|
NIFEDIPINE ER 60 MG TABLET,EXTENDED RELEASE 24 HR [27334]
|
Facility
IP
|
$2.36
|
|
|
Service Code
|
NDC 50268-598-11
|
| Hospital Charge Code |
1711653
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Blue Shield of California Commercial |
$1.77
|
| Rate for Payer: Blue Shield of California EPN |
$1.26
|
| Rate for Payer: Cash Price |
$1.06
|
| Rate for Payer: Central Health Plan Commercial |
$1.89
|
| Rate for Payer: Cigna of CA HMO |
$1.65
|
| Rate for Payer: Cigna of CA PPO |
$1.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.94
|
| Rate for Payer: Galaxy Health WC |
$2.01
|
| Rate for Payer: Global Benefits Group Commercial |
$1.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.47
|
| Rate for Payer: Multiplan Commercial |
$1.77
|
| Rate for Payer: Networks By Design Commercial |
$1.53
|
| Rate for Payer: Prime Health Services Commercial |
$2.01
|
|
|
NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR [27335]
|
Facility
OP
|
$0.78
|
|
|
Service Code
|
NDC 24979-009-01
|
| Hospital Charge Code |
1712601
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.46
|
| Rate for Payer: BCBS Transplant Transplant |
$0.47
|
| Rate for Payer: Blue Shield of California Commercial |
$0.49
|
| Rate for Payer: Blue Shield of California EPN |
$0.38
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Central Health Plan Commercial |
$0.62
|
| Rate for Payer: Cigna of CA HMO |
$0.55
|
| Rate for Payer: Cigna of CA PPO |
$0.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.31
|
| Rate for Payer: Galaxy Health WC |
$0.66
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.59
|
| Rate for Payer: IEHP medi-cal |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: Networks By Design Commercial |
$0.51
|
| Rate for Payer: Prime Health Services Commercial |
$0.66
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.47
|
| Rate for Payer: Riverside University Health MISP |
$0.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.39
|
| Rate for Payer: United Healthcare All Other HMO |
$0.39
|
| Rate for Payer: United Healthcare HMO Rider |
$0.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: Vantage Medical Group Senior |
$0.66
|
|
|
NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR [27335]
|
Facility
OP
|
$2.70
|
|
|
Service Code
|
NDC 50268-599-11
|
| Hospital Charge Code |
1712601
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.60
|
| Rate for Payer: BCBS Transplant Transplant |
$1.62
|
| Rate for Payer: Blue Shield of California Commercial |
$1.70
|
| Rate for Payer: Blue Shield of California EPN |
$1.32
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Central Health Plan Commercial |
$2.16
|
| Rate for Payer: Cigna of CA HMO |
$1.89
|
| Rate for Payer: Cigna of CA PPO |
$1.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.08
|
| Rate for Payer: Galaxy Health WC |
$2.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.43
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.02
|
| Rate for Payer: IEHP medi-cal |
$0.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$2.02
|
| Rate for Payer: Networks By Design Commercial |
$1.76
|
| Rate for Payer: Prime Health Services Commercial |
$2.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.62
|
| Rate for Payer: Riverside University Health MISP |
$1.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.35
|
| Rate for Payer: United Healthcare All Other HMO |
$1.35
|
| Rate for Payer: United Healthcare HMO Rider |
$1.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2.30
|
|
|
NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR [27335]
|
Facility
IP
|
$2.70
|
|
|
Service Code
|
NDC 50268-599-15
|
| Hospital Charge Code |
1712601
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.43 |
| Rate for Payer: Blue Shield of California Commercial |
$2.02
|
| Rate for Payer: Blue Shield of California EPN |
$1.44
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Central Health Plan Commercial |
$2.16
|
| Rate for Payer: Cigna of CA HMO |
$1.89
|
| Rate for Payer: Cigna of CA PPO |
$1.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: Galaxy Health WC |
$2.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$2.02
|
| Rate for Payer: Networks By Design Commercial |
$1.76
|
| Rate for Payer: Prime Health Services Commercial |
$2.30
|
|
|
NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR [27335]
|
Facility
IP
|
$1.04
|
|
|
Service Code
|
NDC 0904-7082-06
|
| Hospital Charge Code |
1712601
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.94 |
| Rate for Payer: Blue Shield of California Commercial |
$0.78
|
| Rate for Payer: Blue Shield of California EPN |
$0.56
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Central Health Plan Commercial |
$0.83
|
| Rate for Payer: Cigna of CA HMO |
$0.73
|
| Rate for Payer: Cigna of CA PPO |
$0.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: Galaxy Health WC |
$0.88
|
| Rate for Payer: Global Benefits Group Commercial |
$0.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.78
|
| Rate for Payer: Networks By Design Commercial |
$0.68
|
| Rate for Payer: Prime Health Services Commercial |
$0.88
|
|
|
NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR [27335]
|
Facility
IP
|
$3.75
|
|
|
Service Code
|
NDC 68084-603-21
|
| Hospital Charge Code |
1712601
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$3.38 |
| Rate for Payer: Blue Shield of California Commercial |
$2.81
|
| Rate for Payer: Blue Shield of California EPN |
$2.00
|
| Rate for Payer: Cash Price |
$1.69
|
| Rate for Payer: Central Health Plan Commercial |
$3.00
|
| Rate for Payer: Cigna of CA HMO |
$2.62
|
| Rate for Payer: Cigna of CA PPO |
$2.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.50
|
| Rate for Payer: Galaxy Health WC |
$3.19
|
| Rate for Payer: Global Benefits Group Commercial |
$2.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$2.81
|
| Rate for Payer: Networks By Design Commercial |
$2.44
|
| Rate for Payer: Prime Health Services Commercial |
$3.19
|
|
|
NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR [27335]
|
Facility
OP
|
$3.75
|
|
|
Service Code
|
NDC 68084-603-11
|
| Hospital Charge Code |
1712601
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$3.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.19
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.22
|
| Rate for Payer: BCBS Transplant Transplant |
$2.25
|
| Rate for Payer: Blue Shield of California Commercial |
$2.36
|
| Rate for Payer: Blue Shield of California EPN |
$1.83
|
| Rate for Payer: Cash Price |
$1.69
|
| Rate for Payer: Central Health Plan Commercial |
$3.00
|
| Rate for Payer: Cigna of CA HMO |
$2.62
|
| Rate for Payer: Cigna of CA PPO |
$2.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.50
|
| Rate for Payer: Galaxy Health WC |
$3.19
|
| Rate for Payer: Global Benefits Group Commercial |
$2.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.38
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.81
|
| Rate for Payer: IEHP medi-cal |
$1.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$2.81
|
| Rate for Payer: Networks By Design Commercial |
$2.44
|
| Rate for Payer: Prime Health Services Commercial |
$3.19
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.25
|
| Rate for Payer: Riverside University Health MISP |
$1.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.88
|
| Rate for Payer: United Healthcare All Other HMO |
$1.88
|
| Rate for Payer: United Healthcare HMO Rider |
$1.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.19
|
| Rate for Payer: Vantage Medical Group Senior |
$3.19
|
|
|
NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR [27335]
|
Facility
OP
|
$3.75
|
|
|
Service Code
|
NDC 68084-603-21
|
| Hospital Charge Code |
1712601
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$3.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.19
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.22
|
| Rate for Payer: BCBS Transplant Transplant |
$2.25
|
| Rate for Payer: Blue Shield of California Commercial |
$2.36
|
| Rate for Payer: Blue Shield of California EPN |
$1.83
|
| Rate for Payer: Cash Price |
$1.69
|
| Rate for Payer: Central Health Plan Commercial |
$3.00
|
| Rate for Payer: Cigna of CA HMO |
$2.62
|
| Rate for Payer: Cigna of CA PPO |
$2.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.50
|
| Rate for Payer: Galaxy Health WC |
$3.19
|
| Rate for Payer: Global Benefits Group Commercial |
$2.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.38
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.81
|
| Rate for Payer: IEHP medi-cal |
$1.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$2.81
|
| Rate for Payer: Networks By Design Commercial |
$2.44
|
| Rate for Payer: Prime Health Services Commercial |
$3.19
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.25
|
| Rate for Payer: Riverside University Health MISP |
$1.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.88
|
| Rate for Payer: United Healthcare All Other HMO |
$1.88
|
| Rate for Payer: United Healthcare HMO Rider |
$1.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.19
|
| Rate for Payer: Vantage Medical Group Senior |
$3.19
|
|
|
NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR [27335]
|
Facility
OP
|
$2.56
|
|
|
Service Code
|
NDC 62175-262-37
|
| Hospital Charge Code |
1712601
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.41
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.51
|
| Rate for Payer: BCBS Transplant Transplant |
$1.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1.61
|
| Rate for Payer: Blue Shield of California EPN |
$1.25
|
| Rate for Payer: Cash Price |
$1.15
|
| Rate for Payer: Central Health Plan Commercial |
$2.05
|
| Rate for Payer: Cigna of CA HMO |
$1.79
|
| Rate for Payer: Cigna of CA PPO |
$1.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.02
|
| Rate for Payer: Galaxy Health WC |
$2.18
|
| Rate for Payer: Global Benefits Group Commercial |
$1.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.92
|
| Rate for Payer: IEHP medi-cal |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.51
|
| Rate for Payer: Multiplan Commercial |
$1.92
|
| Rate for Payer: Networks By Design Commercial |
$1.66
|
| Rate for Payer: Prime Health Services Commercial |
$2.18
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.54
|
| Rate for Payer: Riverside University Health MISP |
$1.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.28
|
| Rate for Payer: United Healthcare All Other HMO |
$1.28
|
| Rate for Payer: United Healthcare HMO Rider |
$1.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.18
|
| Rate for Payer: Vantage Medical Group Senior |
$2.18
|
|
|
NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR [27335]
|
Facility
IP
|
$2.70
|
|
|
Service Code
|
NDC 50268-599-11
|
| Hospital Charge Code |
1712601
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.43 |
| Rate for Payer: Blue Shield of California Commercial |
$2.02
|
| Rate for Payer: Blue Shield of California EPN |
$1.44
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Central Health Plan Commercial |
$2.16
|
| Rate for Payer: Cigna of CA HMO |
$1.89
|
| Rate for Payer: Cigna of CA PPO |
$1.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: Galaxy Health WC |
$2.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$2.02
|
| Rate for Payer: Networks By Design Commercial |
$1.76
|
| Rate for Payer: Prime Health Services Commercial |
$2.30
|
|
|
NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR [27335]
|
Facility
OP
|
$1.04
|
|
|
Service Code
|
NDC 0904-7082-06
|
| Hospital Charge Code |
1712601
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.57
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.61
|
| Rate for Payer: BCBS Transplant Transplant |
$0.62
|
| Rate for Payer: Blue Shield of California Commercial |
$0.65
|
| Rate for Payer: Blue Shield of California EPN |
$0.51
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Central Health Plan Commercial |
$0.83
|
| Rate for Payer: Cigna of CA HMO |
$0.73
|
| Rate for Payer: Cigna of CA PPO |
$0.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.42
|
| Rate for Payer: Galaxy Health WC |
$0.88
|
| Rate for Payer: Global Benefits Group Commercial |
$0.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.94
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.78
|
| Rate for Payer: IEHP medi-cal |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.78
|
| Rate for Payer: Networks By Design Commercial |
$0.68
|
| Rate for Payer: Prime Health Services Commercial |
$0.88
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.62
|
| Rate for Payer: Riverside University Health MISP |
$0.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.52
|
| Rate for Payer: United Healthcare All Other HMO |
$0.52
|
| Rate for Payer: United Healthcare HMO Rider |
$0.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.88
|
| Rate for Payer: Vantage Medical Group Senior |
$0.88
|
|
|
NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR [27335]
|
Facility
OP
|
$2.70
|
|
|
Service Code
|
NDC 50268-599-15
|
| Hospital Charge Code |
1712601
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.60
|
| Rate for Payer: BCBS Transplant Transplant |
$1.62
|
| Rate for Payer: Blue Shield of California Commercial |
$1.70
|
| Rate for Payer: Blue Shield of California EPN |
$1.32
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Central Health Plan Commercial |
$2.16
|
| Rate for Payer: Cigna of CA HMO |
$1.89
|
| Rate for Payer: Cigna of CA PPO |
$1.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.08
|
| Rate for Payer: Galaxy Health WC |
$2.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.43
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.02
|
| Rate for Payer: IEHP medi-cal |
$0.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$2.02
|
| Rate for Payer: Networks By Design Commercial |
$1.76
|
| Rate for Payer: Prime Health Services Commercial |
$2.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.62
|
| Rate for Payer: Riverside University Health MISP |
$1.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.35
|
| Rate for Payer: United Healthcare All Other HMO |
$1.35
|
| Rate for Payer: United Healthcare HMO Rider |
$1.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2.30
|
|
|
NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR [27335]
|
Facility
IP
|
$3.75
|
|
|
Service Code
|
NDC 68084-603-11
|
| Hospital Charge Code |
1712601
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$3.38 |
| Rate for Payer: Blue Shield of California Commercial |
$2.81
|
| Rate for Payer: Blue Shield of California EPN |
$2.00
|
| Rate for Payer: Cash Price |
$1.69
|
| Rate for Payer: Central Health Plan Commercial |
$3.00
|
| Rate for Payer: Cigna of CA HMO |
$2.62
|
| Rate for Payer: Cigna of CA PPO |
$2.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.50
|
| Rate for Payer: Galaxy Health WC |
$3.19
|
| Rate for Payer: Global Benefits Group Commercial |
$2.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$2.81
|
| Rate for Payer: Networks By Design Commercial |
$2.44
|
| Rate for Payer: Prime Health Services Commercial |
$3.19
|
|
|
NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR [27335]
|
Facility
IP
|
$2.56
|
|
|
Service Code
|
NDC 62175-262-37
|
| Hospital Charge Code |
1712601
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: Blue Shield of California Commercial |
$1.92
|
| Rate for Payer: Blue Shield of California EPN |
$1.37
|
| Rate for Payer: Cash Price |
$1.15
|
| Rate for Payer: Central Health Plan Commercial |
$2.05
|
| Rate for Payer: Cigna of CA HMO |
$1.79
|
| Rate for Payer: Cigna of CA PPO |
$1.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.02
|
| Rate for Payer: Galaxy Health WC |
$2.18
|
| Rate for Payer: Global Benefits Group Commercial |
$1.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.51
|
| Rate for Payer: Multiplan Commercial |
$1.92
|
| Rate for Payer: Networks By Design Commercial |
$1.66
|
| Rate for Payer: Prime Health Services Commercial |
$2.18
|
|
|
NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR [27335]
|
Facility
IP
|
$0.78
|
|
|
Service Code
|
NDC 24979-009-01
|
| Hospital Charge Code |
1712601
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.70 |
| Rate for Payer: Blue Shield of California Commercial |
$0.59
|
| Rate for Payer: Blue Shield of California EPN |
$0.42
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Central Health Plan Commercial |
$0.62
|
| Rate for Payer: Cigna of CA HMO |
$0.55
|
| Rate for Payer: Cigna of CA PPO |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: Galaxy Health WC |
$0.66
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: Networks By Design Commercial |
$0.51
|
| Rate for Payer: Prime Health Services Commercial |
$0.66
|
|
|
NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE [37662]
|
Facility
IP
|
$0.67
|
|
|
Service Code
|
NDC 50742-622-01
|
| Hospital Charge Code |
1711654
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Blue Shield of California Commercial |
$0.50
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Central Health Plan Commercial |
$0.54
|
| Rate for Payer: Cigna of CA HMO |
$0.47
|
| Rate for Payer: Cigna of CA PPO |
$0.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.27
|
| Rate for Payer: Galaxy Health WC |
$0.57
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Networks By Design Commercial |
$0.44
|
| Rate for Payer: Prime Health Services Commercial |
$0.57
|
|
|
NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE [37662]
|
Facility
OP
|
$0.67
|
|
|
Service Code
|
NDC 50742-622-01
|
| Hospital Charge Code |
1711654
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.40
|
| Rate for Payer: BCBS Transplant Transplant |
$0.40
|
| Rate for Payer: Blue Shield of California Commercial |
$0.42
|
| Rate for Payer: Blue Shield of California EPN |
$0.33
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Central Health Plan Commercial |
$0.54
|
| Rate for Payer: Cigna of CA HMO |
$0.47
|
| Rate for Payer: Cigna of CA PPO |
$0.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.27
|
| Rate for Payer: Galaxy Health WC |
$0.57
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.50
|
| Rate for Payer: IEHP medi-cal |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Networks By Design Commercial |
$0.44
|
| Rate for Payer: Prime Health Services Commercial |
$0.57
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.40
|
| Rate for Payer: Riverside University Health MISP |
$0.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.34
|
| Rate for Payer: United Healthcare All Other HMO |
$0.34
|
| Rate for Payer: United Healthcare HMO Rider |
$0.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.57
|
| Rate for Payer: Vantage Medical Group Senior |
$0.57
|
|
|
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 |
$0.08 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Blue Shield of California Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Central Health Plan Commercial |
$0.33
|
| 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: Health Management Network EPO/PPO |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.31
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Prime Health Services Commercial |
$0.35
|
|
|
NIFEDIPINE ORAL SUSPENSION COMPOUND 4 MG/ML [4080311]
|
Facility
OP
|
$0.41
|
|
|
Service Code
|
NDC 9994-0803-11
|
| Hospital Charge Code |
1715305
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.24
|
| Rate for Payer: BCBS Transplant Transplant |
$0.25
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Central Health Plan Commercial |
$0.33
|
| Rate for Payer: Cigna of CA HMO |
$0.29
|
| Rate for Payer: Cigna of CA PPO |
$0.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.35
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.37
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.31
|
| Rate for Payer: IEHP medi-cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.31
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Prime Health Services Commercial |
$0.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.25
|
| Rate for Payer: Riverside University Health MISP |
$0.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.21
|
| Rate for Payer: United Healthcare All Other HMO |
$0.21
|
| Rate for Payer: United Healthcare HMO Rider |
$0.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.35
|
| Rate for Payer: Vantage Medical Group Senior |
$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 |
$0.72 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Blue Shield of California Commercial |
$2.70
|
| Rate for Payer: Blue Shield of California EPN |
$1.92
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Central Health Plan Commercial |
$2.88
|
| 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: Health Management Network EPO/PPO |
$3.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| 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 |
$0.72 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.19
|
| 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 Exchange |
$1.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.13
|
| Rate for Payer: BCBS Transplant Transplant |
$2.16
|
| Rate for Payer: Blue Shield of California Commercial |
$2.26
|
| Rate for Payer: Blue Shield of California EPN |
$1.76
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Central Health Plan Commercial |
$2.88
|
| 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: 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 Management Network EPO/PPO |
$3.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.70
|
| Rate for Payer: IEHP medi-cal |
$1.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| 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: Riverside University Health MISP |
$1.44
|
| 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 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 |
$39.76 |
| Max. Negotiated Rate |
$178.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$120.74
|
| 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 Exchange |
$96.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.46
|
| Rate for Payer: BCBS Transplant Transplant |
$119.29
|
| Rate for Payer: Blue Shield of California Commercial |
$125.06
|
| Rate for Payer: Blue Shield of California EPN |
$97.22
|
| Rate for Payer: Cash Price |
$89.47
|
| Rate for Payer: Cash Price |
$89.47
|
| Rate for Payer: Central Health Plan Commercial |
$159.06
|
| 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: 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 Management Network EPO/PPO |
$178.94
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$149.12
|
| Rate for Payer: IEHP medi-cal |
$69.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.76
|
| Rate for Payer: Multiplan Commercial |
$149.12
|
| Rate for Payer: Networks By Design Commercial |
$129.23
|
| Rate for Payer: Prime Health Services Commercial |
$169.00
|
| Rate for Payer: Riverside University Health MISP |
$79.53
|
| 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 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 |
$39.76 |
| Max. Negotiated Rate |
$178.94 |
| Rate for Payer: Blue Shield of California Commercial |
$149.12
|
| Rate for Payer: Blue Shield of California EPN |
$106.17
|
| Rate for Payer: Cash Price |
$89.47
|
| Rate for Payer: Central Health Plan Commercial |
$159.06
|
| 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: Health Management Network EPO/PPO |
$178.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.76
|
| Rate for Payer: Multiplan Commercial |
$149.12
|
| Rate for Payer: Networks By Design Commercial |
$129.23
|
| Rate for Payer: Prime Health Services Commercial |
$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 |
$39.76 |
| Max. Negotiated Rate |
$178.94 |
| Rate for Payer: Blue Shield of California Commercial |
$149.12
|
| Rate for Payer: Blue Shield of California EPN |
$106.17
|
| Rate for Payer: Cash Price |
$89.47
|
| Rate for Payer: Central Health Plan Commercial |
$159.06
|
| 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: Health Management Network EPO/PPO |
$178.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.76
|
| Rate for Payer: Multiplan Commercial |
$149.12
|
| 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 |
$39.76 |
| Max. Negotiated Rate |
$178.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$120.74
|
| 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 Exchange |
$96.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.46
|
| Rate for Payer: BCBS Transplant Transplant |
$119.29
|
| Rate for Payer: Blue Shield of California Commercial |
$125.06
|
| Rate for Payer: Blue Shield of California EPN |
$97.22
|
| Rate for Payer: Cash Price |
$89.47
|
| Rate for Payer: Cash Price |
$89.47
|
| Rate for Payer: Central Health Plan Commercial |
$159.06
|
| 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: 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 Management Network EPO/PPO |
$178.94
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$149.12
|
| Rate for Payer: IEHP medi-cal |
$69.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.76
|
| Rate for Payer: Multiplan Commercial |
$149.12
|
| Rate for Payer: Networks By Design Commercial |
$129.23
|
| Rate for Payer: Prime Health Services Commercial |
$169.00
|
| Rate for Payer: Riverside University Health MISP |
$79.53
|
| 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 Medi-Cal |
$169.00
|
| Rate for Payer: Vantage Medical Group Senior |
$169.00
|
|
