|
METRONIDAZOLE 1 % TOPICAL GEL [41899]
|
Facility
|
IP
|
$3.11
|
|
|
Service Code
|
NDC 51672-4215-3
|
| Hospital Charge Code |
1743755
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$2.49 |
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.49
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.71
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.33
|
|
|
METRONIDAZOLE 1 % TOPICAL GEL [41899]
|
Facility
|
OP
|
$3.11
|
|
|
Service Code
|
NDC 0781-7080-35
|
| Hospital Charge Code |
1743755
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$2.33 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.87
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.87
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.71
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.33
|
|
|
METRONIDAZOLE 1 % TOPICAL GEL [41899]
|
Facility
|
IP
|
$4.44
|
|
|
Service Code
|
NDC 66993-936-61
|
| Hospital Charge Code |
1743755
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$3.55 |
| Rate for Payer: Cash Price |
$2.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.55
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.44
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$3.33
|
|
|
METRONIDAZOLE 1 % TOPICAL GEL [41899]
|
Facility
|
OP
|
$4.44
|
|
|
Service Code
|
NDC 66993-936-61
|
| Hospital Charge Code |
1743755
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$3.33 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$2.66
|
| Rate for Payer: Aetna of CA Government/Medicare |
$2.66
|
| Rate for Payer: Cash Price |
$2.00
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$2.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.44
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$3.33
|
|
|
METRONIDAZOLE 1 % TOPICAL GEL [41899]
|
Facility
|
IP
|
$7.53
|
|
|
Service Code
|
NDC 0299-3820-60
|
| Hospital Charge Code |
1743755
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$6.02 |
| Rate for Payer: Cash Price |
$3.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.02
|
| Rate for Payer: Health Smart Auto/Commercial |
$4.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.14
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$5.65
|
|
|
METRONIDAZOLE 1 % TOPICAL GEL [41899]
|
Facility
|
OP
|
$7.53
|
|
|
Service Code
|
NDC 0299-3820-60
|
| Hospital Charge Code |
1743755
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$5.65 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$4.52
|
| Rate for Payer: Aetna of CA Government/Medicare |
$4.52
|
| Rate for Payer: Cash Price |
$3.39
|
| Rate for Payer: Health Smart Auto/Commercial |
$4.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$4.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.14
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$5.65
|
|
|
METRONIDAZOLE 1 % TOPICAL GEL [41899]
|
Facility
|
OP
|
$3.11
|
|
|
Service Code
|
NDC 51672-4215-3
|
| Hospital Charge Code |
1743755
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$2.33 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.87
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.87
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.71
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.33
|
|
|
METRONIDAZOLE 1 % TOPICAL GEL [41899]
|
Facility
|
IP
|
$3.11
|
|
|
Service Code
|
NDC 0781-7080-35
|
| Hospital Charge Code |
1743755
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$2.49 |
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.49
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.71
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.33
|
|
|
METRONIDAZOLE 250 MG TABLET [5015]
|
Facility
|
OP
|
$0.48
|
|
|
Service Code
|
NDC 0904-1453-61
|
| Hospital Charge Code |
1710210
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.29
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.29
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.36
|
|
|
METRONIDAZOLE 250 MG TABLET [5015]
|
Facility
|
IP
|
$0.36
|
|
|
Service Code
|
NDC 50111-333-01
|
| Hospital Charge Code |
1710210
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.29
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.27
|
|
|
METRONIDAZOLE 250 MG TABLET [5015]
|
Facility
|
OP
|
$0.36
|
|
|
Service Code
|
NDC 50111-333-01
|
| Hospital Charge Code |
1710210
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.22
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.22
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.27
|
|
|
METRONIDAZOLE 250 MG TABLET [5015]
|
Facility
|
IP
|
$0.48
|
|
|
Service Code
|
NDC 0904-1453-61
|
| Hospital Charge Code |
1710210
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.38
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.36
|
|
|
METRONIDAZOLE 375 MG CAPSULE [15057]
|
Facility
|
OP
|
$11.80
|
|
|
Service Code
|
NDC 62332-018-50
|
| Hospital Charge Code |
1711960
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.49 |
| Max. Negotiated Rate |
$8.85 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$7.08
|
| Rate for Payer: Aetna of CA Government/Medicare |
$7.08
|
| Rate for Payer: Cash Price |
$5.31
|
| Rate for Payer: Health Smart Auto/Commercial |
$7.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$7.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.49
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$8.85
|
|
|
METRONIDAZOLE 375 MG CAPSULE [15057]
|
Facility
|
IP
|
$11.80
|
|
|
Service Code
|
NDC 62332-018-50
|
| Hospital Charge Code |
1711960
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.49 |
| Max. Negotiated Rate |
$9.44 |
| Rate for Payer: Cash Price |
$5.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.44
|
| Rate for Payer: Health Smart Auto/Commercial |
$7.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.49
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$8.85
|
|
|
METRONIDAZOLE 500 MG/100 ML IN SODIUM CHLOR(ISO) INTRAVENOUS PIGGYBACK [5018]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
CPT J1836
|
| Hospital Charge Code |
1753035
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Health Smart Auto/Commercial |
$0.02
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.02
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.02
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.02
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.03
|
|
|
METRONIDAZOLE 500 MG/100 ML IN SODIUM CHLOR(ISO) INTRAVENOUS PIGGYBACK [5018]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
CPT J1836
|
| Hospital Charge Code |
1753035
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.02
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.02
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.01
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.02
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.01
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.02
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.02
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.02
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.03
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.02
|
|
|
METRONIDAZOLE 500 MG TABLET [5016]
|
Facility
|
OP
|
$0.90
|
|
|
Service Code
|
NDC 60687-550-11
|
| Hospital Charge Code |
1710196
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.54
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.54
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.68
|
|
|
METRONIDAZOLE 500 MG TABLET [5016]
|
Facility
|
IP
|
$0.90
|
|
|
Service Code
|
NDC 60687-550-01
|
| Hospital Charge Code |
1710196
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.72 |
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.72
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.68
|
|
|
METRONIDAZOLE 500 MG TABLET [5016]
|
Facility
|
IP
|
$0.61
|
|
|
Service Code
|
NDC 16571-664-01
|
| Hospital Charge Code |
1710196
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.49
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.46
|
|
|
METRONIDAZOLE 500 MG TABLET [5016]
|
Facility
|
IP
|
$0.58
|
|
|
Service Code
|
NDC 50111-334-02
|
| Hospital Charge Code |
1710196
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.46
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.44
|
|
|
METRONIDAZOLE 500 MG TABLET [5016]
|
Facility
|
OP
|
$0.61
|
|
|
Service Code
|
NDC 50111-334-01
|
| Hospital Charge Code |
1710196
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.37
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.37
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.46
|
|
|
METRONIDAZOLE 500 MG TABLET [5016]
|
Facility
|
IP
|
$0.61
|
|
|
Service Code
|
NDC 50111-334-01
|
| Hospital Charge Code |
1710196
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.49
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.46
|
|
|
METRONIDAZOLE 500 MG TABLET [5016]
|
Facility
|
IP
|
$0.90
|
|
|
Service Code
|
NDC 60687-550-11
|
| Hospital Charge Code |
1710196
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.72 |
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.72
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.68
|
|
|
METRONIDAZOLE 500 MG TABLET [5016]
|
Facility
|
OP
|
$0.61
|
|
|
Service Code
|
NDC 16571-664-01
|
| Hospital Charge Code |
1710196
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.37
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.37
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.46
|
|
|
METRONIDAZOLE 500 MG TABLET [5016]
|
Facility
|
OP
|
$0.90
|
|
|
Service Code
|
NDC 60687-550-01
|
| Hospital Charge Code |
1710196
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.54
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.54
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.68
|
|
