Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR [27335]

Facility

$0.78

Service Code	NDC 24979-009-01
Hospital Charge Code	1712601
Hospital Revenue Code	259
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.62
Rate for Payer: Cash Price	$0.35
Rate for Payer: Cigna of CA HMO/PPO	$0.62
Rate for Payer: Health Smart Auto/Commercial	$0.47
Rate for Payer: LLUH Dept of Risk Management WC	$0.43
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.59

NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR [27335]

Facility

$0.78

Service Code	NDC 24979-009-01
Hospital Charge Code	1712601
Hospital Revenue Code	259
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.59
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.47
Rate for Payer: Aetna of CA Government/Medicare	$0.47
Rate for Payer: Cash Price	$0.35
Rate for Payer: Health Smart Auto/Commercial	$0.47
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.47
Rate for Payer: LLUH Dept of Risk Management WC	$0.43
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.59

NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR [27335]

Facility

$3.75

Service Code	NDC 68084-603-21
Hospital Charge Code	1712601
Hospital Revenue Code	259
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$2.81
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.25
Rate for Payer: Aetna of CA Government/Medicare	$2.25
Rate for Payer: Cash Price	$1.69
Rate for Payer: Health Smart Auto/Commercial	$2.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.25
Rate for Payer: LLUH Dept of Risk Management WC	$2.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.81

NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR [27335]

Facility

$2.56

Service Code	NDC 62175-262-37
Hospital Charge Code	1712601
Hospital Revenue Code	259
Min. Negotiated Rate	$1.41
Max. Negotiated Rate	$1.92
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.54
Rate for Payer: Aetna of CA Government/Medicare	$1.54
Rate for Payer: Cash Price	$1.15
Rate for Payer: Health Smart Auto/Commercial	$1.54
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.54
Rate for Payer: LLUH Dept of Risk Management WC	$1.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.92

NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR [27335]

Facility

$3.75

Service Code	NDC 68084-603-11
Hospital Charge Code	1712601
Hospital Revenue Code	259
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$3.00
Rate for Payer: Cash Price	$1.69
Rate for Payer: Cigna of CA HMO/PPO	$3.00
Rate for Payer: Health Smart Auto/Commercial	$2.25
Rate for Payer: LLUH Dept of Risk Management WC	$2.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.81

NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR [27335]

Facility

$2.70

Service Code	NDC 50268-599-15
Hospital Charge Code	1712601
Hospital Revenue Code	259
Min. Negotiated Rate	$1.48
Max. Negotiated Rate	$2.02
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.62
Rate for Payer: Aetna of CA Government/Medicare	$1.62
Rate for Payer: Cash Price	$1.22
Rate for Payer: Health Smart Auto/Commercial	$1.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.62
Rate for Payer: LLUH Dept of Risk Management WC	$1.48
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.02

NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR [27335]

Facility

$3.75

Service Code	NDC 68084-603-11
Hospital Charge Code	1712601
Hospital Revenue Code	259
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$2.81
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.25
Rate for Payer: Aetna of CA Government/Medicare	$2.25
Rate for Payer: Cash Price	$1.69
Rate for Payer: Health Smart Auto/Commercial	$2.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.25
Rate for Payer: LLUH Dept of Risk Management WC	$2.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.81

NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR [27335]

Facility

$1.04

Service Code	NDC 0904-7082-06
Hospital Charge Code	1712601
Hospital Revenue Code	259
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$0.78
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.62
Rate for Payer: Aetna of CA Government/Medicare	$0.62
Rate for Payer: Cash Price	$0.47
Rate for Payer: Health Smart Auto/Commercial	$0.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.62
Rate for Payer: LLUH Dept of Risk Management WC	$0.57
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.78

NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR [27335]

Facility

$1.04

Service Code	NDC 0904-7082-06
Hospital Charge Code	1712601
Hospital Revenue Code	259
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$0.83
Rate for Payer: Cash Price	$0.47
Rate for Payer: Cigna of CA HMO/PPO	$0.83
Rate for Payer: Health Smart Auto/Commercial	$0.62
Rate for Payer: LLUH Dept of Risk Management WC	$0.57
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.78

NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR [27335]

Facility

$2.70

Service Code	NDC 50268-599-15
Hospital Charge Code	1712601
Hospital Revenue Code	259
Min. Negotiated Rate	$1.48
Max. Negotiated Rate	$2.16
Rate for Payer: Cash Price	$1.22
Rate for Payer: Cigna of CA HMO/PPO	$2.16
Rate for Payer: Health Smart Auto/Commercial	$1.62
Rate for Payer: LLUH Dept of Risk Management WC	$1.48
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.02

NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR [27335]

Facility

$3.75

Service Code	NDC 68084-603-21
Hospital Charge Code	1712601
Hospital Revenue Code	259
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$3.00
Rate for Payer: Cash Price	$1.69
Rate for Payer: Cigna of CA HMO/PPO	$3.00
Rate for Payer: Health Smart Auto/Commercial	$2.25
Rate for Payer: LLUH Dept of Risk Management WC	$2.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.81

NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR [27335]

Facility

$2.70

Service Code	NDC 50268-599-11
Hospital Charge Code	1712601
Hospital Revenue Code	259
Min. Negotiated Rate	$1.48
Max. Negotiated Rate	$2.02
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.62
Rate for Payer: Aetna of CA Government/Medicare	$1.62
Rate for Payer: Cash Price	$1.22
Rate for Payer: Health Smart Auto/Commercial	$1.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.62
Rate for Payer: LLUH Dept of Risk Management WC	$1.48
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.02

NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR [27335]

Facility

$2.56

Service Code	NDC 62175-262-37
Hospital Charge Code	1712601
Hospital Revenue Code	259
Min. Negotiated Rate	$1.41
Max. Negotiated Rate	$2.05
Rate for Payer: Cash Price	$1.15
Rate for Payer: Cigna of CA HMO/PPO	$2.05
Rate for Payer: Health Smart Auto/Commercial	$1.54
Rate for Payer: LLUH Dept of Risk Management WC	$1.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.92

NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE [37662]

Facility

$0.67

Service Code	NDC 50742-622-01
Hospital Charge Code	1711654
Hospital Revenue Code	259
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.54
Rate for Payer: Cash Price	$0.30
Rate for Payer: Cigna of CA HMO/PPO	$0.54
Rate for Payer: Health Smart Auto/Commercial	$0.40
Rate for Payer: LLUH Dept of Risk Management WC	$0.37
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.50

NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE [37662]

Facility

$0.67

Service Code	NDC 50742-622-01
Hospital Charge Code	1711654
Hospital Revenue Code	259
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.40
Rate for Payer: Aetna of CA Government/Medicare	$0.40
Rate for Payer: Cash Price	$0.30
Rate for Payer: Health Smart Auto/Commercial	$0.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.40
Rate for Payer: LLUH Dept of Risk Management WC	$0.37
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.50

NIFEDIPINE ORAL SUSPENSION COMPOUND 4 MG/ML [4080311]

Facility

$0.41

Service Code	NDC 9994-0803-11
Hospital Charge Code	1715305
Hospital Revenue Code	259
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.33
Rate for Payer: Cash Price	$0.18
Rate for Payer: Cigna of CA HMO/PPO	$0.33
Rate for Payer: Health Smart Auto/Commercial	$0.25
Rate for Payer: LLUH Dept of Risk Management WC	$0.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.31

NIFEDIPINE ORAL SUSPENSION COMPOUND 4 MG/ML [4080311]

Facility

$0.41

Service Code	NDC 9994-0803-11
Hospital Charge Code	1715305
Hospital Revenue Code	259
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.31
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.25
Rate for Payer: Aetna of CA Government/Medicare	$0.25
Rate for Payer: Cash Price	$0.18
Rate for Payer: Health Smart Auto/Commercial	$0.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.25
Rate for Payer: LLUH Dept of Risk Management WC	$0.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.31

NIFURTIMOX 120 MG TABLET [229005]

Facility

$3.60

Service Code	NDC 50419-751-01
Hospital Charge Code	ERX229005
Hospital Revenue Code	259
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$2.70
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.16
Rate for Payer: Aetna of CA Government/Medicare	$2.16
Rate for Payer: Cash Price	$1.62
Rate for Payer: Health Smart Auto/Commercial	$2.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.16
Rate for Payer: LLUH Dept of Risk Management WC	$1.98
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.70

NIFURTIMOX 120 MG TABLET [229005]

Facility

$3.60

Service Code	NDC 50419-751-01
Hospital Charge Code	ERX229005
Hospital Revenue Code	259
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$2.88
Rate for Payer: Cash Price	$1.62
Rate for Payer: Cigna of CA HMO/PPO	$2.88
Rate for Payer: Health Smart Auto/Commercial	$2.16
Rate for Payer: LLUH Dept of Risk Management WC	$1.98
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.70

NILOTINIB 150 MG CAPSULE [105679]

Facility

$198.82

Service Code	NDC 0078-0592-51
Hospital Charge Code	ERX105679
Hospital Revenue Code	250
Min. Negotiated Rate	$109.35
Max. Negotiated Rate	$149.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$119.29
Rate for Payer: Aetna of CA Government/Medicare	$119.29
Rate for Payer: Cash Price	$89.47
Rate for Payer: Health Smart Auto/Commercial	$119.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$119.29
Rate for Payer: LLUH Dept of Risk Management WC	$109.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$149.12

NILOTINIB 150 MG CAPSULE [105679]

Facility

$198.82

Service Code	NDC 0078-0592-51
Hospital Charge Code	ERX105679
Hospital Revenue Code	250
Min. Negotiated Rate	$109.35
Max. Negotiated Rate	$159.06
Rate for Payer: Cash Price	$89.47
Rate for Payer: Cigna of CA HMO/PPO	$159.06
Rate for Payer: Health Smart Auto/Commercial	$119.29
Rate for Payer: LLUH Dept of Risk Management WC	$109.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$149.12

NILOTINIB 200 MG CAPSULE [88720]

Facility

$198.82

Service Code	NDC 0078-0526-51
Hospital Charge Code	ERX88720
Hospital Revenue Code	250
Min. Negotiated Rate	$109.35
Max. Negotiated Rate	$159.06
Rate for Payer: Cash Price	$89.47
Rate for Payer: Cigna of CA HMO/PPO	$159.06
Rate for Payer: Health Smart Auto/Commercial	$119.29
Rate for Payer: LLUH Dept of Risk Management WC	$109.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$149.12

NILOTINIB 200 MG CAPSULE [88720]

Facility

$198.82

Service Code	NDC 0078-0526-51
Hospital Charge Code	ERX88720
Hospital Revenue Code	250
Min. Negotiated Rate	$109.35
Max. Negotiated Rate	$149.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$119.29
Rate for Payer: Aetna of CA Government/Medicare	$119.29
Rate for Payer: Cash Price	$89.47
Rate for Payer: Health Smart Auto/Commercial	$119.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$119.29
Rate for Payer: LLUH Dept of Risk Management WC	$109.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$149.12

NIMODIPINE 30 MG/5 ML ORAL SYRINGE (FOR ORAL USE ONLY) [228034]

Facility

$10.79

Service Code	NDC 24338-230-05
Hospital Charge Code	NDG40820772A
Hospital Revenue Code	259
Min. Negotiated Rate	$5.93
Max. Negotiated Rate	$8.63
Rate for Payer: Cash Price	$4.86
Rate for Payer: Cigna of CA HMO/PPO	$8.63
Rate for Payer: Health Smart Auto/Commercial	$6.47
Rate for Payer: LLUH Dept of Risk Management WC	$5.93
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.09

NIMODIPINE 30 MG/5 ML ORAL SYRINGE (FOR ORAL USE ONLY) [228034]

Facility

$10.79

Service Code	NDC 24338-230-12
Hospital Charge Code	NDG40820772A
Hospital Revenue Code	259
Min. Negotiated Rate	$5.93
Max. Negotiated Rate	$8.09
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.47
Rate for Payer: Aetna of CA Government/Medicare	$6.47
Rate for Payer: Cash Price	$4.86
Rate for Payer: Health Smart Auto/Commercial	$6.47
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.47
Rate for Payer: LLUH Dept of Risk Management WC	$5.93
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.09

Know your out-of-pocket cost for care.

All Charges