Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

NIMODIPINE ORAL SUSPENSION COMPOUND 30 MG/ML [4080312]

Facility

IP

$9.15

Service Code	NDC 9994-0803-12
Hospital Charge Code	1715266
Hospital Revenue Code	259
Min. Negotiated Rate	$5.03
Max. Negotiated Rate	$7.32
Rate for Payer: Cash Price	$4.12
Rate for Payer: Cigna of CA HMO/PPO	$7.32
Rate for Payer: Health Smart Auto/Commercial	$5.49
Rate for Payer: LLUH Dept of Risk Management WC	$5.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.86

NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLET,DOSE PACK [408122221]

Facility

OP

$55.60

Service Code	NDC 0069-5321-03
Hospital Charge Code	ERX408122221
Hospital Revenue Code	259
Min. Negotiated Rate	$30.58
Max. Negotiated Rate	$41.70
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$33.36
Rate for Payer: Aetna of CA Government/Medicare	$33.36
Rate for Payer: Cash Price	$25.02
Rate for Payer: Health Smart Auto/Commercial	$33.36
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$33.36
Rate for Payer: LLUH Dept of Risk Management WC	$30.58
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$41.70

NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLET,DOSE PACK [408122221]

Facility

OP

$0.01

Service Code	NDC 0069-1085-30
Hospital Charge Code	ERX408122221
Hospital Revenue Code	259
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.01
Rate for Payer: Aetna of CA Government/Medicare	$0.01
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: LLUH Dept of Risk Management WC	$0.01
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.01

NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLET,DOSE PACK [408122221]

Facility

IP

$0.01

Service Code	NDC 0069-1085-30
Hospital Charge Code	ERX408122221
Hospital Revenue Code	259
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Cigna of CA HMO/PPO	$0.01
Rate for Payer: Health Smart Auto/Commercial	$0.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.01
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.01

NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLET,DOSE PACK [408122221]

Facility

IP

$0.01

Service Code	NDC 0069-0345-30
Hospital Charge Code	ERX408122221
Hospital Revenue Code	259
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Cigna of CA HMO/PPO	$0.01
Rate for Payer: Health Smart Auto/Commercial	$0.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.01
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.01

NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLET,DOSE PACK [408122221]

Facility

OP

$0.01

Service Code	NDC 0069-0345-06
Hospital Charge Code	ERX408122221
Hospital Revenue Code	259
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.01
Rate for Payer: Aetna of CA Government/Medicare	$0.01
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: LLUH Dept of Risk Management WC	$0.01
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.01

NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLET,DOSE PACK [408122221]

Facility

IP

$0.01

Service Code	NDC 0069-0345-06
Hospital Charge Code	ERX408122221
Hospital Revenue Code	259
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Cigna of CA HMO/PPO	$0.01
Rate for Payer: Health Smart Auto/Commercial	$0.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.01
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.01

NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLET,DOSE PACK [408122221]

Facility

OP

$0.01

Service Code	NDC 0069-0345-30
Hospital Charge Code	ERX408122221
Hospital Revenue Code	259
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.01
Rate for Payer: Aetna of CA Government/Medicare	$0.01
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: LLUH Dept of Risk Management WC	$0.01
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.01

NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLET,DOSE PACK [408122221]

Facility

IP

$55.60

Service Code	NDC 0069-5321-03
Hospital Charge Code	ERX408122221
Hospital Revenue Code	259
Min. Negotiated Rate	$30.58
Max. Negotiated Rate	$44.48
Rate for Payer: Cash Price	$25.02
Rate for Payer: Cigna of CA HMO/PPO	$44.48
Rate for Payer: Health Smart Auto/Commercial	$33.36
Rate for Payer: LLUH Dept of Risk Management WC	$30.58
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$41.70

NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLET,DOSE PACK [408122221]

Facility

IP

$0.01

Service Code	NDC 0069-1085-06
Hospital Charge Code	ERX408122221
Hospital Revenue Code	259
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Cigna of CA HMO/PPO	$0.01
Rate for Payer: Health Smart Auto/Commercial	$0.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.01
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.01

NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLET,DOSE PACK [408122221]

Facility

OP

$0.01

Service Code	NDC 0069-1085-06
Hospital Charge Code	ERX408122221
Hospital Revenue Code	259
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.01
Rate for Payer: Aetna of CA Government/Medicare	$0.01
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: LLUH Dept of Risk Management WC	$0.01
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.01

NIRSEVIMAB-ALIP 100 MG/ML INTRAMUSCULAR SYRINGE [239073]

Facility

OP

$594.00

Service Code	CPT 90381
Hospital Charge Code	NDG239073
Hospital Revenue Code	636
Min. Negotiated Rate	$326.70
Max. Negotiated Rate	$445.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$356.40
Rate for Payer: Aetna of CA Government/Medicare	$356.40
Rate for Payer: Cash Price	$267.30
Rate for Payer: Health Smart Auto/Commercial	$356.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$356.40
Rate for Payer: LLUH Dept of Risk Management WC	$326.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$445.50

NIRSEVIMAB-ALIP 100 MG/ML INTRAMUSCULAR SYRINGE [239073]

Facility

IP

$594.00

Service Code	CPT 90381
Hospital Charge Code	NDG239073
Hospital Revenue Code	636
Min. Negotiated Rate	$326.70
Max. Negotiated Rate	$475.20
Rate for Payer: Health Smart Auto/Commercial	$356.40
Rate for Payer: Cash Price	$267.30
Rate for Payer: Cigna of CA HMO/PPO	$475.20
Rate for Payer: LLUH Dept of Risk Management WC	$326.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$445.50

NIRSEVIMAB-ALIP 50 MG/0.5 ML INTRAMUSCULAR SYRINGE [239072]

Facility

IP

$1,188.00

Service Code	CPT 90380
Hospital Charge Code	NDG239072
Hospital Revenue Code	636
Min. Negotiated Rate	$653.40
Max. Negotiated Rate	$950.40
Rate for Payer: Cash Price	$534.60
Rate for Payer: Cigna of CA HMO/PPO	$950.40
Rate for Payer: Health Smart Auto/Commercial	$712.80
Rate for Payer: LLUH Dept of Risk Management WC	$653.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$891.00

NIRSEVIMAB-ALIP 50 MG/0.5 ML INTRAMUSCULAR SYRINGE [239072]

Facility

OP

$1,188.00

Service Code	CPT 90380
Hospital Charge Code	NDG239072
Hospital Revenue Code	636
Min. Negotiated Rate	$653.40
Max. Negotiated Rate	$891.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$712.80
Rate for Payer: Aetna of CA Government/Medicare	$712.80
Rate for Payer: Cash Price	$534.60
Rate for Payer: Health Smart Auto/Commercial	$712.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$712.80
Rate for Payer: LLUH Dept of Risk Management WC	$653.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$891.00

NITAZOXANIDE 100 MG/5 ML ORAL SUSPENSION [34708]

Facility

IP

$10.44

Service Code	NDC 67546-212-21
Hospital Charge Code	1715312
Hospital Revenue Code	259
Min. Negotiated Rate	$5.74
Max. Negotiated Rate	$8.35
Rate for Payer: Cash Price	$4.70
Rate for Payer: Cigna of CA HMO/PPO	$8.35
Rate for Payer: Health Smart Auto/Commercial	$6.26
Rate for Payer: LLUH Dept of Risk Management WC	$5.74
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.83

NITAZOXANIDE 100 MG/5 ML ORAL SUSPENSION [34708]

Facility

OP

$10.44

Service Code	NDC 67546-212-21
Hospital Charge Code	1715312
Hospital Revenue Code	259
Min. Negotiated Rate	$5.74
Max. Negotiated Rate	$7.83
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.26
Rate for Payer: Aetna of CA Government/Medicare	$6.26
Rate for Payer: Cash Price	$4.70
Rate for Payer: Health Smart Auto/Commercial	$6.26
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.26
Rate for Payer: LLUH Dept of Risk Management WC	$5.74
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.83

NITAZOXANIDE 500 MG TABLET [39254]

Facility

IP

$173.90

Service Code	NDC 67546-111-14
Hospital Charge Code	1711963
Hospital Revenue Code	259
Min. Negotiated Rate	$95.64
Max. Negotiated Rate	$139.12
Rate for Payer: Cash Price	$78.26
Rate for Payer: Cigna of CA HMO/PPO	$139.12
Rate for Payer: Health Smart Auto/Commercial	$104.34
Rate for Payer: LLUH Dept of Risk Management WC	$95.64
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$130.42

NITAZOXANIDE 500 MG TABLET [39254]

Facility

IP

$161.56

Service Code	NDC 67546-111-12
Hospital Charge Code	1711963
Hospital Revenue Code	259
Min. Negotiated Rate	$88.86
Max. Negotiated Rate	$129.25
Rate for Payer: Cash Price	$72.70
Rate for Payer: Cigna of CA HMO/PPO	$129.25
Rate for Payer: Health Smart Auto/Commercial	$96.94
Rate for Payer: LLUH Dept of Risk Management WC	$88.86
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$121.17

NITAZOXANIDE 500 MG TABLET [39254]

Facility

OP

$161.56

Service Code	NDC 67546-111-12
Hospital Charge Code	1711963
Hospital Revenue Code	259
Min. Negotiated Rate	$88.86
Max. Negotiated Rate	$121.17
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$96.94
Rate for Payer: Aetna of CA Government/Medicare	$96.94
Rate for Payer: Cash Price	$72.70
Rate for Payer: Health Smart Auto/Commercial	$96.94
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$96.94
Rate for Payer: LLUH Dept of Risk Management WC	$88.86
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$121.17

NITAZOXANIDE 500 MG TABLET [39254]

Facility

IP

$70.25

Service Code	NDC 64980-526-21
Hospital Charge Code	1711963
Hospital Revenue Code	259
Min. Negotiated Rate	$38.64
Max. Negotiated Rate	$56.20
Rate for Payer: Cash Price	$31.61
Rate for Payer: Cigna of CA HMO/PPO	$56.20
Rate for Payer: Health Smart Auto/Commercial	$42.15
Rate for Payer: LLUH Dept of Risk Management WC	$38.64
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$52.69

NITAZOXANIDE 500 MG TABLET [39254]

Facility

OP

$173.90

Service Code	NDC 67546-111-14
Hospital Charge Code	1711963
Hospital Revenue Code	259
Min. Negotiated Rate	$95.64
Max. Negotiated Rate	$130.42
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$104.34
Rate for Payer: Aetna of CA Government/Medicare	$104.34
Rate for Payer: Cash Price	$78.26
Rate for Payer: Health Smart Auto/Commercial	$104.34
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$104.34
Rate for Payer: LLUH Dept of Risk Management WC	$95.64
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$130.42

NITAZOXANIDE 500 MG TABLET [39254]

Facility

OP

$70.25

Service Code	NDC 64980-526-21
Hospital Charge Code	1711963
Hospital Revenue Code	259
Min. Negotiated Rate	$38.64
Max. Negotiated Rate	$52.69
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$42.15
Rate for Payer: Aetna of CA Government/Medicare	$42.15
Rate for Payer: Cash Price	$31.61
Rate for Payer: Health Smart Auto/Commercial	$42.15
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$42.15
Rate for Payer: LLUH Dept of Risk Management WC	$38.64
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$52.69

NITROFURANTOIN 25 MG/5 ML ORAL SUSPENSION [10723]

Facility

IP

$7.45

Service Code	NDC 16571-740-24
Hospital Charge Code	1715644
Hospital Revenue Code	259
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$5.96
Rate for Payer: Cash Price	$3.35
Rate for Payer: Cigna of CA HMO/PPO	$5.96
Rate for Payer: Health Smart Auto/Commercial	$4.47
Rate for Payer: LLUH Dept of Risk Management WC	$4.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.59

NITROFURANTOIN 25 MG/5 ML ORAL SUSPENSION [10723]

Facility

OP

$7.45

Service Code	NDC 16571-740-24
Hospital Charge Code	1715644
Hospital Revenue Code	259
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$5.59
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.47
Rate for Payer: Aetna of CA Government/Medicare	$4.47
Rate for Payer: Cash Price	$3.35
Rate for Payer: Health Smart Auto/Commercial	$4.47
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.47
Rate for Payer: LLUH Dept of Risk Management WC	$4.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.59

<<
<
576
577
578
579
580
581
582
583
584
585
>
>>