|
RIVAROXABAN 20 MG TABLET [153878]
|
Facility
IP
|
$21.70
|
|
|
Service Code
|
NDC 50458-579-30
|
| Hospital Charge Code |
1712516
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$16.28 |
| Rate for Payer: Adventist Health Commercial |
$4.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.91
|
| Rate for Payer: Cash Price |
$9.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.69
|
| Rate for Payer: Heritage Provider Network Senior |
$14.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.42
|
| Rate for Payer: Multiplan Commercial |
$16.28
|
|
|
RIVAROXABAN 2.5 MG TABLET [222768]
|
Facility
IP
|
$10.85
|
|
|
Service Code
|
NDC 50458-577-60
|
| Hospital Charge Code |
ERX222768
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$8.14 |
| Rate for Payer: Adventist Health Commercial |
$2.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.45
|
| Rate for Payer: Cash Price |
$4.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.35
|
| Rate for Payer: Heritage Provider Network Senior |
$7.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.71
|
| Rate for Payer: Multiplan Commercial |
$8.14
|
|
|
RIVAROXABAN 2.5 MG TABLET [222768]
|
Facility
OP
|
$10.85
|
|
|
Service Code
|
NDC 50458-577-60
|
| Hospital Charge Code |
ERX222768
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$9.22 |
| Rate for Payer: Adventist Health Commercial |
$2.17
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.97
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.14
|
| Rate for Payer: Blue Shield of California Commercial |
$6.74
|
| Rate for Payer: Blue Shield of California EPN |
$6.37
|
| Rate for Payer: Cash Price |
$4.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.22
|
| Rate for Payer: Dignity Health Senior |
$9.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.72
|
| Rate for Payer: Heritage Provider Network Senior |
$6.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.71
|
| Rate for Payer: Multiplan Commercial |
$8.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.22
|
| Rate for Payer: Vantage Medical Group Senior |
$9.22
|
|
|
RIVASTIGMINE 1.5 MG CAPSULE [28278]
|
Facility
IP
|
$1.25
|
|
|
Service Code
|
NDC 51991-793-06
|
| Hospital Charge Code |
1711861
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.94 |
| Rate for Payer: Adventist Health Commercial |
$0.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.86
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.85
|
| Rate for Payer: Heritage Provider Network Senior |
$0.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$0.94
|
|
|
RIVASTIGMINE 1.5 MG CAPSULE [28278]
|
Facility
OP
|
$1.25
|
|
|
Service Code
|
NDC 51991-793-06
|
| Hospital Charge Code |
1711861
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$1.06 |
| Rate for Payer: Adventist Health Commercial |
$0.25
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.94
|
| Rate for Payer: Blue Shield of California Commercial |
$0.78
|
| Rate for Payer: Blue Shield of California EPN |
$0.73
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.06
|
| Rate for Payer: Dignity Health Senior |
$1.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.77
|
| Rate for Payer: Heritage Provider Network Senior |
$0.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$0.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.06
|
| Rate for Payer: Vantage Medical Group Senior |
$1.06
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
IP
|
$16.22
|
|
|
Service Code
|
NDC 0781-7304-31
|
| Hospital Charge Code |
1712347
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$12.16 |
| Rate for Payer: Adventist Health Commercial |
$3.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.14
|
| Rate for Payer: Cash Price |
$7.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.98
|
| Rate for Payer: Heritage Provider Network Senior |
$10.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.06
|
| Rate for Payer: Multiplan Commercial |
$12.16
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
OP
|
$16.22
|
|
|
Service Code
|
NDC 0781-7304-31
|
| Hospital Charge Code |
1712347
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$13.79 |
| Rate for Payer: Adventist Health Commercial |
$3.24
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.79
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.16
|
| Rate for Payer: Blue Shield of California Commercial |
$10.07
|
| Rate for Payer: Blue Shield of California EPN |
$9.52
|
| Rate for Payer: Cash Price |
$7.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.79
|
| Rate for Payer: Dignity Health Senior |
$13.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.04
|
| Rate for Payer: Heritage Provider Network Senior |
$10.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.06
|
| Rate for Payer: Multiplan Commercial |
$12.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.79
|
| Rate for Payer: Vantage Medical Group Senior |
$13.79
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
IP
|
$5.10
|
|
|
Service Code
|
NDC 70710-1196-7
|
| Hospital Charge Code |
1712347
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: Adventist Health Commercial |
$1.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.50
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.45
|
| Rate for Payer: Heritage Provider Network Senior |
$3.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: Multiplan Commercial |
$3.82
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
OP
|
$5.10
|
|
|
Service Code
|
NDC 70710-1196-1
|
| Hospital Charge Code |
1712347
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$4.34 |
| Rate for Payer: Adventist Health Commercial |
$1.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.82
|
| Rate for Payer: Blue Shield of California Commercial |
$3.17
|
| Rate for Payer: Blue Shield of California EPN |
$2.99
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.34
|
| Rate for Payer: Dignity Health Senior |
$4.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.16
|
| Rate for Payer: Heritage Provider Network Senior |
$3.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: Multiplan Commercial |
$3.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Vantage Medical Group Senior |
$4.34
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
IP
|
$2.00
|
|
|
Service Code
|
NDC 0378-9070-93
|
| Hospital Charge Code |
1712347
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.37
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.35
|
| Rate for Payer: Heritage Provider Network Senior |
$1.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
IP
|
$5.10
|
|
|
Service Code
|
NDC 70710-1196-1
|
| Hospital Charge Code |
1712347
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: Adventist Health Commercial |
$1.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.50
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.45
|
| Rate for Payer: Heritage Provider Network Senior |
$3.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: Multiplan Commercial |
$3.82
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
IP
|
$2.00
|
|
|
Service Code
|
NDC 0378-9070-16
|
| Hospital Charge Code |
1712347
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.37
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.35
|
| Rate for Payer: Heritage Provider Network Senior |
$1.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
OP
|
$16.22
|
|
|
Service Code
|
NDC 0781-7304-58
|
| Hospital Charge Code |
1712347
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$13.79 |
| Rate for Payer: Adventist Health Commercial |
$3.24
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.79
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.16
|
| Rate for Payer: Blue Shield of California Commercial |
$10.07
|
| Rate for Payer: Blue Shield of California EPN |
$9.52
|
| Rate for Payer: Cash Price |
$7.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.79
|
| Rate for Payer: Dignity Health Senior |
$13.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.04
|
| Rate for Payer: Heritage Provider Network Senior |
$10.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.06
|
| Rate for Payer: Multiplan Commercial |
$12.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.79
|
| Rate for Payer: Vantage Medical Group Senior |
$13.79
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
OP
|
$5.10
|
|
|
Service Code
|
NDC 70710-1196-7
|
| Hospital Charge Code |
1712347
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$4.34 |
| Rate for Payer: Adventist Health Commercial |
$1.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.82
|
| Rate for Payer: Blue Shield of California Commercial |
$3.17
|
| Rate for Payer: Blue Shield of California EPN |
$2.99
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.34
|
| Rate for Payer: Dignity Health Senior |
$4.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.16
|
| Rate for Payer: Heritage Provider Network Senior |
$3.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: Multiplan Commercial |
$3.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Vantage Medical Group Senior |
$4.34
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
OP
|
$2.00
|
|
|
Service Code
|
NDC 0378-9070-16
|
| Hospital Charge Code |
1712347
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1.24
|
| Rate for Payer: Blue Shield of California EPN |
$1.17
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.70
|
| Rate for Payer: Dignity Health Senior |
$1.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.24
|
| Rate for Payer: Heritage Provider Network Senior |
$1.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1.70
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
OP
|
$2.00
|
|
|
Service Code
|
NDC 0378-9070-93
|
| Hospital Charge Code |
1712347
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1.24
|
| Rate for Payer: Blue Shield of California EPN |
$1.17
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.70
|
| Rate for Payer: Dignity Health Senior |
$1.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.24
|
| Rate for Payer: Heritage Provider Network Senior |
$1.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1.70
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]
|
Facility
IP
|
$16.22
|
|
|
Service Code
|
NDC 0781-7304-58
|
| Hospital Charge Code |
1712347
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$12.16 |
| Rate for Payer: Adventist Health Commercial |
$3.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.14
|
| Rate for Payer: Cash Price |
$7.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.98
|
| Rate for Payer: Heritage Provider Network Senior |
$10.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.06
|
| Rate for Payer: Multiplan Commercial |
$12.16
|
|
|
RIZATRIPTAN 10 MG DISINTEGRATING TABLET [27630]
|
Facility
IP
|
$1.95
|
|
|
Service Code
|
NDC 68462-468-06
|
| Hospital Charge Code |
ERX27630
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.46 |
| Rate for Payer: Adventist Health Commercial |
$0.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.34
|
| Rate for Payer: Cash Price |
$0.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.32
|
| Rate for Payer: Heritage Provider Network Senior |
$1.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.49
|
| Rate for Payer: Multiplan Commercial |
$1.46
|
|
|
RIZATRIPTAN 10 MG DISINTEGRATING TABLET [27630]
|
Facility
OP
|
$1.95
|
|
|
Service Code
|
NDC 68462-468-06
|
| Hospital Charge Code |
ERX27630
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.66 |
| Rate for Payer: Adventist Health Commercial |
$0.39
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.46
|
| Rate for Payer: Blue Shield of California Commercial |
$1.21
|
| Rate for Payer: Blue Shield of California EPN |
$1.14
|
| Rate for Payer: Cash Price |
$0.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.66
|
| Rate for Payer: Dignity Health Senior |
$1.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.21
|
| Rate for Payer: Heritage Provider Network Senior |
$1.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.49
|
| Rate for Payer: Multiplan Commercial |
$1.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.66
|
| Rate for Payer: Vantage Medical Group Senior |
$1.66
|
|
|
RIZATRIPTAN 10 MG TABLET [23377]
|
Facility
IP
|
$1.19
|
|
|
Service Code
|
NDC 57237-088-63
|
| Hospital Charge Code |
1712228
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.89 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.82
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.81
|
| Rate for Payer: Heritage Provider Network Senior |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$0.89
|
|
|
RIZATRIPTAN 10 MG TABLET [23377]
|
Facility
IP
|
$1.80
|
|
|
Service Code
|
NDC 0093-7472-19
|
| Hospital Charge Code |
1712228
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.35 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.24
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.22
|
| Rate for Payer: Heritage Provider Network Senior |
$1.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.35
|
|
|
RIZATRIPTAN 10 MG TABLET [23377]
|
Facility
OP
|
$1.80
|
|
|
Service Code
|
NDC 0093-7472-19
|
| Hospital Charge Code |
1712228
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.53 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1.12
|
| Rate for Payer: Blue Shield of California EPN |
$1.06
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.53
|
| Rate for Payer: Dignity Health Senior |
$1.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.11
|
| Rate for Payer: Heritage Provider Network Senior |
$1.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1.53
|
|
|
RIZATRIPTAN 10 MG TABLET [23377]
|
Facility
OP
|
$1.19
|
|
|
Service Code
|
NDC 57237-088-63
|
| Hospital Charge Code |
1712228
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$1.01 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.89
|
| Rate for Payer: Blue Shield of California Commercial |
$0.74
|
| Rate for Payer: Blue Shield of California EPN |
$0.70
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.01
|
| Rate for Payer: Dignity Health Senior |
$1.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.74
|
| Rate for Payer: Heritage Provider Network Senior |
$0.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$0.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.01
|
| Rate for Payer: Vantage Medical Group Senior |
$1.01
|
|
|
RIZATRIPTAN 5 MG TABLET [23376]
|
Facility
IP
|
$1.44
|
|
|
Service Code
|
NDC 68462-465-40
|
| Hospital Charge Code |
1712622
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.99
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.97
|
| Rate for Payer: Heritage Provider Network Senior |
$0.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.08
|
|
|
RIZATRIPTAN 5 MG TABLET [23376]
|
Facility
OP
|
$1.44
|
|
|
Service Code
|
NDC 68462-465-40
|
| Hospital Charge Code |
1712622
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.89
|
| Rate for Payer: Blue Shield of California EPN |
$0.85
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.22
|
| Rate for Payer: Dignity Health Senior |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.89
|
| Rate for Payer: Heritage Provider Network Senior |
$0.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.22
|
| Rate for Payer: Vantage Medical Group Senior |
$1.22
|
|
