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
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: AlphaCare Medical Group Commercial/Exchange |
$137.33
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$88.86
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$88.86
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.26
|
Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$96.94
|
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
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: AlphaCare Medical Group Commercial/Exchange |
$59.71
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$38.64
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$38.64
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.85
|
Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$42.15
|
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
|
$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
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
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
|
$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: BCBS Transplant Transplant |
$104.34
|
Rate for Payer: Aetna of CA HMO/PPO |
$114.06
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$147.82
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$95.64
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$95.64
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.61
|
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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$104.34
|
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
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$6.33
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.10
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.10
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.44
|
Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$4.47
|
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
|
$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: 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
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$2.93
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.90
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.90
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.06
|
Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$2.07
|
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
IP
|
$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: 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
|
|
NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE [5593]
|
Facility
OP
|
$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: BCBS Transplant Transplant |
$1.69
|
Rate for Payer: Aetna of CA HMO/PPO |
$1.85
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.40
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.55
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.55
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.68
|
Rate for Payer: Blue Shield of California Commercial |
$2.08
|
Rate for Payer: Blue Shield of California EPN |
$1.65
|
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: Dignity Health Commercial/Exchange |
$2.40
|
Rate for Payer: Dignity Health Media |
$2.40
|
Rate for Payer: Dignity Health Medi-Cal |
$2.40
|
Rate for Payer: EPIC Health Plan Commercial |
$1.13
|
Rate for Payer: EPIC Health Plan Transplant |
$1.13
|
Rate for Payer: Galaxy Health WC |
$2.40
|
Rate for Payer: Global Benefits Group Commercial |
$1.69
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.12
|
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
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.69
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.69
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.69
|
Rate for Payer: United Healthcare All Other Commercial |
$1.41
|
Rate for Payer: United Healthcare All Other HMO |
$1.41
|
Rate for Payer: United Healthcare HMO Rider |
$1.41
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$1.41
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.40
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$2.40
|
Rate for Payer: Vantage Medical Group Senior |
$2.40
|
|
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
IP
|
$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: Blue Shield of California Commercial |
$1.42
|
Rate for Payer: Blue Shield of California EPN |
$1.02
|
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: EPIC Health Plan Commercial |
$0.80
|
Rate for Payer: Galaxy Health WC |
$1.69
|
Rate for Payer: Global Benefits Group Commercial |
$1.19
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.76
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
Rate for Payer: Multiplan Commercial |
$1.59
|
Rate for Payer: Networks By Design Commercial |
$1.29
|
Rate for Payer: Prime Health Services Commercial |
$1.69
|
|
NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE [5593]
|
Facility
OP
|
$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: Galaxy Health WC |
$1.69
|
Rate for Payer: Aetna of CA HMO/PPO |
$1.31
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.69
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.09
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.09
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.19
|
Rate for Payer: BCBS Transplant 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: Global Benefits Group Commercial |
$1.19
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$1.19
|
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: AlphaCare Medical Group Commercial/Exchange |
$2.93
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.90
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.90
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.06
|
Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$2.07
|
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 25 MG CAPSULE [5594]
|
Facility
IP
|
$7.03
|
|
Service Code
|
NDC 47781-306-01
|
Hospital Charge Code |
1711065
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$1.69 |
Max. Negotiated Rate |
$5.98 |
Rate for Payer: Blue Shield of California Commercial |
$5.01
|
Rate for Payer: Blue Shield of California EPN |
$3.60
|
Rate for Payer: Cash Price |
$3.16
|
Rate for Payer: Cigna of CA HMO |
$4.92
|
Rate for Payer: Cigna of CA PPO |
$4.92
|
Rate for Payer: EPIC Health Plan Commercial |
$2.81
|
Rate for Payer: Galaxy Health WC |
$5.98
|
Rate for Payer: Global Benefits Group Commercial |
$4.22
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.69
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.68
|
Rate for Payer: LLUH Dept of Risk Management WC |
$1.69
|
Rate for Payer: Multiplan Commercial |
$5.62
|
Rate for Payer: Networks By Design Commercial |
$4.57
|
Rate for Payer: Prime Health Services Commercial |
$5.98
|
|
NITROFURANTOIN MACROCRYSTAL 25 MG CAPSULE [5594]
|
Facility
OP
|
$7.03
|
|
Service Code
|
NDC 47781-306-01
|
Hospital Charge Code |
1711065
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$1.69 |
Max. Negotiated Rate |
$5.98 |
Rate for Payer: Galaxy Health WC |
$5.98
|
Rate for Payer: Aetna of CA HMO/PPO |
$4.61
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.98
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.87
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.87
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.19
|
Rate for Payer: BCBS Transplant Transplant |
$4.22
|
Rate for Payer: Blue Shield of California Commercial |
$5.18
|
Rate for Payer: Blue Shield of California EPN |
$4.11
|
Rate for Payer: Cash Price |
$3.16
|
Rate for Payer: Cigna of CA HMO |
$4.92
|
Rate for Payer: Cigna of CA PPO |
$4.92
|
Rate for Payer: Dignity Health Commercial/Exchange |
$5.98
|
Rate for Payer: Dignity Health Media |
$5.98
|
Rate for Payer: Dignity Health Medi-Cal |
$5.98
|
Rate for Payer: EPIC Health Plan Commercial |
$2.81
|
Rate for Payer: EPIC Health Plan Transplant |
$2.81
|
Rate for Payer: Global Benefits Group Commercial |
$4.22
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.27
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.69
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.68
|
Rate for Payer: LLUH Dept of Risk Management WC |
$1.69
|
Rate for Payer: Multiplan Commercial |
$5.62
|
Rate for Payer: Networks By Design Commercial |
$4.57
|
Rate for Payer: Prime Health Services Commercial |
$5.98
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.22
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.22
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.22
|
Rate for Payer: United Healthcare All Other Commercial |
$3.52
|
Rate for Payer: United Healthcare All Other HMO |
$3.52
|
Rate for Payer: United Healthcare HMO Rider |
$3.52
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$3.52
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.98
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$5.98
|
Rate for Payer: Vantage Medical Group Senior |
$5.98
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE [5595]
|
Facility
IP
|
$1.21
|
|
Service Code
|
NDC 68001-385-00
|
Hospital Charge Code |
1711086
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.29 |
Max. Negotiated Rate |
$1.03 |
Rate for Payer: Blue Shield of California Commercial |
$0.86
|
Rate for Payer: Blue Shield of California EPN |
$0.62
|
Rate for Payer: Cash Price |
$0.54
|
Rate for Payer: Cigna of CA HMO |
$0.85
|
Rate for Payer: Cigna of CA PPO |
$0.85
|
Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
Rate for Payer: Galaxy Health WC |
$1.03
|
Rate for Payer: Global Benefits Group Commercial |
$0.73
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.81
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
Rate for Payer: Multiplan Commercial |
$0.97
|
Rate for Payer: Networks By Design Commercial |
$0.79
|
Rate for Payer: Prime Health Services Commercial |
$1.03
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE [5595]
|
Facility
OP
|
$1.21
|
|
Service Code
|
NDC 68001-385-00
|
Hospital Charge Code |
1711086
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.29 |
Max. Negotiated Rate |
$1.03 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.79
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.03
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.67
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.67
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.72
|
Rate for Payer: BCBS Transplant Transplant |
$0.73
|
Rate for Payer: Blue Shield of California Commercial |
$0.89
|
Rate for Payer: Blue Shield of California EPN |
$0.71
|
Rate for Payer: Cash Price |
$0.54
|
Rate for Payer: Cigna of CA HMO |
$0.85
|
Rate for Payer: Cigna of CA PPO |
$0.85
|
Rate for Payer: Dignity Health Commercial/Exchange |
$1.03
|
Rate for Payer: Dignity Health Media |
$1.03
|
Rate for Payer: Dignity Health Medi-Cal |
$1.03
|
Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
Rate for Payer: EPIC Health Plan Transplant |
$0.48
|
Rate for Payer: Galaxy Health WC |
$1.03
|
Rate for Payer: Global Benefits Group Commercial |
$0.73
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.91
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.81
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
Rate for Payer: Multiplan Commercial |
$0.97
|
Rate for Payer: Networks By Design Commercial |
$0.79
|
Rate for Payer: Prime Health Services Commercial |
$1.03
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.73
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.73
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.73
|
Rate for Payer: United Healthcare All Other Commercial |
$0.61
|
Rate for Payer: United Healthcare All Other HMO |
$0.61
|
Rate for Payer: United Healthcare HMO Rider |
$0.61
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.61
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.03
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$1.03
|
Rate for Payer: Vantage Medical Group Senior |
$1.03
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE [5595]
|
Facility
OP
|
$1.66
|
|
Service Code
|
NDC 47781-307-01
|
Hospital Charge Code |
1711086
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.40 |
Max. Negotiated Rate |
$1.41 |
Rate for Payer: Galaxy Health WC |
$1.41
|
Rate for Payer: Aetna of CA HMO/PPO |
$1.09
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.41
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.91
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.91
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.99
|
Rate for Payer: BCBS Transplant Transplant |
$1.00
|
Rate for Payer: Blue Shield of California Commercial |
$1.22
|
Rate for Payer: Blue Shield of California EPN |
$0.97
|
Rate for Payer: Cash Price |
$0.75
|
Rate for Payer: Cigna of CA HMO |
$1.16
|
Rate for Payer: Cigna of CA PPO |
$1.16
|
Rate for Payer: Dignity Health Commercial/Exchange |
$1.41
|
Rate for Payer: Dignity Health Media |
$1.41
|
Rate for Payer: Dignity Health Medi-Cal |
$1.41
|
Rate for Payer: EPIC Health Plan Commercial |
$0.66
|
Rate for Payer: EPIC Health Plan Transplant |
$0.66
|
Rate for Payer: Global Benefits Group Commercial |
$1.00
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.24
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.11
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.63
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
Rate for Payer: Multiplan Commercial |
$1.33
|
Rate for Payer: Networks By Design Commercial |
$1.08
|
Rate for Payer: Prime Health Services Commercial |
$1.41
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.00
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.00
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.00
|
Rate for Payer: United Healthcare All Other Commercial |
$0.83
|
Rate for Payer: United Healthcare All Other HMO |
$0.83
|
Rate for Payer: United Healthcare HMO Rider |
$0.83
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.83
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.41
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$1.41
|
Rate for Payer: Vantage Medical Group Senior |
$1.41
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE [5595]
|
Facility
IP
|
$1.66
|
|
Service Code
|
NDC 47781-307-01
|
Hospital Charge Code |
1711086
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.40 |
Max. Negotiated Rate |
$1.41 |
Rate for Payer: Blue Shield of California Commercial |
$1.18
|
Rate for Payer: Blue Shield of California EPN |
$0.85
|
Rate for Payer: Cash Price |
$0.75
|
Rate for Payer: Cigna of CA HMO |
$1.16
|
Rate for Payer: Cigna of CA PPO |
$1.16
|
Rate for Payer: EPIC Health Plan Commercial |
$0.66
|
Rate for Payer: Galaxy Health WC |
$1.41
|
Rate for Payer: Global Benefits Group Commercial |
$1.00
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.11
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.63
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
Rate for Payer: Multiplan Commercial |
$1.33
|
Rate for Payer: Networks By Design Commercial |
$1.08
|
Rate for Payer: Prime Health Services Commercial |
$1.41
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE [10724]
|
Facility
OP
|
$1.88
|
|
Service Code
|
NDC 68001-423-00
|
Hospital Charge Code |
1712140
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.45 |
Max. Negotiated Rate |
$1.60 |
Rate for Payer: Aetna of CA HMO/PPO |
$1.23
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.60
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.03
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.03
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.12
|
Rate for Payer: BCBS Transplant Transplant |
$1.13
|
Rate for Payer: Blue Shield of California Commercial |
$1.39
|
Rate for Payer: Blue Shield of California EPN |
$1.10
|
Rate for Payer: Cash Price |
$0.85
|
Rate for Payer: Cigna of CA HMO |
$1.32
|
Rate for Payer: Cigna of CA PPO |
$1.32
|
Rate for Payer: Dignity Health Commercial/Exchange |
$1.60
|
Rate for Payer: Dignity Health Media |
$1.60
|
Rate for Payer: Dignity Health Medi-Cal |
$1.60
|
Rate for Payer: EPIC Health Plan Commercial |
$0.75
|
Rate for Payer: EPIC Health Plan Transplant |
$0.75
|
Rate for Payer: Galaxy Health WC |
$1.60
|
Rate for Payer: Global Benefits Group Commercial |
$1.13
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.41
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.25
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.72
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
Rate for Payer: Multiplan Commercial |
$1.50
|
Rate for Payer: Networks By Design Commercial |
$1.22
|
Rate for Payer: Prime Health Services Commercial |
$1.60
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.13
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.13
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.13
|
Rate for Payer: United Healthcare All Other Commercial |
$0.94
|
Rate for Payer: United Healthcare All Other HMO |
$0.94
|
Rate for Payer: United Healthcare HMO Rider |
$0.94
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.94
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.60
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$1.60
|
Rate for Payer: Vantage Medical Group Senior |
$1.60
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE [10724]
|
Facility
IP
|
$1.88
|
|
Service Code
|
NDC 68001-423-00
|
Hospital Charge Code |
1712140
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.45 |
Max. Negotiated Rate |
$1.60 |
Rate for Payer: Blue Shield of California Commercial |
$1.34
|
Rate for Payer: Blue Shield of California EPN |
$0.96
|
Rate for Payer: Cash Price |
$0.85
|
Rate for Payer: Cigna of CA HMO |
$1.32
|
Rate for Payer: Cigna of CA PPO |
$1.32
|
Rate for Payer: EPIC Health Plan Commercial |
$0.75
|
Rate for Payer: Galaxy Health WC |
$1.60
|
Rate for Payer: Global Benefits Group Commercial |
$1.13
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.25
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.72
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
Rate for Payer: Multiplan Commercial |
$1.50
|
Rate for Payer: Networks By Design Commercial |
$1.22
|
Rate for Payer: Prime Health Services Commercial |
$1.60
|
|