|
NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLET,DOSE PACK [408122221]
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
NDC 0069-1085-06
|
| Hospital Charge Code |
ERX408122221
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: BCBS Transplant Transplant |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.01
|
| Rate for Payer: IEHP medi-cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: Riverside University Health MISP |
$0.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLET,DOSE PACK [408122221]
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
NDC 0069-0345-30
|
| Hospital Charge Code |
ERX408122221
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLET,DOSE PACK [408122221]
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
NDC 0069-0345-30
|
| Hospital Charge Code |
ERX408122221
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: BCBS Transplant Transplant |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.01
|
| Rate for Payer: IEHP medi-cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: Riverside University Health MISP |
$0.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLET,DOSE PACK [408122221]
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
NDC 0069-0345-06
|
| Hospital Charge Code |
ERX408122221
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: BCBS Transplant Transplant |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.01
|
| Rate for Payer: IEHP medi-cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: Riverside University Health MISP |
$0.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLET,DOSE PACK [408122221]
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
NDC 0069-1085-30
|
| Hospital Charge Code |
ERX408122221
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: BCBS Transplant Transplant |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.01
|
| Rate for Payer: IEHP medi-cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: Riverside University Health MISP |
$0.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLET,DOSE PACK [408122221]
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
NDC 0069-0345-06
|
| Hospital Charge Code |
ERX408122221
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLET,DOSE PACK [408122221]
|
Facility
IP
|
$55.60
|
|
|
Service Code
|
NDC 0069-5321-03
|
| Hospital Charge Code |
ERX408122221
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.12 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$41.70
|
| Rate for Payer: Blue Shield of California EPN |
$29.69
|
| Rate for Payer: Cash Price |
$25.02
|
| Rate for Payer: Cash Price |
$25.02
|
| Rate for Payer: Central Health Plan Commercial |
$44.48
|
| Rate for Payer: Cigna of CA HMO |
$38.92
|
| Rate for Payer: Cigna of CA PPO |
$38.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.24
|
| Rate for Payer: Galaxy Health WC |
$47.26
|
| Rate for Payer: Global Benefits Group Commercial |
$33.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$50.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.12
|
| Rate for Payer: Multiplan Commercial |
$41.70
|
| Rate for Payer: Networks By Design Commercial |
$36.14
|
| Rate for Payer: Prime Health Services Commercial |
$47.26
|
|
|
NIRSEVIMAB-ALIP 100 MG/ML INTRAMUSCULAR SYRINGE [239073]
|
Facility
IP
|
$594.00
|
|
|
Service Code
|
CPT 90381
|
| Hospital Charge Code |
NDG239073
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$118.80 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$445.50
|
| Rate for Payer: Blue Shield of California EPN |
$317.20
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Central Health Plan Commercial |
$475.20
|
| Rate for Payer: Cigna of CA HMO |
$415.80
|
| Rate for Payer: Cigna of CA PPO |
$415.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$237.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$237.60
|
| Rate for Payer: Galaxy Health WC |
$504.90
|
| Rate for Payer: Global Benefits Group Commercial |
$356.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$534.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$396.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.80
|
| Rate for Payer: Multiplan Commercial |
$445.50
|
| Rate for Payer: Networks By Design Commercial |
$297.00
|
| Rate for Payer: Prime Health Services Commercial |
$504.90
|
|
|
NIRSEVIMAB-ALIP 100 MG/ML INTRAMUSCULAR SYRINGE [239073]
|
Facility
OP
|
$594.00
|
|
|
Service Code
|
CPT 90381
|
| Hospital Charge Code |
NDG239073
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$118.80 |
| Max. Negotiated Rate |
$3,097.91 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,097.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$504.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$326.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$326.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$287.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$350.94
|
| Rate for Payer: BCBS Transplant Transplant |
$356.40
|
| Rate for Payer: Blue Shield of California Commercial |
$373.63
|
| Rate for Payer: Blue Shield of California EPN |
$290.47
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Central Health Plan Commercial |
$475.20
|
| Rate for Payer: Cigna of CA HMO |
$415.80
|
| Rate for Payer: Cigna of CA PPO |
$415.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$504.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$237.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$237.60
|
| Rate for Payer: Galaxy Health WC |
$504.90
|
| Rate for Payer: Global Benefits Group Commercial |
$356.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$534.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$445.50
|
| Rate for Payer: IEHP medi-cal |
$207.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$396.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.80
|
| Rate for Payer: Multiplan Commercial |
$445.50
|
| Rate for Payer: Networks By Design Commercial |
$297.00
|
| Rate for Payer: Prime Health Services Commercial |
$504.90
|
| Rate for Payer: Riverside University Health MISP |
$237.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$356.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$356.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$297.00
|
| Rate for Payer: United Healthcare HMO Rider |
$297.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$297.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$504.90
|
| Rate for Payer: Vantage Medical Group Senior |
$504.90
|
|
|
NIRSEVIMAB-ALIP 50 MG/0.5 ML INTRAMUSCULAR SYRINGE [239072]
|
Facility
OP
|
$1,188.00
|
|
|
Service Code
|
CPT 90380
|
| Hospital Charge Code |
NDG239072
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$237.60 |
| Max. Negotiated Rate |
$3,097.91 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,097.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,009.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$653.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$653.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$575.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$701.87
|
| Rate for Payer: BCBS Transplant Transplant |
$712.80
|
| Rate for Payer: Blue Shield of California Commercial |
$747.25
|
| Rate for Payer: Blue Shield of California EPN |
$580.93
|
| Rate for Payer: Cash Price |
$534.60
|
| Rate for Payer: Cash Price |
$534.60
|
| Rate for Payer: Central Health Plan Commercial |
$950.40
|
| Rate for Payer: Cigna of CA HMO |
$831.60
|
| Rate for Payer: Cigna of CA PPO |
$831.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,009.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$475.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$475.20
|
| Rate for Payer: Galaxy Health WC |
$1,009.80
|
| Rate for Payer: Global Benefits Group Commercial |
$712.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,069.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$891.00
|
| Rate for Payer: IEHP medi-cal |
$415.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$792.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$237.60
|
| Rate for Payer: Multiplan Commercial |
$891.00
|
| Rate for Payer: Networks By Design Commercial |
$594.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,009.80
|
| Rate for Payer: Riverside University Health MISP |
$475.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$712.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$712.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$594.00
|
| Rate for Payer: United Healthcare All Other HMO |
$594.00
|
| Rate for Payer: United Healthcare HMO Rider |
$594.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$594.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,009.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,009.80
|
|
|
NIRSEVIMAB-ALIP 50 MG/0.5 ML INTRAMUSCULAR SYRINGE [239072]
|
Facility
IP
|
$1,188.00
|
|
|
Service Code
|
CPT 90380
|
| Hospital Charge Code |
NDG239072
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$237.60 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$891.00
|
| Rate for Payer: Blue Shield of California EPN |
$634.39
|
| Rate for Payer: Cash Price |
$534.60
|
| Rate for Payer: Cash Price |
$534.60
|
| Rate for Payer: Central Health Plan Commercial |
$950.40
|
| Rate for Payer: Cigna of CA HMO |
$831.60
|
| Rate for Payer: Cigna of CA PPO |
$831.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$475.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$475.20
|
| Rate for Payer: Galaxy Health WC |
$1,009.80
|
| Rate for Payer: Global Benefits Group Commercial |
$712.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,069.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$792.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$237.60
|
| Rate for Payer: Multiplan Commercial |
$891.00
|
| Rate for Payer: Networks By Design Commercial |
$594.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,009.80
|
|
|
NITAZOXANIDE 100 MG/5 ML ORAL SUSPENSION [34708]
|
Facility
OP
|
$10.44
|
|
|
Service Code
|
NDC 67546-212-21
|
| Hospital Charge Code |
1715312
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$9.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.87
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.17
|
| Rate for Payer: BCBS Transplant Transplant |
$6.26
|
| Rate for Payer: Blue Shield of California Commercial |
$6.57
|
| Rate for Payer: Blue Shield of California EPN |
$5.11
|
| 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: EPIC Health Plan Commercial |
$4.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.18
|
| Rate for Payer: Galaxy Health WC |
$8.87
|
| Rate for Payer: Global Benefits Group Commercial |
$6.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.83
|
| Rate for Payer: IEHP medi-cal |
$3.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.96
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.26
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$8.87
|
| Rate for Payer: Vantage Medical Group Senior |
$8.87
|
|
|
NITAZOXANIDE 100 MG/5 ML ORAL SUSPENSION [34708]
|
Facility
IP
|
$10.44
|
|
|
Service Code
|
NDC 67546-212-21
|
| Hospital Charge Code |
1715312
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$7.83
|
| Rate for Payer: Blue Shield of California EPN |
$5.57
|
| Rate for Payer: Cash Price |
$4.70
|
| 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: 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: Health Management Network EPO/PPO |
$9.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.96
|
| 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 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 |
$14.05 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$52.69
|
| Rate for Payer: Blue Shield of California EPN |
$37.51
|
| Rate for Payer: Cash Price |
$31.61
|
| Rate for Payer: Cash Price |
$31.61
|
| Rate for Payer: Central Health Plan Commercial |
$56.20
|
| 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: Health Management Network EPO/PPO |
$63.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.86
|
| 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
OP
|
$70.25
|
|
|
Service Code
|
NDC 64980-526-21
|
| Hospital Charge Code |
1711963
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.05 |
| Max. Negotiated Rate |
$63.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$42.66
|
| 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 Exchange |
$34.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.50
|
| Rate for Payer: BCBS Transplant Transplant |
$42.15
|
| Rate for Payer: Blue Shield of California Commercial |
$44.19
|
| Rate for Payer: Blue Shield of California EPN |
$34.35
|
| Rate for Payer: Cash Price |
$31.61
|
| Rate for Payer: Central Health Plan Commercial |
$56.20
|
| 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: 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 Management Network EPO/PPO |
$63.22
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$52.69
|
| Rate for Payer: IEHP medi-cal |
$24.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.86
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$42.15
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$59.71
|
| Rate for Payer: Vantage Medical Group Senior |
$59.71
|
|
|
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 |
$34.78 |
| Max. Negotiated Rate |
$156.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$105.61
|
| 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 Exchange |
$84.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$102.74
|
| Rate for Payer: BCBS Transplant Transplant |
$104.34
|
| Rate for Payer: Blue Shield of California Commercial |
$109.38
|
| Rate for Payer: Blue Shield of California EPN |
$85.04
|
| 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 |
$147.82
|
| 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 Management Network EPO/PPO |
$156.51
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$130.42
|
| Rate for Payer: IEHP medi-cal |
$60.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$115.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.78
|
| Rate for Payer: Multiplan Commercial |
$130.42
|
| 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: Riverside University Health 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 Medi-Cal |
$147.82
|
| Rate for Payer: Vantage Medical Group Senior |
$147.82
|
|
|
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 |
$32.31 |
| Max. Negotiated Rate |
$145.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$98.12
|
| 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 Exchange |
$78.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95.45
|
| Rate for Payer: BCBS Transplant Transplant |
$96.94
|
| Rate for Payer: Blue Shield of California Commercial |
$101.62
|
| Rate for Payer: Blue Shield of California EPN |
$79.00
|
| 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: 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 Management Network EPO/PPO |
$145.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$121.17
|
| Rate for Payer: IEHP medi-cal |
$56.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$107.76
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$96.94
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$137.33
|
| Rate for Payer: Vantage Medical Group Senior |
$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 |
$34.78 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$130.42
|
| Rate for Payer: Blue Shield of California EPN |
$92.86
|
| Rate for Payer: Cash Price |
$78.26
|
| 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: 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: Health Management Network EPO/PPO |
$156.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$115.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.78
|
| Rate for Payer: Multiplan Commercial |
$130.42
|
| Rate for Payer: Networks By Design Commercial |
$113.04
|
| Rate for Payer: Prime Health Services Commercial |
$147.82
|
|
|
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 |
$32.31 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$121.17
|
| Rate for Payer: Blue Shield of California EPN |
$86.27
|
| Rate for Payer: Cash Price |
$72.70
|
| 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: 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: Health Management Network EPO/PPO |
$145.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$107.76
|
| 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
|
|
|
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 |
$1.49 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$5.59
|
| Rate for Payer: Blue Shield of California EPN |
$3.98
|
| Rate for Payer: Cash Price |
$3.35
|
| Rate for Payer: Cash Price |
$3.35
|
| Rate for Payer: Central Health Plan Commercial |
$5.96
|
| 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: Health Management Network EPO/PPO |
$6.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.49
|
| Rate for Payer: Multiplan Commercial |
$5.59
|
| Rate for Payer: Networks By Design Commercial |
$4.84
|
| Rate for Payer: Prime Health Services Commercial |
$6.33
|
|
|
NITROFURANTOIN 25 MG/5 ML ORAL SUSPENSION [10723]
|
Facility
OP
|
$7.45
|
|
|
Service Code
|
NDC 16571-740-24
|
| Hospital Charge Code |
1715644
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.52
|
| 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 Exchange |
$3.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.40
|
| Rate for Payer: BCBS Transplant Transplant |
$4.47
|
| Rate for Payer: Blue Shield of California Commercial |
$4.69
|
| Rate for Payer: Blue Shield of California EPN |
$3.64
|
| Rate for Payer: Cash Price |
$3.35
|
| Rate for Payer: Central Health Plan Commercial |
$5.96
|
| 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: 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 Management Network EPO/PPO |
$6.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.59
|
| Rate for Payer: IEHP medi-cal |
$2.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.49
|
| Rate for Payer: Multiplan Commercial |
$5.59
|
| 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: Riverside University Health MISP |
$2.98
|
| 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 Medi-Cal |
$6.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6.33
|
|
|
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 |
$0.69 |
| Max. Negotiated Rate |
$3.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.10
|
| 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 Exchange |
$1.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.04
|
| Rate for Payer: BCBS Transplant Transplant |
$2.07
|
| Rate for Payer: Blue Shield of California Commercial |
$2.17
|
| Rate for Payer: Blue Shield of California EPN |
$1.69
|
| 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: 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 Management Network EPO/PPO |
$3.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.59
|
| Rate for Payer: IEHP medi-cal |
$1.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.30
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.07
|
| Rate for Payer: Riverside University Health 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 |
$1.72
|
| 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 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 50268-624-11
|
| Hospital Charge Code |
1711101
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Cigna of CA PPO |
$2.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2.59
|
| Rate for Payer: Blue Shield of California EPN |
$1.84
|
| Rate for Payer: Cash Price |
$1.55
|
| 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: 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: Health Management Network EPO/PPO |
$3.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.30
|
| 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
|
$2.82
|
|
|
Service Code
|
NDC 47781-308-01
|
| Hospital Charge Code |
1711101
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.71
|
| 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 Exchange |
$1.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.67
|
| Rate for Payer: BCBS Transplant Transplant |
$1.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1.77
|
| Rate for Payer: Blue Shield of California EPN |
$1.38
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Central Health Plan Commercial |
$2.26
|
| 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: 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 Management Network EPO/PPO |
$2.54
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.12
|
| Rate for Payer: IEHP medi-cal |
$0.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$2.12
|
| 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: Riverside University Health MISP |
$1.13
|
| 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 Medi-Cal |
$2.40
|
| Rate for Payer: Vantage Medical Group Senior |
$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 |
$0.40 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.49
|
| Rate for Payer: Blue Shield of California EPN |
$1.06
|
| Rate for Payer: Cash Price |
$0.90
|
| 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: 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: Health Management Network EPO/PPO |
$1.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| 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
|
|
