|
RISPERIDONE 2 MG TABLET [18311]
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
NDC 4354734206
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.16
|
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.13
|
| 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 |
$0.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Senior |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.12
|
| 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 |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Vantage Medical Group Senior |
$0.22
|
|
|
RISPERIDONE 2 MG TABLET [18311]
|
Facility
|
IP
|
$0.26
|
|
|
Service Code
|
NDC 4354734206
|
| 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 |
$0.14
|
| 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 3 MG TABLET [18312]
|
Facility
|
IP
|
$0.61
|
|
|
Service Code
|
NDC 6808427411
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.39
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.41
|
| Rate for Payer: Heritage Provider Network Senior |
$0.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
|
|
RISPERIDONE 3 MG TABLET [18312]
|
Facility
|
IP
|
$0.61
|
|
|
Service Code
|
NDC 6808427401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.39
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.41
|
| Rate for Payer: Heritage Provider Network Senior |
$0.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
|
|
RISPERIDONE 3 MG TABLET [18312]
|
Facility
|
OP
|
$0.61
|
|
|
Service Code
|
NDC 6808427401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.31
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.38
|
| Rate for Payer: Heritage Provider Network Senior |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.24
|
| Rate for Payer: TriValley Medical Group Senior |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.52
|
| Rate for Payer: Vantage Medical Group Senior |
$0.52
|
|
|
RISPERIDONE 3 MG TABLET [18312]
|
Facility
|
OP
|
$0.61
|
|
|
Service Code
|
NDC 6808427411
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.31
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.38
|
| Rate for Payer: Heritage Provider Network Senior |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.24
|
| Rate for Payer: TriValley Medical Group Senior |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.52
|
| Rate for Payer: Vantage Medical Group Senior |
$0.52
|
|
|
RISPERIDONE 4 MG TABLET [18310]
|
Facility
|
OP
|
$0.61
|
|
|
Service Code
|
NDC 6808427701
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.31
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.38
|
| Rate for Payer: Heritage Provider Network Senior |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.24
|
| Rate for Payer: TriValley Medical Group Senior |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.52
|
| Rate for Payer: Vantage Medical Group Senior |
$0.52
|
|
|
RISPERIDONE 4 MG TABLET [18310]
|
Facility
|
IP
|
$0.61
|
|
|
Service Code
|
NDC 6808427711
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.39
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.41
|
| Rate for Payer: Heritage Provider Network Senior |
$0.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
|
|
RISPERIDONE 4 MG TABLET [18310]
|
Facility
|
OP
|
$0.61
|
|
|
Service Code
|
NDC 6808427711
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.31
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.38
|
| Rate for Payer: Heritage Provider Network Senior |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.24
|
| Rate for Payer: TriValley Medical Group Senior |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.52
|
| Rate for Payer: Vantage Medical Group Senior |
$0.52
|
|
|
RISPERIDONE 4 MG TABLET [18310]
|
Facility
|
IP
|
$0.61
|
|
|
Service Code
|
NDC 6808427701
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.39
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.41
|
| Rate for Payer: Heritage Provider Network Senior |
$0.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
|
|
RITLECITINIB 50 MG CAPSULE [238783]
|
Facility
|
IP
|
$187.89
|
|
|
Service Code
|
NDC 0069033428
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$34.01 |
| Max. Negotiated Rate |
$140.92 |
| Rate for Payer: Adventist Health Commercial |
$37.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$121.00
|
| Rate for Payer: Cash Price |
$84.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$127.20
|
| Rate for Payer: Heritage Provider Network Senior |
$127.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.97
|
| Rate for Payer: Multiplan Commercial |
$140.92
|
|
|
RITLECITINIB 50 MG CAPSULE [238783]
|
Facility
|
OP
|
$187.89
|
|
|
Service Code
|
NDC 0069033428
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$34.01 |
| Max. Negotiated Rate |
$159.71 |
| Rate for Payer: Adventist Health Commercial |
$37.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$116.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$159.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$140.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.98
|
| Rate for Payer: Blue Shield of California Commercial |
$114.61
|
| Rate for Payer: Blue Shield of California EPN |
$91.69
|
| Rate for Payer: Cash Price |
$84.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$122.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$159.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$159.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$116.30
|
| Rate for Payer: Heritage Provider Network Senior |
$116.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$89.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$131.52
|
| Rate for Payer: Multiplan Commercial |
$140.92
|
| Rate for Payer: TriValley Medical Group Commercial |
$75.16
|
| Rate for Payer: TriValley Medical Group Senior |
$75.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$93.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$93.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$159.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.71
|
| Rate for Payer: Vantage Medical Group Senior |
$159.71
|
|
|
RITONAVIR 100 MG TABLET [100995]
|
Facility
|
OP
|
$6.40
|
|
|
Service Code
|
NDC 0054040713
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$5.44 |
| Rate for Payer: Adventist Health Commercial |
$1.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3.90
|
| Rate for Payer: Blue Shield of California EPN |
$3.12
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.96
|
| Rate for Payer: Heritage Provider Network Senior |
$3.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.48
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.56
|
| Rate for Payer: TriValley Medical Group Senior |
$2.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.44
|
| Rate for Payer: Vantage Medical Group Senior |
$5.44
|
|
|
RITONAVIR 100 MG TABLET [100995]
|
Facility
|
IP
|
$6.40
|
|
|
Service Code
|
NDC 0054040713
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: Adventist Health Commercial |
$1.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.12
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.33
|
| Rate for Payer: Heritage Provider Network Senior |
$4.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.60
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
|
|
RITONAVIR 100 MG TABLET [100995]
|
Facility
|
IP
|
$3.20
|
|
|
Service Code
|
NDC 3172259730
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: Adventist Health Commercial |
$0.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.06
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.17
|
| Rate for Payer: Heritage Provider Network Senior |
$2.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
|
|
RITONAVIR 100 MG TABLET [100995]
|
Facility
|
OP
|
$3.20
|
|
|
Service Code
|
NDC 6586268730
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: Adventist Health Commercial |
$0.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1.95
|
| Rate for Payer: Blue Shield of California EPN |
$1.56
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.98
|
| Rate for Payer: Heritage Provider Network Senior |
$1.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.24
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.28
|
| Rate for Payer: TriValley Medical Group Senior |
$1.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.72
|
| Rate for Payer: Vantage Medical Group Senior |
$2.72
|
|
|
RITONAVIR 100 MG TABLET [100995]
|
Facility
|
OP
|
$3.20
|
|
|
Service Code
|
NDC 3172259730
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: Adventist Health Commercial |
$0.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1.95
|
| Rate for Payer: Blue Shield of California EPN |
$1.56
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.98
|
| Rate for Payer: Heritage Provider Network Senior |
$1.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.24
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.28
|
| Rate for Payer: TriValley Medical Group Senior |
$1.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.72
|
| Rate for Payer: Vantage Medical Group Senior |
$2.72
|
|
|
RITONAVIR 100 MG TABLET [100995]
|
Facility
|
IP
|
$3.20
|
|
|
Service Code
|
NDC 6586268730
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: Adventist Health Commercial |
$0.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.06
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.17
|
| Rate for Payer: Heritage Provider Network Senior |
$2.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS [22149]
|
Facility
|
IP
|
$112.74
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.41 |
| Max. Negotiated Rate |
$84.56 |
| Rate for Payer: Adventist Health Commercial |
$22.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.60
|
| Rate for Payer: Cash Price |
$50.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$51.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.20
|
| Rate for Payer: Heritage Provider Network Senior |
$52.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.18
|
| Rate for Payer: Multiplan Commercial |
$84.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$40.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.33
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS [22149]
|
Facility
|
OP
|
$112.74
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.41 |
| Max. Negotiated Rate |
$227.83 |
| Rate for Payer: Adventist Health Commercial |
$22.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$69.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$109.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$227.83
|
| Rate for Payer: Blue Shield of California Commercial |
$95.83
|
| Rate for Payer: Blue Shield of California EPN |
$95.83
|
| Rate for Payer: Cash Price |
$50.73
|
| Rate for Payer: Cash Price |
$50.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$51.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$91.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$80.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$80.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$73.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.20
|
| Rate for Payer: Heritage Provider Network Senior |
$52.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$73.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$53.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$98.20
|
| Rate for Payer: Multiplan Commercial |
$84.56
|
| Rate for Payer: TriValley Medical Group Commercial |
$45.10
|
| Rate for Payer: TriValley Medical Group Senior |
$45.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$40.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$91.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$80.61
|
| Rate for Payer: Vantage Medical Group Senior |
$80.61
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS NON-ONCOLOGY [4081336]
|
Facility
|
OP
|
$112.74
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.41 |
| Max. Negotiated Rate |
$227.83 |
| Rate for Payer: Adventist Health Commercial |
$22.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$69.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$109.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$227.83
|
| Rate for Payer: Blue Shield of California Commercial |
$95.83
|
| Rate for Payer: Blue Shield of California EPN |
$95.83
|
| Rate for Payer: Cash Price |
$50.73
|
| Rate for Payer: Cash Price |
$50.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$51.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$91.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$80.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$80.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$73.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.20
|
| Rate for Payer: Heritage Provider Network Senior |
$52.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$73.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$53.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$98.20
|
| Rate for Payer: Multiplan Commercial |
$84.56
|
| Rate for Payer: TriValley Medical Group Commercial |
$45.10
|
| Rate for Payer: TriValley Medical Group Senior |
$45.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$40.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$91.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$80.61
|
| Rate for Payer: Vantage Medical Group Senior |
$80.61
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS NON-ONCOLOGY [4081336]
|
Facility
|
IP
|
$112.74
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.41 |
| Max. Negotiated Rate |
$84.56 |
| Rate for Payer: Adventist Health Commercial |
$22.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.60
|
| Rate for Payer: Cash Price |
$50.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$51.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.20
|
| Rate for Payer: Heritage Provider Network Senior |
$52.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.18
|
| Rate for Payer: Multiplan Commercial |
$84.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$40.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.33
|
|
|
RITUXIMAB 1,400 MG/11.7 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN [218742]
|
Facility
|
IP
|
$674.52
|
|
|
Service Code
|
HCPCS J9311
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$122.09 |
| Max. Negotiated Rate |
$505.89 |
| Rate for Payer: Adventist Health Commercial |
$134.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$434.39
|
| Rate for Payer: Cash Price |
$303.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$310.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$364.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$312.30
|
| Rate for Payer: Heritage Provider Network Senior |
$312.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$122.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.63
|
| Rate for Payer: Multiplan Commercial |
$505.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$243.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$223.33
|
|
|
RITUXIMAB 1,400 MG/11.7 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN [218742]
|
Facility
|
OP
|
$674.52
|
|
|
Service Code
|
HCPCS J9311
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.39 |
| Max. Negotiated Rate |
$505.89 |
| Rate for Payer: Adventist Health Commercial |
$134.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$416.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.91
|
| Rate for Payer: Blue Shield of California Commercial |
$47.91
|
| Rate for Payer: Blue Shield of California EPN |
$47.91
|
| Rate for Payer: Cash Price |
$303.53
|
| Rate for Payer: Cash Price |
$303.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$310.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$431.69
|
| Rate for Payer: EPIC Health Plan Medicare |
$36.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$312.30
|
| Rate for Payer: Heritage Provider Network Senior |
$312.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$36.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$321.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$122.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$48.76
|
| Rate for Payer: Multiplan Commercial |
$505.89
|
| Rate for Payer: TriValley Medical Group Commercial |
$269.81
|
| Rate for Payer: TriValley Medical Group Senior |
$269.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$243.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$223.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.03
|
| Rate for Payer: Vantage Medical Group Senior |
$40.03
|
|
|
RITUXIMAB 1,600 MG/13.4 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN [218821]
|
Facility
|
OP
|
$673.08
|
|
|
Service Code
|
HCPCS J9311
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.39 |
| Max. Negotiated Rate |
$504.81 |
| Rate for Payer: Adventist Health Commercial |
$134.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$415.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.91
|
| Rate for Payer: Blue Shield of California Commercial |
$47.91
|
| Rate for Payer: Blue Shield of California EPN |
$47.91
|
| Rate for Payer: Cash Price |
$302.89
|
| Rate for Payer: Cash Price |
$302.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$309.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$430.77
|
| Rate for Payer: EPIC Health Plan Medicare |
$36.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$311.64
|
| Rate for Payer: Heritage Provider Network Senior |
$311.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$36.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$321.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$121.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$48.76
|
| Rate for Payer: Multiplan Commercial |
$504.81
|
| Rate for Payer: TriValley Medical Group Commercial |
$269.23
|
| Rate for Payer: TriValley Medical Group Senior |
$269.23
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$243.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$222.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.03
|
| Rate for Payer: Vantage Medical Group Senior |
$40.03
|
|
