|
RISPERIDONE 2 MG DISINTEGRATING TABLET [35688]
|
Facility
IP
|
$7.36
|
|
|
Service Code
|
NDC 0781-5312-06
|
| Hospital Charge Code |
1713153
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$5.52 |
| Rate for Payer: Adventist Health Commercial |
$1.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.06
|
| Rate for Payer: Cash Price |
$3.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.98
|
| Rate for Payer: Heritage Provider Network Senior |
$4.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.84
|
| Rate for Payer: Multiplan Commercial |
$5.52
|
|
|
RISPERIDONE 2 MG TABLET [18311]
|
Facility
IP
|
$0.23
|
|
|
Service Code
|
NDC 0904-6360-61
|
| Hospital Charge Code |
1712188
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.16
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Senior |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
|
|
RISPERIDONE 2 MG TABLET [18311]
|
Facility
OP
|
$0.23
|
|
|
Service Code
|
NDC 0904-6360-61
|
| Hospital Charge Code |
1712188
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: Dignity Health Senior |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| 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 Commercial |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
RISPERIDONE 3 MG TABLET [18312]
|
Facility
OP
|
$0.61
|
|
|
Service Code
|
NDC 68084-274-11
|
| Hospital Charge Code |
1712189
|
|
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 Gatekeeper |
$0.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.46
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| 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 Senior |
$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 Permanente of CA Commercial |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| 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 68084-274-01
|
| Hospital Charge Code |
1712189
|
|
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 Gatekeeper |
$0.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.46
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| 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 Senior |
$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 Permanente of CA Commercial |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| 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
IP
|
$0.61
|
|
|
Service Code
|
NDC 68084-274-11
|
| Hospital Charge Code |
1712189
|
|
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 |
$0.42
|
| 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 Permanente of CA 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 68084-274-01
|
| Hospital Charge Code |
1712189
|
|
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 |
$0.42
|
| 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 Permanente of CA 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 68084-277-11
|
| Hospital Charge Code |
1712190
|
|
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 Gatekeeper |
$0.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.46
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| 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 Senior |
$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 Permanente of CA Commercial |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| 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
|
$0.27
|
|
|
Service Code
|
NDC 0904-6362-61
|
| Hospital Charge Code |
1712190
|
|
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 4 MG TABLET [18310]
|
Facility
IP
|
$0.61
|
|
|
Service Code
|
NDC 68084-277-01
|
| Hospital Charge Code |
1712190
|
|
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 |
$0.42
|
| 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 Permanente of CA 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
IP
|
$0.61
|
|
|
Service Code
|
NDC 68084-277-11
|
| Hospital Charge Code |
1712190
|
|
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 |
$0.42
|
| 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 Permanente of CA 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
IP
|
$0.27
|
|
|
Service Code
|
NDC 0904-6362-61
|
| Hospital Charge Code |
1712190
|
|
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 4 MG TABLET [18310]
|
Facility
OP
|
$0.61
|
|
|
Service Code
|
NDC 68084-277-01
|
| Hospital Charge Code |
1712190
|
|
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 Gatekeeper |
$0.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.46
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| 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 Senior |
$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 Permanente of CA Commercial |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.52
|
| Rate for Payer: Vantage Medical Group Senior |
$0.52
|
|
|
RITLECITINIB 50 MG CAPSULE [238783]
|
Facility
OP
|
$161.54
|
|
|
Service Code
|
NDC 0069-0334-28
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$29.24 |
| Max. Negotiated Rate |
$137.31 |
| Rate for Payer: Adventist Health Commercial |
$32.31
|
| Rate for Payer: Aetna of CA Gatekeeper |
$86.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$110.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$137.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$88.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$121.16
|
| Rate for Payer: Blue Shield of California Commercial |
$100.32
|
| Rate for Payer: Blue Shield of California EPN |
$94.82
|
| Rate for Payer: Cash Price |
$72.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$105.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$137.31
|
| Rate for Payer: Dignity Health Senior |
$137.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$99.99
|
| Rate for Payer: Heritage Provider Network Senior |
$99.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$77.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.38
|
| Rate for Payer: Multiplan Commercial |
$121.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$137.31
|
| Rate for Payer: Vantage Medical Group Senior |
$137.31
|
|
|
RITLECITINIB 50 MG CAPSULE [238783]
|
Facility
IP
|
$161.54
|
|
|
Service Code
|
NDC 0069-0334-28
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$29.24 |
| Max. Negotiated Rate |
$121.16 |
| Rate for Payer: Adventist Health Commercial |
$32.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$110.98
|
| Rate for Payer: Cash Price |
$72.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$109.36
|
| Rate for Payer: Heritage Provider Network Senior |
$109.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.38
|
| Rate for Payer: Multiplan Commercial |
$121.16
|
|
|
RITONAVIR 100 MG TABLET [100995]
|
Facility
OP
|
$3.20
|
|
|
Service Code
|
NDC 31722-597-30
|
| Hospital Charge Code |
1712621
|
|
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 Gatekeeper |
$1.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.76
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1.99
|
| Rate for Payer: Blue Shield of California EPN |
$1.88
|
| 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 Senior |
$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 Permanente of CA Commercial |
$1.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| 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 65862-687-30
|
| Hospital Charge Code |
1712621
|
|
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 Gatekeeper |
$1.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.76
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1.99
|
| Rate for Payer: Blue Shield of California EPN |
$1.88
|
| 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 Senior |
$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 Permanente of CA Commercial |
$1.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| 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 65862-687-30
|
| Hospital Charge Code |
1712621
|
|
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 |
$2.20
|
| 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 Permanente of CA 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
IP
|
$6.40
|
|
|
Service Code
|
NDC 0054-0407-13
|
| Hospital Charge Code |
1712621
|
|
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 |
$4.40
|
| 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 Permanente of CA 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
OP
|
$6.40
|
|
|
Service Code
|
NDC 0054-0407-13
|
| Hospital Charge Code |
1712621
|
|
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 Gatekeeper |
$3.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3.97
|
| Rate for Payer: Blue Shield of California EPN |
$3.76
|
| 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 Senior |
$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 Permanente of CA Commercial |
$3.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.60
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| 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
|
$3.20
|
|
|
Service Code
|
NDC 31722-597-30
|
| Hospital Charge Code |
1712621
|
|
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 |
$2.20
|
| 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 Permanente of CA Medi-Cal |
$0.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
|
|
RITONAVIR 80 MG/ML ORAL SOLUTION [16440]
|
Facility
OP
|
$7.20
|
|
|
Service Code
|
NDC 0074-1940-63
|
| Hospital Charge Code |
1715199
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$6.12 |
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4.47
|
| Rate for Payer: Blue Shield of California EPN |
$4.23
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: Dignity Health Senior |
$6.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.46
|
| Rate for Payer: Heritage Provider Network Senior |
$4.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.12
|
|
|
RITONAVIR 80 MG/ML ORAL SOLUTION [16440]
|
Facility
IP
|
$7.20
|
|
|
Service Code
|
NDC 0074-1940-63
|
| Hospital Charge Code |
1715199
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.95
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.87
|
| Rate for Payer: Heritage Provider Network Senior |
$4.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS [22149]
|
Facility
IP
|
$112.74
|
|
|
Service Code
|
CPT J9312
|
| Hospital Charge Code |
1755659
|
|
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 |
$77.45
|
| 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 |
$76.32
|
| Rate for Payer: Heritage Provider Network Senior |
$76.32
|
| Rate for Payer: Kaiser Permanente of CA 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 |
$41.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.67
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS [22149]
|
Facility
OP
|
$112.74
|
|
|
Service Code
|
CPT J9312
|
| Hospital Charge Code |
1755659
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.41 |
| Max. Negotiated Rate |
$200.85 |
| Rate for Payer: Adventist Health Commercial |
$22.55
|
| Rate for Payer: Aetna of CA Gatekeeper |
$155.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$77.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$99.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$87.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$87.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$200.85
|
| 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 |
$118.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$87.12
|
| Rate for Payer: Dignity Health Senior |
$87.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$79.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.20
|
| Rate for Payer: Heritage Provider Network Senior |
$52.20
|
| Rate for Payer: Humana Medicare |
$79.20
|
| Rate for Payer: IEHP Medi-Cal |
$130.51
|
| Rate for Payer: IEHP Medicare Advantage |
$79.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$150.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$93.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$99.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$99.79
|
| Rate for Payer: Multiplan Commercial |
$84.56
|
| Rate for Payer: TriValley Medical Group Commercial |
$87.12
|
| Rate for Payer: TriValley Medical Group Senior |
$79.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$41.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$118.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$87.12
|
| Rate for Payer: Vantage Medical Group Senior |
$79.20
|
|
