|
NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR [27333]
|
Facility
IP
|
$1.38
|
|
|
Service Code
|
NDC 68084-597-65
|
| Hospital Charge Code |
1711652
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.95
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.93
|
| Rate for Payer: Heritage Provider Network Senior |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.04
|
|
|
NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR [27333]
|
Facility
OP
|
$1.38
|
|
|
Service Code
|
NDC 50268-597-15
|
| Hospital Charge Code |
1711652
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.17 |
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.76
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.86
|
| Rate for Payer: Blue Shield of California EPN |
$0.81
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.17
|
| Rate for Payer: Dignity Health Senior |
$1.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.85
|
| Rate for Payer: Heritage Provider Network Senior |
$0.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.17
|
| Rate for Payer: Vantage Medical Group Senior |
$1.17
|
|
|
NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR [27333]
|
Facility
OP
|
$1.38
|
|
|
Service Code
|
NDC 50268-597-11
|
| Hospital Charge Code |
1711652
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.17 |
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.76
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.86
|
| Rate for Payer: Blue Shield of California EPN |
$0.81
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.17
|
| Rate for Payer: Dignity Health Senior |
$1.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.85
|
| Rate for Payer: Heritage Provider Network Senior |
$0.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.17
|
| Rate for Payer: Vantage Medical Group Senior |
$1.17
|
|
|
NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR [27333]
|
Facility
IP
|
$1.38
|
|
|
Service Code
|
NDC 50268-597-15
|
| Hospital Charge Code |
1711652
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.95
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.93
|
| Rate for Payer: Heritage Provider Network Senior |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.04
|
|
|
NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR [27333]
|
Facility
OP
|
$1.79
|
|
|
Service Code
|
NDC 68084-597-11
|
| Hospital Charge Code |
1711652
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.52 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1.11
|
| Rate for Payer: Blue Shield of California EPN |
$1.05
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.52
|
| Rate for Payer: Dignity Health Senior |
$1.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.11
|
| Rate for Payer: Heritage Provider Network Senior |
$1.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.52
|
| Rate for Payer: Vantage Medical Group Senior |
$1.52
|
|
|
NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR [27333]
|
Facility
IP
|
$1.79
|
|
|
Service Code
|
NDC 68084-597-11
|
| Hospital Charge Code |
1711652
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.23
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.21
|
| Rate for Payer: Heritage Provider Network Senior |
$1.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
|
|
NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR [27333]
|
Facility
OP
|
$1.79
|
|
|
Service Code
|
NDC 68084-597-01
|
| Hospital Charge Code |
1711652
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.52 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1.11
|
| Rate for Payer: Blue Shield of California EPN |
$1.05
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.52
|
| Rate for Payer: Dignity Health Senior |
$1.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.11
|
| Rate for Payer: Heritage Provider Network Senior |
$1.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.52
|
| Rate for Payer: Vantage Medical Group Senior |
$1.52
|
|
|
NIFEDIPINE ER 60 MG TABLET,EXTENDED RELEASE [10720]
|
Facility
IP
|
$0.38
|
|
|
Service Code
|
NDC 50742-621-01
|
| Hospital Charge Code |
ERX10720
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.26
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.26
|
| Rate for Payer: Heritage Provider Network Senior |
$0.26
|
| 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 |
$0.29
|
|
|
NIFEDIPINE ER 60 MG TABLET,EXTENDED RELEASE [10720]
|
Facility
OP
|
$0.38
|
|
|
Service Code
|
NDC 50742-621-01
|
| Hospital Charge Code |
ERX10720
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.32
|
| Rate for Payer: Dignity Health Senior |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.24
|
| Rate for Payer: Heritage Provider Network Senior |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.18
|
| 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 |
$0.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Vantage Medical Group Senior |
$0.32
|
|
|
NIFEDIPINE ER 60 MG TABLET,EXTENDED RELEASE 24 HR [27334]
|
Facility
IP
|
$2.36
|
|
|
Service Code
|
NDC 50268-598-15
|
| Hospital Charge Code |
1711653
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.77 |
| Rate for Payer: Adventist Health Commercial |
$0.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.62
|
| Rate for Payer: Cash Price |
$1.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.60
|
| Rate for Payer: Heritage Provider Network Senior |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: Multiplan Commercial |
$1.77
|
|
|
NIFEDIPINE ER 60 MG TABLET,EXTENDED RELEASE 24 HR [27334]
|
Facility
OP
|
$2.36
|
|
|
Service Code
|
NDC 50268-598-15
|
| Hospital Charge Code |
1711653
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$2.01 |
| Rate for Payer: Adventist Health Commercial |
$0.47
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.77
|
| Rate for Payer: Blue Shield of California Commercial |
$1.47
|
| Rate for Payer: Blue Shield of California EPN |
$1.39
|
| Rate for Payer: Cash Price |
$1.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.01
|
| Rate for Payer: Dignity Health Senior |
$2.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.46
|
| Rate for Payer: Heritage Provider Network Senior |
$1.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: Multiplan Commercial |
$1.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.01
|
| Rate for Payer: Vantage Medical Group Senior |
$2.01
|
|
|
NIFEDIPINE ER 60 MG TABLET,EXTENDED RELEASE 24 HR [27334]
|
Facility
OP
|
$2.97
|
|
|
Service Code
|
NDC 68084-598-11
|
| Hospital Charge Code |
1711653
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.52 |
| Rate for Payer: Adventist Health Commercial |
$0.59
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.23
|
| Rate for Payer: Blue Shield of California Commercial |
$1.84
|
| Rate for Payer: Blue Shield of California EPN |
$1.74
|
| Rate for Payer: Cash Price |
$1.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.52
|
| Rate for Payer: Dignity Health Senior |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.84
|
| Rate for Payer: Heritage Provider Network Senior |
$1.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$2.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.52
|
| Rate for Payer: Vantage Medical Group Senior |
$2.52
|
|
|
NIFEDIPINE ER 60 MG TABLET,EXTENDED RELEASE 24 HR [27334]
|
Facility
IP
|
$2.97
|
|
|
Service Code
|
NDC 68084-598-01
|
| Hospital Charge Code |
1711653
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.23 |
| Rate for Payer: Adventist Health Commercial |
$0.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.04
|
| Rate for Payer: Cash Price |
$1.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.01
|
| Rate for Payer: Heritage Provider Network Senior |
$2.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$2.23
|
|
|
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 |
$0.43 |
| Max. Negotiated Rate |
$1.77 |
| Rate for Payer: Adventist Health Commercial |
$0.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.62
|
| Rate for Payer: Cash Price |
$1.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.60
|
| Rate for Payer: Heritage Provider Network Senior |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: Multiplan Commercial |
$1.77
|
|
|
NIFEDIPINE ER 60 MG TABLET,EXTENDED RELEASE 24 HR [27334]
|
Facility
OP
|
$2.36
|
|
|
Service Code
|
NDC 50268-598-11
|
| Hospital Charge Code |
1711653
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$2.01 |
| Rate for Payer: Adventist Health Commercial |
$0.47
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.77
|
| Rate for Payer: Blue Shield of California Commercial |
$1.47
|
| Rate for Payer: Blue Shield of California EPN |
$1.39
|
| Rate for Payer: Cash Price |
$1.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.01
|
| Rate for Payer: Dignity Health Senior |
$2.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.46
|
| Rate for Payer: Heritage Provider Network Senior |
$1.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: Multiplan Commercial |
$1.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.01
|
| Rate for Payer: Vantage Medical Group Senior |
$2.01
|
|
|
NIFEDIPINE ER 60 MG TABLET,EXTENDED RELEASE 24 HR [27334]
|
Facility
IP
|
$2.97
|
|
|
Service Code
|
NDC 68084-598-11
|
| Hospital Charge Code |
1711653
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.23 |
| Rate for Payer: Adventist Health Commercial |
$0.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.04
|
| Rate for Payer: Cash Price |
$1.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.01
|
| Rate for Payer: Heritage Provider Network Senior |
$2.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$2.23
|
|
|
NIFEDIPINE ER 60 MG TABLET,EXTENDED RELEASE 24 HR [27334]
|
Facility
OP
|
$2.97
|
|
|
Service Code
|
NDC 68084-598-01
|
| Hospital Charge Code |
1711653
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.52 |
| Rate for Payer: Adventist Health Commercial |
$0.59
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.23
|
| Rate for Payer: Blue Shield of California Commercial |
$1.84
|
| Rate for Payer: Blue Shield of California EPN |
$1.74
|
| Rate for Payer: Cash Price |
$1.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.52
|
| Rate for Payer: Dignity Health Senior |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.84
|
| Rate for Payer: Heritage Provider Network Senior |
$1.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$2.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.52
|
| Rate for Payer: Vantage Medical Group Senior |
$2.52
|
|
|
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 |
$0.19 |
| Max. Negotiated Rate |
$0.78 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.71
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.70
|
| Rate for Payer: Heritage Provider Network Senior |
$0.70
|
| 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: Multiplan Commercial |
$0.78
|
|
|
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 |
$0.68 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.58
|
| Rate for Payer: Cash Price |
$1.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.54
|
| Rate for Payer: Heritage Provider Network Senior |
$2.54
|
| 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 |
1712601
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$2.30 |
| 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: 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 |
$2.02
|
| Rate for Payer: Blue Shield of California Commercial |
$1.68
|
| Rate for Payer: Blue Shield of California EPN |
$1.58
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.30
|
| Rate for Payer: Dignity Health Senior |
$2.30
|
| 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 |
$1.30
|
| 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
|
| 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
OP
|
$2.56
|
|
|
Service Code
|
NDC 62175-262-37
|
| Hospital Charge Code |
1712601
|
|
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: 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 |
$1.92
|
| Rate for Payer: Blue Shield of California Commercial |
$1.59
|
| Rate for Payer: Blue Shield of California EPN |
$1.50
|
| Rate for Payer: Cash Price |
$1.15
|
| 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 |
$1.23
|
| 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: Multiplan Commercial |
$1.92
|
| 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 |
1712601
|
|
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: Aetna of CA Non-Gatekeeper |
$1.85
|
| Rate for Payer: Cash Price |
$1.22
|
| 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
OP
|
$3.75
|
|
|
Service Code
|
NDC 68084-603-21
|
| Hospital Charge Code |
1712601
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$3.19 |
| 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 |
$2.58
|
| 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 |
$2.81
|
| Rate for Payer: Blue Shield of California Commercial |
$2.33
|
| Rate for Payer: Blue Shield of California EPN |
$2.20
|
| Rate for Payer: Cash Price |
$1.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.19
|
| Rate for Payer: Dignity Health Senior |
$3.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| 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 |
$1.81
|
| 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
|
| 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
IP
|
$0.78
|
|
|
Service Code
|
NDC 24979-009-01
|
| Hospital Charge Code |
1712601
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.54
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.53
|
| Rate for Payer: Heritage Provider Network Senior |
$0.53
|
| 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: Multiplan Commercial |
$0.59
|
|
|
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 |
$0.68 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.58
|
| Rate for Payer: Cash Price |
$1.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.54
|
| Rate for Payer: Heritage Provider Network Senior |
$2.54
|
| 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
|
|
