|
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
|
|
|
NIMODIPINE 30 MG/5 ML ORAL SYRINGE (FOR ORAL USE ONLY) [228034]
|
Facility
|
OP
|
$12.82
|
|
|
Service Code
|
NDC 24338-230-05
|
| 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
|
OP
|
$12.82
|
|
|
Service Code
|
NDC 24338-230-30
|
| 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 CAPSULE [10722]
|
Facility
|
IP
|
$3.45
|
|
|
Service Code
|
NDC 69452-209-13
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.59 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Cash Price |
$1.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.34
|
| Rate for Payer: Heritage Provider Network Senior |
$2.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$2.59
|
|
|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 57664-135-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.06
|
| Rate for Payer: Heritage Provider Network Senior |
$4.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
|
|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
|
OP
|
$1.44
|
|
|
Service Code
|
NDC 23155-512-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.88
|
| Rate for Payer: Blue Shield of California EPN |
$0.70
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.22
|
| Rate for Payer: Dignity Health Senior |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.89
|
| Rate for Payer: Heritage Provider Network Senior |
$0.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.01
|
| Rate for Payer: Multiplan Commercial |
$1.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.58
|
| Rate for Payer: TriValley Medical Group Senior |
$0.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.22
|
| Rate for Payer: Vantage Medical Group Senior |
$1.22
|
|
|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
|
IP
|
$1.44
|
|
|
Service Code
|
NDC 23155-512-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.97
|
| Rate for Payer: Heritage Provider Network Senior |
$0.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.08
|
|
|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
|
OP
|
$3.45
|
|
|
Service Code
|
NDC 69452-209-07
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.93 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.59
|
| Rate for Payer: Blue Shield of California Commercial |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$1.68
|
| Rate for Payer: Cash Price |
$1.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.93
|
| Rate for Payer: Dignity Health Senior |
$2.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.14
|
| Rate for Payer: Heritage Provider Network Senior |
$2.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.42
|
| Rate for Payer: Multiplan Commercial |
$2.59
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.38
|
| Rate for Payer: TriValley Medical Group Senior |
$1.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.93
|
| Rate for Payer: Vantage Medical Group Senior |
$2.93
|
|
|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
|
IP
|
$1.44
|
|
|
Service Code
|
NDC 23155-512-00
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.97
|
| Rate for Payer: Heritage Provider Network Senior |
$0.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.08
|
|
|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 57664-135-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.50
|
| Rate for Payer: Blue Shield of California Commercial |
$3.66
|
| Rate for Payer: Blue Shield of California EPN |
$2.93
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.10
|
| Rate for Payer: Dignity Health Senior |
$5.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.71
|
| Rate for Payer: Heritage Provider Network Senior |
$3.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.20
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.40
|
| Rate for Payer: TriValley Medical Group Senior |
$2.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$5.10
|
|
|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
|
OP
|
$1.44
|
|
|
Service Code
|
NDC 23155-512-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.88
|
| Rate for Payer: Blue Shield of California EPN |
$0.70
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.22
|
| Rate for Payer: Dignity Health Senior |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.89
|
| Rate for Payer: Heritage Provider Network Senior |
$0.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.01
|
| Rate for Payer: Multiplan Commercial |
$1.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.58
|
| Rate for Payer: TriValley Medical Group Senior |
$0.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.93 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.59
|
| Rate for Payer: Blue Shield of California Commercial |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$1.68
|
| Rate for Payer: Cash Price |
$1.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.93
|
| Rate for Payer: Dignity Health Senior |
$2.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.14
|
| Rate for Payer: Heritage Provider Network Senior |
$2.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.42
|
| Rate for Payer: Multiplan Commercial |
$2.59
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.38
|
| Rate for Payer: TriValley Medical Group Senior |
$1.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.93
|
| Rate for Payer: Vantage Medical Group Senior |
$2.93
|
|
|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
|
OP
|
$3.45
|
|
|
Service Code
|
NDC 69452-209-20
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.93 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.59
|
| Rate for Payer: Blue Shield of California Commercial |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$1.68
|
| Rate for Payer: Cash Price |
$1.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.93
|
| Rate for Payer: Dignity Health Senior |
$2.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.14
|
| Rate for Payer: Heritage Provider Network Senior |
$2.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.42
|
| Rate for Payer: Multiplan Commercial |
$2.59
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.38
|
| Rate for Payer: TriValley Medical Group Senior |
$1.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.93
|
| Rate for Payer: Vantage Medical Group Senior |
$2.93
|
|
|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
|
IP
|
$3.45
|
|
|
Service Code
|
NDC 69452-209-20
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.59 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Cash Price |
$1.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.34
|
| Rate for Payer: Heritage Provider Network Senior |
$2.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$2.59
|
|
|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
|
IP
|
$1.44
|
|
|
Service Code
|
NDC 23155-512-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.97
|
| Rate for Payer: Heritage Provider Network Senior |
$0.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.08
|
|
|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
|
OP
|
$1.44
|
|
|
Service Code
|
NDC 23155-512-00
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.88
|
| Rate for Payer: Blue Shield of California EPN |
$0.70
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.22
|
| Rate for Payer: Dignity Health Senior |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.89
|
| Rate for Payer: Heritage Provider Network Senior |
$0.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.01
|
| Rate for Payer: Multiplan Commercial |
$1.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.58
|
| Rate for Payer: TriValley Medical Group Senior |
$0.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 69452-209-07
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.59 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Cash Price |
$1.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.34
|
| Rate for Payer: Heritage Provider Network Senior |
$2.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$2.59
|
|
|
NIMODIPINE 60 MG/10 ML ORAL SOLUTION [232032]
|
Facility
|
OP
|
$13.16
|
|
|
Service Code
|
NDC 24338-260-08
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$11.19 |
| Rate for Payer: Adventist Health Commercial |
$2.63
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.87
|
| Rate for Payer: Blue Shield of California Commercial |
$8.03
|
| Rate for Payer: Blue Shield of California EPN |
$6.42
|
| Rate for Payer: Cash Price |
$7.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.19
|
| Rate for Payer: Dignity Health Senior |
$11.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.15
|
| Rate for Payer: Heritage Provider Network Senior |
$8.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.21
|
| Rate for Payer: Multiplan Commercial |
$9.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.26
|
| Rate for Payer: TriValley Medical Group Senior |
$5.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.19
|
| Rate for Payer: Vantage Medical Group Senior |
$11.19
|
|
|
NIMODIPINE 60 MG/10 ML ORAL SOLUTION [232032]
|
Facility
|
IP
|
$13.16
|
|
|
Service Code
|
NDC 24338-260-08
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$9.87 |
| Rate for Payer: Adventist Health Commercial |
$2.63
|
| Rate for Payer: Cash Price |
$7.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.91
|
| Rate for Payer: Heritage Provider Network Senior |
$8.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.29
|
| Rate for Payer: Multiplan Commercial |
$9.87
|
|
|
NIMODIPINE 60 MG/10 ML ORAL SYRINGE (FOR ORAL USE ONLY) [228035]
|
Facility
|
IP
|
$12.82
|
|
|
Service Code
|
NDC 24338-260-10
|
| 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 60 MG/10 ML ORAL SYRINGE (FOR ORAL USE ONLY) [228035]
|
Facility
|
OP
|
$12.82
|
|
|
Service Code
|
NDC 24338-260-12
|
| 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 60 MG/10 ML ORAL SYRINGE (FOR ORAL USE ONLY) [228035]
|
Facility
|
IP
|
$12.82
|
|
|
Service Code
|
NDC 24338-260-12
|
| 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 60 MG/10 ML ORAL SYRINGE (FOR ORAL USE ONLY) [228035]
|
Facility
|
OP
|
$12.82
|
|
|
Service Code
|
NDC 24338-260-10
|
| 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 ORAL SUSPENSION COMPOUND 30 MG/ML [4080312]
|
Facility
|
OP
|
$9.15
|
|
|
Service Code
|
NDC 9994-0803-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$7.78 |
| Rate for Payer: Adventist Health Commercial |
$1.83
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.86
|
| Rate for Payer: Blue Shield of California Commercial |
$5.58
|
| Rate for Payer: Blue Shield of California EPN |
$4.47
|
| Rate for Payer: Cash Price |
$5.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.78
|
| Rate for Payer: Dignity Health Senior |
$7.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.66
|
| Rate for Payer: Heritage Provider Network Senior |
$5.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.41
|
| Rate for Payer: Multiplan Commercial |
$6.86
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.66
|
| Rate for Payer: TriValley Medical Group Senior |
$3.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7.78
|
|
|
NIMODIPINE ORAL SUSPENSION COMPOUND 30 MG/ML [4080312]
|
Facility
|
IP
|
$9.15
|
|
|
Service Code
|
NDC 9994-0803-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$6.86 |
| Rate for Payer: Adventist Health Commercial |
$1.83
|
| Rate for Payer: Cash Price |
$5.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.19
|
| Rate for Payer: Heritage Provider Network Senior |
$6.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.29
|
| Rate for Payer: Multiplan Commercial |
$6.86
|
|
