Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

FELBAMATE 400 MG TABLET [10024]

Facility

OP

$1.67

Service Code	NDC 72578-056-01
Hospital Charge Code	1711604
Hospital Revenue Code	259
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.00
Rate for Payer: Aetna of CA Government/Medicare	$1.00
Rate for Payer: Cash Price	$0.75
Rate for Payer: Health Smart Auto/Commercial	$1.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.00
Rate for Payer: LLUH Dept of Risk Management WC	$0.92
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.25

FELBAMATE 400 MG TABLET [10024]

Facility

OP

$2.88

Service Code	NDC 65162-734-09
Hospital Charge Code	1711604
Hospital Revenue Code	259
Min. Negotiated Rate	$1.58
Max. Negotiated Rate	$2.16
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.73
Rate for Payer: Aetna of CA Government/Medicare	$1.73
Rate for Payer: Cash Price	$1.30
Rate for Payer: Health Smart Auto/Commercial	$1.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.73
Rate for Payer: LLUH Dept of Risk Management WC	$1.58
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.16

FELBAMATE 400 MG TABLET [10024]

Facility

OP

$17.64

Service Code	NDC 0037-0430-01
Hospital Charge Code	1711604
Hospital Revenue Code	259
Min. Negotiated Rate	$9.70
Max. Negotiated Rate	$13.23
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.58
Rate for Payer: Aetna of CA Government/Medicare	$10.58
Rate for Payer: Cash Price	$7.94
Rate for Payer: Health Smart Auto/Commercial	$10.58
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.58
Rate for Payer: LLUH Dept of Risk Management WC	$9.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$13.23

FELBAMATE 400 MG TABLET [10024]

Facility

IP

$1.67

Service Code	NDC 72578-056-01
Hospital Charge Code	1711604
Hospital Revenue Code	259
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.34
Rate for Payer: Cash Price	$0.75
Rate for Payer: Cigna of CA HMO/PPO	$1.34
Rate for Payer: Health Smart Auto/Commercial	$1.00
Rate for Payer: LLUH Dept of Risk Management WC	$0.92
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.25

FELBAMATE 400 MG TABLET [10024]

Facility

IP

$2.88

Service Code	NDC 65162-734-09
Hospital Charge Code	1711604
Hospital Revenue Code	259
Min. Negotiated Rate	$1.58
Max. Negotiated Rate	$2.30
Rate for Payer: Cash Price	$1.30
Rate for Payer: Cigna of CA HMO/PPO	$2.30
Rate for Payer: Health Smart Auto/Commercial	$1.73
Rate for Payer: LLUH Dept of Risk Management WC	$1.58
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.16

FELBAMATE 400 MG TABLET [10024]

Facility

IP

$17.64

Service Code	NDC 0037-0430-01
Hospital Charge Code	1711604
Hospital Revenue Code	259
Min. Negotiated Rate	$9.70
Max. Negotiated Rate	$14.11
Rate for Payer: Cash Price	$7.94
Rate for Payer: Cigna of CA HMO/PPO	$14.11
Rate for Payer: Health Smart Auto/Commercial	$10.58
Rate for Payer: LLUH Dept of Risk Management WC	$9.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$13.23

FELBAMATE 600 MG/5 ML ORAL SUSPENSION [10023]

Facility

IP

$0.50

Service Code	NDC 66689-825-08
Hospital Charge Code	1715111
Hospital Revenue Code	259
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.40
Rate for Payer: Cash Price	$0.23
Rate for Payer: Cigna of CA HMO/PPO	$0.40
Rate for Payer: Health Smart Auto/Commercial	$0.30
Rate for Payer: LLUH Dept of Risk Management WC	$0.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.38

FELBAMATE 600 MG/5 ML ORAL SUSPENSION [10023]

Facility

IP

$9.15

Service Code	NDC 0037-0442-67
Hospital Charge Code	1715111
Hospital Revenue Code	259
Min. Negotiated Rate	$5.03
Max. Negotiated Rate	$7.32
Rate for Payer: Cash Price	$4.12
Rate for Payer: Cigna of CA HMO/PPO	$7.32
Rate for Payer: Health Smart Auto/Commercial	$5.49
Rate for Payer: LLUH Dept of Risk Management WC	$5.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.86

FELBAMATE 600 MG/5 ML ORAL SUSPENSION [10023]

Facility

OP

$0.50

Service Code	NDC 66689-825-08
Hospital Charge Code	1715111
Hospital Revenue Code	259
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.38
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.30
Rate for Payer: Aetna of CA Government/Medicare	$0.30
Rate for Payer: Cash Price	$0.23
Rate for Payer: Health Smart Auto/Commercial	$0.30
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.30
Rate for Payer: LLUH Dept of Risk Management WC	$0.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.38

FELBAMATE 600 MG/5 ML ORAL SUSPENSION [10023]

Facility

OP

$1.04

Service Code	NDC 65162-686-88
Hospital Charge Code	1715111
Hospital Revenue Code	259
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$0.78
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.62
Rate for Payer: Aetna of CA Government/Medicare	$0.62
Rate for Payer: Cash Price	$0.47
Rate for Payer: Health Smart Auto/Commercial	$0.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.62
Rate for Payer: LLUH Dept of Risk Management WC	$0.57
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.78

FELBAMATE 600 MG/5 ML ORAL SUSPENSION [10023]

Facility

IP

$1.04

Service Code	NDC 65162-686-88
Hospital Charge Code	1715111
Hospital Revenue Code	259
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$0.83
Rate for Payer: Cash Price	$0.47
Rate for Payer: Cigna of CA HMO/PPO	$0.83
Rate for Payer: Health Smart Auto/Commercial	$0.62
Rate for Payer: LLUH Dept of Risk Management WC	$0.57
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.78

FELBAMATE 600 MG/5 ML ORAL SUSPENSION [10023]

Facility

IP

$2.57

Service Code	NDC 51525-0442-8
Hospital Charge Code	1715111
Hospital Revenue Code	259
Min. Negotiated Rate	$1.41
Max. Negotiated Rate	$2.06
Rate for Payer: Cash Price	$1.16
Rate for Payer: Cigna of CA HMO/PPO	$2.06
Rate for Payer: Health Smart Auto/Commercial	$1.54
Rate for Payer: LLUH Dept of Risk Management WC	$1.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.93

FELBAMATE 600 MG/5 ML ORAL SUSPENSION [10023]

Facility

OP

$2.57

Service Code	NDC 51525-0442-8
Hospital Charge Code	1715111
Hospital Revenue Code	259
Min. Negotiated Rate	$1.41
Max. Negotiated Rate	$1.93
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.54
Rate for Payer: Aetna of CA Government/Medicare	$1.54
Rate for Payer: Cash Price	$1.16
Rate for Payer: Health Smart Auto/Commercial	$1.54
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.54
Rate for Payer: LLUH Dept of Risk Management WC	$1.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.93

FELBAMATE 600 MG/5 ML ORAL SUSPENSION [10023]

Facility

OP

$9.15

Service Code	NDC 0037-0442-67
Hospital Charge Code	1715111
Hospital Revenue Code	259
Min. Negotiated Rate	$5.03
Max. Negotiated Rate	$6.86
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.49
Rate for Payer: Aetna of CA Government/Medicare	$5.49
Rate for Payer: Cash Price	$4.12
Rate for Payer: Health Smart Auto/Commercial	$5.49
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.49
Rate for Payer: LLUH Dept of Risk Management WC	$5.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.86

FELBAMATE 600 MG TABLET [10025]

Facility

OP

$1.30

Service Code	NDC 62559-731-01
Hospital Charge Code	1711593
Hospital Revenue Code	259
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.78
Rate for Payer: Aetna of CA Government/Medicare	$0.78
Rate for Payer: Cash Price	$0.59
Rate for Payer: Health Smart Auto/Commercial	$0.78
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.78
Rate for Payer: LLUH Dept of Risk Management WC	$0.72
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.98

FELBAMATE 600 MG TABLET [10025]

Facility

IP

$1.30

Service Code	NDC 62559-731-01
Hospital Charge Code	1711593
Hospital Revenue Code	259
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$1.04
Rate for Payer: Cash Price	$0.59
Rate for Payer: Cigna of CA HMO/PPO	$1.04
Rate for Payer: Health Smart Auto/Commercial	$0.78
Rate for Payer: LLUH Dept of Risk Management WC	$0.72
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.98

FELODIPINE ER 10 MG TABLET,EXTENDED RELEASE 24 HR [27491]

Facility

OP

$2.34

Service Code	NDC 53489-370-01
Hospital Charge Code	1712157
Hospital Revenue Code	259
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$1.76
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.40
Rate for Payer: Aetna of CA Government/Medicare	$1.40
Rate for Payer: Cash Price	$1.05
Rate for Payer: Health Smart Auto/Commercial	$1.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.40
Rate for Payer: LLUH Dept of Risk Management WC	$1.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.76

FELODIPINE ER 10 MG TABLET,EXTENDED RELEASE 24 HR [27491]

Facility

IP

$2.34

Service Code	NDC 53489-370-01
Hospital Charge Code	1712157
Hospital Revenue Code	259
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$1.87
Rate for Payer: Cash Price	$1.05
Rate for Payer: Cigna of CA HMO/PPO	$1.87
Rate for Payer: Health Smart Auto/Commercial	$1.40
Rate for Payer: LLUH Dept of Risk Management WC	$1.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.76

FELODIPINE ER 2.5 MG TABLET,EXTENDED RELEASE 24 HR [27489]

Facility

OP

$0.65

Service Code	NDC 57237-108-01
Hospital Charge Code	1712195
Hospital Revenue Code	259
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.49
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.39
Rate for Payer: Aetna of CA Government/Medicare	$0.39
Rate for Payer: Cash Price	$0.29
Rate for Payer: Health Smart Auto/Commercial	$0.39
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.39
Rate for Payer: LLUH Dept of Risk Management WC	$0.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.49

FELODIPINE ER 2.5 MG TABLET,EXTENDED RELEASE 24 HR [27489]

Facility

IP

$0.65

Service Code	NDC 57237-108-01
Hospital Charge Code	1712195
Hospital Revenue Code	259
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.52
Rate for Payer: Cash Price	$0.29
Rate for Payer: Cigna of CA HMO/PPO	$0.52
Rate for Payer: Health Smart Auto/Commercial	$0.39
Rate for Payer: LLUH Dept of Risk Management WC	$0.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.49

FELODIPINE ER 2.5 MG TABLET,EXTENDED RELEASE 24 HR [27489]

Facility

IP

$0.46

Service Code	NDC 68462-233-01
Hospital Charge Code	1712195
Hospital Revenue Code	259
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.37
Rate for Payer: Cash Price	$0.21
Rate for Payer: Cigna of CA HMO/PPO	$0.37
Rate for Payer: Health Smart Auto/Commercial	$0.28
Rate for Payer: LLUH Dept of Risk Management WC	$0.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.35

FELODIPINE ER 2.5 MG TABLET,EXTENDED RELEASE 24 HR [27489]

Facility

OP

$0.46

Service Code	NDC 68462-233-01
Hospital Charge Code	1712195
Hospital Revenue Code	259
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.35
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.28
Rate for Payer: Aetna of CA Government/Medicare	$0.28
Rate for Payer: Cash Price	$0.21
Rate for Payer: Health Smart Auto/Commercial	$0.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.28
Rate for Payer: LLUH Dept of Risk Management WC	$0.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.35

FENOFIBRATE 150 MG CAPSULE [88131]

Facility

OP

$9.54

Service Code	NDC 66869-147-30
Hospital Charge Code	1712564
Hospital Revenue Code	259
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$7.16
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.72
Rate for Payer: Aetna of CA Government/Medicare	$5.72
Rate for Payer: Cash Price	$4.29
Rate for Payer: Health Smart Auto/Commercial	$5.72
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.72
Rate for Payer: LLUH Dept of Risk Management WC	$5.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.16

FENOFIBRATE 150 MG CAPSULE [88131]

Facility

IP

$9.54

Service Code	NDC 66869-147-30
Hospital Charge Code	1712564
Hospital Revenue Code	259
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$7.63
Rate for Payer: Cash Price	$4.29
Rate for Payer: Cigna of CA HMO/PPO	$7.63
Rate for Payer: Health Smart Auto/Commercial	$5.72
Rate for Payer: LLUH Dept of Risk Management WC	$5.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.16

FENOFIBRATE 160 MG TABLET [28252]

Facility

IP

$3.51

Service Code	NDC 68084-328-21
Hospital Charge Code	1712496
Hospital Revenue Code	259
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$2.81
Rate for Payer: Cash Price	$1.58
Rate for Payer: Cigna of CA HMO/PPO	$2.81
Rate for Payer: Health Smart Auto/Commercial	$2.11
Rate for Payer: LLUH Dept of Risk Management WC	$1.93
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.63

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