|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
IP
|
$3.45
|
|
|
Service Code
|
NDC 69452-209-13
|
| Hospital Charge Code |
1711278
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$2.93 |
| Rate for Payer: Blue Shield of California Commercial |
$2.46
|
| Rate for Payer: Blue Shield of California EPN |
$1.77
|
| 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: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: Galaxy Health WC |
$2.93
|
| Rate for Payer: Global Benefits Group Commercial |
$2.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: Multiplan Commercial |
$2.76
|
| Rate for Payer: Networks By Design Commercial |
$2.24
|
| Rate for Payer: Prime Health Services Commercial |
$2.93
|
|
|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
IP
|
$1.44
|
|
|
Service Code
|
NDC 23155-512-11
|
| Hospital Charge Code |
1711278
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Blue Shield of California Commercial |
$1.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.74
|
| 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: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.15
|
| Rate for Payer: Networks By Design Commercial |
$0.94
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
|
|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
IP
|
$3.45
|
|
|
Service Code
|
NDC 69452-209-07
|
| Hospital Charge Code |
1711278
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$2.93 |
| Rate for Payer: Blue Shield of California Commercial |
$2.46
|
| Rate for Payer: Blue Shield of California EPN |
$1.77
|
| 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: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: Galaxy Health WC |
$2.93
|
| Rate for Payer: Global Benefits Group Commercial |
$2.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: Multiplan Commercial |
$2.76
|
| Rate for Payer: Networks By Design Commercial |
$2.24
|
| Rate for Payer: Prime Health Services Commercial |
$2.93
|
|
|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
OP
|
$6.00
|
|
|
Service Code
|
NDC 57664-135-60
|
| Hospital Charge Code |
1711278
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.57
|
| Rate for Payer: BCBS Transplant Transplant |
$3.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4.42
|
| Rate for Payer: Blue Shield of California EPN |
$3.50
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.10
|
| Rate for Payer: Dignity Health Media |
$5.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$5.10
|
|
|
NIMODIPINE 60 MG/10 ML ORAL SYRINGE (FOR ORAL USE ONLY) [228035]
|
Facility
OP
|
$10.79
|
|
|
Service Code
|
NDC 24338-260-12
|
| Hospital Charge Code |
NDG40820772B
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$9.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.43
|
| Rate for Payer: BCBS Transplant Transplant |
$6.47
|
| Rate for Payer: Blue Shield of California Commercial |
$7.95
|
| Rate for Payer: Blue Shield of California EPN |
$6.30
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Cigna of CA HMO |
$7.55
|
| Rate for Payer: Cigna of CA PPO |
$7.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.17
|
| Rate for Payer: Dignity Health Media |
$9.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.32
|
| Rate for Payer: Galaxy Health WC |
$9.17
|
| Rate for Payer: Global Benefits Group Commercial |
$6.47
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.59
|
| Rate for Payer: Multiplan Commercial |
$8.63
|
| Rate for Payer: Networks By Design Commercial |
$7.01
|
| Rate for Payer: Prime Health Services Commercial |
$9.17
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.40
|
| Rate for Payer: United Healthcare All Other HMO |
$5.40
|
| Rate for Payer: United Healthcare HMO Rider |
$5.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.17
|
| Rate for Payer: Vantage Medical Group Senior |
$9.17
|
|
|
NIMODIPINE 60 MG/10 ML ORAL SYRINGE (FOR ORAL USE ONLY) [228035]
|
Facility
IP
|
$10.79
|
|
|
Service Code
|
NDC 24338-260-10
|
| Hospital Charge Code |
NDG40820772B
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$9.17 |
| Rate for Payer: Blue Shield of California Commercial |
$7.68
|
| Rate for Payer: Blue Shield of California EPN |
$5.52
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Cigna of CA HMO |
$7.55
|
| Rate for Payer: Cigna of CA PPO |
$7.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.32
|
| Rate for Payer: Galaxy Health WC |
$9.17
|
| Rate for Payer: Global Benefits Group Commercial |
$6.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.59
|
| Rate for Payer: Multiplan Commercial |
$8.63
|
| Rate for Payer: Networks By Design Commercial |
$7.01
|
| Rate for Payer: Prime Health Services Commercial |
$9.17
|
|
|
NIMODIPINE 60 MG/10 ML ORAL SYRINGE (FOR ORAL USE ONLY) [228035]
|
Facility
IP
|
$10.79
|
|
|
Service Code
|
NDC 24338-260-12
|
| Hospital Charge Code |
NDG40820772B
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$9.17 |
| Rate for Payer: Blue Shield of California Commercial |
$7.68
|
| Rate for Payer: Blue Shield of California EPN |
$5.52
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Cigna of CA HMO |
$7.55
|
| Rate for Payer: Cigna of CA PPO |
$7.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.32
|
| Rate for Payer: Galaxy Health WC |
$9.17
|
| Rate for Payer: Global Benefits Group Commercial |
$6.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.59
|
| Rate for Payer: Multiplan Commercial |
$8.63
|
| Rate for Payer: Networks By Design Commercial |
$7.01
|
| Rate for Payer: Prime Health Services Commercial |
$9.17
|
|
|
NIMODIPINE 60 MG/10 ML ORAL SYRINGE (FOR ORAL USE ONLY) [228035]
|
Facility
OP
|
$10.79
|
|
|
Service Code
|
NDC 24338-260-10
|
| Hospital Charge Code |
NDG40820772B
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$9.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.43
|
| Rate for Payer: BCBS Transplant Transplant |
$6.47
|
| Rate for Payer: Blue Shield of California Commercial |
$7.95
|
| Rate for Payer: Blue Shield of California EPN |
$6.30
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Cigna of CA HMO |
$7.55
|
| Rate for Payer: Cigna of CA PPO |
$7.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.17
|
| Rate for Payer: Dignity Health Media |
$9.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.32
|
| Rate for Payer: Galaxy Health WC |
$9.17
|
| Rate for Payer: Global Benefits Group Commercial |
$6.47
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.59
|
| Rate for Payer: Multiplan Commercial |
$8.63
|
| Rate for Payer: Networks By Design Commercial |
$7.01
|
| Rate for Payer: Prime Health Services Commercial |
$9.17
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.40
|
| Rate for Payer: United Healthcare All Other HMO |
$5.40
|
| Rate for Payer: United Healthcare HMO Rider |
$5.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.17
|
| Rate for Payer: Vantage Medical Group Senior |
$9.17
|
|
|
NIMODIPINE ORAL SUSPENSION COMPOUND 30 MG/ML [4080312]
|
Facility
IP
|
$9.15
|
|
|
Service Code
|
NDC 9994-0803-12
|
| Hospital Charge Code |
1715266
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$7.78 |
| Rate for Payer: Blue Shield of California Commercial |
$6.51
|
| Rate for Payer: Blue Shield of California EPN |
$4.68
|
| Rate for Payer: Cash Price |
$4.12
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Cigna of CA PPO |
$6.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.66
|
| Rate for Payer: Galaxy Health WC |
$7.78
|
| Rate for Payer: Global Benefits Group Commercial |
$5.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.49
|
| Rate for Payer: 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 9994-0803-12
|
| Hospital Charge Code |
1715266
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$7.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.45
|
| Rate for Payer: BCBS Transplant Transplant |
$5.49
|
| Rate for Payer: Blue Shield of California Commercial |
$6.74
|
| Rate for Payer: Blue Shield of California EPN |
$5.34
|
| Rate for Payer: Cash Price |
$4.12
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Cigna of CA PPO |
$6.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.78
|
| Rate for Payer: Dignity Health Media |
$7.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.66
|
| Rate for Payer: Galaxy Health WC |
$7.78
|
| Rate for Payer: Global Benefits Group Commercial |
$5.49
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.49
|
| Rate for Payer: 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.49
|
| 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
|
$0.01
|
|
|
Service Code
|
NDC 0069-1085-06
|
| 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: AlphaCare Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$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
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 0069-1085-06
|
| 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
|
|
|
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: United Healthcare HMO Rider |
$27.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$47.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$30.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$30.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.13
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$33.36
|
| 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 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 0069-1085-30
|
| 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 0069-0345-06
|
| 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: AlphaCare Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$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
IP
|
$0.01
|
|
|
Service Code
|
NDC 0069-0345-30
|
| 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 0069-1085-30
|
| 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: AlphaCare Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$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 0069-0345-30
|
| 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: AlphaCare Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$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
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$504.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$326.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$326.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$353.91
|
| Rate for Payer: BCBS Transplant 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 Transplant 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
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$1,009.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$653.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$653.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$707.81
|
| Rate for Payer: BCBS Transplant 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 Transplant 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
|
|
|
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: Galaxy Health WC |
$8.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.85
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.87
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.22
|
| Rate for Payer: BCBS Transplant 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: Global Benefits Group Commercial |
$6.26
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$6.26
|
| 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
|
|
