|
NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR [27335]
|
Facility
|
IP
|
$3.74
|
|
|
Service Code
|
NDC 68084-603-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.53
|
| Rate for Payer: Heritage Provider Network Senior |
$2.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.94
|
| Rate for Payer: Multiplan Commercial |
$2.81
|
|
|
NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR [27335]
|
Facility
|
OP
|
$2.56
|
|
|
Service Code
|
NDC 62175-262-37
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$2.18 |
| Rate for Payer: Adventist Health Commercial |
$0.51
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.92
|
| Rate for Payer: Blue Shield of California Commercial |
$1.56
|
| Rate for Payer: Blue Shield of California EPN |
$1.25
|
| Rate for Payer: Cash Price |
$1.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.18
|
| Rate for Payer: Dignity Health Senior |
$2.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.79
|
| Rate for Payer: Multiplan Commercial |
$1.92
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.02
|
| Rate for Payer: TriValley Medical Group Senior |
$1.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.18
|
| 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 50268-599-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$2.02 |
| Rate for Payer: Adventist Health Commercial |
$0.54
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.83
|
| Rate for Payer: Heritage Provider Network Senior |
$1.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: Multiplan Commercial |
$2.02
|
|
|
NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR [27335]
|
Facility
|
IP
|
$3.74
|
|
|
Service Code
|
NDC 68084-603-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.53
|
| Rate for Payer: Heritage Provider Network Senior |
$2.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.94
|
| Rate for Payer: Multiplan Commercial |
$2.81
|
|
|
NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR [27335]
|
Facility
|
OP
|
$2.70
|
|
|
Service Code
|
NDC 50268-599-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: Adventist Health Commercial |
$0.54
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.02
|
| Rate for Payer: Blue Shield of California Commercial |
$1.65
|
| Rate for Payer: Blue Shield of California EPN |
$1.32
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.29
|
| Rate for Payer: Dignity Health Senior |
$2.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.67
|
| Rate for Payer: Heritage Provider Network Senior |
$1.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.89
|
| Rate for Payer: Multiplan Commercial |
$2.02
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.08
|
| Rate for Payer: TriValley Medical Group Senior |
$1.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.29
|
| Rate for Payer: Vantage Medical Group Senior |
$2.29
|
|
|
NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR [27335]
|
Facility
|
OP
|
$2.70
|
|
|
Service Code
|
NDC 50268-599-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: Adventist Health Commercial |
$0.54
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.02
|
| Rate for Payer: Blue Shield of California Commercial |
$1.65
|
| Rate for Payer: Blue Shield of California EPN |
$1.32
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.29
|
| Rate for Payer: Dignity Health Senior |
$2.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.67
|
| Rate for Payer: Heritage Provider Network Senior |
$1.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.89
|
| Rate for Payer: Multiplan Commercial |
$2.02
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.08
|
| Rate for Payer: TriValley Medical Group Senior |
$1.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.29
|
| Rate for Payer: Vantage Medical Group Senior |
$2.29
|
|
|
NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR [27335]
|
Facility
|
OP
|
$1.04
|
|
|
Service Code
|
NDC 0904-7082-06
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.88 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.78
|
| Rate for Payer: Blue Shield of California Commercial |
$0.63
|
| Rate for Payer: Blue Shield of California EPN |
$0.51
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.88
|
| Rate for Payer: Dignity Health Senior |
$0.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.64
|
| Rate for Payer: Heritage Provider Network Senior |
$0.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.73
|
| Rate for Payer: Multiplan Commercial |
$0.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.42
|
| Rate for Payer: TriValley Medical Group Senior |
$0.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.88
|
| 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
|
$0.78
|
|
|
Service Code
|
NDC 24979-009-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.59
|
| Rate for Payer: Blue Shield of California Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California EPN |
$0.38
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.66
|
| Rate for Payer: Dignity Health Senior |
$0.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.48
|
| Rate for Payer: Heritage Provider Network Senior |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.31
|
| Rate for Payer: TriValley Medical Group Senior |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.66
|
| 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
|
$3.74
|
|
|
Service Code
|
NDC 68084-603-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$3.18 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.81
|
| Rate for Payer: Blue Shield of California Commercial |
$2.28
|
| Rate for Payer: Blue Shield of California EPN |
$1.83
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.18
|
| Rate for Payer: Dignity Health Senior |
$3.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.32
|
| Rate for Payer: Heritage Provider Network Senior |
$2.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.62
|
| Rate for Payer: Multiplan Commercial |
$2.81
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.50
|
| Rate for Payer: TriValley Medical Group Senior |
$1.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.18
|
| Rate for Payer: Vantage Medical Group Senior |
$3.18
|
|
|
NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR [27335]
|
Facility
|
OP
|
$3.74
|
|
|
Service Code
|
NDC 68084-603-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$3.18 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.81
|
| Rate for Payer: Blue Shield of California Commercial |
$2.28
|
| Rate for Payer: Blue Shield of California EPN |
$1.83
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.18
|
| Rate for Payer: Dignity Health Senior |
$3.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.32
|
| Rate for Payer: Heritage Provider Network Senior |
$2.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.62
|
| Rate for Payer: Multiplan Commercial |
$2.81
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.50
|
| Rate for Payer: TriValley Medical Group Senior |
$1.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.18
|
| Rate for Payer: Vantage Medical Group Senior |
$3.18
|
|
|
NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE [37662]
|
Facility
|
OP
|
$0.67
|
|
|
Service Code
|
NDC 50742-622-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.50
|
| Rate for Payer: Blue Shield of California Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California EPN |
$0.33
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.57
|
| Rate for Payer: Dignity Health Senior |
$0.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.41
|
| Rate for Payer: Heritage Provider Network Senior |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.47
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.27
|
| Rate for Payer: TriValley Medical Group Senior |
$0.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.57
|
| Rate for Payer: Vantage Medical Group Senior |
$0.57
|
|
|
NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE [37662]
|
Facility
|
IP
|
$0.67
|
|
|
Service Code
|
NDC 50742-622-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.45
|
| Rate for Payer: Heritage Provider Network Senior |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
|
|
NIFEDIPINE ORAL SUSPENSION COMPOUND 4 MG/ML [4080311]
|
Facility
|
OP
|
$0.41
|
|
|
Service Code
|
NDC 9994-0803-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.31
|
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.35
|
| Rate for Payer: Dignity Health Senior |
$0.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.25
|
| Rate for Payer: Heritage Provider Network Senior |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.35
|
| Rate for Payer: Vantage Medical Group Senior |
$0.35
|
|
|
NIFEDIPINE ORAL SUSPENSION COMPOUND 4 MG/ML [4080311]
|
Facility
|
IP
|
$0.41
|
|
|
Service Code
|
NDC 9994-0803-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.28
|
| Rate for Payer: Heritage Provider Network Senior |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.31
|
|
|
NIFURTIMOX 120 MG TABLET [229005]
|
Facility
|
OP
|
$3.60
|
|
|
Service Code
|
NDC 50419-751-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.70
|
| Rate for Payer: Blue Shield of California Commercial |
$2.20
|
| Rate for Payer: Blue Shield of California EPN |
$1.76
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.06
|
| Rate for Payer: Dignity Health Senior |
$3.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.23
|
| Rate for Payer: Heritage Provider Network Senior |
$2.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.52
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.44
|
| Rate for Payer: TriValley Medical Group Senior |
$1.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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
|
|
|
NIFURTIMOX 120 MG TABLET [229005]
|
Facility
|
IP
|
$3.60
|
|
|
Service Code
|
NDC 50419-751-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$2.70 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.44
|
| Rate for Payer: Heritage Provider Network Senior |
$2.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
|
|
NILOTINIB HCL 150 MG CAPSULE [105679]
|
Facility
|
OP
|
$231.91
|
|
|
Service Code
|
NDC 0078-0592-51
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$41.98 |
| Max. Negotiated Rate |
$197.12 |
| Rate for Payer: Adventist Health Commercial |
$46.38
|
| Rate for Payer: Aetna of CA Gatekeeper |
$123.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$159.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$197.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.93
|
| Rate for Payer: Blue Shield of California Commercial |
$141.47
|
| Rate for Payer: Blue Shield of California EPN |
$113.17
|
| Rate for Payer: Cash Price |
$127.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$150.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$197.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.12
|
| Rate for Payer: Dignity Health Senior |
$197.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$143.55
|
| Rate for Payer: Heritage Provider Network Senior |
$143.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$110.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$162.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$162.34
|
| Rate for Payer: Multiplan Commercial |
$173.93
|
| Rate for Payer: TriValley Medical Group Commercial |
$92.76
|
| Rate for Payer: TriValley Medical Group Senior |
$92.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$115.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$115.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$197.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$197.12
|
| Rate for Payer: Vantage Medical Group Senior |
$197.12
|
|
|
NILOTINIB HCL 150 MG CAPSULE [105679]
|
Facility
|
IP
|
$231.91
|
|
|
Service Code
|
NDC 0078-0592-51
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$41.98 |
| Max. Negotiated Rate |
$173.93 |
| Rate for Payer: Adventist Health Commercial |
$46.38
|
| Rate for Payer: Cash Price |
$127.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.00
|
| Rate for Payer: Heritage Provider Network Senior |
$157.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.98
|
| Rate for Payer: Multiplan Commercial |
$173.93
|
|
|
NILOTINIB HCL 200 MG CAPSULE [88720]
|
Facility
|
OP
|
$231.91
|
|
|
Service Code
|
NDC 0078-0526-51
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$41.98 |
| Max. Negotiated Rate |
$197.12 |
| Rate for Payer: Adventist Health Commercial |
$46.38
|
| Rate for Payer: Aetna of CA Gatekeeper |
$123.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$159.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$197.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.93
|
| Rate for Payer: Blue Shield of California Commercial |
$141.47
|
| Rate for Payer: Blue Shield of California EPN |
$113.17
|
| Rate for Payer: Cash Price |
$127.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$150.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$197.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.12
|
| Rate for Payer: Dignity Health Senior |
$197.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$143.55
|
| Rate for Payer: Heritage Provider Network Senior |
$143.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$110.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$162.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$162.34
|
| Rate for Payer: Multiplan Commercial |
$173.93
|
| Rate for Payer: TriValley Medical Group Commercial |
$92.76
|
| Rate for Payer: TriValley Medical Group Senior |
$92.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$115.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$115.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$197.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$197.12
|
| Rate for Payer: Vantage Medical Group Senior |
$197.12
|
|
|
NILOTINIB HCL 200 MG CAPSULE [88720]
|
Facility
|
IP
|
$231.91
|
|
|
Service Code
|
NDC 0078-0526-51
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$41.98 |
| Max. Negotiated Rate |
$173.93 |
| Rate for Payer: Adventist Health Commercial |
$46.38
|
| Rate for Payer: Cash Price |
$127.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.00
|
| Rate for Payer: Heritage Provider Network Senior |
$157.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.98
|
| Rate for Payer: Multiplan Commercial |
$173.93
|
|
|
NIMODIPINE 30 MG/5 ML ORAL SYRINGE (FOR ORAL USE ONLY) [228034]
|
Facility
|
OP
|
$12.82
|
|
|
Service Code
|
NDC 24338-230-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$10.90 |
| Rate for Payer: Adventist Health Commercial |
$2.56
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.81
|
| 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: Blue Shield of California Commercial |
$7.82
|
| Rate for Payer: Blue Shield of California EPN |
$6.26
|
| Rate for Payer: Cash Price |
$7.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.90
|
| Rate for Payer: Dignity Health Senior |
$10.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.94
|
| Rate for Payer: Heritage Provider Network Senior |
$7.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.21
|
| 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 |
$9.62
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.13
|
| Rate for Payer: TriValley Medical Group Senior |
$5.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 24338-230-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$9.62 |
| Rate for Payer: Adventist Health Commercial |
$2.56
|
| Rate for Payer: Cash Price |
$7.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.68
|
| Rate for Payer: Heritage Provider Network Senior |
$8.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.21
|
| Rate for Payer: Multiplan Commercial |
$9.62
|
|
|
NIMODIPINE 30 MG/5 ML ORAL SYRINGE (FOR ORAL USE ONLY) [228034]
|
Facility
|
IP
|
$12.82
|
|
|
Service Code
|
NDC 24338-230-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$9.62 |
| Rate for Payer: Adventist Health Commercial |
$2.56
|
| Rate for Payer: Cash Price |
$7.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.68
|
| Rate for Payer: Heritage Provider Network Senior |
$8.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.21
|
| Rate for Payer: Multiplan Commercial |
$9.62
|
|
|
NIMODIPINE 30 MG/5 ML ORAL SYRINGE (FOR ORAL USE ONLY) [228034]
|
Facility
|
OP
|
$12.82
|
|
|
Service Code
|
NDC 24338-230-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$10.90 |
| Rate for Payer: Adventist Health Commercial |
$2.56
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.81
|
| 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: Blue Shield of California Commercial |
$7.82
|
| Rate for Payer: Blue Shield of California EPN |
$6.26
|
| Rate for Payer: Cash Price |
$7.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.90
|
| Rate for Payer: Dignity Health Senior |
$10.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.94
|
| Rate for Payer: Heritage Provider Network Senior |
$7.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.21
|
| 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 |
$9.62
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.13
|
| Rate for Payer: TriValley Medical Group Senior |
$5.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 24338-230-05
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$9.62 |
| Rate for Payer: Adventist Health Commercial |
$2.56
|
| Rate for Payer: Cash Price |
$7.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.68
|
| Rate for Payer: Heritage Provider Network Senior |
$8.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.21
|
| Rate for Payer: Multiplan Commercial |
$9.62
|
|
