|
NIMODIPINE 60 MG/10 ML ORAL SYRINGE (FOR ORAL USE ONLY) [228035]
|
Facility
|
OP
|
$13.20
|
|
|
Service Code
|
NDC 2433826012
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.60
|
| Rate for Payer: Blue Shield of California Commercial |
$8.05
|
| Rate for Payer: Blue Shield of California EPN |
$6.44
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.17
|
| Rate for Payer: Heritage Provider Network Senior |
$8.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.28
|
| Rate for Payer: TriValley Medical Group Senior |
$5.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: Vantage Medical Group Senior |
$11.22
|
|
|
NIMODIPINE 60 MG/10 ML ORAL SYRINGE (FOR ORAL USE ONLY) [228035]
|
Facility
|
IP
|
$13.20
|
|
|
Service Code
|
NDC 2433826010
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.50
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.94
|
| Rate for Payer: Heritage Provider Network Senior |
$8.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.30
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
|
|
NIMODIPINE 60 MG/10 ML ORAL SYRINGE (FOR ORAL USE ONLY) [228035]
|
Facility
|
OP
|
$13.20
|
|
|
Service Code
|
NDC 2433826010
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.60
|
| Rate for Payer: Blue Shield of California Commercial |
$8.05
|
| Rate for Payer: Blue Shield of California EPN |
$6.44
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.17
|
| Rate for Payer: Heritage Provider Network Senior |
$8.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.28
|
| Rate for Payer: TriValley Medical Group Senior |
$5.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Senior |
$11.22
|
|
|
NIMODIPINE ORAL SUSPENSION COMPOUND 30 MG/ML [4080312]
|
Facility
|
OP
|
$9.15
|
|
|
Service Code
|
NDC 9994080312
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$7.78 |
| Rate for Payer: Adventist Health Commercial |
$1.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.58
|
| Rate for Payer: Blue Shield of California Commercial |
$5.58
|
| Rate for Payer: Blue Shield of California EPN |
$4.47
|
| Rate for Payer: Cash Price |
$4.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.66
|
| Rate for Payer: Heritage Provider Network Senior |
$5.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.41
|
| Rate for Payer: Multiplan Commercial |
$6.86
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.66
|
| Rate for Payer: TriValley Medical Group Senior |
$3.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7.78
|
|
|
NIMODIPINE ORAL SUSPENSION COMPOUND 30 MG/ML [4080312]
|
Facility
|
IP
|
$9.15
|
|
|
Service Code
|
NDC 9994080312
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$6.86 |
| Rate for Payer: Adventist Health Commercial |
$1.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.89
|
| Rate for Payer: Cash Price |
$4.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.19
|
| Rate for Payer: Heritage Provider Network Senior |
$6.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.29
|
| Rate for Payer: Multiplan Commercial |
$6.86
|
|
|
NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLET,DOSE PACK [408122221]
|
Facility
|
IP
|
$59.84
|
|
|
Service Code
|
NDC 0069532103
|
| 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: Aetna of CA Non-Gatekeeper |
$38.54
|
| Rate for Payer: Cash Price |
$26.93
|
| 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 Foundation Hospitals 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
|
IP
|
$59.84
|
|
|
Service Code
|
NDC 0069532130
|
| 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: Aetna of CA Non-Gatekeeper |
$38.54
|
| Rate for Payer: Cash Price |
$26.93
|
| 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 Foundation Hospitals 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 0069532103
|
| 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 Non-Gatekeeper |
$36.98
|
| 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 HMO/PPO |
$29.93
|
| 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 |
$26.93
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$28.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 0069532130
|
| 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 Non-Gatekeeper |
$36.98
|
| 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 HMO/PPO |
$29.93
|
| 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 |
$26.93
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$28.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
|
|
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 |
$129.25 |
| Max. Negotiated Rate |
$535.55 |
| Rate for Payer: Adventist Health Commercial |
$142.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$459.86
|
| Rate for Payer: Cash Price |
$321.33
|
| Rate for Payer: Cigna of CA HMO/PPO |
$328.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$385.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$330.61
|
| Rate for Payer: Heritage Provider Network Senior |
$330.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$129.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.52
|
| Rate for Payer: Multiplan Commercial |
$535.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$257.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$236.43
|
|
|
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 |
$129.25 |
| Max. Negotiated Rate |
$1,223.94 |
| Rate for Payer: Adventist Health Commercial |
$142.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$441.30
|
| 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 HMO/PPO |
$1,223.94
|
| 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 |
$321.33
|
| Rate for Payer: Cash Price |
$321.33
|
| Rate for Payer: Cigna of CA HMO/PPO |
$328.47
|
| 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: EPIC Health Plan Commercial |
$457.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$330.61
|
| Rate for Payer: Heritage Provider Network Senior |
$330.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$340.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$129.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$499.85
|
| Rate for Payer: Multiplan Commercial |
$535.55
|
| Rate for Payer: TriValley Medical Group Commercial |
$285.63
|
| Rate for Payer: TriValley Medical Group Senior |
$285.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$257.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$236.43
|
| 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 50 MG/0.5 ML INTRAMUSCULAR SYRINGE [239072]
|
Facility
|
IP
|
$1,428.14
|
|
|
Service Code
|
HCPCS 90380
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$258.49 |
| Max. Negotiated Rate |
$1,071.11 |
| Rate for Payer: Adventist Health Commercial |
$285.63
|
| Rate for Payer: Adventist Health Commercial |
$285.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$919.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$919.73
|
| Rate for Payer: Cash Price |
$642.66
|
| Rate for Payer: Cash Price |
$642.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$656.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$656.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$771.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$771.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$661.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$661.23
|
| Rate for Payer: Heritage Provider Network Senior |
$661.23
|
| Rate for Payer: Heritage Provider Network Senior |
$661.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$258.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$258.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$357.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$357.04
|
| Rate for Payer: Multiplan Commercial |
$1,071.11
|
| Rate for Payer: Multiplan Commercial |
$1,071.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$515.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$515.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$472.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$472.86
|
|
|
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 |
$258.49 |
| Max. Negotiated Rate |
$1,223.94 |
| Rate for Payer: Adventist Health Commercial |
$285.63
|
| Rate for Payer: Adventist Health Commercial |
$285.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$882.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$882.59
|
| 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 HMO/PPO |
$1,223.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,223.94
|
| Rate for Payer: Blue Shield of California Commercial |
$530.14
|
| Rate for Payer: Blue Shield of California Commercial |
$530.14
|
| Rate for Payer: Blue Shield of California EPN |
$530.14
|
| Rate for Payer: Blue Shield of California EPN |
$530.14
|
| Rate for Payer: Cash Price |
$642.66
|
| Rate for Payer: Cash Price |
$642.67
|
| Rate for Payer: Cash Price |
$642.66
|
| Rate for Payer: Cash Price |
$642.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$656.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$656.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,213.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,213.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,213.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,213.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,213.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,213.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$914.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$914.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$661.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$661.23
|
| Rate for Payer: Heritage Provider Network Senior |
$661.23
|
| Rate for Payer: Heritage Provider Network Senior |
$661.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$681.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$681.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$258.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$258.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$357.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$357.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$999.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$999.70
|
| Rate for Payer: Multiplan Commercial |
$1,071.11
|
| Rate for Payer: Multiplan Commercial |
$1,071.11
|
| Rate for Payer: TriValley Medical Group Commercial |
$571.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$571.26
|
| Rate for Payer: TriValley Medical Group Senior |
$571.26
|
| Rate for Payer: TriValley Medical Group Senior |
$571.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$515.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$515.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$472.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$472.86
|
| 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
|
OP
|
$10.44
|
|
|
Service Code
|
NDC 6754621221
|
| 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 Non-Gatekeeper |
$6.45
|
| 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 HMO/PPO |
$5.22
|
| 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 |
$4.70
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$4.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 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 |
$1.89 |
| Max. Negotiated Rate |
$7.83 |
| Rate for Payer: Adventist Health Commercial |
$2.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.72
|
| Rate for Payer: Cash Price |
$4.70
|
| 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 Foundation Hospitals Medi-Cal |
$1.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.61
|
| Rate for Payer: Multiplan Commercial |
$7.83
|
|
|
NITAZOXANIDE 500 MG TABLET [39254]
|
Facility
|
IP
|
$70.25
|
|
|
Service Code
|
NDC 6498052621
|
| 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: Aetna of CA Non-Gatekeeper |
$45.24
|
| Rate for Payer: Cash Price |
$31.61
|
| 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 Foundation Hospitals 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
|
$156.11
|
|
|
Service Code
|
NDC 6498052660
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$28.26 |
| Max. Negotiated Rate |
$132.69 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.48
|
| Rate for Payer: Adventist Health Commercial |
$31.22
|
| 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 HMO/PPO |
$78.09
|
| 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 |
$70.25
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$74.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
OP
|
$70.25
|
|
|
Service Code
|
NDC 6498052621
|
| 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 Non-Gatekeeper |
$43.41
|
| 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 HMO/PPO |
$35.14
|
| 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 |
$31.61
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$33.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
IP
|
$161.56
|
|
|
Service Code
|
NDC 6754611112
|
| 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: Aetna of CA Non-Gatekeeper |
$104.04
|
| Rate for Payer: Cash Price |
$72.70
|
| 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 Foundation Hospitals 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
|
IP
|
$156.11
|
|
|
Service Code
|
NDC 6498052660
|
| 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: Aetna of CA Non-Gatekeeper |
$100.53
|
| Rate for Payer: Cash Price |
$70.25
|
| 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 Foundation Hospitals 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
|
OP
|
$161.56
|
|
|
Service Code
|
NDC 6754611112
|
| 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 Non-Gatekeeper |
$99.84
|
| 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 HMO/PPO |
$80.81
|
| 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 |
$72.70
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$77.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
$173.90
|
|
|
Service Code
|
NDC 6754611114
|
| 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: Aetna of CA Non-Gatekeeper |
$111.99
|
| Rate for Payer: Cash Price |
$78.26
|
| 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 Foundation Hospitals Medi-Cal |
$31.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.48
|
| Rate for Payer: Multiplan Commercial |
$130.43
|
|
|
NITAZOXANIDE 500 MG TABLET [39254]
|
Facility
|
OP
|
$173.90
|
|
|
Service Code
|
NDC 6754611114
|
| 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 Non-Gatekeeper |
$107.47
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$86.98
|
| 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 |
$78.26
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$82.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
|
|
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 |
$0.36 |
| Max. Negotiated Rate |
$1.69 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.23
|
| 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 HMO/PPO |
$1.00
|
| 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 |
$0.90
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$0.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
IP
|
$3.45
|
|
|
Service Code
|
NDC 5026862415
|
| 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: Aetna of CA Non-Gatekeeper |
$2.22
|
| Rate for Payer: Cash Price |
$1.55
|
| 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 Foundation Hospitals Medi-Cal |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$2.59
|
|
