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Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE [5593]

Facility

IP

$3.45

Service Code	NDC 50268-624-11
Hospital Charge Code	1711101
Hospital Revenue Code	259
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$2.76
Rate for Payer: Cash Price	$1.55
Rate for Payer: Cigna of CA HMO/PPO	$2.76
Rate for Payer: Health Smart Auto/Commercial	$2.07
Rate for Payer: LLUH Dept of Risk Management WC	$1.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.59

NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE [5593]

Facility

OP

$3.45

Service Code	NDC 50268-624-11
Hospital Charge Code	1711101
Hospital Revenue Code	259
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$2.59
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.07
Rate for Payer: Aetna of CA Government/Medicare	$2.07
Rate for Payer: Cash Price	$1.55
Rate for Payer: Health Smart Auto/Commercial	$2.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.07
Rate for Payer: LLUH Dept of Risk Management WC	$1.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.59

NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE [5593]

Facility

IP

$1.99

Service Code	NDC 68001-386-00
Hospital Charge Code	1711101
Hospital Revenue Code	259
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.59
Rate for Payer: Cash Price	$0.90
Rate for Payer: Cigna of CA HMO/PPO	$1.59
Rate for Payer: Health Smart Auto/Commercial	$1.19
Rate for Payer: LLUH Dept of Risk Management WC	$1.09
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.49

NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE [5593]

Facility

OP

$1.99

Service Code	NDC 68001-386-00
Hospital Charge Code	1711101
Hospital Revenue Code	259
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.49
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.19
Rate for Payer: Aetna of CA Government/Medicare	$1.19
Rate for Payer: Cash Price	$0.90
Rate for Payer: Health Smart Auto/Commercial	$1.19
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.19
Rate for Payer: LLUH Dept of Risk Management WC	$1.09
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.49

NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE [5593]

Facility

OP

$3.45

Service Code	NDC 50268-624-15
Hospital Charge Code	1711101
Hospital Revenue Code	259
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$2.59
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.07
Rate for Payer: Aetna of CA Government/Medicare	$2.07
Rate for Payer: Cash Price	$1.55
Rate for Payer: Health Smart Auto/Commercial	$2.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.07
Rate for Payer: LLUH Dept of Risk Management WC	$1.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.59

NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE [5593]

Facility

IP

$3.45

Service Code	NDC 50268-624-15
Hospital Charge Code	1711101
Hospital Revenue Code	259
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$2.76
Rate for Payer: Cash Price	$1.55
Rate for Payer: Cigna of CA HMO/PPO	$2.76
Rate for Payer: Health Smart Auto/Commercial	$2.07
Rate for Payer: LLUH Dept of Risk Management WC	$1.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.59

NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE [5593]

Facility

IP

$2.82

Service Code	NDC 47781-308-01
Hospital Charge Code	1711101
Hospital Revenue Code	259
Min. Negotiated Rate	$1.55
Max. Negotiated Rate	$2.26
Rate for Payer: Cash Price	$1.27
Rate for Payer: Cigna of CA HMO/PPO	$2.26
Rate for Payer: Health Smart Auto/Commercial	$1.69
Rate for Payer: LLUH Dept of Risk Management WC	$1.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.12

NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE [5593]

Facility

OP

$2.82

Service Code	NDC 47781-308-01
Hospital Charge Code	1711101
Hospital Revenue Code	259
Min. Negotiated Rate	$1.55
Max. Negotiated Rate	$2.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.69
Rate for Payer: Aetna of CA Government/Medicare	$1.69
Rate for Payer: Cash Price	$1.27
Rate for Payer: Health Smart Auto/Commercial	$1.69
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.69
Rate for Payer: LLUH Dept of Risk Management WC	$1.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.12

NITROFURANTOIN MACROCRYSTAL 25 MG CAPSULE [5594]

Facility

OP

$7.03

Service Code	NDC 47781-306-01
Hospital Charge Code	1711065
Hospital Revenue Code	259
Min. Negotiated Rate	$3.87
Max. Negotiated Rate	$5.27
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.22
Rate for Payer: Aetna of CA Government/Medicare	$4.22
Rate for Payer: Cash Price	$3.16
Rate for Payer: Health Smart Auto/Commercial	$4.22
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.22
Rate for Payer: LLUH Dept of Risk Management WC	$3.87
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.27

NITROFURANTOIN MACROCRYSTAL 25 MG CAPSULE [5594]

Facility

IP

$7.03

Service Code	NDC 47781-306-01
Hospital Charge Code	1711065
Hospital Revenue Code	259
Min. Negotiated Rate	$3.87
Max. Negotiated Rate	$5.62
Rate for Payer: Cash Price	$3.16
Rate for Payer: Cigna of CA HMO/PPO	$5.62
Rate for Payer: Health Smart Auto/Commercial	$4.22
Rate for Payer: LLUH Dept of Risk Management WC	$3.87
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.27

NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE [5595]

Facility

OP

$1.66

Service Code	NDC 47781-307-01
Hospital Charge Code	1711086
Hospital Revenue Code	259
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$1.24
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.00
Rate for Payer: Aetna of CA Government/Medicare	$1.00
Rate for Payer: Cash Price	$0.75
Rate for Payer: Health Smart Auto/Commercial	$1.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.00
Rate for Payer: LLUH Dept of Risk Management WC	$0.91
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.24

NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE [5595]

Facility

IP

$1.66

Service Code	NDC 47781-307-01
Hospital Charge Code	1711086
Hospital Revenue Code	259
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$1.33
Rate for Payer: Cash Price	$0.75
Rate for Payer: Cigna of CA HMO/PPO	$1.33
Rate for Payer: Health Smart Auto/Commercial	$1.00
Rate for Payer: LLUH Dept of Risk Management WC	$0.91
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.24

NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE [5595]

Facility

IP

$1.21

Service Code	NDC 68001-385-00
Hospital Charge Code	1711086
Hospital Revenue Code	259
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.54
Rate for Payer: Cigna of CA HMO/PPO	$0.97
Rate for Payer: Health Smart Auto/Commercial	$0.73
Rate for Payer: LLUH Dept of Risk Management WC	$0.67
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.91

NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE [5595]

Facility

OP

$1.21

Service Code	NDC 68001-385-00
Hospital Charge Code	1711086
Hospital Revenue Code	259
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$0.91
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.73
Rate for Payer: Aetna of CA Government/Medicare	$0.73
Rate for Payer: Cash Price	$0.54
Rate for Payer: Health Smart Auto/Commercial	$0.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.73
Rate for Payer: LLUH Dept of Risk Management WC	$0.67
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.91

NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE [10724]

Facility

IP

$1.88

Service Code	NDC 68001-423-00
Hospital Charge Code	1712140
Hospital Revenue Code	259
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$1.50
Rate for Payer: Cash Price	$0.85
Rate for Payer: Cigna of CA HMO/PPO	$1.50
Rate for Payer: Health Smart Auto/Commercial	$1.13
Rate for Payer: LLUH Dept of Risk Management WC	$1.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.41

NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE [10724]

Facility

IP

$1.88

Service Code	NDC 0185-0122-01
Hospital Charge Code	1712140
Hospital Revenue Code	259
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$1.50
Rate for Payer: Cash Price	$0.85
Rate for Payer: Cigna of CA HMO/PPO	$1.50
Rate for Payer: Health Smart Auto/Commercial	$1.13
Rate for Payer: LLUH Dept of Risk Management WC	$1.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.41

NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE [10724]

Facility

OP

$1.88

Service Code	NDC 0185-0122-01
Hospital Charge Code	1712140
Hospital Revenue Code	259
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$1.41
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.13
Rate for Payer: Aetna of CA Government/Medicare	$1.13
Rate for Payer: Cash Price	$0.85
Rate for Payer: Health Smart Auto/Commercial	$1.13
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.13
Rate for Payer: LLUH Dept of Risk Management WC	$1.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.41

NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE [10724]

Facility

OP

$1.88

Service Code	NDC 68001-423-00
Hospital Charge Code	1712140
Hospital Revenue Code	259
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$1.41
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.13
Rate for Payer: Aetna of CA Government/Medicare	$1.13
Rate for Payer: Cash Price	$0.85
Rate for Payer: Health Smart Auto/Commercial	$1.13
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.13
Rate for Payer: LLUH Dept of Risk Management WC	$1.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.41

NITROGLYCERIN 0.1 MG/HR TRANSDERMAL 24 HOUR PATCH [27471]

Facility

OP

$0.73

Service Code	NDC 0378-9102-16
Hospital Charge Code	1743505
Hospital Revenue Code	259
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.55
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.44
Rate for Payer: Aetna of CA Government/Medicare	$0.44
Rate for Payer: Cash Price	$0.33
Rate for Payer: Health Smart Auto/Commercial	$0.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.44
Rate for Payer: LLUH Dept of Risk Management WC	$0.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.55

NITROGLYCERIN 0.1 MG/HR TRANSDERMAL 24 HOUR PATCH [27471]

Facility

IP

$0.73

Service Code	NDC 0378-9102-93
Hospital Charge Code	1743505
Hospital Revenue Code	259
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.58
Rate for Payer: Cash Price	$0.33
Rate for Payer: Cigna of CA HMO/PPO	$0.58
Rate for Payer: Health Smart Auto/Commercial	$0.44
Rate for Payer: LLUH Dept of Risk Management WC	$0.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.55

NITROGLYCERIN 0.1 MG/HR TRANSDERMAL 24 HOUR PATCH [27471]

Facility

OP

$0.73

Service Code	NDC 0378-9102-93
Hospital Charge Code	1743505
Hospital Revenue Code	259
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.55
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.44
Rate for Payer: Aetna of CA Government/Medicare	$0.44
Rate for Payer: Cash Price	$0.33
Rate for Payer: Health Smart Auto/Commercial	$0.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.44
Rate for Payer: LLUH Dept of Risk Management WC	$0.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.55

NITROGLYCERIN 0.1 MG/HR TRANSDERMAL 24 HOUR PATCH [27471]

Facility

IP

$0.73

Service Code	NDC 0378-9102-16
Hospital Charge Code	1743505
Hospital Revenue Code	259
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.58
Rate for Payer: Cash Price	$0.33
Rate for Payer: Cigna of CA HMO/PPO	$0.58
Rate for Payer: Health Smart Auto/Commercial	$0.44
Rate for Payer: LLUH Dept of Risk Management WC	$0.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.55

NITROGLYCERIN 0.2 MG/HR TRANSDERMAL 24 HOUR PATCH [27472]

Facility

IP

$0.85

Service Code	NDC 49730-111-30
Hospital Charge Code	1743506
Hospital Revenue Code	259
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$0.68
Rate for Payer: Cash Price	$0.38
Rate for Payer: Cigna of CA HMO/PPO	$0.68
Rate for Payer: Health Smart Auto/Commercial	$0.51
Rate for Payer: LLUH Dept of Risk Management WC	$0.47
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.64

NITROGLYCERIN 0.2 MG/HR TRANSDERMAL 24 HOUR PATCH [27472]

Facility

OP

$0.85

Service Code	NDC 49730-111-30
Hospital Charge Code	1743506
Hospital Revenue Code	259
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$0.64
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.51
Rate for Payer: Aetna of CA Government/Medicare	$0.51
Rate for Payer: Cash Price	$0.38
Rate for Payer: Health Smart Auto/Commercial	$0.51
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.51
Rate for Payer: LLUH Dept of Risk Management WC	$0.47
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.64

NITROGLYCERIN 0.2 MG/HR TRANSDERMAL 24 HOUR PATCH [27472]

Facility

IP

$0.85

Service Code	NDC 0378-9104-16
Hospital Charge Code	1743506
Hospital Revenue Code	259
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$0.68
Rate for Payer: Cash Price	$0.38
Rate for Payer: Cigna of CA HMO/PPO	$0.68
Rate for Payer: Health Smart Auto/Commercial	$0.51
Rate for Payer: LLUH Dept of Risk Management WC	$0.47
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.64

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