|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
|
IP
|
$1.44
|
|
|
Service Code
|
NDC 2315551230
|
| 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 |
$0.73
|
| Rate for Payer: Blue Shield of California Commercial |
$1.11
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Cigna of CA HMO |
$1.01
|
| Rate for Payer: Cigna of CA PPO |
$1.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$0.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.85
|
| 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 60 MG/10 ML ORAL SOLUTION [232032]
|
Facility
|
OP
|
$13.55
|
|
|
Service Code
|
NDC 2433826008
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$11.52 |
| Rate for Payer: Adventist Health Commercial |
$2.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.70
|
| Rate for Payer: Cash Price |
$6.10
|
| Rate for Payer: Cigna of CA HMO |
$9.48
|
| Rate for Payer: Cigna of CA PPO |
$9.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.42
|
| Rate for Payer: EPIC Health Plan Senior |
$5.42
|
| Rate for Payer: Galaxy Health WC |
$11.52
|
| Rate for Payer: Global Benefits Group Commercial |
$8.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.48
|
| Rate for Payer: Multiplan Commercial |
$10.84
|
| Rate for Payer: Networks By Design Commercial |
$8.81
|
| Rate for Payer: Prime Health Services Commercial |
$11.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.78
|
| Rate for Payer: United Healthcare All Other HMO |
$6.78
|
| Rate for Payer: United Healthcare HMO Rider |
$6.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.52
|
| Rate for Payer: Vantage Medical Group Senior |
$11.52
|
|
|
NIMODIPINE 60 MG/10 ML ORAL SOLUTION [232032]
|
Facility
|
IP
|
$13.55
|
|
|
Service Code
|
NDC 2433826008
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$11.52 |
| Rate for Payer: Adventist Health Commercial |
$2.71
|
| Rate for Payer: Blue Shield of California Commercial |
$10.42
|
| Rate for Payer: Blue Shield of California Commercial |
$6.87
|
| Rate for Payer: Cash Price |
$6.10
|
| Rate for Payer: Cigna of CA HMO |
$9.48
|
| Rate for Payer: Cigna of CA PPO |
$9.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.42
|
| Rate for Payer: EPIC Health Plan Senior |
$5.42
|
| Rate for Payer: Galaxy Health WC |
$11.52
|
| Rate for Payer: Global Benefits Group Commercial |
$8.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.25
|
| Rate for Payer: Multiplan Commercial |
$10.84
|
| Rate for Payer: Networks By Design Commercial |
$8.81
|
| Rate for Payer: Prime Health Services Commercial |
$11.52
|
|
|
NIMODIPINE 60 MG/10 ML ORAL SYRINGE (FOR ORAL USE ONLY) [228035]
|
Facility
|
OP
|
$13.20
|
|
|
Service Code
|
NDC 2433826010
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.47
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cigna of CA HMO |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$9.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$10.56
|
| Rate for Payer: Networks By Design Commercial |
$8.58
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.60
|
| Rate for Payer: United Healthcare All Other HMO |
$6.60
|
| Rate for Payer: United Healthcare HMO Rider |
$6.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: Vantage Medical Group Senior |
$11.22
|
|
|
NIMODIPINE 60 MG/10 ML ORAL SYRINGE (FOR ORAL USE ONLY) [228035]
|
Facility
|
IP
|
$13.20
|
|
|
Service Code
|
NDC 2433826010
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Blue Shield of California Commercial |
$10.15
|
| Rate for Payer: Blue Shield of California Commercial |
$6.69
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cigna of CA HMO |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$9.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Multiplan Commercial |
$10.56
|
| Rate for Payer: Networks By Design Commercial |
$8.58
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
|
|
NIMODIPINE 60 MG/10 ML ORAL SYRINGE (FOR ORAL USE ONLY) [228035]
|
Facility
|
IP
|
$13.20
|
|
|
Service Code
|
NDC 2433826012
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Blue Shield of California Commercial |
$10.15
|
| Rate for Payer: Blue Shield of California Commercial |
$6.69
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cigna of CA HMO |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$9.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Multiplan Commercial |
$10.56
|
| Rate for Payer: Networks By Design Commercial |
$8.58
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
|
|
NIMODIPINE 60 MG/10 ML ORAL SYRINGE (FOR ORAL USE ONLY) [228035]
|
Facility
|
OP
|
$13.20
|
|
|
Service Code
|
NDC 2433826012
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.47
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cigna of CA HMO |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$9.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$10.56
|
| Rate for Payer: Networks By Design Commercial |
$8.58
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.60
|
| Rate for Payer: United Healthcare All Other HMO |
$6.60
|
| Rate for Payer: United Healthcare HMO Rider |
$6.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: Vantage Medical Group Senior |
$11.22
|
|
|
NIMODIPINE ORAL SUSPENSION COMPOUND 30 MG/ML [4080312]
|
Facility
|
IP
|
$9.15
|
|
|
Service Code
|
NDC 9994080312
|
| 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 |
$4.64
|
| Rate for Payer: Blue Shield of California Commercial |
$7.04
|
| Rate for Payer: Cash Price |
$4.12
|
| Rate for Payer: Cigna of CA HMO |
$6.41
|
| Rate for Payer: Cigna of CA PPO |
$6.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$5.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.40
|
| 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
|
|
|
NIMODIPINE ORAL SUSPENSION COMPOUND 30 MG/ML [4080312]
|
Facility
|
OP
|
$9.15
|
|
|
Service Code
|
NDC 9994080312
|
| 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 |
$5.87
|
| Rate for Payer: Cash Price |
$4.12
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$5.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.40
|
| 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
|
|
|
NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLET,DOSE PACK [408122221]
|
Facility
|
OP
|
$59.84
|
|
|
Service Code
|
NDC 0069532130
|
| 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 |
$38.40
|
| Rate for Payer: Cash Price |
$26.93
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$38.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.31
|
| 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
|
OP
|
$59.84
|
|
|
Service Code
|
NDC 0069532103
|
| 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 |
$38.40
|
| Rate for Payer: Cash Price |
$26.93
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$38.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.31
|
| 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 0069532130
|
| 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 |
$30.34
|
| Rate for Payer: Blue Shield of California Commercial |
$46.02
|
| Rate for Payer: Cash Price |
$26.93
|
| Rate for Payer: Cigna of CA HMO |
$41.89
|
| Rate for Payer: Cigna of CA PPO |
$41.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$38.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.31
|
| 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
|
IP
|
$59.84
|
|
|
Service Code
|
NDC 0069532103
|
| 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 |
$30.34
|
| Rate for Payer: Blue Shield of California Commercial |
$46.02
|
| Rate for Payer: Cash Price |
$26.93
|
| Rate for Payer: Cigna of CA HMO |
$41.89
|
| Rate for Payer: Cigna of CA PPO |
$41.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$38.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.31
|
| 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
|
OP
|
$714.07
|
|
|
Service Code
|
HCPCS 90381
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$142.81 |
| Max. Negotiated Rate |
$3,685.71 |
| Rate for Payer: Adventist Health Commercial |
$142.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,685.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$606.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$392.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$535.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,289.91
|
| Rate for Payer: Blue Shield of California Commercial |
$623.70
|
| Rate for Payer: Cash Price |
$321.33
|
| Rate for Payer: Cash Price |
$321.33
|
| Rate for Payer: Cigna of CA HMO |
$499.85
|
| Rate for Payer: Cigna of CA PPO |
$499.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$606.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$606.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$606.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$499.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$285.63
|
| Rate for Payer: EPIC Health Plan Senior |
$285.63
|
| Rate for Payer: Galaxy Health WC |
$606.96
|
| Rate for Payer: Global Benefits Group Commercial |
$428.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,007.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$453.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,139.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$421.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$499.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$499.85
|
| Rate for Payer: Multiplan Commercial |
$571.26
|
| Rate for Payer: Networks By Design Commercial |
$357.04
|
| Rate for Payer: Prime Health Services Commercial |
$606.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$428.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$428.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$267.99
|
| Rate for Payer: United Healthcare All Other HMO |
$260.85
|
| Rate for Payer: United Healthcare HMO Rider |
$255.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$233.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$606.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$606.96
|
| Rate for Payer: Vantage Medical Group Senior |
$606.96
|
|
|
NIRSEVIMAB-ALIP 100 MG/ML INTRAMUSCULAR SYRINGE [239073]
|
Facility
|
IP
|
$714.07
|
|
|
Service Code
|
HCPCS 90381
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$142.81 |
| Max. Negotiated Rate |
$606.96 |
| Rate for Payer: Adventist Health Commercial |
$142.81
|
| Rate for Payer: Blue Shield of California Commercial |
$362.03
|
| Rate for Payer: Blue Shield of California Commercial |
$549.12
|
| Rate for Payer: Cash Price |
$321.33
|
| Rate for Payer: Cigna of CA HMO |
$499.85
|
| Rate for Payer: Cigna of CA PPO |
$499.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$499.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$285.63
|
| Rate for Payer: EPIC Health Plan Senior |
$285.63
|
| Rate for Payer: Galaxy Health WC |
$606.96
|
| Rate for Payer: Global Benefits Group Commercial |
$428.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$453.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$421.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.38
|
| Rate for Payer: Multiplan Commercial |
$571.26
|
| Rate for Payer: Networks By Design Commercial |
$357.04
|
| Rate for Payer: Prime Health Services Commercial |
$606.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$267.99
|
| Rate for Payer: United Healthcare All Other HMO |
$260.85
|
| Rate for Payer: United Healthcare HMO Rider |
$255.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$233.86
|
|
|
NIRSEVIMAB-ALIP 50 MG/0.5 ML INTRAMUSCULAR SYRINGE [239072]
|
Facility
|
OP
|
$1,428.14
|
|
|
Service Code
|
HCPCS 90380
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$285.63 |
| Max. Negotiated Rate |
$3,685.71 |
| Rate for Payer: Adventist Health Commercial |
$285.63
|
| Rate for Payer: Adventist Health Commercial |
$285.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,685.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,685.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,213.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,213.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$785.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$785.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,071.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,071.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,289.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,289.91
|
| Rate for Payer: Blue Shield of California Commercial |
$623.70
|
| Rate for Payer: Blue Shield of California Commercial |
$623.70
|
| Rate for Payer: Cash Price |
$642.66
|
| Rate for Payer: Cash Price |
$642.67
|
| Rate for Payer: Cash Price |
$642.66
|
| Rate for Payer: Cash Price |
$642.67
|
| Rate for Payer: Cigna of CA HMO |
$999.71
|
| Rate for Payer: Cigna of CA HMO |
$999.70
|
| Rate for Payer: Cigna of CA PPO |
$999.71
|
| Rate for Payer: Cigna of CA PPO |
$999.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,213.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,213.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,213.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,213.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,213.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,213.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$999.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$999.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.26
|
| Rate for Payer: EPIC Health Plan Senior |
$571.26
|
| Rate for Payer: EPIC Health Plan Senior |
$571.26
|
| Rate for Payer: Galaxy Health WC |
$1,213.93
|
| Rate for Payer: Galaxy Health WC |
$1,213.92
|
| Rate for Payer: Global Benefits Group Commercial |
$856.89
|
| Rate for Payer: Global Benefits Group Commercial |
$856.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,007.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,007.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$906.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$906.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,139.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,139.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$842.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$842.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$999.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$999.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$999.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$999.71
|
| Rate for Payer: Multiplan Commercial |
$1,142.52
|
| Rate for Payer: Multiplan Commercial |
$1,142.51
|
| Rate for Payer: Networks By Design Commercial |
$714.08
|
| Rate for Payer: Networks By Design Commercial |
$714.07
|
| Rate for Payer: Prime Health Services Commercial |
$1,213.92
|
| Rate for Payer: Prime Health Services Commercial |
$1,213.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$856.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$856.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$856.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$856.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$535.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$535.98
|
| Rate for Payer: United Healthcare All Other HMO |
$521.70
|
| Rate for Payer: United Healthcare All Other HMO |
$521.70
|
| Rate for Payer: United Healthcare HMO Rider |
$510.42
|
| Rate for Payer: United Healthcare HMO Rider |
$510.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$467.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$467.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,213.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,213.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,213.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,213.93
|
| Rate for Payer: Vantage Medical Group Senior |
$1,213.92
|
| Rate for Payer: Vantage Medical Group Senior |
$1,213.93
|
|
|
NIRSEVIMAB-ALIP 50 MG/0.5 ML INTRAMUSCULAR SYRINGE [239072]
|
Facility
|
IP
|
$1,428.15
|
|
|
Service Code
|
HCPCS 90380
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$285.63 |
| Max. Negotiated Rate |
$1,213.93 |
| Rate for Payer: Adventist Health Commercial |
$285.63
|
| Rate for Payer: Adventist Health Commercial |
$285.63
|
| Rate for Payer: Blue Shield of California Commercial |
$724.07
|
| Rate for Payer: Blue Shield of California Commercial |
$1,098.25
|
| Rate for Payer: Blue Shield of California Commercial |
$724.07
|
| Rate for Payer: Blue Shield of California Commercial |
$1,098.24
|
| Rate for Payer: Cash Price |
$642.66
|
| Rate for Payer: Cash Price |
$642.67
|
| Rate for Payer: Cigna of CA HMO |
$999.71
|
| Rate for Payer: Cigna of CA HMO |
$999.70
|
| Rate for Payer: Cigna of CA PPO |
$999.70
|
| Rate for Payer: Cigna of CA PPO |
$999.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$999.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$999.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.26
|
| Rate for Payer: EPIC Health Plan Senior |
$571.26
|
| Rate for Payer: EPIC Health Plan Senior |
$571.26
|
| Rate for Payer: Galaxy Health WC |
$1,213.92
|
| Rate for Payer: Galaxy Health WC |
$1,213.93
|
| Rate for Payer: Global Benefits Group Commercial |
$856.89
|
| Rate for Payer: Global Benefits Group Commercial |
$856.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$906.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$906.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$842.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$842.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.76
|
| Rate for Payer: Multiplan Commercial |
$1,142.51
|
| Rate for Payer: Multiplan Commercial |
$1,142.52
|
| Rate for Payer: Networks By Design Commercial |
$714.08
|
| Rate for Payer: Networks By Design Commercial |
$714.07
|
| Rate for Payer: Prime Health Services Commercial |
$1,213.93
|
| Rate for Payer: Prime Health Services Commercial |
$1,213.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$535.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$535.98
|
| Rate for Payer: United Healthcare All Other HMO |
$521.70
|
| Rate for Payer: United Healthcare All Other HMO |
$521.70
|
| Rate for Payer: United Healthcare HMO Rider |
$510.42
|
| Rate for Payer: United Healthcare HMO Rider |
$510.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$467.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$467.72
|
|
|
NITAZOXANIDE 100 MG/5 ML ORAL SUSPENSION [34708]
|
Facility
|
IP
|
$10.44
|
|
|
Service Code
|
NDC 6754621221
|
| 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: Blue Shield of California Commercial |
$5.29
|
| Rate for Payer: Blue Shield of California Commercial |
$8.03
|
| Rate for Payer: Cash Price |
$4.70
|
| Rate for Payer: Cigna of CA HMO |
$7.31
|
| Rate for Payer: Cigna of CA PPO |
$7.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.31
|
| 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 Foundation Hospitals Commercial/Self Funded |
$6.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.51
|
| 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
|
|
|
NITAZOXANIDE 100 MG/5 ML ORAL SUSPENSION [34708]
|
Facility
|
OP
|
$10.44
|
|
|
Service Code
|
NDC 6754621221
|
| 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 |
$6.70
|
| Rate for Payer: Cash Price |
$4.70
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.31
|
| 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 Foundation Hospitals Commercial/Self Funded |
$6.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.16
|
| 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
|
IP
|
$161.56
|
|
|
Service Code
|
NDC 6754611112
|
| 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 |
$124.24
|
| Rate for Payer: Blue Shield of California Commercial |
$81.91
|
| Rate for Payer: Cash Price |
$72.70
|
| Rate for Payer: Cigna of CA HMO |
$113.09
|
| Rate for Payer: Cigna of CA PPO |
$113.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$102.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.32
|
| 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
|
$156.11
|
|
|
Service Code
|
NDC 6498052660
|
| 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 |
$100.18
|
| Rate for Payer: Cash Price |
$70.25
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$99.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$56.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92.10
|
| 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
|
OP
|
$70.25
|
|
|
Service Code
|
NDC 6498052621
|
| 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: 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 |
$45.08
|
| Rate for Payer: Cash Price |
$31.61
|
| Rate for Payer: Cigna of CA HMO |
$49.17
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$44.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.45
|
| 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
|
IP
|
$173.90
|
|
|
Service Code
|
NDC 6754611114
|
| 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 |
$133.73
|
| Rate for Payer: Blue Shield of California Commercial |
$88.17
|
| Rate for Payer: Cash Price |
$78.26
|
| Rate for Payer: Cigna of CA HMO |
$121.73
|
| Rate for Payer: Cigna of CA PPO |
$121.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$110.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$102.60
|
| 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
|
|
|
NITAZOXANIDE 500 MG TABLET [39254]
|
Facility
|
OP
|
$161.56
|
|
|
Service Code
|
NDC 6754611112
|
| 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 |
$103.67
|
| Rate for Payer: Cash Price |
$72.70
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$102.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.32
|
| 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
|
$156.11
|
|
|
Service Code
|
NDC 6498052660
|
| 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 |
$120.05
|
| Rate for Payer: Blue Shield of California Commercial |
$79.15
|
| Rate for Payer: Cash Price |
$70.25
|
| Rate for Payer: Cigna of CA HMO |
$109.28
|
| Rate for Payer: Cigna of CA PPO |
$109.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$99.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92.10
|
| 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
|
|
