|
NIFEDIPINE ORAL SUSPENSION COMPOUND 4 MG/ML [4080311]
|
Facility
IP
|
$0.41
|
|
|
Service Code
|
NDC 9994-0803-11
|
| Hospital Charge Code |
1715305
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.29
|
| Rate for Payer: Cigna of CA PPO |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.35
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.33
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Prime Health Services Commercial |
$0.35
|
|
|
NIFURTIMOX 120 MG TABLET [229005]
|
Facility
IP
|
$3.60
|
|
|
Service Code
|
NDC 50419-751-01
|
| Hospital Charge Code |
ERX229005
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Blue Shield of California Commercial |
$2.56
|
| Rate for Payer: Blue Shield of California EPN |
$1.84
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Networks By Design Commercial |
$2.34
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
|
|
NIFURTIMOX 120 MG TABLET [229005]
|
Facility
OP
|
$3.60
|
|
|
Service Code
|
NDC 50419-751-01
|
| Hospital Charge Code |
ERX229005
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.14
|
| Rate for Payer: BCBS Transplant Transplant |
$2.16
|
| Rate for Payer: Blue Shield of California Commercial |
$2.65
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Media |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Networks By Design Commercial |
$2.34
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other HMO |
$1.80
|
| Rate for Payer: United Healthcare HMO Rider |
$1.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
|
|
NILOTINIB 150 MG CAPSULE [105679]
|
Facility
OP
|
$198.82
|
|
|
Service Code
|
NDC 0078-0592-51
|
| Hospital Charge Code |
ERX105679
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.72 |
| Max. Negotiated Rate |
$169.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$130.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$169.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$109.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$109.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.46
|
| Rate for Payer: BCBS Transplant Transplant |
$119.29
|
| Rate for Payer: Blue Shield of California Commercial |
$146.53
|
| Rate for Payer: Blue Shield of California EPN |
$116.11
|
| Rate for Payer: Cash Price |
$89.47
|
| Rate for Payer: Cash Price |
$89.47
|
| Rate for Payer: Cigna of CA HMO |
$127.24
|
| Rate for Payer: Cigna of CA PPO |
$147.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$169.00
|
| Rate for Payer: Dignity Health Media |
$169.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$169.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$79.53
|
| Rate for Payer: Galaxy Health WC |
$169.00
|
| Rate for Payer: Global Benefits Group Commercial |
$119.29
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$149.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.72
|
| Rate for Payer: Multiplan Commercial |
$159.06
|
| Rate for Payer: Networks By Design Commercial |
$129.23
|
| Rate for Payer: Prime Health Services Commercial |
$169.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$119.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$119.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.41
|
| Rate for Payer: United Healthcare All Other HMO |
$99.41
|
| Rate for Payer: United Healthcare HMO Rider |
$99.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$169.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$169.00
|
| Rate for Payer: Vantage Medical Group Senior |
$169.00
|
|
|
NILOTINIB 150 MG CAPSULE [105679]
|
Facility
IP
|
$198.82
|
|
|
Service Code
|
NDC 0078-0592-51
|
| Hospital Charge Code |
ERX105679
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.72 |
| Max. Negotiated Rate |
$169.00 |
| Rate for Payer: Blue Shield of California Commercial |
$141.56
|
| Rate for Payer: Blue Shield of California EPN |
$101.80
|
| Rate for Payer: Cash Price |
$89.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.53
|
| Rate for Payer: Galaxy Health WC |
$169.00
|
| Rate for Payer: Global Benefits Group Commercial |
$119.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.72
|
| Rate for Payer: Multiplan Commercial |
$159.06
|
| Rate for Payer: Networks By Design Commercial |
$129.23
|
| Rate for Payer: Prime Health Services Commercial |
$169.00
|
|
|
NILOTINIB 200 MG CAPSULE [88720]
|
Facility
OP
|
$198.82
|
|
|
Service Code
|
NDC 0078-0526-51
|
| Hospital Charge Code |
ERX88720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.72 |
| Max. Negotiated Rate |
$169.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$130.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$169.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$109.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$109.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.46
|
| Rate for Payer: BCBS Transplant Transplant |
$119.29
|
| Rate for Payer: Blue Shield of California Commercial |
$146.53
|
| Rate for Payer: Blue Shield of California EPN |
$116.11
|
| Rate for Payer: Cash Price |
$89.47
|
| Rate for Payer: Cash Price |
$89.47
|
| Rate for Payer: Cigna of CA HMO |
$127.24
|
| Rate for Payer: Cigna of CA PPO |
$147.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$169.00
|
| Rate for Payer: Dignity Health Media |
$169.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$169.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$79.53
|
| Rate for Payer: Galaxy Health WC |
$169.00
|
| Rate for Payer: Global Benefits Group Commercial |
$119.29
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$149.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.72
|
| Rate for Payer: Multiplan Commercial |
$159.06
|
| Rate for Payer: Networks By Design Commercial |
$129.23
|
| Rate for Payer: Prime Health Services Commercial |
$169.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$119.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$119.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.41
|
| Rate for Payer: United Healthcare All Other HMO |
$99.41
|
| Rate for Payer: United Healthcare HMO Rider |
$99.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$169.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$169.00
|
| Rate for Payer: Vantage Medical Group Senior |
$169.00
|
|
|
NILOTINIB 200 MG CAPSULE [88720]
|
Facility
IP
|
$198.82
|
|
|
Service Code
|
NDC 0078-0526-51
|
| Hospital Charge Code |
ERX88720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.72 |
| Max. Negotiated Rate |
$169.00 |
| Rate for Payer: Blue Shield of California Commercial |
$141.56
|
| Rate for Payer: Blue Shield of California EPN |
$101.80
|
| Rate for Payer: Cash Price |
$89.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.53
|
| Rate for Payer: Galaxy Health WC |
$169.00
|
| Rate for Payer: Global Benefits Group Commercial |
$119.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.72
|
| Rate for Payer: Multiplan Commercial |
$159.06
|
| Rate for Payer: Networks By Design Commercial |
$129.23
|
| Rate for Payer: Prime Health Services Commercial |
$169.00
|
|
|
NIMODIPINE 30 MG/5 ML ORAL SYRINGE (FOR ORAL USE ONLY) [228034]
|
Facility
OP
|
$10.79
|
|
|
Service Code
|
NDC 24338-230-05
|
| Hospital Charge Code |
NDG40820772A
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$9.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.43
|
| Rate for Payer: BCBS Transplant Transplant |
$6.47
|
| Rate for Payer: Blue Shield of California Commercial |
$7.95
|
| Rate for Payer: Blue Shield of California EPN |
$6.30
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Cigna of CA HMO |
$7.55
|
| Rate for Payer: Cigna of CA PPO |
$7.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.17
|
| Rate for Payer: Dignity Health Media |
$9.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.32
|
| Rate for Payer: Galaxy Health WC |
$9.17
|
| Rate for Payer: Global Benefits Group Commercial |
$6.47
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.59
|
| Rate for Payer: Multiplan Commercial |
$8.63
|
| Rate for Payer: Networks By Design Commercial |
$7.01
|
| Rate for Payer: Prime Health Services Commercial |
$9.17
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.40
|
| Rate for Payer: United Healthcare All Other HMO |
$5.40
|
| Rate for Payer: United Healthcare HMO Rider |
$5.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.17
|
| Rate for Payer: Vantage Medical Group Senior |
$9.17
|
|
|
NIMODIPINE 30 MG/5 ML ORAL SYRINGE (FOR ORAL USE ONLY) [228034]
|
Facility
OP
|
$10.79
|
|
|
Service Code
|
NDC 24338-230-12
|
| Hospital Charge Code |
NDG40820772A
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$9.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.43
|
| Rate for Payer: BCBS Transplant Transplant |
$6.47
|
| Rate for Payer: Blue Shield of California Commercial |
$7.95
|
| Rate for Payer: Blue Shield of California EPN |
$6.30
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Cigna of CA HMO |
$7.55
|
| Rate for Payer: Cigna of CA PPO |
$7.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.17
|
| Rate for Payer: Dignity Health Media |
$9.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.32
|
| Rate for Payer: Galaxy Health WC |
$9.17
|
| Rate for Payer: Global Benefits Group Commercial |
$6.47
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.59
|
| Rate for Payer: Multiplan Commercial |
$8.63
|
| Rate for Payer: Networks By Design Commercial |
$7.01
|
| Rate for Payer: Prime Health Services Commercial |
$9.17
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.40
|
| Rate for Payer: United Healthcare All Other HMO |
$5.40
|
| Rate for Payer: United Healthcare HMO Rider |
$5.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.17
|
| Rate for Payer: Vantage Medical Group Senior |
$9.17
|
|
|
NIMODIPINE 30 MG/5 ML ORAL SYRINGE (FOR ORAL USE ONLY) [228034]
|
Facility
IP
|
$10.79
|
|
|
Service Code
|
NDC 24338-230-12
|
| Hospital Charge Code |
NDG40820772A
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$9.17 |
| Rate for Payer: Blue Shield of California Commercial |
$7.68
|
| Rate for Payer: Blue Shield of California EPN |
$5.52
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Cigna of CA HMO |
$7.55
|
| Rate for Payer: Cigna of CA PPO |
$7.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.32
|
| Rate for Payer: Galaxy Health WC |
$9.17
|
| Rate for Payer: Global Benefits Group Commercial |
$6.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.59
|
| Rate for Payer: Multiplan Commercial |
$8.63
|
| Rate for Payer: Networks By Design Commercial |
$7.01
|
| Rate for Payer: Prime Health Services Commercial |
$9.17
|
|
|
NIMODIPINE 30 MG/5 ML ORAL SYRINGE (FOR ORAL USE ONLY) [228034]
|
Facility
IP
|
$10.79
|
|
|
Service Code
|
NDC 24338-230-05
|
| Hospital Charge Code |
NDG40820772A
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$9.17 |
| Rate for Payer: Blue Shield of California Commercial |
$7.68
|
| Rate for Payer: Blue Shield of California EPN |
$5.52
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Cigna of CA HMO |
$7.55
|
| Rate for Payer: Cigna of CA PPO |
$7.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.32
|
| Rate for Payer: Galaxy Health WC |
$9.17
|
| Rate for Payer: Global Benefits Group Commercial |
$6.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.59
|
| Rate for Payer: Multiplan Commercial |
$8.63
|
| Rate for Payer: Networks By Design Commercial |
$7.01
|
| Rate for Payer: Prime Health Services Commercial |
$9.17
|
|
|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
OP
|
$1.44
|
|
|
Service Code
|
NDC 23155-512-11
|
| Hospital Charge Code |
1711278
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.86
|
| Rate for Payer: BCBS Transplant Transplant |
$0.86
|
| Rate for Payer: Blue Shield of California Commercial |
$1.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.84
|
| 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 Media |
$1.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.55
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.86
|
| 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 69452-209-20
|
| Hospital Charge Code |
1711278
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$2.93 |
| Rate for Payer: Blue Shield of California Commercial |
$2.46
|
| Rate for Payer: Blue Shield of California EPN |
$1.77
|
| 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: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: Galaxy Health WC |
$2.93
|
| Rate for Payer: Global Benefits Group Commercial |
$2.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.31
|
| 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
|
$2.53
|
|
|
Service Code
|
NDC 68084-912-31
|
| Hospital Charge Code |
1711278
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$2.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.51
|
| Rate for Payer: BCBS Transplant Transplant |
$1.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1.86
|
| Rate for Payer: Blue Shield of California EPN |
$1.48
|
| Rate for Payer: Cash Price |
$1.14
|
| Rate for Payer: Cigna of CA HMO |
$1.77
|
| Rate for Payer: Cigna of CA PPO |
$1.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.15
|
| Rate for Payer: Dignity Health Media |
$2.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.01
|
| Rate for Payer: Galaxy Health WC |
$2.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1.52
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.61
|
| Rate for Payer: Multiplan Commercial |
$2.02
|
| Rate for Payer: Networks By Design Commercial |
$1.64
|
| Rate for Payer: Prime Health Services Commercial |
$2.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.26
|
| Rate for Payer: United Healthcare All Other HMO |
$1.26
|
| Rate for Payer: United Healthcare HMO Rider |
$1.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.15
|
| Rate for Payer: Vantage Medical Group Senior |
$2.15
|
|
|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
IP
|
$1.44
|
|
|
Service Code
|
NDC 23155-512-00
|
| Hospital Charge Code |
1711278
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Blue Shield of California Commercial |
$1.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.74
|
| 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: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.55
|
| 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
|
$1.44
|
|
|
Service Code
|
NDC 23155-512-30
|
| Hospital Charge Code |
1711278
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.86
|
| Rate for Payer: BCBS Transplant Transplant |
$0.86
|
| Rate for Payer: Blue Shield of California Commercial |
$1.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.84
|
| 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 Media |
$1.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.55
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.86
|
| 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
|
$2.53
|
|
|
Service Code
|
NDC 68084-912-31
|
| Hospital Charge Code |
1711278
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$2.15 |
| Rate for Payer: Blue Shield of California Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California EPN |
$1.30
|
| Rate for Payer: Cash Price |
$1.14
|
| Rate for Payer: Cigna of CA HMO |
$1.77
|
| Rate for Payer: Cigna of CA PPO |
$1.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.01
|
| Rate for Payer: Galaxy Health WC |
$2.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.61
|
| Rate for Payer: Multiplan Commercial |
$2.02
|
| Rate for Payer: Networks By Design Commercial |
$1.64
|
| Rate for Payer: Prime Health Services Commercial |
$2.15
|
|
|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
OP
|
$3.45
|
|
|
Service Code
|
NDC 69452-209-20
|
| Hospital Charge Code |
1711278
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$2.93 |
| Rate for Payer: Galaxy Health WC |
$2.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.06
|
| Rate for Payer: BCBS Transplant Transplant |
$2.07
|
| Rate for Payer: Blue Shield of California Commercial |
$2.54
|
| Rate for Payer: Blue Shield of California EPN |
$2.01
|
| 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 Media |
$2.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.38
|
| Rate for Payer: Global Benefits Group Commercial |
$2.07
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.31
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.72
|
| Rate for Payer: United Healthcare All Other HMO |
$1.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.72
|
| Rate for Payer: Vantage Medical Group 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 23155-512-00
|
| Hospital Charge Code |
1711278
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.86
|
| Rate for Payer: BCBS Transplant Transplant |
$0.86
|
| Rate for Payer: Blue Shield of California Commercial |
$1.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.84
|
| 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 Media |
$1.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.58
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.55
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.86
|
| 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
OP
|
$3.45
|
|
|
Service Code
|
NDC 69452-209-13
|
| Hospital Charge Code |
1711278
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$2.93 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.06
|
| Rate for Payer: BCBS Transplant Transplant |
$2.07
|
| Rate for Payer: Blue Shield of California Commercial |
$2.54
|
| Rate for Payer: Blue Shield of California EPN |
$2.01
|
| 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 Media |
$2.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.38
|
| Rate for Payer: Galaxy Health WC |
$2.93
|
| Rate for Payer: Global Benefits Group Commercial |
$2.07
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.31
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.72
|
| Rate for Payer: United Healthcare All Other HMO |
$1.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.72
|
| Rate for Payer: Vantage Medical Group 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
|
$2.53
|
|
|
Service Code
|
NDC 68084-912-33
|
| Hospital Charge Code |
1711278
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$2.15 |
| Rate for Payer: BCBS Transplant Transplant |
$1.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.51
|
| Rate for Payer: Blue Shield of California Commercial |
$1.86
|
| Rate for Payer: Blue Shield of California EPN |
$1.48
|
| Rate for Payer: Cash Price |
$1.14
|
| Rate for Payer: Cigna of CA HMO |
$1.77
|
| Rate for Payer: Cigna of CA PPO |
$1.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.15
|
| Rate for Payer: Dignity Health Media |
$2.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.01
|
| Rate for Payer: Galaxy Health WC |
$2.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1.52
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.61
|
| Rate for Payer: Multiplan Commercial |
$2.02
|
| Rate for Payer: Networks By Design Commercial |
$1.64
|
| Rate for Payer: Prime Health Services Commercial |
$2.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.26
|
| Rate for Payer: United Healthcare All Other HMO |
$1.26
|
| Rate for Payer: United Healthcare HMO Rider |
$1.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.15
|
| Rate for Payer: Vantage Medical Group Senior |
$2.15
|
|
|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
IP
|
$6.00
|
|
|
Service Code
|
NDC 57664-135-60
|
| Hospital Charge Code |
1711278
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: Blue Shield of California Commercial |
$4.27
|
| Rate for Payer: Blue Shield of California EPN |
$3.07
|
| 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: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.29
|
| 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
IP
|
$1.44
|
|
|
Service Code
|
NDC 23155-512-30
|
| Hospital Charge Code |
1711278
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Blue Shield of California Commercial |
$1.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.74
|
| 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: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.55
|
| 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 69452-209-07
|
| Hospital Charge Code |
1711278
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$2.93 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.06
|
| Rate for Payer: BCBS Transplant Transplant |
$2.07
|
| Rate for Payer: Blue Shield of California Commercial |
$2.54
|
| Rate for Payer: Blue Shield of California EPN |
$2.01
|
| 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 Media |
$2.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.38
|
| Rate for Payer: Galaxy Health WC |
$2.93
|
| Rate for Payer: Global Benefits Group Commercial |
$2.07
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.31
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.72
|
| Rate for Payer: United Healthcare All Other HMO |
$1.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.72
|
| Rate for Payer: Vantage Medical Group 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
|
$2.53
|
|
|
Service Code
|
NDC 68084-912-33
|
| Hospital Charge Code |
1711278
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$2.15 |
| Rate for Payer: Blue Shield of California Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California EPN |
$1.30
|
| Rate for Payer: Cash Price |
$1.14
|
| Rate for Payer: Cigna of CA HMO |
$1.77
|
| Rate for Payer: Cigna of CA PPO |
$1.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.01
|
| Rate for Payer: Galaxy Health WC |
$2.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.61
|
| Rate for Payer: Multiplan Commercial |
$2.02
|
| Rate for Payer: Networks By Design Commercial |
$1.64
|
| Rate for Payer: Prime Health Services Commercial |
$2.15
|
|
