|
NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLET,DOSE PACK [408122221]
|
Facility
|
OP
|
$59.84
|
|
|
Service Code
|
NDC 0069532130
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.97 |
| Max. Negotiated Rate |
$53.86 |
| Rate for Payer: Adventist Health Commercial |
$11.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.81
|
| Rate for Payer: Blue Shield of California Commercial |
$37.94
|
| Rate for Payer: Blue Shield of California EPN |
$23.88
|
| Rate for Payer: Cash Price |
$26.93
|
| Rate for Payer: Central Health Plan Commercial |
$47.87
|
| Rate for Payer: Cigna of CA HMO |
$41.89
|
| Rate for Payer: Cigna of CA PPO |
$41.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.94
|
| Rate for Payer: EPIC Health Plan Senior |
$23.94
|
| Rate for Payer: Galaxy Health WC |
$50.86
|
| Rate for Payer: Global Benefits Group Commercial |
$35.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$41.89
|
| Rate for Payer: Multiplan Commercial |
$44.88
|
| Rate for Payer: Networks By Design Commercial |
$38.90
|
| Rate for Payer: Prime Health Services Commercial |
$50.86
|
| Rate for Payer: Riverside University Health System MISP |
$23.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.92
|
| Rate for Payer: United Healthcare All Other HMO |
$29.92
|
| Rate for Payer: United Healthcare HMO Rider |
$29.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.86
|
| Rate for Payer: Vantage Medical Group Senior |
$50.86
|
|
|
NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLET,DOSE PACK [408122221]
|
Facility
|
OP
|
$59.84
|
|
|
Service Code
|
NDC 0069532103
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.97 |
| Max. Negotiated Rate |
$53.86 |
| Rate for Payer: Adventist Health Commercial |
$11.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.81
|
| Rate for Payer: Blue Shield of California Commercial |
$37.94
|
| Rate for Payer: Blue Shield of California EPN |
$23.88
|
| Rate for Payer: Cash Price |
$26.93
|
| Rate for Payer: Central Health Plan Commercial |
$47.87
|
| Rate for Payer: Cigna of CA HMO |
$41.89
|
| Rate for Payer: Cigna of CA PPO |
$41.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.94
|
| Rate for Payer: EPIC Health Plan Senior |
$23.94
|
| Rate for Payer: Galaxy Health WC |
$50.86
|
| Rate for Payer: Global Benefits Group Commercial |
$35.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$41.89
|
| Rate for Payer: Multiplan Commercial |
$44.88
|
| Rate for Payer: Networks By Design Commercial |
$38.90
|
| Rate for Payer: Prime Health Services Commercial |
$50.86
|
| Rate for Payer: Riverside University Health System MISP |
$23.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.92
|
| Rate for Payer: United Healthcare All Other HMO |
$29.92
|
| Rate for Payer: United Healthcare HMO Rider |
$29.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.86
|
| Rate for Payer: Vantage Medical Group Senior |
$50.86
|
|
|
NIRSEVIMAB-ALIP 100 MG/ML INTRAMUSCULAR SYRINGE [239073]
|
Facility
|
OP
|
$714.07
|
|
|
Service Code
|
HCPCS 90381
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$142.81 |
| Max. Negotiated Rate |
$3,252.84 |
| Rate for Payer: Adventist Health Commercial |
$142.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,252.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$606.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$392.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$535.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$999.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,246.95
|
| Rate for Payer: Blue Shield of California Commercial |
$686.07
|
| Rate for Payer: Blue Shield of California EPN |
$623.70
|
| Rate for Payer: Cash Price |
$321.33
|
| Rate for Payer: Cash Price |
$321.33
|
| Rate for Payer: Central Health Plan Commercial |
$571.26
|
| Rate for Payer: Cigna of CA HMO |
$499.85
|
| Rate for Payer: Cigna of CA PPO |
$499.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$606.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$606.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$606.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$499.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$285.63
|
| Rate for Payer: EPIC Health Plan Senior |
$285.63
|
| Rate for Payer: Galaxy Health WC |
$606.96
|
| Rate for Payer: Global Benefits Group Commercial |
$428.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$642.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,031.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$453.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,139.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$421.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$499.85
|
| Rate for Payer: Multiplan Commercial |
$535.55
|
| Rate for Payer: Networks By Design Commercial |
$357.04
|
| Rate for Payer: Prime Health Services Commercial |
$606.96
|
| Rate for Payer: Riverside University Health System MISP |
$285.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$428.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$428.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$267.99
|
| Rate for Payer: United Healthcare All Other HMO |
$260.85
|
| Rate for Payer: United Healthcare HMO Rider |
$255.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$233.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$606.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$606.96
|
| Rate for Payer: Vantage Medical Group Senior |
$606.96
|
|
|
NIRSEVIMAB-ALIP 100 MG/ML INTRAMUSCULAR SYRINGE [239073]
|
Facility
|
IP
|
$714.07
|
|
|
Service Code
|
HCPCS 90381
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$142.81 |
| Max. Negotiated Rate |
$642.66 |
| Rate for Payer: Adventist Health Commercial |
$142.81
|
| Rate for Payer: Blue Shield of California Commercial |
$572.68
|
| Rate for Payer: Blue Shield of California EPN |
$359.89
|
| Rate for Payer: Cash Price |
$321.33
|
| Rate for Payer: Central Health Plan Commercial |
$571.26
|
| Rate for Payer: Cigna of CA HMO |
$499.85
|
| Rate for Payer: Cigna of CA PPO |
$499.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$499.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$285.63
|
| Rate for Payer: EPIC Health Plan Senior |
$285.63
|
| Rate for Payer: Galaxy Health WC |
$606.96
|
| Rate for Payer: Global Benefits Group Commercial |
$428.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$642.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$453.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$421.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.81
|
| Rate for Payer: Multiplan Commercial |
$535.55
|
| Rate for Payer: Networks By Design Commercial |
$357.04
|
| Rate for Payer: Prime Health Services Commercial |
$606.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$267.99
|
| Rate for Payer: United Healthcare All Other HMO |
$260.85
|
| Rate for Payer: United Healthcare HMO Rider |
$255.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$233.86
|
|
|
NIRSEVIMAB-ALIP 50 MG/0.5 ML INTRAMUSCULAR SYRINGE [239072]
|
Facility
|
IP
|
$1,428.15
|
|
|
Service Code
|
HCPCS 90380
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$285.63 |
| Max. Negotiated Rate |
$1,285.34 |
| Rate for Payer: Adventist Health Commercial |
$285.63
|
| Rate for Payer: Adventist Health Commercial |
$285.63
|
| Rate for Payer: Blue Shield of California Commercial |
$1,145.38
|
| Rate for Payer: Blue Shield of California Commercial |
$1,145.37
|
| Rate for Payer: Blue Shield of California EPN |
$719.78
|
| Rate for Payer: Blue Shield of California EPN |
$719.79
|
| Rate for Payer: Cash Price |
$642.67
|
| Rate for Payer: Cash Price |
$642.66
|
| Rate for Payer: Central Health Plan Commercial |
$1,142.52
|
| Rate for Payer: Central Health Plan Commercial |
$1,142.51
|
| Rate for Payer: Cigna of CA HMO |
$999.70
|
| Rate for Payer: Cigna of CA HMO |
$999.71
|
| Rate for Payer: Cigna of CA PPO |
$999.70
|
| Rate for Payer: Cigna of CA PPO |
$999.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$999.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$999.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.26
|
| Rate for Payer: EPIC Health Plan Senior |
$571.26
|
| Rate for Payer: EPIC Health Plan Senior |
$571.26
|
| Rate for Payer: Galaxy Health WC |
$1,213.93
|
| Rate for Payer: Galaxy Health WC |
$1,213.92
|
| Rate for Payer: Global Benefits Group Commercial |
$856.88
|
| Rate for Payer: Global Benefits Group Commercial |
$856.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,285.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,285.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$906.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$906.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$842.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$842.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.63
|
| Rate for Payer: Multiplan Commercial |
$1,071.11
|
| Rate for Payer: Multiplan Commercial |
$1,071.11
|
| Rate for Payer: Networks By Design Commercial |
$714.07
|
| Rate for Payer: Networks By Design Commercial |
$714.08
|
| Rate for Payer: Prime Health Services Commercial |
$1,213.93
|
| Rate for Payer: Prime Health Services Commercial |
$1,213.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$535.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$535.98
|
| Rate for Payer: United Healthcare All Other HMO |
$521.70
|
| Rate for Payer: United Healthcare All Other HMO |
$521.70
|
| Rate for Payer: United Healthcare HMO Rider |
$510.42
|
| Rate for Payer: United Healthcare HMO Rider |
$510.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$467.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$467.72
|
|
|
NIRSEVIMAB-ALIP 50 MG/0.5 ML INTRAMUSCULAR SYRINGE [239072]
|
Facility
|
OP
|
$1,428.14
|
|
|
Service Code
|
HCPCS 90380
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$285.63 |
| Max. Negotiated Rate |
$3,252.84 |
| Rate for Payer: Adventist Health Commercial |
$285.63
|
| Rate for Payer: Adventist Health Commercial |
$285.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,252.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,252.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,213.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,213.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$785.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$785.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,071.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,071.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$999.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$999.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,246.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,246.95
|
| Rate for Payer: Blue Shield of California Commercial |
$686.07
|
| Rate for Payer: Blue Shield of California Commercial |
$686.07
|
| Rate for Payer: Blue Shield of California EPN |
$623.70
|
| Rate for Payer: Blue Shield of California EPN |
$623.70
|
| Rate for Payer: Cash Price |
$642.67
|
| Rate for Payer: Cash Price |
$642.67
|
| Rate for Payer: Cash Price |
$642.66
|
| Rate for Payer: Cash Price |
$642.66
|
| Rate for Payer: Central Health Plan Commercial |
$1,142.51
|
| Rate for Payer: Central Health Plan Commercial |
$1,142.52
|
| Rate for Payer: Cigna of CA HMO |
$999.70
|
| Rate for Payer: Cigna of CA HMO |
$999.71
|
| Rate for Payer: Cigna of CA PPO |
$999.71
|
| Rate for Payer: Cigna of CA PPO |
$999.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,213.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,213.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,213.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,213.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,213.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,213.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$999.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$999.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.26
|
| Rate for Payer: EPIC Health Plan Senior |
$571.26
|
| Rate for Payer: EPIC Health Plan Senior |
$571.26
|
| Rate for Payer: Galaxy Health WC |
$1,213.93
|
| Rate for Payer: Galaxy Health WC |
$1,213.92
|
| Rate for Payer: Global Benefits Group Commercial |
$856.88
|
| Rate for Payer: Global Benefits Group Commercial |
$856.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,285.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,285.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,031.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,031.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$906.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$906.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,139.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,139.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$842.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$842.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$999.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$999.71
|
| Rate for Payer: Multiplan Commercial |
$1,071.11
|
| Rate for Payer: Multiplan Commercial |
$1,071.11
|
| Rate for Payer: Networks By Design Commercial |
$714.08
|
| Rate for Payer: Networks By Design Commercial |
$714.07
|
| Rate for Payer: Prime Health Services Commercial |
$1,213.92
|
| Rate for Payer: Prime Health Services Commercial |
$1,213.93
|
| Rate for Payer: Riverside University Health System MISP |
$571.26
|
| Rate for Payer: Riverside University Health System MISP |
$571.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$856.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$856.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$856.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$856.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$535.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$535.98
|
| Rate for Payer: United Healthcare All Other HMO |
$521.70
|
| Rate for Payer: United Healthcare All Other HMO |
$521.70
|
| Rate for Payer: United Healthcare HMO Rider |
$510.42
|
| Rate for Payer: United Healthcare HMO Rider |
$510.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$467.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$467.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,213.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,213.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,213.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,213.93
|
| Rate for Payer: Vantage Medical Group Senior |
$1,213.93
|
| Rate for Payer: Vantage Medical Group Senior |
$1,213.92
|
|
|
NITAZOXANIDE 100 MG/5 ML ORAL SUSPENSION [34708]
|
Facility
|
IP
|
$10.44
|
|
|
Service Code
|
NDC 6754621221
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$9.40 |
| Rate for Payer: Adventist Health Commercial |
$2.09
|
| Rate for Payer: Blue Shield of California Commercial |
$8.37
|
| Rate for Payer: Blue Shield of California EPN |
$5.26
|
| Rate for Payer: Cash Price |
$4.70
|
| Rate for Payer: Central Health Plan Commercial |
$8.35
|
| Rate for Payer: Cigna of CA HMO |
$7.31
|
| Rate for Payer: Cigna of CA PPO |
$7.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.18
|
| Rate for Payer: EPIC Health Plan Senior |
$4.18
|
| Rate for Payer: Galaxy Health WC |
$8.87
|
| Rate for Payer: Global Benefits Group Commercial |
$6.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.09
|
| Rate for Payer: Multiplan Commercial |
$7.83
|
| Rate for Payer: Networks By Design Commercial |
$6.79
|
| Rate for Payer: Prime Health Services Commercial |
$8.87
|
|
|
NITAZOXANIDE 100 MG/5 ML ORAL SUSPENSION [34708]
|
Facility
|
OP
|
$10.44
|
|
|
Service Code
|
NDC 6754621221
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$9.40 |
| Rate for Payer: Adventist Health Commercial |
$2.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.07
|
| Rate for Payer: Blue Shield of California Commercial |
$6.62
|
| Rate for Payer: Blue Shield of California EPN |
$4.17
|
| Rate for Payer: Cash Price |
$4.70
|
| Rate for Payer: Central Health Plan Commercial |
$8.35
|
| Rate for Payer: Cigna of CA HMO |
$7.31
|
| Rate for Payer: Cigna of CA PPO |
$7.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.18
|
| Rate for Payer: EPIC Health Plan Senior |
$4.18
|
| Rate for Payer: Galaxy Health WC |
$8.87
|
| Rate for Payer: Global Benefits Group Commercial |
$6.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.31
|
| Rate for Payer: Multiplan Commercial |
$7.83
|
| Rate for Payer: Networks By Design Commercial |
$6.79
|
| Rate for Payer: Prime Health Services Commercial |
$8.87
|
| Rate for Payer: Riverside University Health System MISP |
$4.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.22
|
| Rate for Payer: United Healthcare All Other HMO |
$5.22
|
| Rate for Payer: United Healthcare HMO Rider |
$5.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.87
|
| Rate for Payer: Vantage Medical Group Senior |
$8.87
|
|
|
NITAZOXANIDE 500 MG TABLET [39254]
|
Facility
|
IP
|
$173.90
|
|
|
Service Code
|
NDC 6754611114
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$34.78 |
| Max. Negotiated Rate |
$156.51 |
| Rate for Payer: Adventist Health Commercial |
$34.78
|
| Rate for Payer: Blue Shield of California Commercial |
$139.47
|
| Rate for Payer: Blue Shield of California EPN |
$87.65
|
| Rate for Payer: Cash Price |
$78.26
|
| Rate for Payer: Central Health Plan Commercial |
$139.12
|
| Rate for Payer: Cigna of CA HMO |
$121.73
|
| Rate for Payer: Cigna of CA PPO |
$121.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$121.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.56
|
| Rate for Payer: EPIC Health Plan Senior |
$69.56
|
| Rate for Payer: Galaxy Health WC |
$147.81
|
| Rate for Payer: Global Benefits Group Commercial |
$104.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$156.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$110.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$102.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.78
|
| Rate for Payer: Multiplan Commercial |
$130.43
|
| Rate for Payer: Networks By Design Commercial |
$113.03
|
| Rate for Payer: Prime Health Services Commercial |
$147.81
|
|
|
NITAZOXANIDE 500 MG TABLET [39254]
|
Facility
|
IP
|
$70.25
|
|
|
Service Code
|
NDC 6498052621
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.05 |
| Max. Negotiated Rate |
$63.23 |
| Rate for Payer: Adventist Health Commercial |
$14.05
|
| Rate for Payer: Blue Shield of California Commercial |
$56.34
|
| Rate for Payer: Blue Shield of California EPN |
$35.41
|
| Rate for Payer: Cash Price |
$31.61
|
| Rate for Payer: Central Health Plan Commercial |
$56.20
|
| Rate for Payer: Cigna of CA HMO |
$49.17
|
| Rate for Payer: Cigna of CA PPO |
$49.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.10
|
| Rate for Payer: EPIC Health Plan Senior |
$28.10
|
| Rate for Payer: Galaxy Health WC |
$59.71
|
| Rate for Payer: Global Benefits Group Commercial |
$42.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.05
|
| Rate for Payer: Multiplan Commercial |
$52.69
|
| Rate for Payer: Networks By Design Commercial |
$45.66
|
| Rate for Payer: Prime Health Services Commercial |
$59.71
|
|
|
NITAZOXANIDE 500 MG TABLET [39254]
|
Facility
|
IP
|
$156.11
|
|
|
Service Code
|
NDC 6498052660
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$31.22 |
| Max. Negotiated Rate |
$140.50 |
| Rate for Payer: Adventist Health Commercial |
$31.22
|
| Rate for Payer: Blue Shield of California Commercial |
$125.20
|
| Rate for Payer: Blue Shield of California EPN |
$78.68
|
| Rate for Payer: Cash Price |
$70.25
|
| Rate for Payer: Central Health Plan Commercial |
$124.89
|
| Rate for Payer: Cigna of CA HMO |
$109.28
|
| Rate for Payer: Cigna of CA PPO |
$109.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.44
|
| Rate for Payer: EPIC Health Plan Senior |
$62.44
|
| Rate for Payer: Galaxy Health WC |
$132.69
|
| Rate for Payer: Global Benefits Group Commercial |
$93.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.22
|
| Rate for Payer: Multiplan Commercial |
$117.08
|
| Rate for Payer: Networks By Design Commercial |
$101.47
|
| Rate for Payer: Prime Health Services Commercial |
$132.69
|
|
|
NITAZOXANIDE 500 MG TABLET [39254]
|
Facility
|
OP
|
$70.25
|
|
|
Service Code
|
NDC 6498052621
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.05 |
| Max. Negotiated Rate |
$63.23 |
| Rate for Payer: Adventist Health Commercial |
$14.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.86
|
| Rate for Payer: Blue Shield of California Commercial |
$44.54
|
| Rate for Payer: Blue Shield of California EPN |
$28.03
|
| Rate for Payer: Cash Price |
$31.61
|
| Rate for Payer: Central Health Plan Commercial |
$56.20
|
| Rate for Payer: Cigna of CA HMO |
$49.17
|
| Rate for Payer: Cigna of CA PPO |
$49.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.10
|
| Rate for Payer: EPIC Health Plan Senior |
$28.10
|
| Rate for Payer: Galaxy Health WC |
$59.71
|
| Rate for Payer: Global Benefits Group Commercial |
$42.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.17
|
| Rate for Payer: Multiplan Commercial |
$52.69
|
| Rate for Payer: Networks By Design Commercial |
$45.66
|
| Rate for Payer: Prime Health Services Commercial |
$59.71
|
| Rate for Payer: Riverside University Health System MISP |
$28.10
|
| 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 6754611112
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$32.31 |
| Max. Negotiated Rate |
$145.40 |
| Rate for Payer: Adventist Health Commercial |
$32.31
|
| Rate for Payer: Blue Shield of California Commercial |
$129.57
|
| Rate for Payer: Blue Shield of California EPN |
$81.43
|
| Rate for Payer: Cash Price |
$72.70
|
| Rate for Payer: Central Health Plan Commercial |
$129.25
|
| Rate for Payer: Cigna of CA HMO |
$113.09
|
| Rate for Payer: Cigna of CA PPO |
$113.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.62
|
| Rate for Payer: EPIC Health Plan Senior |
$64.62
|
| Rate for Payer: Galaxy Health WC |
$137.33
|
| Rate for Payer: Global Benefits Group Commercial |
$96.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$145.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$102.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.31
|
| Rate for Payer: Multiplan Commercial |
$121.17
|
| Rate for Payer: Networks By Design Commercial |
$105.01
|
| Rate for Payer: Prime Health Services Commercial |
$137.33
|
|
|
NITAZOXANIDE 500 MG TABLET [39254]
|
Facility
|
OP
|
$156.11
|
|
|
Service Code
|
NDC 6498052660
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$31.22 |
| Max. Negotiated Rate |
$140.50 |
| Rate for Payer: Adventist Health Commercial |
$31.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$132.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$85.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$75.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.81
|
| Rate for Payer: Blue Shield of California Commercial |
$98.97
|
| Rate for Payer: Blue Shield of California EPN |
$62.29
|
| Rate for Payer: Cash Price |
$70.25
|
| Rate for Payer: Central Health Plan Commercial |
$124.89
|
| Rate for Payer: Cigna of CA HMO |
$109.28
|
| Rate for Payer: Cigna of CA PPO |
$109.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$132.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$132.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.44
|
| Rate for Payer: EPIC Health Plan Senior |
$62.44
|
| Rate for Payer: Galaxy Health WC |
$132.69
|
| Rate for Payer: Global Benefits Group Commercial |
$93.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$56.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$109.28
|
| Rate for Payer: Multiplan Commercial |
$117.08
|
| Rate for Payer: Networks By Design Commercial |
$101.47
|
| Rate for Payer: Prime Health Services Commercial |
$132.69
|
| Rate for Payer: Riverside University Health System MISP |
$62.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.06
|
| Rate for Payer: United Healthcare All Other HMO |
$78.06
|
| Rate for Payer: United Healthcare HMO Rider |
$78.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$78.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$132.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$132.69
|
| Rate for Payer: Vantage Medical Group Senior |
$132.69
|
|
|
NITAZOXANIDE 500 MG TABLET [39254]
|
Facility
|
OP
|
$161.56
|
|
|
Service Code
|
NDC 6754611112
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$32.31 |
| Max. Negotiated Rate |
$145.40 |
| Rate for Payer: Adventist Health Commercial |
$32.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$98.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$137.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$78.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.98
|
| Rate for Payer: Blue Shield of California Commercial |
$102.43
|
| Rate for Payer: Blue Shield of California EPN |
$64.46
|
| Rate for Payer: Cash Price |
$72.70
|
| Rate for Payer: Central Health Plan Commercial |
$129.25
|
| Rate for Payer: Cigna of CA HMO |
$113.09
|
| Rate for Payer: Cigna of CA PPO |
$113.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$137.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$137.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.62
|
| Rate for Payer: EPIC Health Plan Senior |
$64.62
|
| Rate for Payer: Galaxy Health WC |
$137.33
|
| Rate for Payer: Global Benefits Group Commercial |
$96.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$145.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$102.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$113.09
|
| Rate for Payer: Multiplan Commercial |
$121.17
|
| Rate for Payer: Networks By Design Commercial |
$105.01
|
| Rate for Payer: Prime Health Services Commercial |
$137.33
|
| Rate for Payer: Riverside University Health System MISP |
$64.62
|
| 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
|
$173.90
|
|
|
Service Code
|
NDC 6754611114
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$34.78 |
| Max. Negotiated Rate |
$156.51 |
| Rate for Payer: Adventist Health Commercial |
$34.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$105.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$147.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$95.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$130.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$84.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.16
|
| Rate for Payer: Blue Shield of California Commercial |
$110.25
|
| Rate for Payer: Blue Shield of California EPN |
$69.39
|
| Rate for Payer: Cash Price |
$78.26
|
| Rate for Payer: Central Health Plan Commercial |
$139.12
|
| Rate for Payer: Cigna of CA HMO |
$121.73
|
| Rate for Payer: Cigna of CA PPO |
$121.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$147.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$147.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$121.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.56
|
| Rate for Payer: EPIC Health Plan Senior |
$69.56
|
| Rate for Payer: Galaxy Health WC |
$147.81
|
| Rate for Payer: Global Benefits Group Commercial |
$104.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$156.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$110.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$102.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$121.73
|
| Rate for Payer: Multiplan Commercial |
$130.43
|
| Rate for Payer: Networks By Design Commercial |
$113.03
|
| Rate for Payer: Prime Health Services Commercial |
$147.81
|
| Rate for Payer: Riverside University Health System MISP |
$69.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$104.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$104.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.95
|
| Rate for Payer: United Healthcare All Other HMO |
$86.95
|
| Rate for Payer: United Healthcare HMO Rider |
$86.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$147.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.81
|
| Rate for Payer: Vantage Medical Group Senior |
$147.81
|
|
|
NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE [5593]
|
Facility
|
OP
|
$3.45
|
|
|
Service Code
|
NDC 5026862411
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$3.10 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2.19
|
| Rate for Payer: Blue Shield of California EPN |
$1.38
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Central Health Plan Commercial |
$2.76
|
| Rate for Payer: Cigna of CA HMO |
$2.42
|
| Rate for Payer: Cigna of CA PPO |
$2.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: EPIC Health Plan Senior |
$1.38
|
| Rate for Payer: Galaxy Health WC |
$2.93
|
| Rate for Payer: Global Benefits Group Commercial |
$2.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.42
|
| Rate for Payer: Multiplan Commercial |
$2.59
|
| Rate for Payer: Networks By Design Commercial |
$2.24
|
| Rate for Payer: Prime Health Services Commercial |
$2.93
|
| Rate for Payer: Riverside University Health System MISP |
$1.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.73
|
| Rate for Payer: United Healthcare All Other HMO |
$1.73
|
| Rate for Payer: United Healthcare HMO Rider |
$1.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.93
|
| Rate for Payer: Vantage Medical Group Senior |
$2.93
|
|
|
NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE [5593]
|
Facility
|
IP
|
$1.99
|
|
|
Service Code
|
NDC 6800160500
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.79 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1.60
|
| Rate for Payer: Blue Shield of California EPN |
$1.00
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$1.59
|
| Rate for Payer: Cigna of CA HMO |
$1.39
|
| Rate for Payer: Cigna of CA PPO |
$1.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Senior |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.69
|
| Rate for Payer: Global Benefits Group Commercial |
$1.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.49
|
| 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 6800160500
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.79 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.79
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$1.59
|
| Rate for Payer: Cigna of CA HMO |
$1.39
|
| Rate for Payer: Cigna of CA PPO |
$1.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Senior |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.69
|
| Rate for Payer: Global Benefits Group Commercial |
$1.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.39
|
| Rate for Payer: Multiplan Commercial |
$1.49
|
| Rate for Payer: Networks By Design Commercial |
$1.29
|
| Rate for Payer: Prime Health Services Commercial |
$1.69
|
| Rate for Payer: Riverside University Health System MISP |
$0.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1.69
|
|
|
NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE [5593]
|
Facility
|
IP
|
$3.45
|
|
|
Service Code
|
NDC 5026862415
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$3.10 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Blue Shield of California EPN |
$1.74
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Central Health Plan Commercial |
$2.76
|
| Rate for Payer: Cigna of CA HMO |
$2.42
|
| Rate for Payer: Cigna of CA PPO |
$2.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: EPIC Health Plan Senior |
$1.38
|
| Rate for Payer: Galaxy Health WC |
$2.93
|
| Rate for Payer: Global Benefits Group Commercial |
$2.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$2.59
|
| 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
|
IP
|
$3.45
|
|
|
Service Code
|
NDC 5026862411
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$3.10 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Blue Shield of California EPN |
$1.74
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Central Health Plan Commercial |
$2.76
|
| Rate for Payer: Cigna of CA HMO |
$2.42
|
| Rate for Payer: Cigna of CA PPO |
$2.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: EPIC Health Plan Senior |
$1.38
|
| Rate for Payer: Galaxy Health WC |
$2.93
|
| Rate for Payer: Global Benefits Group Commercial |
$2.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$2.59
|
| 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 5026862415
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$3.10 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2.19
|
| Rate for Payer: Blue Shield of California EPN |
$1.38
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Central Health Plan Commercial |
$2.76
|
| Rate for Payer: Cigna of CA HMO |
$2.42
|
| Rate for Payer: Cigna of CA PPO |
$2.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: EPIC Health Plan Senior |
$1.38
|
| Rate for Payer: Galaxy Health WC |
$2.93
|
| Rate for Payer: Global Benefits Group Commercial |
$2.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.42
|
| Rate for Payer: Multiplan Commercial |
$2.59
|
| Rate for Payer: Networks By Design Commercial |
$2.24
|
| Rate for Payer: Prime Health Services Commercial |
$2.93
|
| Rate for Payer: Riverside University Health System MISP |
$1.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.73
|
| Rate for Payer: United Healthcare All Other HMO |
$1.73
|
| Rate for Payer: United Healthcare HMO Rider |
$1.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.93
|
| Rate for Payer: Vantage Medical Group Senior |
$2.93
|
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE [5595]
|
Facility
|
OP
|
$0.25
|
|
|
Service Code
|
NDC 6233239031
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Central Health Plan Commercial |
$0.20
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
| Rate for Payer: Riverside University Health System MISP |
$0.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Vantage Medical Group Senior |
$0.21
|
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE [5595]
|
Facility
|
IP
|
$0.25
|
|
|
Service Code
|
NDC 6233239031
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Central Health Plan Commercial |
$0.20
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE [10724]
|
Facility
|
OP
|
$0.43
|
|
|
Service Code
|
NDC 7075640411
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.25
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Central Health Plan Commercial |
$0.34
|
| Rate for Payer: Cigna of CA HMO |
$0.30
|
| Rate for Payer: Cigna of CA PPO |
$0.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: EPIC Health Plan Senior |
$0.17
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$0.32
|
| Rate for Payer: Networks By Design Commercial |
$0.28
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
| Rate for Payer: Riverside University Health System MISP |
$0.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO |
$0.22
|
| Rate for Payer: United Healthcare HMO Rider |
$0.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Vantage Medical Group Senior |
$0.37
|
|
