|
NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLET,DOSE PACK [408122221]
|
Facility
|
IP
|
$55.60
|
|
|
Service Code
|
NDC 0069-5321-03
|
| Hospital Charge Code |
ERX408122221
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.34 |
| Max. Negotiated Rate |
$47.26 |
| Rate for Payer: Blue Shield of California Commercial |
$39.59
|
| Rate for Payer: Blue Shield of California EPN |
$28.47
|
| Rate for Payer: Cash Price |
$25.02
|
| Rate for Payer: Cigna of CA HMO |
$38.92
|
| Rate for Payer: Cigna of CA PPO |
$38.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.24
|
| Rate for Payer: Galaxy Health WC |
$47.26
|
| Rate for Payer: Global Benefits Group Commercial |
$33.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.34
|
| Rate for Payer: Multiplan Commercial |
$44.48
|
| Rate for Payer: Networks By Design Commercial |
$36.14
|
| Rate for Payer: Prime Health Services Commercial |
$47.26
|
|
|
NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLET,DOSE PACK [408122221]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 0069-1085-30
|
| Hospital Charge Code |
ERX408122221
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLET,DOSE PACK [408122221]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 0069-0345-30
|
| Hospital Charge Code |
ERX408122221
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Blue Distinction Transplant |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Media |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLET,DOSE PACK [408122221]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 0069-1085-30
|
| Hospital Charge Code |
ERX408122221
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Blue Distinction Transplant |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Media |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLET,DOSE PACK [408122221]
|
Facility
|
OP
|
$55.60
|
|
|
Service Code
|
NDC 0069-5321-03
|
| Hospital Charge Code |
ERX408122221
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.34 |
| Max. Negotiated Rate |
$47.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$36.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$47.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.13
|
| Rate for Payer: Blue Distinction Transplant |
$33.36
|
| Rate for Payer: Blue Shield of California Commercial |
$40.98
|
| Rate for Payer: Blue Shield of California EPN |
$32.47
|
| Rate for Payer: Cash Price |
$25.02
|
| Rate for Payer: Cigna of CA HMO |
$38.92
|
| Rate for Payer: Cigna of CA PPO |
$38.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$47.26
|
| Rate for Payer: Dignity Health Media |
$47.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$22.24
|
| Rate for Payer: Galaxy Health WC |
$47.26
|
| Rate for Payer: Global Benefits Group Commercial |
$33.36
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$41.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.34
|
| Rate for Payer: Multiplan Commercial |
$44.48
|
| Rate for Payer: Networks By Design Commercial |
$36.14
|
| Rate for Payer: Prime Health Services Commercial |
$47.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.80
|
| Rate for Payer: United Healthcare All Other HMO |
$27.80
|
| Rate for Payer: United Healthcare HMO Rider |
$27.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$47.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.26
|
| Rate for Payer: Vantage Medical Group Senior |
$47.26
|
|
|
NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLET,DOSE PACK [408122221]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 0069-1085-06
|
| Hospital Charge Code |
ERX408122221
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLET,DOSE PACK [408122221]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 0069-0345-06
|
| Hospital Charge Code |
ERX408122221
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
NIRSEVIMAB-ALIP 100 MG/ML INTRAMUSCULAR SYRINGE [239073]
|
Facility
|
OP
|
$594.00
|
|
|
Service Code
|
CPT 90381
|
| Hospital Charge Code |
NDG239073
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$142.56 |
| Max. Negotiated Rate |
$3,510.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,510.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$504.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$326.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$326.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$353.91
|
| Rate for Payer: Blue Distinction Transplant |
$356.40
|
| Rate for Payer: Blue Shield of California Commercial |
$437.78
|
| Rate for Payer: Blue Shield of California EPN |
$346.90
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Cigna of CA HMO |
$415.80
|
| Rate for Payer: Cigna of CA PPO |
$415.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$504.90
|
| Rate for Payer: Dignity Health Media |
$504.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$504.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$237.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$237.60
|
| Rate for Payer: Galaxy Health WC |
$504.90
|
| Rate for Payer: Global Benefits Group Commercial |
$356.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$445.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$396.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$948.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.56
|
| Rate for Payer: Multiplan Commercial |
$475.20
|
| Rate for Payer: Networks By Design Commercial |
$297.00
|
| Rate for Payer: Prime Health Services Commercial |
$504.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$356.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$356.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$297.00
|
| Rate for Payer: United Healthcare HMO Rider |
$297.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$297.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$504.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$504.90
|
| Rate for Payer: Vantage Medical Group Senior |
$504.90
|
|
|
NIRSEVIMAB-ALIP 100 MG/ML INTRAMUSCULAR SYRINGE [239073]
|
Facility
|
IP
|
$594.00
|
|
|
Service Code
|
CPT 90381
|
| Hospital Charge Code |
NDG239073
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$142.56 |
| Max. Negotiated Rate |
$504.90 |
| Rate for Payer: Blue Shield of California Commercial |
$422.93
|
| Rate for Payer: Blue Shield of California EPN |
$304.13
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Cigna of CA HMO |
$415.80
|
| Rate for Payer: Cigna of CA PPO |
$415.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$237.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$237.60
|
| Rate for Payer: Galaxy Health WC |
$504.90
|
| Rate for Payer: Global Benefits Group Commercial |
$356.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$396.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$226.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.56
|
| Rate for Payer: Multiplan Commercial |
$475.20
|
| Rate for Payer: Networks By Design Commercial |
$297.00
|
| Rate for Payer: Prime Health Services Commercial |
$504.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$224.29
|
| Rate for Payer: United Healthcare All Other HMO |
$219.07
|
| Rate for Payer: United Healthcare HMO Rider |
$214.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.02
|
|
|
NIRSEVIMAB-ALIP 50 MG/0.5 ML INTRAMUSCULAR SYRINGE [239072]
|
Facility
|
OP
|
$1,188.00
|
|
|
Service Code
|
CPT 90380
|
| Hospital Charge Code |
NDG239072
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$285.12 |
| Max. Negotiated Rate |
$3,510.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,510.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,009.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$653.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$653.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$707.81
|
| Rate for Payer: Blue Distinction Transplant |
$712.80
|
| Rate for Payer: Blue Shield of California Commercial |
$875.56
|
| Rate for Payer: Blue Shield of California EPN |
$693.79
|
| Rate for Payer: Cash Price |
$534.60
|
| Rate for Payer: Cash Price |
$534.60
|
| Rate for Payer: Cigna of CA HMO |
$831.60
|
| Rate for Payer: Cigna of CA PPO |
$831.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,009.80
|
| Rate for Payer: Dignity Health Media |
$1,009.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,009.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$475.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$475.20
|
| Rate for Payer: Galaxy Health WC |
$1,009.80
|
| Rate for Payer: Global Benefits Group Commercial |
$712.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$891.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$792.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$948.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.12
|
| Rate for Payer: Multiplan Commercial |
$950.40
|
| Rate for Payer: Networks By Design Commercial |
$594.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,009.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$712.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$712.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$594.00
|
| Rate for Payer: United Healthcare All Other HMO |
$594.00
|
| Rate for Payer: United Healthcare HMO Rider |
$594.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$594.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,009.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,009.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,009.80
|
|
|
NIRSEVIMAB-ALIP 50 MG/0.5 ML INTRAMUSCULAR SYRINGE [239072]
|
Facility
|
IP
|
$1,188.00
|
|
|
Service Code
|
CPT 90380
|
| Hospital Charge Code |
NDG239072
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$285.12 |
| Max. Negotiated Rate |
$1,009.80 |
| Rate for Payer: Blue Shield of California Commercial |
$845.86
|
| Rate for Payer: Blue Shield of California EPN |
$608.26
|
| Rate for Payer: Cash Price |
$534.60
|
| Rate for Payer: Cigna of CA HMO |
$831.60
|
| Rate for Payer: Cigna of CA PPO |
$831.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$475.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$475.20
|
| Rate for Payer: Galaxy Health WC |
$1,009.80
|
| Rate for Payer: Global Benefits Group Commercial |
$712.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$792.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$452.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.12
|
| Rate for Payer: Multiplan Commercial |
$950.40
|
| Rate for Payer: Networks By Design Commercial |
$594.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,009.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$448.59
|
| Rate for Payer: United Healthcare All Other HMO |
$438.13
|
| Rate for Payer: United Healthcare HMO Rider |
$428.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$392.04
|
|
|
NITAZOXANIDE 100 MG/5 ML ORAL SUSPENSION [34708]
|
Facility
|
OP
|
$10.44
|
|
|
Service Code
|
NDC 67546-212-21
|
| Hospital Charge Code |
1715312
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.51 |
| Max. Negotiated Rate |
$8.87 |
| 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 |
$5.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.22
|
| Rate for Payer: Blue Distinction Transplant |
$6.26
|
| Rate for Payer: Blue Shield of California Commercial |
$7.69
|
| Rate for Payer: Blue Shield of California EPN |
$6.10
|
| 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 Media |
$8.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.18
|
| Rate for Payer: Galaxy Health WC |
$8.87
|
| Rate for Payer: Global Benefits Group Commercial |
$6.26
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.83
|
| 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: 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
|
| 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 100 MG/5 ML ORAL SUSPENSION [34708]
|
Facility
|
IP
|
$10.44
|
|
|
Service Code
|
NDC 67546-212-21
|
| Hospital Charge Code |
1715312
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.51 |
| Max. Negotiated Rate |
$8.87 |
| Rate for Payer: Blue Shield of California Commercial |
$7.43
|
| Rate for Payer: Blue Shield of California EPN |
$5.35
|
| 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: EPIC Health Plan Commercial |
$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: 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 500 MG TABLET [39254]
|
Facility
|
IP
|
$173.90
|
|
|
Service Code
|
NDC 67546-111-14
|
| Hospital Charge Code |
1711963
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$41.74 |
| Max. Negotiated Rate |
$147.82 |
| Rate for Payer: Blue Shield of California Commercial |
$123.82
|
| Rate for Payer: Blue Shield of California EPN |
$89.04
|
| 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: EPIC Health Plan Commercial |
$69.56
|
| Rate for Payer: Galaxy Health WC |
$147.82
|
| 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: LLUH Dept of Risk Management WC |
$41.74
|
| Rate for Payer: Multiplan Commercial |
$139.12
|
| Rate for Payer: Networks By Design Commercial |
$113.04
|
| Rate for Payer: Prime Health Services Commercial |
$147.82
|
|
|
NITAZOXANIDE 500 MG TABLET [39254]
|
Facility
|
OP
|
$70.25
|
|
|
Service Code
|
NDC 64980-526-21
|
| Hospital Charge Code |
1711963
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.86 |
| Max. Negotiated Rate |
$59.71 |
| 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 |
$38.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.85
|
| Rate for Payer: Blue Distinction Transplant |
$42.15
|
| Rate for Payer: Blue Shield of California Commercial |
$51.77
|
| Rate for Payer: Blue Shield of California EPN |
$41.03
|
| Rate for Payer: Cash Price |
$31.61
|
| Rate for Payer: Cigna of CA HMO |
$49.18
|
| Rate for Payer: Cigna of CA PPO |
$49.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.71
|
| Rate for Payer: Dignity Health Media |
$59.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$28.10
|
| Rate for Payer: Galaxy Health WC |
$59.71
|
| Rate for Payer: Global Benefits Group Commercial |
$42.15
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$52.69
|
| 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: 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
|
| 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
|
$161.56
|
|
|
Service Code
|
NDC 67546-111-12
|
| Hospital Charge Code |
1711963
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$38.77 |
| Max. Negotiated Rate |
$137.33 |
| Rate for Payer: Blue Shield of California Commercial |
$115.03
|
| Rate for Payer: Blue Shield of California EPN |
$82.72
|
| 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: EPIC Health Plan Commercial |
$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: 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
|
$173.90
|
|
|
Service Code
|
NDC 67546-111-14
|
| Hospital Charge Code |
1711963
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$41.74 |
| Max. Negotiated Rate |
$147.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$114.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$147.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$95.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$95.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.61
|
| Rate for Payer: Blue Distinction Transplant |
$104.34
|
| Rate for Payer: Blue Shield of California Commercial |
$128.16
|
| Rate for Payer: Blue Shield of California EPN |
$101.56
|
| 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: Dignity Health Commercial/Exchange |
$147.82
|
| Rate for Payer: Dignity Health Media |
$147.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$69.56
|
| Rate for Payer: Galaxy Health WC |
$147.82
|
| Rate for Payer: Global Benefits Group Commercial |
$104.34
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$130.42
|
| 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: LLUH Dept of Risk Management WC |
$41.74
|
| Rate for Payer: Multiplan Commercial |
$139.12
|
| Rate for Payer: Networks By Design Commercial |
$113.04
|
| Rate for Payer: Prime Health Services Commercial |
$147.82
|
| 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 |
$147.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.82
|
| Rate for Payer: Vantage Medical Group Senior |
$147.82
|
|
|
NITAZOXANIDE 500 MG TABLET [39254]
|
Facility
|
IP
|
$70.25
|
|
|
Service Code
|
NDC 64980-526-21
|
| Hospital Charge Code |
1711963
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.86 |
| Max. Negotiated Rate |
$59.71 |
| Rate for Payer: Blue Shield of California Commercial |
$50.02
|
| Rate for Payer: Blue Shield of California EPN |
$35.97
|
| Rate for Payer: Cash Price |
$31.61
|
| Rate for Payer: Cigna of CA HMO |
$49.18
|
| Rate for Payer: Cigna of CA PPO |
$49.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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
|
OP
|
$161.56
|
|
|
Service Code
|
NDC 67546-111-12
|
| Hospital Charge Code |
1711963
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$38.77 |
| Max. Negotiated Rate |
$137.33 |
| 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 |
$88.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.26
|
| Rate for Payer: Blue Distinction Transplant |
$96.94
|
| Rate for Payer: Blue Shield of California Commercial |
$119.07
|
| Rate for Payer: Blue Shield of California EPN |
$94.35
|
| 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 Media |
$137.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$137.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$64.62
|
| Rate for Payer: Galaxy Health WC |
$137.33
|
| Rate for Payer: Global Benefits Group Commercial |
$96.94
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$121.17
|
| 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: 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
|
| 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
|
|
|
NITROFURANTOIN 25 MG/5 ML ORAL SUSPENSION [10723]
|
Facility
|
OP
|
$7.45
|
|
|
Service Code
|
NDC 16571-740-24
|
| Hospital Charge Code |
1715644
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$6.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.44
|
| Rate for Payer: Blue Distinction Transplant |
$4.47
|
| Rate for Payer: Blue Shield of California Commercial |
$5.49
|
| Rate for Payer: Blue Shield of California EPN |
$4.35
|
| Rate for Payer: Cash Price |
$3.35
|
| Rate for Payer: Cigna of CA HMO |
$5.22
|
| Rate for Payer: Cigna of CA PPO |
$5.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.33
|
| Rate for Payer: Dignity Health Media |
$6.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.98
|
| Rate for Payer: Galaxy Health WC |
$6.33
|
| Rate for Payer: Global Benefits Group Commercial |
$4.47
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.79
|
| Rate for Payer: Multiplan Commercial |
$5.96
|
| Rate for Payer: Networks By Design Commercial |
$4.84
|
| Rate for Payer: Prime Health Services Commercial |
$6.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.72
|
| Rate for Payer: United Healthcare All Other HMO |
$3.72
|
| Rate for Payer: United Healthcare HMO Rider |
$3.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6.33
|
|
|
NITROFURANTOIN 25 MG/5 ML ORAL SUSPENSION [10723]
|
Facility
|
IP
|
$7.45
|
|
|
Service Code
|
NDC 16571-740-24
|
| Hospital Charge Code |
1715644
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$6.33 |
| Rate for Payer: Blue Shield of California Commercial |
$5.30
|
| Rate for Payer: Blue Shield of California EPN |
$3.81
|
| Rate for Payer: Cash Price |
$3.35
|
| Rate for Payer: Cigna of CA HMO |
$5.22
|
| Rate for Payer: Cigna of CA PPO |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.98
|
| Rate for Payer: Galaxy Health WC |
$6.33
|
| Rate for Payer: Global Benefits Group Commercial |
$4.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.79
|
| Rate for Payer: Multiplan Commercial |
$5.96
|
| Rate for Payer: Networks By Design Commercial |
$4.84
|
| Rate for Payer: Prime Health Services Commercial |
$6.33
|
|
|
NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE [5593]
|
Facility
|
IP
|
$2.82
|
|
|
Service Code
|
NDC 47781-308-01
|
| Hospital Charge Code |
1711101
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: Blue Shield of California Commercial |
$2.01
|
| Rate for Payer: Blue Shield of California EPN |
$1.44
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Cigna of CA HMO |
$1.97
|
| Rate for Payer: Cigna of CA PPO |
$1.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.13
|
| Rate for Payer: Galaxy Health WC |
$2.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: Multiplan Commercial |
$2.26
|
| Rate for Payer: Networks By Design Commercial |
$1.83
|
| Rate for Payer: Prime Health Services Commercial |
$2.40
|
|
|
NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE [5593]
|
Facility
|
OP
|
$3.45
|
|
|
Service Code
|
NDC 50268-624-11
|
| Hospital Charge Code |
1711101
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$2.93 |
| 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 |
$1.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.06
|
| Rate for Payer: Blue Distinction Transplant |
$2.07
|
| Rate for Payer: Blue Shield of California Commercial |
$2.54
|
| Rate for Payer: Blue Shield of California EPN |
$2.01
|
| Rate for Payer: Cash Price |
$1.55
|
| 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 Media |
$2.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.38
|
| Rate for Payer: Galaxy Health WC |
$2.93
|
| Rate for Payer: Global Benefits Group Commercial |
$2.07
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.59
|
| 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: 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
|
| 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 |
$1.72
|
| Rate for Payer: United Healthcare All Other HMO |
$1.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.72
|
| 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
|
OP
|
$1.99
|
|
|
Service Code
|
NDC 68001-386-00
|
| Hospital Charge Code |
1711101
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.69 |
| 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 |
$1.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.19
|
| Rate for Payer: Blue Distinction Transplant |
$1.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1.47
|
| Rate for Payer: Blue Shield of California EPN |
$1.16
|
| Rate for Payer: Cash Price |
$0.90
|
| 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 Media |
$1.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.69
|
| Rate for Payer: Global Benefits Group Commercial |
$1.19
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.49
|
| 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: 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
|
| 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
|
OP
|
$3.45
|
|
|
Service Code
|
NDC 50268-624-15
|
| Hospital Charge Code |
1711101
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$2.93 |
| 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 |
$1.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.06
|
| Rate for Payer: Blue Distinction Transplant |
$2.07
|
| Rate for Payer: Blue Shield of California Commercial |
$2.54
|
| Rate for Payer: Blue Shield of California EPN |
$2.01
|
| Rate for Payer: Cash Price |
$1.55
|
| 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 Media |
$2.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.38
|
| Rate for Payer: Galaxy Health WC |
$2.93
|
| Rate for Payer: Global Benefits Group Commercial |
$2.07
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.59
|
| 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: 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
|
| 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 |
$1.72
|
| Rate for Payer: United Healthcare All Other HMO |
$1.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.72
|
| 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
|
|
