|
NIFEDIPINE 10 MG PO CAPS
|
Facility
|
OP
|
$0.46
|
|
|
Service Code
|
NDC 2315519401
|
| Hospital Charge Code |
2315519401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.23
|
| Rate for Payer: Aetna Government |
$0.23
|
| Rate for Payer: Brighton Health Commercial |
$0.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.31
|
| Rate for Payer: EmblemHealth Commercial |
$0.23
|
| Rate for Payer: Group Health Inc Commercial |
$0.23
|
| Rate for Payer: Group Health Inc Medicare |
$0.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.30
|
|
|
NIFEDIPINE 10 MG PO CAPS
|
Facility
|
OP
|
$1.29
|
|
|
Service Code
|
NDC 0904722961
|
| Hospital Charge Code |
0904722961
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$1.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.65
|
| Rate for Payer: Aetna Government |
$0.65
|
| Rate for Payer: Brighton Health Commercial |
$0.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.88
|
| Rate for Payer: EmblemHealth Commercial |
$0.65
|
| Rate for Payer: Group Health Inc Commercial |
$0.65
|
| Rate for Payer: Group Health Inc Medicare |
$0.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.84
|
|
|
NIFEDIPINE 10 MG PO CAPS
|
Facility
|
IP
|
$1.29
|
|
|
Service Code
|
NDC 0904722961
|
| Hospital Charge Code |
0904722961
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.65
|
|
|
NIFEDIPINE 10 MG PO CAPS
|
Facility
|
IP
|
$0.46
|
|
|
Service Code
|
NDC 2315519401
|
| Hospital Charge Code |
2315519401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.23
|
|
|
NIFEDIPINE ER OSMOTIC RELEASE 30 MG PO TB24
|
Facility
|
OP
|
$1.31
|
|
|
Service Code
|
NDC 5074226003
|
| Hospital Charge Code |
5074226003
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.66
|
| Rate for Payer: Aetna Government |
$0.66
|
| Rate for Payer: Brighton Health Commercial |
$0.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.89
|
| Rate for Payer: EmblemHealth Commercial |
$0.66
|
| Rate for Payer: Group Health Inc Commercial |
$0.66
|
| Rate for Payer: Group Health Inc Medicare |
$0.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.85
|
|
|
NIFEDIPINE ER OSMOTIC RELEASE 30 MG PO TB24
|
Facility
|
IP
|
$1.34
|
|
|
Service Code
|
NDC 6217526037
|
| Hospital Charge Code |
6217526037
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.67
|
|
|
NIFEDIPINE ER OSMOTIC RELEASE 30 MG PO TB24
|
Facility
|
IP
|
$1.31
|
|
|
Service Code
|
NDC 5026859711
|
| Hospital Charge Code |
5026859711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.66
|
|
|
NIFEDIPINE ER OSMOTIC RELEASE 30 MG PO TB24
|
Facility
|
IP
|
$1.31
|
|
|
Service Code
|
NDC 5026859715
|
| Hospital Charge Code |
5026859715
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.66
|
|
|
NIFEDIPINE ER OSMOTIC RELEASE 30 MG PO TB24
|
Facility
|
OP
|
$1.31
|
|
|
Service Code
|
NDC 5026859715
|
| Hospital Charge Code |
5026859715
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.66
|
| Rate for Payer: Aetna Government |
$0.66
|
| Rate for Payer: Brighton Health Commercial |
$0.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.89
|
| Rate for Payer: EmblemHealth Commercial |
$0.66
|
| Rate for Payer: Group Health Inc Commercial |
$0.66
|
| Rate for Payer: Group Health Inc Medicare |
$0.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.85
|
|
|
NIFEDIPINE ER OSMOTIC RELEASE 30 MG PO TB24
|
Facility
|
OP
|
$1.34
|
|
|
Service Code
|
NDC 6217526037
|
| Hospital Charge Code |
6217526037
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$1.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.67
|
| Rate for Payer: Aetna Government |
$0.67
|
| Rate for Payer: Brighton Health Commercial |
$1.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.91
|
| Rate for Payer: EmblemHealth Commercial |
$0.67
|
| Rate for Payer: Group Health Inc Commercial |
$0.67
|
| Rate for Payer: Group Health Inc Medicare |
$0.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.87
|
|
|
NIFEDIPINE ER OSMOTIC RELEASE 30 MG PO TB24
|
Facility
|
IP
|
$1.33
|
|
|
Service Code
|
NDC 5074226001
|
| Hospital Charge Code |
5074226001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.66
|
|
|
NIFEDIPINE ER OSMOTIC RELEASE 30 MG PO TB24
|
Facility
|
OP
|
$1.33
|
|
|
Service Code
|
NDC 5074226001
|
| Hospital Charge Code |
5074226001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$1.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.66
|
| Rate for Payer: Aetna Government |
$0.66
|
| Rate for Payer: Brighton Health Commercial |
$0.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.90
|
| Rate for Payer: EmblemHealth Commercial |
$0.66
|
| Rate for Payer: Group Health Inc Commercial |
$0.66
|
| Rate for Payer: Group Health Inc Medicare |
$0.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.86
|
|
|
NIFEDIPINE ER OSMOTIC RELEASE 30 MG PO TB24
|
Facility
|
IP
|
$1.31
|
|
|
Service Code
|
NDC 5074226003
|
| Hospital Charge Code |
5074226003
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.66
|
|
|
NIFEDIPINE ER OSMOTIC RELEASE 30 MG PO TB24
|
Facility
|
IP
|
$1.79
|
|
|
Service Code
|
NDC 6808459711
|
| Hospital Charge Code |
6808459711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.90
|
|
|
NIFEDIPINE ER OSMOTIC RELEASE 30 MG PO TB24
|
Facility
|
OP
|
$1.31
|
|
|
Service Code
|
NDC 5026859711
|
| Hospital Charge Code |
5026859711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.66
|
| Rate for Payer: Aetna Government |
$0.66
|
| Rate for Payer: Brighton Health Commercial |
$0.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.89
|
| Rate for Payer: EmblemHealth Commercial |
$0.66
|
| Rate for Payer: Group Health Inc Commercial |
$0.66
|
| Rate for Payer: Group Health Inc Medicare |
$0.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.85
|
|
|
NIFEDIPINE ER OSMOTIC RELEASE 30 MG PO TB24
|
Facility
|
OP
|
$1.79
|
|
|
Service Code
|
NDC 6808459711
|
| Hospital Charge Code |
6808459711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.90
|
| Rate for Payer: Aetna Government |
$0.90
|
| Rate for Payer: Brighton Health Commercial |
$1.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.22
|
| Rate for Payer: EmblemHealth Commercial |
$0.90
|
| Rate for Payer: Group Health Inc Commercial |
$0.90
|
| Rate for Payer: Group Health Inc Medicare |
$0.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.16
|
|
|
NIFEDIPINE ER OSMOTIC RELEASE 60 MG PO TB24
|
Facility
|
OP
|
$2.27
|
|
|
Service Code
|
NDC 5074226103
|
| Hospital Charge Code |
5074226103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$1.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.13
|
| Rate for Payer: Aetna Government |
$1.13
|
| Rate for Payer: Brighton Health Commercial |
$1.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.54
|
| Rate for Payer: EmblemHealth Commercial |
$1.13
|
| Rate for Payer: Group Health Inc Commercial |
$1.13
|
| Rate for Payer: Group Health Inc Medicare |
$0.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.47
|
|
|
NIFEDIPINE ER OSMOTIC RELEASE 60 MG PO TB24
|
Facility
|
IP
|
$2.27
|
|
|
Service Code
|
NDC 5074226103
|
| Hospital Charge Code |
5074226103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$1.13 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.13
|
|
|
NIFEDIPINE ER OSMOTIC RELEASE 60 MG PO TB24
|
Facility
|
OP
|
$2.29
|
|
|
Service Code
|
NDC 5074226101
|
| Hospital Charge Code |
5074226101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$1.83 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.15
|
| Rate for Payer: Aetna Government |
$1.15
|
| Rate for Payer: Brighton Health Commercial |
$1.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.56
|
| Rate for Payer: EmblemHealth Commercial |
$1.15
|
| Rate for Payer: Group Health Inc Commercial |
$1.15
|
| Rate for Payer: Group Health Inc Medicare |
$0.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.49
|
|
|
NIFEDIPINE ER OSMOTIC RELEASE 60 MG PO TB24
|
Facility
|
IP
|
$2.29
|
|
|
Service Code
|
NDC 5074226101
|
| Hospital Charge Code |
5074226101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$1.15 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.15
|
|
|
NIFEDIPINE ER OSMOTIC RELEASE 60 MG PO TB24
|
Facility
|
OP
|
$2.25
|
|
|
Service Code
|
NDC 5026859815
|
| Hospital Charge Code |
5026859815
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.13
|
| Rate for Payer: Aetna Government |
$1.13
|
| Rate for Payer: Brighton Health Commercial |
$1.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.53
|
| Rate for Payer: EmblemHealth Commercial |
$1.13
|
| Rate for Payer: Group Health Inc Commercial |
$1.13
|
| Rate for Payer: Group Health Inc Medicare |
$0.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.47
|
|
|
NIFEDIPINE ER OSMOTIC RELEASE 60 MG PO TB24
|
Facility
|
IP
|
$2.25
|
|
|
Service Code
|
NDC 5026859815
|
| Hospital Charge Code |
5026859815
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$1.13 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.13
|
|
|
NIFEDIPINE ER OSMOTIC RELEASE 60 MG PO TB24
|
Facility
|
OP
|
$2.25
|
|
|
Service Code
|
NDC 5026859811
|
| Hospital Charge Code |
5026859811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.13
|
| Rate for Payer: Aetna Government |
$1.13
|
| Rate for Payer: Brighton Health Commercial |
$1.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.53
|
| Rate for Payer: EmblemHealth Commercial |
$1.13
|
| Rate for Payer: Group Health Inc Commercial |
$1.13
|
| Rate for Payer: Group Health Inc Medicare |
$0.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.47
|
|
|
NIFEDIPINE ER OSMOTIC RELEASE 60 MG PO TB24
|
Facility
|
IP
|
$2.25
|
|
|
Service Code
|
NDC 5026859811
|
| Hospital Charge Code |
5026859811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$1.13 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.13
|
|
|
NIFEDIPINE ER OSMOTIC RELEASE 60 MG PO TB24
|
Facility
|
OP
|
$3.50
|
|
|
Service Code
|
NDC 0904708161
|
| Hospital Charge Code |
0904708161
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.75
|
| Rate for Payer: Aetna Government |
$1.75
|
| Rate for Payer: Brighton Health Commercial |
$2.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.38
|
| Rate for Payer: EmblemHealth Commercial |
$1.75
|
| Rate for Payer: Group Health Inc Commercial |
$1.75
|
| Rate for Payer: Group Health Inc Medicare |
$1.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.27
|
|