|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
|
IP
|
$3.45
|
|
|
Service Code
|
NDC 69452-209-20
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$2.93 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2.55
|
| Rate for Payer: Blue Shield of California EPN |
$1.68
|
| Rate for Payer: Cash Price |
$1.90
|
| Rate for Payer: Cigna of CA HMO |
$2.42
|
| Rate for Payer: Cigna of CA PPO |
$2.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: EPIC Health Plan Senior |
$1.38
|
| Rate for Payer: Galaxy Health WC |
$2.93
|
| Rate for Payer: Global Benefits Group Commercial |
$2.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: Multiplan Commercial |
$2.76
|
| Rate for Payer: Networks By Design Commercial |
$2.24
|
| Rate for Payer: Prime Health Services Commercial |
$2.93
|
|
|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
|
IP
|
$1.44
|
|
|
Service Code
|
NDC 23155-512-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$1.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.70
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: Cigna of CA HMO |
$1.01
|
| Rate for Payer: Cigna of CA PPO |
$1.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Senior |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.15
|
| Rate for Payer: Networks By Design Commercial |
$0.94
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
|
|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
|
IP
|
$3.45
|
|
|
Service Code
|
NDC 69452-209-13
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$2.93 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2.55
|
| Rate for Payer: Blue Shield of California EPN |
$1.68
|
| Rate for Payer: Cash Price |
$1.90
|
| Rate for Payer: Cigna of CA HMO |
$2.42
|
| Rate for Payer: Cigna of CA PPO |
$2.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: EPIC Health Plan Senior |
$1.38
|
| Rate for Payer: Galaxy Health WC |
$2.93
|
| Rate for Payer: Global Benefits Group Commercial |
$2.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: Multiplan Commercial |
$2.76
|
| Rate for Payer: Networks By Design Commercial |
$2.24
|
| Rate for Payer: Prime Health Services Commercial |
$2.93
|
|
|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
|
OP
|
$1.44
|
|
|
Service Code
|
NDC 23155-512-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.88
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: Cigna of CA HMO |
$1.01
|
| Rate for Payer: Cigna of CA PPO |
$1.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Senior |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.01
|
| Rate for Payer: Multiplan Commercial |
$1.15
|
| Rate for Payer: Networks By Design Commercial |
$0.94
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.72
|
| Rate for Payer: United Healthcare All Other HMO |
$0.72
|
| Rate for Payer: United Healthcare HMO Rider |
$0.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.22
|
| Rate for Payer: Vantage Medical Group Senior |
$1.22
|
|
|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
|
IP
|
$1.44
|
|
|
Service Code
|
NDC 23155-512-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$1.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.70
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: Cigna of CA HMO |
$1.01
|
| Rate for Payer: Cigna of CA PPO |
$1.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Senior |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.15
|
| Rate for Payer: Networks By Design Commercial |
$0.94
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
|
|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
|
OP
|
$1.44
|
|
|
Service Code
|
NDC 23155-512-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.88
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: Cigna of CA HMO |
$1.01
|
| Rate for Payer: Cigna of CA PPO |
$1.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Senior |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.01
|
| Rate for Payer: Multiplan Commercial |
$1.15
|
| Rate for Payer: Networks By Design Commercial |
$0.94
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.72
|
| Rate for Payer: United Healthcare All Other HMO |
$0.72
|
| Rate for Payer: United Healthcare HMO Rider |
$0.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.22
|
| Rate for Payer: Vantage Medical Group Senior |
$1.22
|
|
|
NIMODIPINE 60 MG/10 ML ORAL SOLUTION [232032]
|
Facility
|
OP
|
$13.16
|
|
|
Service Code
|
NDC 24338-260-08
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$11.19 |
| Rate for Payer: Adventist Health Commercial |
$2.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.08
|
| Rate for Payer: Cash Price |
$7.24
|
| Rate for Payer: Cigna of CA HMO |
$9.21
|
| Rate for Payer: Cigna of CA PPO |
$9.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.26
|
| Rate for Payer: EPIC Health Plan Senior |
$5.26
|
| Rate for Payer: Galaxy Health WC |
$11.19
|
| Rate for Payer: Global Benefits Group Commercial |
$7.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.21
|
| Rate for Payer: Multiplan Commercial |
$10.53
|
| Rate for Payer: Networks By Design Commercial |
$8.55
|
| Rate for Payer: Prime Health Services Commercial |
$11.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.58
|
| Rate for Payer: United Healthcare All Other HMO |
$6.58
|
| Rate for Payer: United Healthcare HMO Rider |
$6.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.19
|
| Rate for Payer: Vantage Medical Group Senior |
$11.19
|
|
|
NIMODIPINE 60 MG/10 ML ORAL SOLUTION [232032]
|
Facility
|
IP
|
$13.16
|
|
|
Service Code
|
NDC 24338-260-08
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$11.19 |
| Rate for Payer: Adventist Health Commercial |
$2.63
|
| Rate for Payer: Blue Shield of California Commercial |
$9.71
|
| Rate for Payer: Blue Shield of California EPN |
$6.40
|
| Rate for Payer: Cash Price |
$7.24
|
| Rate for Payer: Cigna of CA HMO |
$9.21
|
| Rate for Payer: Cigna of CA PPO |
$9.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.26
|
| Rate for Payer: EPIC Health Plan Senior |
$5.26
|
| Rate for Payer: Galaxy Health WC |
$11.19
|
| Rate for Payer: Global Benefits Group Commercial |
$7.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.16
|
| Rate for Payer: Multiplan Commercial |
$10.53
|
| Rate for Payer: Networks By Design Commercial |
$8.55
|
| Rate for Payer: Prime Health Services Commercial |
$11.19
|
|
|
NIMODIPINE 60 MG/10 ML ORAL SYRINGE (FOR ORAL USE ONLY) [228035]
|
Facility
|
IP
|
$12.82
|
|
|
Service Code
|
NDC 24338-260-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$10.90 |
| Rate for Payer: Adventist Health Commercial |
$2.56
|
| Rate for Payer: Blue Shield of California Commercial |
$9.46
|
| Rate for Payer: Blue Shield of California EPN |
$6.23
|
| Rate for Payer: Cash Price |
$7.05
|
| Rate for Payer: Cigna of CA HMO |
$8.97
|
| Rate for Payer: Cigna of CA PPO |
$8.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.13
|
| Rate for Payer: EPIC Health Plan Senior |
$5.13
|
| Rate for Payer: Galaxy Health WC |
$10.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.08
|
| Rate for Payer: Multiplan Commercial |
$10.26
|
| Rate for Payer: Networks By Design Commercial |
$8.33
|
| Rate for Payer: Prime Health Services Commercial |
$10.90
|
|
|
NIMODIPINE 60 MG/10 ML ORAL SYRINGE (FOR ORAL USE ONLY) [228035]
|
Facility
|
OP
|
$12.82
|
|
|
Service Code
|
NDC 24338-260-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$10.90 |
| Rate for Payer: Adventist Health Commercial |
$2.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.87
|
| Rate for Payer: Cash Price |
$7.05
|
| Rate for Payer: Cigna of CA HMO |
$8.97
|
| Rate for Payer: Cigna of CA PPO |
$8.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.13
|
| Rate for Payer: EPIC Health Plan Senior |
$5.13
|
| Rate for Payer: Galaxy Health WC |
$10.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.97
|
| Rate for Payer: Multiplan Commercial |
$10.26
|
| Rate for Payer: Networks By Design Commercial |
$8.33
|
| Rate for Payer: Prime Health Services Commercial |
$10.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.41
|
| Rate for Payer: United Healthcare All Other HMO |
$6.41
|
| Rate for Payer: United Healthcare HMO Rider |
$6.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.90
|
| Rate for Payer: Vantage Medical Group Senior |
$10.90
|
|
|
NIMODIPINE 60 MG/10 ML ORAL SYRINGE (FOR ORAL USE ONLY) [228035]
|
Facility
|
IP
|
$12.82
|
|
|
Service Code
|
NDC 24338-260-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$10.90 |
| Rate for Payer: Adventist Health Commercial |
$2.56
|
| Rate for Payer: Blue Shield of California Commercial |
$9.46
|
| Rate for Payer: Blue Shield of California EPN |
$6.23
|
| Rate for Payer: Cash Price |
$7.05
|
| Rate for Payer: Cigna of CA HMO |
$8.97
|
| Rate for Payer: Cigna of CA PPO |
$8.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.13
|
| Rate for Payer: EPIC Health Plan Senior |
$5.13
|
| Rate for Payer: Galaxy Health WC |
$10.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.08
|
| Rate for Payer: Multiplan Commercial |
$10.26
|
| Rate for Payer: Networks By Design Commercial |
$8.33
|
| Rate for Payer: Prime Health Services Commercial |
$10.90
|
|
|
NIMODIPINE 60 MG/10 ML ORAL SYRINGE (FOR ORAL USE ONLY) [228035]
|
Facility
|
OP
|
$12.82
|
|
|
Service Code
|
NDC 24338-260-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$10.90 |
| Rate for Payer: Adventist Health Commercial |
$2.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.87
|
| Rate for Payer: Cash Price |
$7.05
|
| Rate for Payer: Cigna of CA HMO |
$8.97
|
| Rate for Payer: Cigna of CA PPO |
$8.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.13
|
| Rate for Payer: EPIC Health Plan Senior |
$5.13
|
| Rate for Payer: Galaxy Health WC |
$10.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.97
|
| Rate for Payer: Multiplan Commercial |
$10.26
|
| Rate for Payer: Networks By Design Commercial |
$8.33
|
| Rate for Payer: Prime Health Services Commercial |
$10.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.41
|
| Rate for Payer: United Healthcare All Other HMO |
$6.41
|
| Rate for Payer: United Healthcare HMO Rider |
$6.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.90
|
| Rate for Payer: Vantage Medical Group Senior |
$10.90
|
|
|
NIMODIPINE ORAL SUSPENSION COMPOUND 30 MG/ML [4080312]
|
Facility
|
OP
|
$9.15
|
|
|
Service Code
|
NDC 9994-0803-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$7.78 |
| Rate for Payer: Adventist Health Commercial |
$1.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.62
|
| Rate for Payer: Cash Price |
$5.03
|
| Rate for Payer: Cigna of CA HMO |
$6.41
|
| Rate for Payer: Cigna of CA PPO |
$6.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.66
|
| Rate for Payer: EPIC Health Plan Senior |
$3.66
|
| Rate for Payer: Galaxy Health WC |
$7.78
|
| Rate for Payer: Global Benefits Group Commercial |
$5.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.41
|
| Rate for Payer: Multiplan Commercial |
$7.32
|
| Rate for Payer: Networks By Design Commercial |
$5.95
|
| Rate for Payer: Prime Health Services Commercial |
$7.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.58
|
| Rate for Payer: United Healthcare All Other HMO |
$4.58
|
| Rate for Payer: United Healthcare HMO Rider |
$4.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7.78
|
|
|
NIMODIPINE ORAL SUSPENSION COMPOUND 30 MG/ML [4080312]
|
Facility
|
IP
|
$9.15
|
|
|
Service Code
|
NDC 9994-0803-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$7.78 |
| Rate for Payer: Adventist Health Commercial |
$1.83
|
| Rate for Payer: Blue Shield of California Commercial |
$6.75
|
| Rate for Payer: Blue Shield of California EPN |
$4.45
|
| Rate for Payer: Cash Price |
$5.03
|
| Rate for Payer: Cigna of CA HMO |
$6.41
|
| Rate for Payer: Cigna of CA PPO |
$6.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.66
|
| Rate for Payer: EPIC Health Plan Senior |
$3.66
|
| Rate for Payer: Galaxy Health WC |
$7.78
|
| Rate for Payer: Global Benefits Group Commercial |
$5.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Multiplan Commercial |
$7.32
|
| Rate for Payer: Networks By Design Commercial |
$5.95
|
| Rate for Payer: Prime Health Services Commercial |
$7.78
|
|
|
NIRMATRELVIR 150 MG (10)-RITONAVIR 100 MG (10) TABLETS IN A DOSE PACK [234239]
|
Facility
|
OP
|
$89.77
|
|
|
Service Code
|
NDC 0069-5317-20
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.95 |
| Max. Negotiated Rate |
$76.30 |
| Rate for Payer: Adventist Health Commercial |
$17.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$58.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.13
|
| Rate for Payer: Cash Price |
$49.37
|
| Rate for Payer: Cigna of CA HMO |
$62.84
|
| Rate for Payer: Cigna of CA PPO |
$62.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$76.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$76.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.91
|
| Rate for Payer: EPIC Health Plan Senior |
$35.91
|
| Rate for Payer: Galaxy Health WC |
$76.30
|
| Rate for Payer: Global Benefits Group Commercial |
$53.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$62.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$62.84
|
| Rate for Payer: Multiplan Commercial |
$71.82
|
| Rate for Payer: Networks By Design Commercial |
$58.35
|
| Rate for Payer: Prime Health Services Commercial |
$76.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$53.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$44.88
|
| Rate for Payer: United Healthcare All Other HMO |
$44.88
|
| Rate for Payer: United Healthcare HMO Rider |
$44.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.30
|
| Rate for Payer: Vantage Medical Group Senior |
$76.30
|
|
|
NIRMATRELVIR 150 MG (10)-RITONAVIR 100 MG (10) TABLETS IN A DOSE PACK [234239]
|
Facility
|
OP
|
$89.77
|
|
|
Service Code
|
NDC 0069-5317-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.95 |
| Max. Negotiated Rate |
$76.30 |
| Rate for Payer: Adventist Health Commercial |
$17.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$58.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.13
|
| Rate for Payer: Cash Price |
$49.37
|
| Rate for Payer: Cigna of CA HMO |
$62.84
|
| Rate for Payer: Cigna of CA PPO |
$62.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$76.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$76.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.91
|
| Rate for Payer: EPIC Health Plan Senior |
$35.91
|
| Rate for Payer: Galaxy Health WC |
$76.30
|
| Rate for Payer: Global Benefits Group Commercial |
$53.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$62.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$62.84
|
| Rate for Payer: Multiplan Commercial |
$71.82
|
| Rate for Payer: Networks By Design Commercial |
$58.35
|
| Rate for Payer: Prime Health Services Commercial |
$76.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$53.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$44.88
|
| Rate for Payer: United Healthcare All Other HMO |
$44.88
|
| Rate for Payer: United Healthcare HMO Rider |
$44.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.30
|
| Rate for Payer: Vantage Medical Group Senior |
$76.30
|
|
|
NIRMATRELVIR 150 MG (10)-RITONAVIR 100 MG (10) TABLETS IN A DOSE PACK [234239]
|
Facility
|
IP
|
$89.77
|
|
|
Service Code
|
NDC 0069-5317-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.95 |
| Max. Negotiated Rate |
$76.30 |
| Rate for Payer: Adventist Health Commercial |
$17.95
|
| Rate for Payer: Blue Shield of California Commercial |
$66.25
|
| Rate for Payer: Blue Shield of California EPN |
$43.63
|
| Rate for Payer: Cash Price |
$49.37
|
| Rate for Payer: Cigna of CA HMO |
$62.84
|
| Rate for Payer: Cigna of CA PPO |
$62.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.91
|
| Rate for Payer: EPIC Health Plan Senior |
$35.91
|
| Rate for Payer: Galaxy Health WC |
$76.30
|
| Rate for Payer: Global Benefits Group Commercial |
$53.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.54
|
| Rate for Payer: Multiplan Commercial |
$71.82
|
| Rate for Payer: Networks By Design Commercial |
$58.35
|
| Rate for Payer: Prime Health Services Commercial |
$76.30
|
|
|
NIRMATRELVIR 150 MG (10)-RITONAVIR 100 MG (10) TABLETS IN A DOSE PACK [234239]
|
Facility
|
IP
|
$89.77
|
|
|
Service Code
|
NDC 0069-5317-20
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.95 |
| Max. Negotiated Rate |
$76.30 |
| Rate for Payer: Adventist Health Commercial |
$17.95
|
| Rate for Payer: Blue Shield of California Commercial |
$66.25
|
| Rate for Payer: Blue Shield of California EPN |
$43.63
|
| Rate for Payer: Cash Price |
$49.37
|
| Rate for Payer: Cigna of CA HMO |
$62.84
|
| Rate for Payer: Cigna of CA PPO |
$62.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.91
|
| Rate for Payer: EPIC Health Plan Senior |
$35.91
|
| Rate for Payer: Galaxy Health WC |
$76.30
|
| Rate for Payer: Global Benefits Group Commercial |
$53.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.54
|
| Rate for Payer: Multiplan Commercial |
$71.82
|
| Rate for Payer: Networks By Design Commercial |
$58.35
|
| Rate for Payer: Prime Health Services Commercial |
$76.30
|
|
|
NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLET,DOSE PACK [408122221]
|
Facility
|
OP
|
$59.84
|
|
|
Service Code
|
NDC 0069-5321-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.97 |
| Max. Negotiated Rate |
$50.86 |
| Rate for Payer: Adventist Health Commercial |
$11.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.75
|
| Rate for Payer: Cash Price |
$32.91
|
| Rate for Payer: Cigna of CA HMO |
$41.89
|
| Rate for Payer: Cigna of CA PPO |
$41.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.94
|
| Rate for Payer: EPIC Health Plan Senior |
$23.94
|
| Rate for Payer: Galaxy Health WC |
$50.86
|
| Rate for Payer: Global Benefits Group Commercial |
$35.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.89
|
| Rate for Payer: Multiplan Commercial |
$47.87
|
| Rate for Payer: Networks By Design Commercial |
$38.90
|
| Rate for Payer: Prime Health Services Commercial |
$50.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.92
|
| Rate for Payer: United Healthcare All Other HMO |
$29.92
|
| Rate for Payer: United Healthcare HMO Rider |
$29.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.86
|
| Rate for Payer: Vantage Medical Group Senior |
$50.86
|
|
|
NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLET,DOSE PACK [408122221]
|
Facility
|
IP
|
$59.84
|
|
|
Service Code
|
NDC 0069-5321-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.97 |
| Max. Negotiated Rate |
$50.86 |
| Rate for Payer: Adventist Health Commercial |
$11.97
|
| Rate for Payer: Blue Shield of California Commercial |
$44.16
|
| Rate for Payer: Blue Shield of California EPN |
$29.08
|
| Rate for Payer: Cash Price |
$32.91
|
| Rate for Payer: Cigna of CA HMO |
$41.89
|
| Rate for Payer: Cigna of CA PPO |
$41.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.94
|
| Rate for Payer: EPIC Health Plan Senior |
$23.94
|
| Rate for Payer: Galaxy Health WC |
$50.86
|
| Rate for Payer: Global Benefits Group Commercial |
$35.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.36
|
| Rate for Payer: Multiplan Commercial |
$47.87
|
| Rate for Payer: Networks By Design Commercial |
$38.90
|
| Rate for Payer: Prime Health Services Commercial |
$50.86
|
|
|
NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLET,DOSE PACK [408122221]
|
Facility
|
OP
|
$59.84
|
|
|
Service Code
|
NDC 0069-5321-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.97 |
| Max. Negotiated Rate |
$50.86 |
| Rate for Payer: Adventist Health Commercial |
$11.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.75
|
| Rate for Payer: Cash Price |
$32.91
|
| Rate for Payer: Cigna of CA HMO |
$41.89
|
| Rate for Payer: Cigna of CA PPO |
$41.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.94
|
| Rate for Payer: EPIC Health Plan Senior |
$23.94
|
| Rate for Payer: Galaxy Health WC |
$50.86
|
| Rate for Payer: Global Benefits Group Commercial |
$35.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.89
|
| Rate for Payer: Multiplan Commercial |
$47.87
|
| Rate for Payer: Networks By Design Commercial |
$38.90
|
| Rate for Payer: Prime Health Services Commercial |
$50.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.92
|
| Rate for Payer: United Healthcare All Other HMO |
$29.92
|
| Rate for Payer: United Healthcare HMO Rider |
$29.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.86
|
| Rate for Payer: Vantage Medical Group Senior |
$50.86
|
|
|
NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLET,DOSE PACK [408122221]
|
Facility
|
IP
|
$59.84
|
|
|
Service Code
|
NDC 0069-5321-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.97 |
| Max. Negotiated Rate |
$50.86 |
| Rate for Payer: Adventist Health Commercial |
$11.97
|
| Rate for Payer: Blue Shield of California Commercial |
$44.16
|
| Rate for Payer: Blue Shield of California EPN |
$29.08
|
| Rate for Payer: Cash Price |
$32.91
|
| Rate for Payer: Cigna of CA HMO |
$41.89
|
| Rate for Payer: Cigna of CA PPO |
$41.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.94
|
| Rate for Payer: EPIC Health Plan Senior |
$23.94
|
| Rate for Payer: Galaxy Health WC |
$50.86
|
| Rate for Payer: Global Benefits Group Commercial |
$35.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.36
|
| Rate for Payer: Multiplan Commercial |
$47.87
|
| Rate for Payer: Networks By Design Commercial |
$38.90
|
| Rate for Payer: Prime Health Services Commercial |
$50.86
|
|
|
NIRSEVIMAB-ALIP 100 MG/ML INTRAMUSCULAR SYRINGE [239073]
|
Facility
|
IP
|
$667.36
|
|
|
Service Code
|
HCPCS 90381
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$133.47 |
| Max. Negotiated Rate |
$567.26 |
| Rate for Payer: Adventist Health Commercial |
$133.47
|
| Rate for Payer: Blue Shield of California Commercial |
$492.51
|
| Rate for Payer: Blue Shield of California EPN |
$324.34
|
| Rate for Payer: Cash Price |
$367.05
|
| Rate for Payer: Cigna of CA HMO |
$467.15
|
| Rate for Payer: Cigna of CA PPO |
$467.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$266.94
|
| Rate for Payer: EPIC Health Plan Senior |
$266.94
|
| Rate for Payer: Galaxy Health WC |
$567.26
|
| Rate for Payer: Global Benefits Group Commercial |
$400.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$445.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$254.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$413.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.17
|
| Rate for Payer: Multiplan Commercial |
$533.89
|
| Rate for Payer: Networks By Design Commercial |
$333.68
|
| Rate for Payer: Prime Health Services Commercial |
$567.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$250.46
|
| Rate for Payer: United Healthcare All Other HMO |
$243.79
|
| Rate for Payer: United Healthcare HMO Rider |
$238.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$218.56
|
|
|
NIRSEVIMAB-ALIP 100 MG/ML INTRAMUSCULAR SYRINGE [239073]
|
Facility
|
OP
|
$667.36
|
|
|
Service Code
|
HCPCS 90381
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$133.47 |
| Max. Negotiated Rate |
$1,510.70 |
| Rate for Payer: Adventist Health Commercial |
$133.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$437.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$567.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$367.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$500.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,510.70
|
| Rate for Payer: Blue Shield of California Commercial |
$623.70
|
| Rate for Payer: Blue Shield of California EPN |
$623.70
|
| Rate for Payer: Cash Price |
$367.05
|
| Rate for Payer: Cash Price |
$367.05
|
| Rate for Payer: Cigna of CA HMO |
$467.15
|
| Rate for Payer: Cigna of CA PPO |
$467.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$567.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$567.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$266.94
|
| Rate for Payer: EPIC Health Plan Senior |
$266.94
|
| Rate for Payer: Galaxy Health WC |
$567.26
|
| Rate for Payer: Global Benefits Group Commercial |
$400.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$880.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$445.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$996.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$413.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$467.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$467.15
|
| Rate for Payer: Multiplan Commercial |
$533.89
|
| Rate for Payer: Networks By Design Commercial |
$333.68
|
| Rate for Payer: Prime Health Services Commercial |
$567.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$400.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$400.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$250.46
|
| Rate for Payer: United Healthcare All Other HMO |
$243.79
|
| Rate for Payer: United Healthcare HMO Rider |
$238.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$218.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$567.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$567.26
|
| Rate for Payer: Vantage Medical Group Senior |
$567.26
|
|
|
NITAZOXANIDE 100 MG/5 ML ORAL SUSPENSION [34708]
|
Facility
|
OP
|
$10.44
|
|
|
Service Code
|
NDC 67546-212-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$8.87 |
| Rate for Payer: Adventist Health Commercial |
$2.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.41
|
| Rate for Payer: Cash Price |
$5.74
|
| Rate for Payer: Cigna of CA HMO |
$7.31
|
| Rate for Payer: Cigna of CA PPO |
$7.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.18
|
| Rate for Payer: EPIC Health Plan Senior |
$4.18
|
| Rate for Payer: Galaxy Health WC |
$8.87
|
| Rate for Payer: Global Benefits Group Commercial |
$6.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.31
|
| Rate for Payer: Multiplan Commercial |
$8.35
|
| Rate for Payer: Networks By Design Commercial |
$6.79
|
| Rate for Payer: Prime Health Services Commercial |
$8.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.22
|
| Rate for Payer: United Healthcare All Other HMO |
$5.22
|
| Rate for Payer: United Healthcare HMO Rider |
$5.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.87
|
| Rate for Payer: Vantage Medical Group Senior |
$8.87
|
|
