|
RINGER'S INTRAVENOUS SOLUTION [11295]
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
NDC 0264-7780-00
|
|
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 Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
RINGER'S INTRAVENOUS SOLUTION [11295]
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
NDC 0264-7780-00
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
RIOCIGUAT 0.5 MG TABLET [203879]
|
Facility
IP
|
$164.16
|
|
|
Service Code
|
NDC 50419-250-01
|
| Hospital Charge Code |
ERX203879
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$29.71 |
| Max. Negotiated Rate |
$123.12 |
| Rate for Payer: Adventist Health Commercial |
$32.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$112.78
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.14
|
| Rate for Payer: Heritage Provider Network Senior |
$111.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.04
|
| Rate for Payer: Multiplan Commercial |
$123.12
|
|
|
RIOCIGUAT 0.5 MG TABLET [203879]
|
Facility
OP
|
$164.16
|
|
|
Service Code
|
NDC 50419-250-01
|
| Hospital Charge Code |
ERX203879
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$29.71 |
| Max. Negotiated Rate |
$139.54 |
| Rate for Payer: Adventist Health Commercial |
$32.83
|
| Rate for Payer: Aetna of CA Gatekeeper |
$87.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$112.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$139.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$90.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$123.12
|
| Rate for Payer: Blue Shield of California Commercial |
$101.94
|
| Rate for Payer: Blue Shield of California EPN |
$96.36
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$106.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$139.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$139.54
|
| Rate for Payer: Dignity Health Senior |
$139.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.62
|
| Rate for Payer: Heritage Provider Network Senior |
$101.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$79.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.04
|
| Rate for Payer: Multiplan Commercial |
$123.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$139.54
|
| Rate for Payer: Vantage Medical Group Senior |
$139.54
|
|
|
RIOCIGUAT 0.5 MG TABLET [203879]
|
Facility
OP
|
$164.16
|
|
|
Service Code
|
NDC 50419-250-91
|
| Hospital Charge Code |
ERX203879
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$29.71 |
| Max. Negotiated Rate |
$139.54 |
| Rate for Payer: Adventist Health Commercial |
$32.83
|
| Rate for Payer: Aetna of CA Gatekeeper |
$87.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$112.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$139.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$90.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$123.12
|
| Rate for Payer: Blue Shield of California Commercial |
$101.94
|
| Rate for Payer: Blue Shield of California EPN |
$96.36
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$106.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$139.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$139.54
|
| Rate for Payer: Dignity Health Senior |
$139.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.62
|
| Rate for Payer: Heritage Provider Network Senior |
$101.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$79.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.04
|
| Rate for Payer: Multiplan Commercial |
$123.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$139.54
|
| Rate for Payer: Vantage Medical Group Senior |
$139.54
|
|
|
RIOCIGUAT 0.5 MG TABLET [203879]
|
Facility
IP
|
$164.16
|
|
|
Service Code
|
NDC 50419-250-91
|
| Hospital Charge Code |
ERX203879
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$29.71 |
| Max. Negotiated Rate |
$123.12 |
| Rate for Payer: Adventist Health Commercial |
$32.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$112.78
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.14
|
| Rate for Payer: Heritage Provider Network Senior |
$111.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.04
|
| Rate for Payer: Multiplan Commercial |
$123.12
|
|
|
RIOCIGUAT 1 MG TABLET [203880]
|
Facility
IP
|
$164.16
|
|
|
Service Code
|
NDC 50419-251-01
|
| Hospital Charge Code |
ERX203880
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$29.71 |
| Max. Negotiated Rate |
$123.12 |
| Rate for Payer: Adventist Health Commercial |
$32.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$112.78
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.14
|
| Rate for Payer: Heritage Provider Network Senior |
$111.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.04
|
| Rate for Payer: Multiplan Commercial |
$123.12
|
|
|
RIOCIGUAT 1 MG TABLET [203880]
|
Facility
IP
|
$164.16
|
|
|
Service Code
|
NDC 50419-251-91
|
| Hospital Charge Code |
ERX203880
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$29.71 |
| Max. Negotiated Rate |
$123.12 |
| Rate for Payer: Adventist Health Commercial |
$32.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$112.78
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.14
|
| Rate for Payer: Heritage Provider Network Senior |
$111.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.04
|
| Rate for Payer: Multiplan Commercial |
$123.12
|
|
|
RIOCIGUAT 1 MG TABLET [203880]
|
Facility
OP
|
$164.16
|
|
|
Service Code
|
NDC 50419-251-01
|
| Hospital Charge Code |
ERX203880
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$29.71 |
| Max. Negotiated Rate |
$139.54 |
| Rate for Payer: Adventist Health Commercial |
$32.83
|
| Rate for Payer: Aetna of CA Gatekeeper |
$87.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$112.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$139.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$90.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$123.12
|
| Rate for Payer: Blue Shield of California Commercial |
$101.94
|
| Rate for Payer: Blue Shield of California EPN |
$96.36
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$106.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$139.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$139.54
|
| Rate for Payer: Dignity Health Senior |
$139.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.62
|
| Rate for Payer: Heritage Provider Network Senior |
$101.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$79.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.04
|
| Rate for Payer: Multiplan Commercial |
$123.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$139.54
|
| Rate for Payer: Vantage Medical Group Senior |
$139.54
|
|
|
RIOCIGUAT 1 MG TABLET [203880]
|
Facility
OP
|
$164.16
|
|
|
Service Code
|
NDC 50419-251-91
|
| Hospital Charge Code |
ERX203880
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$29.71 |
| Max. Negotiated Rate |
$139.54 |
| Rate for Payer: Adventist Health Commercial |
$32.83
|
| Rate for Payer: Aetna of CA Gatekeeper |
$87.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$112.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$139.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$90.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$123.12
|
| Rate for Payer: Blue Shield of California Commercial |
$101.94
|
| Rate for Payer: Blue Shield of California EPN |
$96.36
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$106.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$139.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$139.54
|
| Rate for Payer: Dignity Health Senior |
$139.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.62
|
| Rate for Payer: Heritage Provider Network Senior |
$101.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$79.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.04
|
| Rate for Payer: Multiplan Commercial |
$123.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$139.54
|
| Rate for Payer: Vantage Medical Group Senior |
$139.54
|
|
|
RIOCIGUAT 2.5 MG TABLET [203883]
|
Facility
OP
|
$164.16
|
|
|
Service Code
|
NDC 50419-254-01
|
| Hospital Charge Code |
ERX203883
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$29.71 |
| Max. Negotiated Rate |
$139.54 |
| Rate for Payer: Adventist Health Commercial |
$32.83
|
| Rate for Payer: Aetna of CA Gatekeeper |
$87.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$112.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$139.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$90.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$123.12
|
| Rate for Payer: Blue Shield of California Commercial |
$101.94
|
| Rate for Payer: Blue Shield of California EPN |
$96.36
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$106.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$139.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$139.54
|
| Rate for Payer: Dignity Health Senior |
$139.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.62
|
| Rate for Payer: Heritage Provider Network Senior |
$101.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$79.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.04
|
| Rate for Payer: Multiplan Commercial |
$123.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$139.54
|
| Rate for Payer: Vantage Medical Group Senior |
$139.54
|
|
|
RIOCIGUAT 2.5 MG TABLET [203883]
|
Facility
IP
|
$164.16
|
|
|
Service Code
|
NDC 50419-254-01
|
| Hospital Charge Code |
ERX203883
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$29.71 |
| Max. Negotiated Rate |
$123.12 |
| Rate for Payer: Adventist Health Commercial |
$32.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$112.78
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.14
|
| Rate for Payer: Heritage Provider Network Senior |
$111.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.04
|
| Rate for Payer: Multiplan Commercial |
$123.12
|
|
|
RIOCIGUAT 2.5 MG TABLET [203883]
|
Facility
IP
|
$164.16
|
|
|
Service Code
|
NDC 50419-254-91
|
| Hospital Charge Code |
ERX203883
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$29.71 |
| Max. Negotiated Rate |
$123.12 |
| Rate for Payer: Adventist Health Commercial |
$32.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$112.78
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.14
|
| Rate for Payer: Heritage Provider Network Senior |
$111.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.04
|
| Rate for Payer: Multiplan Commercial |
$123.12
|
|
|
RIOCIGUAT 2.5 MG TABLET [203883]
|
Facility
OP
|
$164.16
|
|
|
Service Code
|
NDC 50419-254-91
|
| Hospital Charge Code |
ERX203883
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$29.71 |
| Max. Negotiated Rate |
$139.54 |
| Rate for Payer: Adventist Health Commercial |
$32.83
|
| Rate for Payer: Aetna of CA Gatekeeper |
$87.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$112.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$139.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$90.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$123.12
|
| Rate for Payer: Blue Shield of California Commercial |
$101.94
|
| Rate for Payer: Blue Shield of California EPN |
$96.36
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$106.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$139.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$139.54
|
| Rate for Payer: Dignity Health Senior |
$139.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.62
|
| Rate for Payer: Heritage Provider Network Senior |
$101.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$79.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.04
|
| Rate for Payer: Multiplan Commercial |
$123.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$139.54
|
| Rate for Payer: Vantage Medical Group Senior |
$139.54
|
|
|
RIPRETINIB 50 MG TABLET [228115]
|
Facility
OP
|
$521.40
|
|
|
Service Code
|
NDC 73207-101-30
|
| Hospital Charge Code |
ERX228115
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$94.37 |
| Max. Negotiated Rate |
$443.19 |
| Rate for Payer: Adventist Health Commercial |
$104.28
|
| Rate for Payer: Aetna of CA Gatekeeper |
$278.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$358.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$443.19
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$286.77
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$391.05
|
| Rate for Payer: Blue Shield of California Commercial |
$323.79
|
| Rate for Payer: Blue Shield of California EPN |
$306.06
|
| Rate for Payer: Cash Price |
$234.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$338.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$443.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$443.19
|
| Rate for Payer: Dignity Health Senior |
$443.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$322.75
|
| Rate for Payer: Heritage Provider Network Senior |
$322.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$251.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.35
|
| Rate for Payer: Multiplan Commercial |
$391.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$443.19
|
| Rate for Payer: Vantage Medical Group Senior |
$443.19
|
|
|
RIPRETINIB 50 MG TABLET [228115]
|
Facility
IP
|
$521.40
|
|
|
Service Code
|
NDC 73207-101-30
|
| Hospital Charge Code |
ERX228115
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$94.37 |
| Max. Negotiated Rate |
$391.05 |
| Rate for Payer: Adventist Health Commercial |
$104.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$358.20
|
| Rate for Payer: Cash Price |
$234.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$352.99
|
| Rate for Payer: Heritage Provider Network Senior |
$352.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.35
|
| Rate for Payer: Multiplan Commercial |
$391.05
|
|
|
RISANKIZUMAB-RZAA 60 MG/ML INTRAVENOUS SOLUTION [234679]
|
Facility
OP
|
$1,140.22
|
|
|
Service Code
|
CPT J2327
|
| Hospital Charge Code |
NDG234679
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.36 |
| Max. Negotiated Rate |
$855.16 |
| Rate for Payer: Adventist Health Commercial |
$228.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$783.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.55
|
| Rate for Payer: Blue Shield of California Commercial |
$15.53
|
| Rate for Payer: Blue Shield of California EPN |
$15.53
|
| Rate for Payer: Cash Price |
$513.10
|
| Rate for Payer: Cash Price |
$513.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$524.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.90
|
| Rate for Payer: Dignity Health Senior |
$16.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$729.74
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$527.92
|
| Rate for Payer: Heritage Provider Network Senior |
$527.92
|
| Rate for Payer: Humana Medicare |
$15.36
|
| Rate for Payer: IEHP Medi-Cal |
$30.92
|
| Rate for Payer: IEHP Medicare Advantage |
$15.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$29.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$206.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.36
|
| Rate for Payer: Multiplan Commercial |
$855.16
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.90
|
| Rate for Payer: TriValley Medical Group Senior |
$15.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$415.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$380.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.90
|
| Rate for Payer: Vantage Medical Group Senior |
$16.90
|
|
|
RISANKIZUMAB-RZAA 60 MG/ML INTRAVENOUS SOLUTION [234679]
|
Facility
IP
|
$1,140.22
|
|
|
Service Code
|
CPT J2327
|
| Hospital Charge Code |
NDG234679
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$206.38 |
| Max. Negotiated Rate |
$855.16 |
| Rate for Payer: Adventist Health Commercial |
$228.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$783.33
|
| Rate for Payer: Cash Price |
$513.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$524.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$615.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$771.93
|
| Rate for Payer: Heritage Provider Network Senior |
$771.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$206.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.06
|
| Rate for Payer: Multiplan Commercial |
$855.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$415.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$380.95
|
|
|
RISEDRONATE 35 MG TABLET [32895]
|
Facility
IP
|
$102.29
|
|
|
Service Code
|
NDC 0430-0472-03
|
| Hospital Charge Code |
1711871
|
|
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 |
$70.27
|
| 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 Permanente of CA Medi-Cal |
$18.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.57
|
| Rate for Payer: Multiplan Commercial |
$76.72
|
|
|
RISEDRONATE 35 MG TABLET [32895]
|
Facility
OP
|
$102.29
|
|
|
Service Code
|
NDC 0430-0472-03
|
| Hospital Charge Code |
1711871
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$18.51 |
| Max. Negotiated Rate |
$86.95 |
| Rate for Payer: Adventist Health Commercial |
$20.46
|
| Rate for Payer: Aetna of CA Gatekeeper |
$54.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$70.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$86.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$56.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$76.72
|
| Rate for Payer: Blue Shield of California Commercial |
$63.52
|
| Rate for Payer: Blue Shield of California EPN |
$60.04
|
| 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 Senior |
$86.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.32
|
| Rate for Payer: Heritage Provider Network Senior |
$63.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$49.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.57
|
| Rate for Payer: Multiplan Commercial |
$76.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$86.95
|
| Rate for Payer: Vantage Medical Group Senior |
$86.95
|
|
|
RISPERIDONE 0.25 MG TABLET [25519]
|
Facility
IP
|
$0.20
|
|
|
Service Code
|
NDC 0904-6357-61
|
| Hospital Charge Code |
1712235
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.14
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Senior |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
|
|
RISPERIDONE 0.25 MG TABLET [25519]
|
Facility
OP
|
$0.27
|
|
|
Service Code
|
NDC 68084-270-01
|
| Hospital Charge Code |
1712235
|
|
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 Gatekeeper |
$0.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| 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 Senior |
$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 Permanente of CA Commercial |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| 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 68084-270-01
|
| Hospital Charge Code |
1712235
|
|
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 |
$0.19
|
| 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 Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
|
|
RISPERIDONE 0.25 MG TABLET [25519]
|
Facility
OP
|
$0.20
|
|
|
Service Code
|
NDC 0904-6357-61
|
| Hospital Charge Code |
1712235
|
|
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 Gatekeeper |
$0.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.17
|
| Rate for Payer: Dignity Health Senior |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Senior |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Vantage Medical Group Senior |
$0.17
|
|
|
RISPERIDONE 0.25 MG TABLET [25519]
|
Facility
OP
|
$0.27
|
|
|
Service Code
|
NDC 68084-270-11
|
| Hospital Charge Code |
1712235
|
|
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 Gatekeeper |
$0.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| 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 Senior |
$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 Permanente of CA Commercial |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Vantage Medical Group Senior |
$0.23
|
|
