|
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
|
|
|
NITAZOXANIDE 500 MG TABLET [39254]
|
Facility
|
OP
|
$161.56
|
|
|
Service Code
|
NDC 67546-111-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$32.31 |
| Max. Negotiated Rate |
$137.33 |
| Rate for Payer: Adventist Health Commercial |
$32.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$105.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$137.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$99.21
|
| Rate for Payer: Cash Price |
$88.86
|
| Rate for Payer: Cigna of CA HMO |
$113.09
|
| Rate for Payer: Cigna of CA PPO |
$113.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$137.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$137.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.62
|
| Rate for Payer: EPIC Health Plan Senior |
$64.62
|
| Rate for Payer: Galaxy Health WC |
$137.33
|
| Rate for Payer: Global Benefits Group Commercial |
$96.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$107.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$113.09
|
| Rate for Payer: Multiplan Commercial |
$129.25
|
| Rate for Payer: Networks By Design Commercial |
$105.01
|
| Rate for Payer: Prime Health Services Commercial |
$137.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$96.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$96.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$80.78
|
| Rate for Payer: United Healthcare All Other HMO |
$80.78
|
| Rate for Payer: United Healthcare HMO Rider |
$80.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$80.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$137.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$137.33
|
| Rate for Payer: Vantage Medical Group Senior |
$137.33
|
|
|
NITAZOXANIDE 500 MG TABLET [39254]
|
Facility
|
IP
|
$161.56
|
|
|
Service Code
|
NDC 67546-111-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$32.31 |
| Max. Negotiated Rate |
$137.33 |
| Rate for Payer: Adventist Health Commercial |
$32.31
|
| Rate for Payer: Blue Shield of California Commercial |
$119.23
|
| Rate for Payer: Blue Shield of California EPN |
$78.52
|
| Rate for Payer: Cash Price |
$88.86
|
| Rate for Payer: Cigna of CA HMO |
$113.09
|
| Rate for Payer: Cigna of CA PPO |
$113.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.62
|
| Rate for Payer: EPIC Health Plan Senior |
$64.62
|
| Rate for Payer: Galaxy Health WC |
$137.33
|
| Rate for Payer: Global Benefits Group Commercial |
$96.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$107.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.77
|
| Rate for Payer: Multiplan Commercial |
$129.25
|
| Rate for Payer: Networks By Design Commercial |
$105.01
|
| Rate for Payer: Prime Health Services Commercial |
$137.33
|
|
|
NITAZOXANIDE 500 MG TABLET [39254]
|
Facility
|
OP
|
$70.25
|
|
|
Service Code
|
NDC 64980-526-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.05 |
| Max. Negotiated Rate |
$59.71 |
| Rate for Payer: Cigna of CA HMO |
$49.17
|
| Rate for Payer: Adventist Health Commercial |
$14.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.14
|
| Rate for Payer: Cash Price |
$38.64
|
| Rate for Payer: Cigna of CA PPO |
$49.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.10
|
| Rate for Payer: EPIC Health Plan Senior |
$28.10
|
| Rate for Payer: Galaxy Health WC |
$59.71
|
| Rate for Payer: Global Benefits Group Commercial |
$42.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.17
|
| Rate for Payer: Multiplan Commercial |
$56.20
|
| Rate for Payer: Networks By Design Commercial |
$45.66
|
| Rate for Payer: Prime Health Services Commercial |
$59.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.12
|
| Rate for Payer: United Healthcare All Other HMO |
$35.12
|
| Rate for Payer: United Healthcare HMO Rider |
$35.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.71
|
| Rate for Payer: Vantage Medical Group Senior |
$59.71
|
|
|
NITAZOXANIDE 500 MG TABLET [39254]
|
Facility
|
OP
|
$173.90
|
|
|
Service Code
|
NDC 67546-111-14
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$34.78 |
| Max. Negotiated Rate |
$147.81 |
| Rate for Payer: Adventist Health Commercial |
$34.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$114.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$147.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$95.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$130.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.79
|
| Rate for Payer: Cash Price |
$95.65
|
| Rate for Payer: Cigna of CA HMO |
$121.73
|
| Rate for Payer: Cigna of CA PPO |
$121.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$147.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$147.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.56
|
| Rate for Payer: EPIC Health Plan Senior |
$69.56
|
| Rate for Payer: Galaxy Health WC |
$147.81
|
| Rate for Payer: Global Benefits Group Commercial |
$104.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$115.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$107.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$121.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$121.73
|
| Rate for Payer: Multiplan Commercial |
$139.12
|
| Rate for Payer: Networks By Design Commercial |
$113.03
|
| Rate for Payer: Prime Health Services Commercial |
$147.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$104.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$104.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.95
|
| Rate for Payer: United Healthcare All Other HMO |
$86.95
|
| Rate for Payer: United Healthcare HMO Rider |
$86.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$147.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.81
|
| Rate for Payer: Vantage Medical Group Senior |
$147.81
|
|
|
NITAZOXANIDE 500 MG TABLET [39254]
|
Facility
|
IP
|
$70.25
|
|
|
Service Code
|
NDC 64980-526-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.05 |
| Max. Negotiated Rate |
$59.71 |
| Rate for Payer: Adventist Health Commercial |
$14.05
|
| Rate for Payer: Blue Shield of California Commercial |
$51.84
|
| Rate for Payer: Blue Shield of California EPN |
$34.14
|
| Rate for Payer: Cash Price |
$38.64
|
| Rate for Payer: Cigna of CA HMO |
$49.17
|
| Rate for Payer: Cigna of CA PPO |
$49.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.10
|
| Rate for Payer: EPIC Health Plan Senior |
$28.10
|
| Rate for Payer: Galaxy Health WC |
$59.71
|
| Rate for Payer: Global Benefits Group Commercial |
$42.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.86
|
| Rate for Payer: Multiplan Commercial |
$56.20
|
| Rate for Payer: Networks By Design Commercial |
$45.66
|
| Rate for Payer: Prime Health Services Commercial |
$59.71
|
|
|
NITAZOXANIDE 500 MG TABLET [39254]
|
Facility
|
IP
|
$156.11
|
|
|
Service Code
|
NDC 64980-526-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$31.22 |
| Max. Negotiated Rate |
$132.69 |
| Rate for Payer: Adventist Health Commercial |
$31.22
|
| Rate for Payer: Blue Shield of California Commercial |
$115.21
|
| Rate for Payer: Blue Shield of California EPN |
$75.87
|
| Rate for Payer: Cash Price |
$85.86
|
| Rate for Payer: Cigna of CA HMO |
$109.28
|
| Rate for Payer: Cigna of CA PPO |
$109.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.44
|
| Rate for Payer: EPIC Health Plan Senior |
$62.44
|
| Rate for Payer: Galaxy Health WC |
$132.69
|
| Rate for Payer: Global Benefits Group Commercial |
$93.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$96.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.47
|
| Rate for Payer: Multiplan Commercial |
$124.89
|
| Rate for Payer: Networks By Design Commercial |
$101.47
|
| Rate for Payer: Prime Health Services Commercial |
$132.69
|
|
|
NITAZOXANIDE 500 MG TABLET [39254]
|
Facility
|
OP
|
$156.11
|
|
|
Service Code
|
NDC 64980-526-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$31.22 |
| Max. Negotiated Rate |
$132.69 |
| Rate for Payer: Adventist Health Commercial |
$31.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$102.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$132.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$85.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95.87
|
| Rate for Payer: Cash Price |
$85.86
|
| Rate for Payer: Cigna of CA HMO |
$109.28
|
| Rate for Payer: Cigna of CA PPO |
$109.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$132.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$132.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.44
|
| Rate for Payer: EPIC Health Plan Senior |
$62.44
|
| Rate for Payer: Galaxy Health WC |
$132.69
|
| Rate for Payer: Global Benefits Group Commercial |
$93.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$96.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$109.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$109.28
|
| Rate for Payer: Multiplan Commercial |
$124.89
|
| Rate for Payer: Networks By Design Commercial |
$101.47
|
| Rate for Payer: Prime Health Services Commercial |
$132.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.06
|
| Rate for Payer: United Healthcare All Other HMO |
$78.06
|
| Rate for Payer: United Healthcare HMO Rider |
$78.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$78.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$132.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$132.69
|
| Rate for Payer: Vantage Medical Group Senior |
$132.69
|
|
|
NITAZOXANIDE 500 MG TABLET [39254]
|
Facility
|
IP
|
$173.90
|
|
|
Service Code
|
NDC 67546-111-14
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$34.78 |
| Max. Negotiated Rate |
$147.81 |
| Rate for Payer: Adventist Health Commercial |
$34.78
|
| Rate for Payer: Blue Shield of California Commercial |
$128.34
|
| Rate for Payer: Blue Shield of California EPN |
$84.52
|
| Rate for Payer: Cash Price |
$95.65
|
| Rate for Payer: Cigna of CA HMO |
$121.73
|
| Rate for Payer: Cigna of CA PPO |
$121.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.56
|
| Rate for Payer: EPIC Health Plan Senior |
$69.56
|
| Rate for Payer: Galaxy Health WC |
$147.81
|
| Rate for Payer: Global Benefits Group Commercial |
$104.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$115.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$107.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.74
|
| Rate for Payer: Multiplan Commercial |
$139.12
|
| Rate for Payer: Networks By Design Commercial |
$113.03
|
| Rate for Payer: Prime Health Services Commercial |
$147.81
|
|
|
NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE [5593]
|
Facility
|
OP
|
$1.99
|
|
|
Service Code
|
NDC 68001-605-00
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.69 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.22
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: Cigna of CA HMO |
$1.39
|
| Rate for Payer: Cigna of CA PPO |
$1.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Senior |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.69
|
| Rate for Payer: Global Benefits Group Commercial |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.39
|
| Rate for Payer: Multiplan Commercial |
$1.59
|
| Rate for Payer: Networks By Design Commercial |
$1.29
|
| Rate for Payer: Prime Health Services Commercial |
$1.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1.69
|
|
|
NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE [5593]
|
Facility
|
IP
|
$1.99
|
|
|
Service Code
|
NDC 68001-605-00
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.69 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1.47
|
| Rate for Payer: Blue Shield of California EPN |
$0.97
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: Cigna of CA HMO |
$1.39
|
| Rate for Payer: Cigna of CA PPO |
$1.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Senior |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.69
|
| Rate for Payer: Global Benefits Group Commercial |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.59
|
| Rate for Payer: Networks By Design Commercial |
$1.29
|
| Rate for Payer: Prime Health Services Commercial |
$1.69
|
|
|
NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE [5593]
|
Facility
|
OP
|
$3.45
|
|
|
Service Code
|
NDC 50268-624-11
|
| 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: Aetna of CA HMO/PPO |
$2.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.12
|
| 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: Dignity Health Commercial/Exchange |
$2.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.93
|
| 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: Molina Healthcare of CA Medi-Cal |
$2.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.42
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.73
|
| Rate for Payer: United Healthcare All Other HMO |
$1.73
|
| Rate for Payer: United Healthcare HMO Rider |
$1.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.93
|
| Rate for Payer: Vantage Medical Group Senior |
$2.93
|
|
|
NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE [5593]
|
Facility
|
IP
|
$3.45
|
|
|
Service Code
|
NDC 50268-624-11
|
| 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
|
|
|
NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE [5593]
|
Facility
|
OP
|
$3.45
|
|
|
Service Code
|
NDC 50268-624-15
|
| 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: Aetna of CA HMO/PPO |
$2.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.12
|
| 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: Dignity Health Commercial/Exchange |
$2.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.93
|
| 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: Molina Healthcare of CA Medi-Cal |
$2.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.42
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.73
|
| Rate for Payer: United Healthcare All Other HMO |
$1.73
|
| Rate for Payer: United Healthcare HMO Rider |
$1.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.93
|
| Rate for Payer: Vantage Medical Group Senior |
$2.93
|
|
|
NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE [5593]
|
Facility
|
IP
|
$3.45
|
|
|
Service Code
|
NDC 50268-624-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$2.93 |
| Rate for Payer: Cigna of CA HMO |
$2.42
|
| 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 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
|
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE [5595]
|
Facility
|
OP
|
$0.25
|
|
|
Service Code
|
NDC 62332-390-31
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Vantage Medical Group Senior |
$0.21
|
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE [5595]
|
Facility
|
IP
|
$0.25
|
|
|
Service Code
|
NDC 62332-390-31
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE [10724]
|
Facility
|
IP
|
$0.43
|
|
|
Service Code
|
NDC 70756-404-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cigna of CA HMO |
$0.30
|
| Rate for Payer: Cigna of CA PPO |
$0.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: EPIC Health Plan Senior |
$0.17
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.34
|
| Rate for Payer: Networks By Design Commercial |
$0.28
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE [10724]
|
Facility
|
IP
|
$0.60
|
|
|
Service Code
|
NDC 0185-0122-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE [10724]
|
Facility
|
OP
|
$0.60
|
|
|
Service Code
|
NDC 0185-0122-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.37
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE [10724]
|
Facility
|
OP
|
$0.43
|
|
|
Service Code
|
NDC 70756-404-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.26
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cigna of CA HMO |
$0.30
|
| Rate for Payer: Cigna of CA PPO |
$0.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: EPIC Health Plan Senior |
$0.17
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$0.34
|
| Rate for Payer: Networks By Design Commercial |
$0.28
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO |
$0.22
|
| Rate for Payer: United Healthcare HMO Rider |
$0.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Vantage Medical Group Senior |
$0.37
|
|
|
NITROGLYCERIN 0.1 MG/HR TRANSDERMAL 24 HOUR PATCH [27471]
|
Facility
|
OP
|
$0.73
|
|
|
Service Code
|
NDC 0378-9102-93
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.45
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Cigna of CA HMO |
$0.51
|
| Rate for Payer: Cigna of CA PPO |
$0.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: EPIC Health Plan Senior |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.62
|
| Rate for Payer: Global Benefits Group Commercial |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.51
|
| Rate for Payer: Multiplan Commercial |
$0.58
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.37
|
| Rate for Payer: United Healthcare All Other HMO |
$0.37
|
| Rate for Payer: United Healthcare HMO Rider |
$0.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.62
|
| Rate for Payer: Vantage Medical Group Senior |
$0.62
|
|
|
NITROGLYCERIN 0.1 MG/HR TRANSDERMAL 24 HOUR PATCH [27471]
|
Facility
|
IP
|
$0.73
|
|
|
Service Code
|
NDC 0378-9102-16
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.54
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Cigna of CA HMO |
$0.51
|
| Rate for Payer: Cigna of CA PPO |
$0.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: EPIC Health Plan Senior |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.62
|
| Rate for Payer: Global Benefits Group Commercial |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.58
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.62
|
|
|
NITROGLYCERIN 0.1 MG/HR TRANSDERMAL 24 HOUR PATCH [27471]
|
Facility
|
OP
|
$0.73
|
|
|
Service Code
|
NDC 0378-9102-16
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.45
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Cigna of CA HMO |
$0.51
|
| Rate for Payer: Cigna of CA PPO |
$0.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: EPIC Health Plan Senior |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.62
|
| Rate for Payer: Global Benefits Group Commercial |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.51
|
| Rate for Payer: Multiplan Commercial |
$0.58
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.37
|
| Rate for Payer: United Healthcare All Other HMO |
$0.37
|
| Rate for Payer: United Healthcare HMO Rider |
$0.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.62
|
| Rate for Payer: Vantage Medical Group Senior |
$0.62
|
|
|
NITROGLYCERIN 0.1 MG/HR TRANSDERMAL 24 HOUR PATCH [27471]
|
Facility
|
IP
|
$0.73
|
|
|
Service Code
|
NDC 0378-9102-93
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.54
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Cigna of CA HMO |
$0.51
|
| Rate for Payer: Cigna of CA PPO |
$0.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: EPIC Health Plan Senior |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.62
|
| Rate for Payer: Global Benefits Group Commercial |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.58
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.62
|
|
