|
NILOTINIB HCL 150 MG CAPSULE [105679]
|
Facility
|
OP
|
$238.86
|
|
|
Service Code
|
NDC 0078059251
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$47.77 |
| Max. Negotiated Rate |
$203.03 |
| Rate for Payer: Adventist Health Commercial |
$47.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$156.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$203.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$131.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$179.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.28
|
| Rate for Payer: Cash Price |
$107.49
|
| Rate for Payer: Cigna of CA HMO |
$167.20
|
| Rate for Payer: Cigna of CA PPO |
$167.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$203.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$203.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$203.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$167.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.54
|
| Rate for Payer: EPIC Health Plan Senior |
$95.54
|
| Rate for Payer: Galaxy Health WC |
$203.03
|
| Rate for Payer: Global Benefits Group Commercial |
$143.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$151.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$86.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$140.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$167.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$167.20
|
| Rate for Payer: Multiplan Commercial |
$191.09
|
| Rate for Payer: Networks By Design Commercial |
$155.26
|
| Rate for Payer: Prime Health Services Commercial |
$203.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$143.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$143.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$119.43
|
| Rate for Payer: United Healthcare All Other HMO |
$119.43
|
| Rate for Payer: United Healthcare HMO Rider |
$119.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$119.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$203.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$203.03
|
| Rate for Payer: Vantage Medical Group Senior |
$203.03
|
|
|
NILOTINIB HCL 150 MG CAPSULE [105679]
|
Facility
|
IP
|
$238.86
|
|
|
Service Code
|
NDC 0078059251
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$47.77 |
| Max. Negotiated Rate |
$203.03 |
| Rate for Payer: Adventist Health Commercial |
$47.77
|
| Rate for Payer: Blue Shield of California Commercial |
$121.10
|
| Rate for Payer: Blue Shield of California Commercial |
$183.68
|
| Rate for Payer: Cash Price |
$107.49
|
| Rate for Payer: Cigna of CA HMO |
$167.20
|
| Rate for Payer: Cigna of CA PPO |
$167.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$167.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.54
|
| Rate for Payer: EPIC Health Plan Senior |
$95.54
|
| Rate for Payer: Galaxy Health WC |
$203.03
|
| Rate for Payer: Global Benefits Group Commercial |
$143.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$151.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$140.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.33
|
| Rate for Payer: Multiplan Commercial |
$191.09
|
| Rate for Payer: Networks By Design Commercial |
$155.26
|
| Rate for Payer: Prime Health Services Commercial |
$203.03
|
|
|
NILOTINIB HCL 200 MG CAPSULE [88720]
|
Facility
|
OP
|
$238.86
|
|
|
Service Code
|
NDC 0078052651
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$47.77 |
| Max. Negotiated Rate |
$203.03 |
| Rate for Payer: Adventist Health Commercial |
$47.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$156.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$203.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$131.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$179.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.28
|
| Rate for Payer: Cash Price |
$107.49
|
| Rate for Payer: Cigna of CA HMO |
$167.20
|
| Rate for Payer: Cigna of CA PPO |
$167.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$203.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$203.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$203.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$167.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.54
|
| Rate for Payer: EPIC Health Plan Senior |
$95.54
|
| Rate for Payer: Galaxy Health WC |
$203.03
|
| Rate for Payer: Global Benefits Group Commercial |
$143.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$151.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$86.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$140.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$167.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$167.20
|
| Rate for Payer: Multiplan Commercial |
$191.09
|
| Rate for Payer: Networks By Design Commercial |
$155.26
|
| Rate for Payer: Prime Health Services Commercial |
$203.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$143.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$143.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$119.43
|
| Rate for Payer: United Healthcare All Other HMO |
$119.43
|
| Rate for Payer: United Healthcare HMO Rider |
$119.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$119.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$203.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$203.03
|
| Rate for Payer: Vantage Medical Group Senior |
$203.03
|
|
|
NILOTINIB HCL 200 MG CAPSULE [88720]
|
Facility
|
IP
|
$238.86
|
|
|
Service Code
|
NDC 0078052651
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$47.77 |
| Max. Negotiated Rate |
$203.03 |
| Rate for Payer: Adventist Health Commercial |
$47.77
|
| Rate for Payer: Blue Shield of California Commercial |
$121.10
|
| Rate for Payer: Blue Shield of California Commercial |
$183.68
|
| Rate for Payer: Cash Price |
$107.49
|
| Rate for Payer: Cigna of CA HMO |
$167.20
|
| Rate for Payer: Cigna of CA PPO |
$167.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$167.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.54
|
| Rate for Payer: EPIC Health Plan Senior |
$95.54
|
| Rate for Payer: Galaxy Health WC |
$203.03
|
| Rate for Payer: Global Benefits Group Commercial |
$143.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$151.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$140.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.33
|
| Rate for Payer: Multiplan Commercial |
$191.09
|
| Rate for Payer: Networks By Design Commercial |
$155.26
|
| Rate for Payer: Prime Health Services Commercial |
$203.03
|
|
|
NIMODIPINE 30 MG/5 ML ORAL SYRINGE (FOR ORAL USE ONLY) [228034]
|
Facility
|
IP
|
$13.20
|
|
|
Service Code
|
NDC 2433823015
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Blue Shield of California Commercial |
$10.15
|
| Rate for Payer: Blue Shield of California Commercial |
$6.69
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cigna of CA HMO |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$9.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Multiplan Commercial |
$10.56
|
| Rate for Payer: Networks By Design Commercial |
$8.58
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
|
|
NIMODIPINE 30 MG/5 ML ORAL SYRINGE (FOR ORAL USE ONLY) [228034]
|
Facility
|
IP
|
$12.82
|
|
|
Service Code
|
NDC 2433823012
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$10.90 |
| Rate for Payer: Adventist Health Commercial |
$2.56
|
| Rate for Payer: Blue Shield of California Commercial |
$6.50
|
| Rate for Payer: Blue Shield of California Commercial |
$9.86
|
| Rate for Payer: Cash Price |
$5.77
|
| Rate for Payer: Cigna of CA HMO |
$8.97
|
| Rate for Payer: Cigna of CA PPO |
$8.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.13
|
| Rate for Payer: EPIC Health Plan Senior |
$5.13
|
| Rate for Payer: Galaxy Health WC |
$10.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.08
|
| Rate for Payer: Multiplan Commercial |
$10.26
|
| Rate for Payer: Networks By Design Commercial |
$8.33
|
| Rate for Payer: Prime Health Services Commercial |
$10.90
|
|
|
NIMODIPINE 30 MG/5 ML ORAL SYRINGE (FOR ORAL USE ONLY) [228034]
|
Facility
|
OP
|
$13.20
|
|
|
Service Code
|
NDC 2433823015
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.66
|
| 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 |
$8.47
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cigna of CA HMO |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$9.24
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$10.56
|
| Rate for Payer: Networks By Design Commercial |
$8.58
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.60
|
| Rate for Payer: United Healthcare All Other HMO |
$6.60
|
| Rate for Payer: United Healthcare HMO Rider |
$6.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$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 30 MG/5 ML ORAL SYRINGE (FOR ORAL USE ONLY) [228034]
|
Facility
|
OP
|
$13.20
|
|
|
Service Code
|
NDC 2433823030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.66
|
| 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 |
$8.47
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cigna of CA HMO |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$9.24
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$10.56
|
| Rate for Payer: Networks By Design Commercial |
$8.58
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.60
|
| Rate for Payer: United Healthcare All Other HMO |
$6.60
|
| Rate for Payer: United Healthcare HMO Rider |
$6.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$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 30 MG/5 ML ORAL SYRINGE (FOR ORAL USE ONLY) [228034]
|
Facility
|
OP
|
$12.82
|
|
|
Service Code
|
NDC 2433823005
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$10.90 |
| Rate for Payer: Adventist Health Commercial |
$2.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.23
|
| Rate for Payer: Cash Price |
$5.77
|
| Rate for Payer: Cigna of CA HMO |
$8.97
|
| Rate for Payer: Cigna of CA PPO |
$8.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.13
|
| Rate for Payer: EPIC Health Plan Senior |
$5.13
|
| Rate for Payer: Galaxy Health WC |
$10.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.97
|
| Rate for Payer: Multiplan Commercial |
$10.26
|
| Rate for Payer: Networks By Design Commercial |
$8.33
|
| Rate for Payer: Prime Health Services Commercial |
$10.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.41
|
| Rate for Payer: United Healthcare All Other HMO |
$6.41
|
| Rate for Payer: United Healthcare HMO Rider |
$6.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.90
|
| Rate for Payer: Vantage Medical Group Senior |
$10.90
|
|
|
NIMODIPINE 30 MG/5 ML ORAL SYRINGE (FOR ORAL USE ONLY) [228034]
|
Facility
|
IP
|
$12.82
|
|
|
Service Code
|
NDC 2433823005
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$10.90 |
| Rate for Payer: Adventist Health Commercial |
$2.56
|
| Rate for Payer: Blue Shield of California Commercial |
$6.50
|
| Rate for Payer: Blue Shield of California Commercial |
$9.86
|
| Rate for Payer: Cash Price |
$5.77
|
| Rate for Payer: Cigna of CA HMO |
$8.97
|
| Rate for Payer: Cigna of CA PPO |
$8.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.13
|
| Rate for Payer: EPIC Health Plan Senior |
$5.13
|
| Rate for Payer: Galaxy Health WC |
$10.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.08
|
| Rate for Payer: Multiplan Commercial |
$10.26
|
| Rate for Payer: Networks By Design Commercial |
$8.33
|
| Rate for Payer: Prime Health Services Commercial |
$10.90
|
|
|
NIMODIPINE 30 MG/5 ML ORAL SYRINGE (FOR ORAL USE ONLY) [228034]
|
Facility
|
IP
|
$13.20
|
|
|
Service Code
|
NDC 2433823030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Blue Shield of California Commercial |
$10.15
|
| Rate for Payer: Blue Shield of California Commercial |
$6.69
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cigna of CA HMO |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$9.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Multiplan Commercial |
$10.56
|
| Rate for Payer: Networks By Design Commercial |
$8.58
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
|
|
NIMODIPINE 30 MG/5 ML ORAL SYRINGE (FOR ORAL USE ONLY) [228034]
|
Facility
|
OP
|
$12.82
|
|
|
Service Code
|
NDC 2433823012
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$10.90 |
| Rate for Payer: Adventist Health Commercial |
$2.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.23
|
| Rate for Payer: Cash Price |
$5.77
|
| Rate for Payer: Cigna of CA HMO |
$8.97
|
| Rate for Payer: Cigna of CA PPO |
$8.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.13
|
| Rate for Payer: EPIC Health Plan Senior |
$5.13
|
| Rate for Payer: Galaxy Health WC |
$10.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.97
|
| Rate for Payer: Multiplan Commercial |
$10.26
|
| Rate for Payer: Networks By Design Commercial |
$8.33
|
| Rate for Payer: Prime Health Services Commercial |
$10.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.41
|
| Rate for Payer: United Healthcare All Other HMO |
$6.41
|
| Rate for Payer: United Healthcare HMO Rider |
$6.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.90
|
| Rate for Payer: Vantage Medical Group Senior |
$10.90
|
|
|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
|
OP
|
$1.44
|
|
|
Service Code
|
NDC 2315551200
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.92
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Cigna of CA HMO |
$1.01
|
| Rate for Payer: Cigna of CA PPO |
$1.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Senior |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.01
|
| Rate for Payer: Multiplan Commercial |
$1.15
|
| Rate for Payer: Networks By Design Commercial |
$0.94
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.72
|
| Rate for Payer: United Healthcare All Other HMO |
$0.72
|
| Rate for Payer: United Healthcare HMO Rider |
$0.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.22
|
| Rate for Payer: Vantage Medical Group Senior |
$1.22
|
|
|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
|
IP
|
$1.44
|
|
|
Service Code
|
NDC 2315551211
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.73
|
| Rate for Payer: Blue Shield of California Commercial |
$1.11
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Cigna of CA HMO |
$1.01
|
| Rate for Payer: Cigna of CA PPO |
$1.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Senior |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.15
|
| Rate for Payer: Networks By Design Commercial |
$0.94
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
|
|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
|
OP
|
$3.45
|
|
|
Service Code
|
NDC 6945220920
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$2.93 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.21
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Cigna of CA HMO |
$2.42
|
| Rate for Payer: Cigna of CA PPO |
$2.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: EPIC Health Plan Senior |
$1.38
|
| Rate for Payer: Galaxy Health WC |
$2.93
|
| Rate for Payer: Global Benefits Group Commercial |
$2.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| 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 |
$2.76
|
| Rate for Payer: Networks By Design Commercial |
$2.24
|
| Rate for Payer: Prime Health Services Commercial |
$2.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.73
|
| Rate for Payer: United Healthcare All Other HMO |
$1.73
|
| Rate for Payer: United Healthcare HMO Rider |
$1.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.93
|
| Rate for Payer: Vantage Medical Group Senior |
$2.93
|
|
|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
|
IP
|
$1.44
|
|
|
Service Code
|
NDC 2315551200
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.73
|
| Rate for Payer: Blue Shield of California Commercial |
$1.11
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Cigna of CA HMO |
$1.01
|
| Rate for Payer: Cigna of CA PPO |
$1.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Senior |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.15
|
| Rate for Payer: Networks By Design Commercial |
$0.94
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
|
|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
|
OP
|
$3.45
|
|
|
Service Code
|
NDC 6945220907
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$2.93 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.21
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Cigna of CA HMO |
$2.42
|
| Rate for Payer: Cigna of CA PPO |
$2.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: EPIC Health Plan Senior |
$1.38
|
| Rate for Payer: Galaxy Health WC |
$2.93
|
| Rate for Payer: Global Benefits Group Commercial |
$2.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| 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 |
$2.76
|
| Rate for Payer: Networks By Design Commercial |
$2.24
|
| Rate for Payer: Prime Health Services Commercial |
$2.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.73
|
| Rate for Payer: United Healthcare All Other HMO |
$1.73
|
| Rate for Payer: United Healthcare HMO Rider |
$1.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.93
|
| Rate for Payer: Vantage Medical Group Senior |
$2.93
|
|
|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
|
OP
|
$1.44
|
|
|
Service Code
|
NDC 2315551211
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.92
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Cigna of CA HMO |
$1.01
|
| Rate for Payer: Cigna of CA PPO |
$1.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Senior |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.01
|
| Rate for Payer: Multiplan Commercial |
$1.15
|
| Rate for Payer: Networks By Design Commercial |
$0.94
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.72
|
| Rate for Payer: United Healthcare All Other HMO |
$0.72
|
| Rate for Payer: United Healthcare HMO Rider |
$0.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.22
|
| Rate for Payer: Vantage Medical Group Senior |
$1.22
|
|
|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
|
IP
|
$3.45
|
|
|
Service Code
|
NDC 6945220913
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$2.93 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1.75
|
| Rate for Payer: Blue Shield of California Commercial |
$2.65
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Cigna of CA HMO |
$2.42
|
| Rate for Payer: Cigna of CA PPO |
$2.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: EPIC Health Plan Senior |
$1.38
|
| Rate for Payer: Galaxy Health WC |
$2.93
|
| Rate for Payer: Global Benefits Group Commercial |
$2.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: Multiplan Commercial |
$2.76
|
| Rate for Payer: Networks By Design Commercial |
$2.24
|
| Rate for Payer: Prime Health Services Commercial |
$2.93
|
|
|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
|
OP
|
$3.45
|
|
|
Service Code
|
NDC 6945220913
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$2.93 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.21
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Cigna of CA HMO |
$2.42
|
| Rate for Payer: Cigna of CA PPO |
$2.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: EPIC Health Plan Senior |
$1.38
|
| Rate for Payer: Galaxy Health WC |
$2.93
|
| Rate for Payer: Global Benefits Group Commercial |
$2.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| 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 |
$2.76
|
| Rate for Payer: Networks By Design Commercial |
$2.24
|
| Rate for Payer: Prime Health Services Commercial |
$2.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.73
|
| Rate for Payer: United Healthcare All Other HMO |
$1.73
|
| Rate for Payer: United Healthcare HMO Rider |
$1.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.93
|
| Rate for Payer: Vantage Medical Group Senior |
$2.93
|
|
|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 5766413560
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3.04
|
| Rate for Payer: Blue Shield of California Commercial |
$4.61
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
|
|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
|
OP
|
$1.44
|
|
|
Service Code
|
NDC 2315551230
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.92
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Cigna of CA HMO |
$1.01
|
| Rate for Payer: Cigna of CA PPO |
$1.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Senior |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.01
|
| Rate for Payer: Multiplan Commercial |
$1.15
|
| Rate for Payer: Networks By Design Commercial |
$0.94
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.72
|
| Rate for Payer: United Healthcare All Other HMO |
$0.72
|
| Rate for Payer: United Healthcare HMO Rider |
$0.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.22
|
| Rate for Payer: Vantage Medical Group Senior |
$1.22
|
|
|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
|
IP
|
$1.44
|
|
|
Service Code
|
NDC 2315551230
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.73
|
| Rate for Payer: Blue Shield of California Commercial |
$1.11
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Cigna of CA HMO |
$1.01
|
| Rate for Payer: Cigna of CA PPO |
$1.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Senior |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.15
|
| Rate for Payer: Networks By Design Commercial |
$0.94
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
|
|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
|
IP
|
$3.45
|
|
|
Service Code
|
NDC 6945220907
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$2.93 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1.75
|
| Rate for Payer: Blue Shield of California Commercial |
$2.65
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Cigna of CA HMO |
$2.42
|
| Rate for Payer: Cigna of CA PPO |
$2.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: EPIC Health Plan Senior |
$1.38
|
| Rate for Payer: Galaxy Health WC |
$2.93
|
| Rate for Payer: Global Benefits Group Commercial |
$2.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: Multiplan Commercial |
$2.76
|
| Rate for Payer: Networks By Design Commercial |
$2.24
|
| Rate for Payer: Prime Health Services Commercial |
$2.93
|
|
|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
|
IP
|
$3.45
|
|
|
Service Code
|
NDC 6945220920
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$2.93 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1.75
|
| Rate for Payer: Blue Shield of California Commercial |
$2.65
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Cigna of CA HMO |
$2.42
|
| Rate for Payer: Cigna of CA PPO |
$2.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: EPIC Health Plan Senior |
$1.38
|
| Rate for Payer: Galaxy Health WC |
$2.93
|
| Rate for Payer: Global Benefits Group Commercial |
$2.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: Multiplan Commercial |
$2.76
|
| Rate for Payer: Networks By Design Commercial |
$2.24
|
| Rate for Payer: Prime Health Services Commercial |
$2.93
|
|
