
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
|
|
RISPERIDONE 0.5 MG DISINTEGRATING TABLET [35686]
|
Facility
|
OP
|
$4.20
|
|
|
Service Code
|
NDC 4988431152
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.10
|
| Rate for Payer: Blue Shield of California Commercial |
$2.56
|
| Rate for Payer: Blue Shield of California EPN |
$2.05
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.60
|
| Rate for Payer: Heritage Provider Network Senior |
$2.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.94
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.68
|
| Rate for Payer: TriValley Medical Group Senior |
$1.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.57
|
| Rate for Payer: Vantage Medical Group Senior |
$3.57
|
|
|
RISPERIDONE 0.5 MG TABLET [25520]
|
Facility
|
IP
|
$0.15
|
|
|
Service Code
|
NDC 6838211314
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.10
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Senior |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
|
|
RISPERIDONE 0.5 MG TABLET [25520]
|
Facility
|
OP
|
$0.15
|
|
|
Service Code
|
NDC 6838211314
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Senior |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Vantage Medical Group Senior |
$0.13
|
|
|
RISPERIDONE 0.5 MG TABLET [25520]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 4354734006
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Senior |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Senior |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
|
|
RISPERIDONE 0.5 MG TABLET [25520]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 4354734006
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.14
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Senior |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
|
|
RISPERIDONE 1 MG DISINTEGRATING TABLET [35687]
|
Facility
|
IP
|
$4.90
|
|
|
Service Code
|
NDC 4988431552
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Adventist Health Commercial |
$0.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.16
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.32
|
| Rate for Payer: Heritage Provider Network Senior |
$3.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.23
|
| Rate for Payer: Multiplan Commercial |
$3.67
|
|
|
RISPERIDONE 1 MG DISINTEGRATING TABLET [35687]
|
Facility
|
IP
|
$4.90
|
|
|
Service Code
|
NDC 4988431555
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Adventist Health Commercial |
$0.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.16
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.32
|
| Rate for Payer: Heritage Provider Network Senior |
$3.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.23
|
| Rate for Payer: Multiplan Commercial |
$3.67
|
|
|
RISPERIDONE 1 MG DISINTEGRATING TABLET [35687]
|
Facility
|
OP
|
$4.90
|
|
|
Service Code
|
NDC 4988431552
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$4.17 |
| Rate for Payer: Adventist Health Commercial |
$0.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.45
|
| Rate for Payer: Blue Shield of California Commercial |
$2.99
|
| Rate for Payer: Blue Shield of California EPN |
$2.39
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.03
|
| Rate for Payer: Heritage Provider Network Senior |
$3.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.43
|
| Rate for Payer: Multiplan Commercial |
$3.67
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.96
|
| Rate for Payer: TriValley Medical Group Senior |
$1.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4.17
|
|
