|
NIRMATRELVIR 150 MG (10)-RITONAVIR 100 MG (10) TABLETS IN A DOSE PACK [234239]
|
Facility
|
IP
|
$89.77
|
|
|
Service Code
|
NDC 0069-5317-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$67.33 |
| Rate for Payer: Adventist Health Commercial |
$17.95
|
| Rate for Payer: Cash Price |
$49.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.77
|
| Rate for Payer: Heritage Provider Network Senior |
$60.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.44
|
| Rate for Payer: Multiplan Commercial |
$67.33
|
|
|
NIRMATRELVIR 150 MG (10)-RITONAVIR 100 MG (10) TABLETS IN A DOSE PACK [234239]
|
Facility
|
OP
|
$89.77
|
|
|
Service Code
|
NDC 0069-5317-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$76.30 |
| Rate for Payer: Adventist Health Commercial |
$17.95
|
| Rate for Payer: Aetna of CA Gatekeeper |
$47.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.33
|
| Rate for Payer: Blue Shield of California Commercial |
$54.76
|
| Rate for Payer: Blue Shield of California EPN |
$43.81
|
| Rate for Payer: Cash Price |
$49.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$58.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$76.30
|
| Rate for Payer: Dignity Health Senior |
$76.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.57
|
| Rate for Payer: Heritage Provider Network Senior |
$55.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$42.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$62.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$62.84
|
| Rate for Payer: Multiplan Commercial |
$67.33
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.91
|
| Rate for Payer: TriValley Medical Group Senior |
$35.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$44.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$44.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.30
|
| Rate for Payer: Vantage Medical Group Senior |
$76.30
|
|
|
NIRMATRELVIR 150 MG (10)-RITONAVIR 100 MG (10) TABLETS IN A DOSE PACK [234239]
|
Facility
|
IP
|
$89.77
|
|
|
Service Code
|
NDC 0069-5317-20
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$67.33 |
| Rate for Payer: Adventist Health Commercial |
$17.95
|
| Rate for Payer: Cash Price |
$49.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.77
|
| Rate for Payer: Heritage Provider Network Senior |
$60.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.44
|
| Rate for Payer: Multiplan Commercial |
$67.33
|
|
|
NIRMATRELVIR 150 MG (10)-RITONAVIR 100 MG (10) TABLETS IN A DOSE PACK [234239]
|
Facility
|
OP
|
$89.77
|
|
|
Service Code
|
NDC 0069-5317-20
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$76.30 |
| Rate for Payer: Adventist Health Commercial |
$17.95
|
| Rate for Payer: Aetna of CA Gatekeeper |
$47.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.33
|
| Rate for Payer: Blue Shield of California Commercial |
$54.76
|
| Rate for Payer: Blue Shield of California EPN |
$43.81
|
| Rate for Payer: Cash Price |
$49.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$58.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$76.30
|
| Rate for Payer: Dignity Health Senior |
$76.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.57
|
| Rate for Payer: Heritage Provider Network Senior |
$55.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$42.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$62.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$62.84
|
| Rate for Payer: Multiplan Commercial |
$67.33
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.91
|
| Rate for Payer: TriValley Medical Group Senior |
$35.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$44.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$44.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.30
|
| Rate for Payer: Vantage Medical Group Senior |
$76.30
|
|
|
NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLET,DOSE PACK [408122221]
|
Facility
|
IP
|
$59.84
|
|
|
Service Code
|
NDC 0069-5321-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.83 |
| Max. Negotiated Rate |
$44.88 |
| Rate for Payer: Adventist Health Commercial |
$11.97
|
| Rate for Payer: Cash Price |
$32.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.51
|
| Rate for Payer: Heritage Provider Network Senior |
$40.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.96
|
| Rate for Payer: Multiplan Commercial |
$44.88
|
|
|
NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLET,DOSE PACK [408122221]
|
Facility
|
OP
|
$59.84
|
|
|
Service Code
|
NDC 0069-5321-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.83 |
| Max. Negotiated Rate |
$50.86 |
| Rate for Payer: Adventist Health Commercial |
$11.97
|
| Rate for Payer: Aetna of CA Gatekeeper |
$31.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.11
|
| 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: Blue Shield of California Commercial |
$36.50
|
| Rate for Payer: Blue Shield of California EPN |
$29.20
|
| Rate for Payer: Cash Price |
$32.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$38.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.86
|
| Rate for Payer: Dignity Health Senior |
$50.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.04
|
| Rate for Payer: Heritage Provider Network Senior |
$37.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$28.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.89
|
| Rate for Payer: Multiplan Commercial |
$44.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$23.94
|
| Rate for Payer: TriValley Medical Group Senior |
$23.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 0069-5321-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.83 |
| Max. Negotiated Rate |
$50.86 |
| Rate for Payer: Adventist Health Commercial |
$11.97
|
| Rate for Payer: Aetna of CA Gatekeeper |
$31.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.11
|
| 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: Blue Shield of California Commercial |
$36.50
|
| Rate for Payer: Blue Shield of California EPN |
$29.20
|
| Rate for Payer: Cash Price |
$32.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$38.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.86
|
| Rate for Payer: Dignity Health Senior |
$50.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.04
|
| Rate for Payer: Heritage Provider Network Senior |
$37.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$28.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.89
|
| Rate for Payer: Multiplan Commercial |
$44.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$23.94
|
| Rate for Payer: TriValley Medical Group Senior |
$23.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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
|
IP
|
$59.84
|
|
|
Service Code
|
NDC 0069-5321-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.83 |
| Max. Negotiated Rate |
$44.88 |
| Rate for Payer: Adventist Health Commercial |
$11.97
|
| Rate for Payer: Cash Price |
$32.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.51
|
| Rate for Payer: Heritage Provider Network Senior |
$40.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.96
|
| Rate for Payer: Multiplan Commercial |
$44.88
|
|
|
NIRSEVIMAB-ALIP 100 MG/ML INTRAMUSCULAR SYRINGE [239073]
|
Facility
|
IP
|
$667.36
|
|
|
Service Code
|
HCPCS 90381
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$120.79 |
| Max. Negotiated Rate |
$500.52 |
| Rate for Payer: Adventist Health Commercial |
$133.47
|
| Rate for Payer: Cash Price |
$367.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$306.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$360.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$308.99
|
| Rate for Payer: Heritage Provider Network Senior |
$308.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.84
|
| Rate for Payer: Multiplan Commercial |
$500.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$241.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.96
|
|
|
NIRSEVIMAB-ALIP 100 MG/ML INTRAMUSCULAR SYRINGE [239073]
|
Facility
|
OP
|
$667.36
|
|
|
Service Code
|
HCPCS 90381
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$120.79 |
| Max. Negotiated Rate |
$1,440.36 |
| Rate for Payer: Adventist Health Commercial |
$133.47
|
| Rate for Payer: Aetna of CA Gatekeeper |
$356.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$458.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$567.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$367.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$500.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,440.36
|
| Rate for Payer: Blue Shield of California Commercial |
$530.14
|
| Rate for Payer: Blue Shield of California EPN |
$530.14
|
| Rate for Payer: Cash Price |
$367.05
|
| Rate for Payer: Cash Price |
$367.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$306.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$567.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$567.26
|
| Rate for Payer: Dignity Health Senior |
$567.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$427.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$308.99
|
| Rate for Payer: Heritage Provider Network Senior |
$308.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$849.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$318.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$467.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$467.15
|
| Rate for Payer: Multiplan Commercial |
$500.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$266.94
|
| Rate for Payer: TriValley Medical Group Senior |
$266.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$241.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$567.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$567.26
|
| Rate for Payer: Vantage Medical Group Senior |
$567.26
|
|
|
NITAZOXANIDE 100 MG/5 ML ORAL SUSPENSION [34708]
|
Facility
|
IP
|
$10.44
|
|
|
Service Code
|
NDC 67546-212-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$7.83 |
| Rate for Payer: Adventist Health Commercial |
$2.09
|
| Rate for Payer: Cash Price |
$5.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.07
|
| Rate for Payer: Heritage Provider Network Senior |
$7.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.61
|
| Rate for Payer: Multiplan Commercial |
$7.83
|
|
|
NITAZOXANIDE 100 MG/5 ML ORAL SUSPENSION [34708]
|
Facility
|
OP
|
$10.44
|
|
|
Service Code
|
NDC 67546-212-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$8.87 |
| Rate for Payer: Adventist Health Commercial |
$2.09
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.17
|
| 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: Blue Shield of California Commercial |
$6.37
|
| Rate for Payer: Blue Shield of California EPN |
$5.09
|
| Rate for Payer: Cash Price |
$5.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.87
|
| Rate for Payer: Dignity Health Senior |
$8.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.46
|
| Rate for Payer: Heritage Provider Network Senior |
$6.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.31
|
| Rate for Payer: Multiplan Commercial |
$7.83
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.18
|
| Rate for Payer: TriValley Medical Group Senior |
$4.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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
|
$161.56
|
|
|
Service Code
|
NDC 67546-111-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$29.24 |
| Max. Negotiated Rate |
$121.17 |
| Rate for Payer: Adventist Health Commercial |
$32.31
|
| Rate for Payer: Cash Price |
$88.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$109.38
|
| Rate for Payer: Heritage Provider Network Senior |
$109.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.39
|
| Rate for Payer: Multiplan Commercial |
$121.17
|
|
|
NITAZOXANIDE 500 MG TABLET [39254]
|
Facility
|
OP
|
$156.11
|
|
|
Service Code
|
NDC 64980-526-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$28.26 |
| Max. Negotiated Rate |
$132.69 |
| Rate for Payer: Adventist Health Commercial |
$31.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$83.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$107.25
|
| 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: Blue Shield of California Commercial |
$95.23
|
| Rate for Payer: Blue Shield of California EPN |
$76.18
|
| Rate for Payer: Cash Price |
$85.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$101.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$132.69
|
| Rate for Payer: Dignity Health Senior |
$132.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$96.63
|
| Rate for Payer: Heritage Provider Network Senior |
$96.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$74.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$109.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$109.28
|
| Rate for Payer: Multiplan Commercial |
$117.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$62.44
|
| Rate for Payer: TriValley Medical Group Senior |
$62.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$78.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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
|
IP
|
$70.25
|
|
|
Service Code
|
NDC 64980-526-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.72 |
| Max. Negotiated Rate |
$52.69 |
| Rate for Payer: Adventist Health Commercial |
$14.05
|
| Rate for Payer: Cash Price |
$38.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.56
|
| Rate for Payer: Heritage Provider Network Senior |
$47.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.56
|
| Rate for Payer: Multiplan Commercial |
$52.69
|
|
|
NITAZOXANIDE 500 MG TABLET [39254]
|
Facility
|
OP
|
$173.90
|
|
|
Service Code
|
NDC 67546-111-14
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$31.48 |
| Max. Negotiated Rate |
$147.81 |
| Rate for Payer: Adventist Health Commercial |
$34.78
|
| Rate for Payer: Aetna of CA Gatekeeper |
$92.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$119.47
|
| 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: Blue Shield of California Commercial |
$106.08
|
| Rate for Payer: Blue Shield of California EPN |
$84.86
|
| Rate for Payer: Cash Price |
$95.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$113.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$147.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.81
|
| Rate for Payer: Dignity Health Senior |
$147.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$107.64
|
| Rate for Payer: Heritage Provider Network Senior |
$107.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$82.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$121.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$121.73
|
| Rate for Payer: Multiplan Commercial |
$130.43
|
| Rate for Payer: TriValley Medical Group Commercial |
$69.56
|
| Rate for Payer: TriValley Medical Group Senior |
$69.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$86.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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
|
|
|
NITAZOXANIDE 500 MG TABLET [39254]
|
Facility
|
OP
|
$70.25
|
|
|
Service Code
|
NDC 64980-526-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.72 |
| Max. Negotiated Rate |
$59.71 |
| Rate for Payer: Adventist Health Commercial |
$14.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.26
|
| 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: Blue Shield of California Commercial |
$42.85
|
| Rate for Payer: Blue Shield of California EPN |
$34.28
|
| Rate for Payer: Cash Price |
$38.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$45.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.71
|
| Rate for Payer: Dignity Health Senior |
$59.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.48
|
| Rate for Payer: Heritage Provider Network Senior |
$43.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$33.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.17
|
| Rate for Payer: Multiplan Commercial |
$52.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$28.10
|
| Rate for Payer: TriValley Medical Group Senior |
$28.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$35.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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
|
OP
|
$161.56
|
|
|
Service Code
|
NDC 67546-111-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$29.24 |
| Max. Negotiated Rate |
$137.33 |
| Rate for Payer: Adventist Health Commercial |
$32.31
|
| Rate for Payer: Aetna of CA Gatekeeper |
$86.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$110.99
|
| 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: Blue Shield of California Commercial |
$98.55
|
| Rate for Payer: Blue Shield of California EPN |
$78.84
|
| Rate for Payer: Cash Price |
$88.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$105.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$137.33
|
| Rate for Payer: Dignity Health Senior |
$137.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$100.01
|
| Rate for Payer: Heritage Provider Network Senior |
$100.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$77.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$113.09
|
| Rate for Payer: Multiplan Commercial |
$121.17
|
| Rate for Payer: TriValley Medical Group Commercial |
$64.62
|
| Rate for Payer: TriValley Medical Group Senior |
$64.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$80.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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
|
IP
|
$156.11
|
|
|
Service Code
|
NDC 64980-526-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$28.26 |
| Max. Negotiated Rate |
$117.08 |
| Rate for Payer: Adventist Health Commercial |
$31.22
|
| Rate for Payer: Cash Price |
$85.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$105.69
|
| Rate for Payer: Heritage Provider Network Senior |
$105.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.03
|
| Rate for Payer: Multiplan Commercial |
$117.08
|
|
|
NITAZOXANIDE 500 MG TABLET [39254]
|
Facility
|
IP
|
$173.90
|
|
|
Service Code
|
NDC 67546-111-14
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$31.48 |
| Max. Negotiated Rate |
$130.43 |
| Rate for Payer: Adventist Health Commercial |
$34.78
|
| Rate for Payer: Cash Price |
$95.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$117.73
|
| Rate for Payer: Heritage Provider Network Senior |
$117.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.48
|
| Rate for Payer: Multiplan Commercial |
$130.43
|
|
|
NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE [5593]
|
Facility
|
OP
|
$1.99
|
|
|
Service Code
|
NDC 68001-605-00
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.69 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.37
|
| 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: Blue Shield of California Commercial |
$1.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.97
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.69
|
| Rate for Payer: Dignity Health Senior |
$1.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.23
|
| Rate for Payer: Heritage Provider Network Senior |
$1.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.39
|
| Rate for Payer: Multiplan Commercial |
$1.49
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.80
|
| Rate for Payer: TriValley Medical Group Senior |
$0.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1.69
|
|
|
NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE [5593]
|
Facility
|
OP
|
$3.45
|
|
|
Service Code
|
NDC 50268-624-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.93 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.37
|
| 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: Blue Shield of California Commercial |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$1.68
|
| Rate for Payer: Cash Price |
$1.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.93
|
| Rate for Payer: Dignity Health Senior |
$2.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.14
|
| Rate for Payer: Heritage Provider Network Senior |
$2.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.42
|
| Rate for Payer: Multiplan Commercial |
$2.59
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.38
|
| Rate for Payer: TriValley Medical Group Senior |
$1.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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
|
$3.45
|
|
|
Service Code
|
NDC 50268-624-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.59 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Cash Price |
$1.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.34
|
| Rate for Payer: Heritage Provider Network Senior |
$2.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$2.59
|
|
|
NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE [5593]
|
Facility
|
IP
|
$3.45
|
|
|
Service Code
|
NDC 50268-624-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.59 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Cash Price |
$1.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.34
|
| Rate for Payer: Heritage Provider Network Senior |
$2.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$2.59
|
|
|
NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE [5593]
|
Facility
|
IP
|
$1.99
|
|
|
Service Code
|
NDC 68001-605-00
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.49 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.35
|
| Rate for Payer: Heritage Provider Network Senior |
$1.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$1.49
|
|
