|
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 |
$0.31 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.77
|
| Rate for Payer: Blue Distinction Transplant |
$0.78
|
| Rate for Payer: Blue Shield of California Commercial |
$0.96
|
| Rate for Payer: Blue Shield of California EPN |
$0.76
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cigna of CA HMO |
$0.91
|
| Rate for Payer: Cigna of CA PPO |
$0.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.10
|
| Rate for Payer: Dignity Health Media |
$1.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.78
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$1.04
|
| Rate for Payer: Networks By Design Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.65
|
| Rate for Payer: United Healthcare All Other HMO |
$0.65
|
| Rate for Payer: United Healthcare HMO Rider |
$0.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1.10
|
|
|
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 |
$0.56 |
| Max. Negotiated Rate |
$1.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.39
|
| Rate for Payer: Blue Distinction Transplant |
$1.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1.72
|
| Rate for Payer: Blue Shield of California EPN |
$1.37
|
| Rate for Payer: Cash Price |
$1.05
|
| Rate for Payer: Cigna of CA HMO |
$1.64
|
| Rate for Payer: Cigna of CA PPO |
$1.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.99
|
| Rate for Payer: Dignity Health Media |
$1.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.94
|
| Rate for Payer: Galaxy Health WC |
$1.99
|
| Rate for Payer: Global Benefits Group Commercial |
$1.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$1.87
|
| Rate for Payer: Networks By Design Commercial |
$1.52
|
| Rate for Payer: Prime Health Services Commercial |
$1.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.17
|
| Rate for Payer: United Healthcare All Other HMO |
$1.17
|
| Rate for Payer: United Healthcare HMO Rider |
$1.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.99
|
| Rate for Payer: Vantage Medical Group Senior |
$1.99
|
|
|
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 |
$0.56 |
| Max. Negotiated Rate |
$1.99 |
| Rate for Payer: Blue Shield of California Commercial |
$1.67
|
| Rate for Payer: Blue Shield of California EPN |
$1.20
|
| Rate for Payer: Cash Price |
$1.05
|
| Rate for Payer: Cigna of CA HMO |
$1.64
|
| Rate for Payer: Cigna of CA PPO |
$1.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.94
|
| Rate for Payer: Galaxy Health WC |
$1.99
|
| Rate for Payer: Global Benefits Group Commercial |
$1.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$1.87
|
| Rate for Payer: Networks By Design Commercial |
$1.52
|
| Rate for Payer: Prime Health Services Commercial |
$1.99
|
|
|
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 |
$0.16 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.39
|
| Rate for Payer: Blue Distinction Transplant |
$0.39
|
| 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 |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.46
|
| Rate for Payer: Cigna of CA PPO |
$0.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.55
|
| Rate for Payer: Dignity Health Media |
$0.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.55
|
| Rate for Payer: Global Benefits Group Commercial |
$0.39
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.52
|
| Rate for Payer: Networks By Design Commercial |
$0.42
|
| Rate for Payer: Prime Health Services Commercial |
$0.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.33
|
| Rate for Payer: United Healthcare All Other HMO |
$0.33
|
| Rate for Payer: United Healthcare HMO Rider |
$0.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: Vantage Medical Group Senior |
$0.55
|
|
|
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 |
$0.16 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California EPN |
$0.33
|
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.46
|
| Rate for Payer: Cigna of CA PPO |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.55
|
| Rate for Payer: Global Benefits Group Commercial |
$0.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.52
|
| Rate for Payer: Networks By Design Commercial |
$0.42
|
| Rate for Payer: Prime Health Services Commercial |
$0.55
|
|
|
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 |
$0.11 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: Blue Shield of California Commercial |
$0.33
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Cigna of CA HMO |
$0.32
|
| Rate for Payer: Cigna of CA PPO |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.30
|
| Rate for Payer: Prime Health Services Commercial |
$0.39
|
|
|
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 |
$0.11 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.27
|
| Rate for Payer: Blue Distinction Transplant |
$0.28
|
| Rate for Payer: Blue Shield of California Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Cigna of CA HMO |
$0.32
|
| Rate for Payer: Cigna of CA PPO |
$0.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.39
|
| Rate for Payer: Dignity Health Media |
$0.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.28
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.30
|
| Rate for Payer: Prime Health Services Commercial |
$0.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.23
|
| Rate for Payer: United Healthcare All Other HMO |
$0.23
|
| Rate for Payer: United Healthcare HMO Rider |
$0.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.39
|
| Rate for Payer: Vantage Medical Group Senior |
$0.39
|
|
|
FEMALE REPRODUCTIVE SYSTEM INFECTIONS
|
Facility
|
IP
|
$25,330.32
|
|
|
Service Code
|
APR-DRG 5314
|
| Min. Negotiated Rate |
$19,431.03 |
| Max. Negotiated Rate |
$25,330.32 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19,431.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25,330.32
|
|
|
FEMALE REPRODUCTIVE SYSTEM INFECTIONS
|
Facility
|
IP
|
$10,023.60
|
|
|
Service Code
|
APR-DRG 5312
|
| Min. Negotiated Rate |
$7,689.16 |
| Max. Negotiated Rate |
$10,023.60 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,689.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,023.60
|
|
|
FEMALE REPRODUCTIVE SYSTEM INFECTIONS
|
Facility
|
IP
|
$15,476.98
|
|
|
Service Code
|
APR-DRG 5313
|
| Min. Negotiated Rate |
$11,872.47 |
| Max. Negotiated Rate |
$15,476.98 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,872.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15,476.98
|
|
|
FEMALE REPRODUCTIVE SYSTEM INFECTIONS
|
Facility
|
IP
|
$7,679.08
|
|
|
Service Code
|
APR-DRG 5311
|
| Min. Negotiated Rate |
$5,890.66 |
| Max. Negotiated Rate |
$7,679.08 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,890.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,679.08
|
|
|
FEMALE REPRODUCTIVE SYSTEM MALIGNANCY
|
Facility
|
IP
|
$16,450.62
|
|
|
Service Code
|
APR-DRG 5303
|
| Min. Negotiated Rate |
$12,619.36 |
| Max. Negotiated Rate |
$16,450.62 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12,619.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,450.62
|
|
|
FEMALE REPRODUCTIVE SYSTEM MALIGNANCY
|
Facility
|
IP
|
$8,402.66
|
|
|
Service Code
|
APR-DRG 5301
|
| Min. Negotiated Rate |
$6,445.72 |
| Max. Negotiated Rate |
$8,402.66 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,445.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,402.66
|
|
|
FEMALE REPRODUCTIVE SYSTEM MALIGNANCY
|
Facility
|
IP
|
$26,417.47
|
|
|
Service Code
|
APR-DRG 5304
|
| Min. Negotiated Rate |
$20,264.98 |
| Max. Negotiated Rate |
$26,417.47 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20,264.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26,417.47
|
|
|
FEMALE REPRODUCTIVE SYSTEM MALIGNANCY
|
Facility
|
IP
|
$11,314.67
|
|
|
Service Code
|
APR-DRG 5302
|
| Min. Negotiated Rate |
$8,679.54 |
| Max. Negotiated Rate |
$11,314.67 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8,679.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,314.67
|
|
|
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES
|
Facility
|
IP
|
$12,497.57
|
|
|
Service Code
|
APR-DRG 5141
|
| Min. Negotiated Rate |
$9,586.95 |
| Max. Negotiated Rate |
$12,497.57 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9,586.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,497.57
|
|
|
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES
|
Facility
|
IP
|
$59,811.72
|
|
|
Service Code
|
APR-DRG 5144
|
| Min. Negotiated Rate |
$45,881.88 |
| Max. Negotiated Rate |
$59,811.72 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$45,881.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59,811.72
|
|
|
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES
|
Facility
|
IP
|
$18,539.74
|
|
|
Service Code
|
APR-DRG 5142
|
| Min. Negotiated Rate |
$14,221.94 |
| Max. Negotiated Rate |
$18,539.74 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14,221.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,539.74
|
|
|
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES
|
Facility
|
IP
|
$35,784.88
|
|
|
Service Code
|
APR-DRG 5143
|
| Min. Negotiated Rate |
$27,450.77 |
| Max. Negotiated Rate |
$35,784.88 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27,450.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35,784.88
|
|
|
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 |
$2.29 |
| Max. Negotiated Rate |
$8.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.68
|
| Rate for Payer: Blue Distinction Transplant |
$5.72
|
| Rate for Payer: Blue Shield of California Commercial |
$7.03
|
| Rate for Payer: Blue Shield of California EPN |
$5.57
|
| Rate for Payer: Cash Price |
$4.29
|
| Rate for Payer: Cigna of CA HMO |
$6.68
|
| Rate for Payer: Cigna of CA PPO |
$6.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.11
|
| Rate for Payer: Dignity Health Media |
$8.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.82
|
| Rate for Payer: Galaxy Health WC |
$8.11
|
| Rate for Payer: Global Benefits Group Commercial |
$5.72
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.29
|
| Rate for Payer: Multiplan Commercial |
$7.63
|
| Rate for Payer: Networks By Design Commercial |
$6.20
|
| Rate for Payer: Prime Health Services Commercial |
$8.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.77
|
| Rate for Payer: United Healthcare All Other HMO |
$4.77
|
| Rate for Payer: United Healthcare HMO Rider |
$4.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.11
|
| Rate for Payer: Vantage Medical Group Senior |
$8.11
|
|
|
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 |
$2.29 |
| Max. Negotiated Rate |
$8.11 |
| Rate for Payer: Blue Shield of California Commercial |
$6.79
|
| Rate for Payer: Blue Shield of California EPN |
$4.88
|
| Rate for Payer: Cash Price |
$4.29
|
| Rate for Payer: Cigna of CA HMO |
$6.68
|
| Rate for Payer: Cigna of CA PPO |
$6.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.82
|
| Rate for Payer: Galaxy Health WC |
$8.11
|
| Rate for Payer: Global Benefits Group Commercial |
$5.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.29
|
| Rate for Payer: Multiplan Commercial |
$7.63
|
| Rate for Payer: Networks By Design Commercial |
$6.20
|
| Rate for Payer: Prime Health Services Commercial |
$8.11
|
|
|
FENOFIBRATE 160 MG TABLET [28252]
|
Facility
|
IP
|
$3.51
|
|
|
Service Code
|
NDC 68084-328-11
|
| Hospital Charge Code |
1712496
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$2.98 |
| Rate for Payer: Blue Shield of California Commercial |
$2.50
|
| Rate for Payer: Blue Shield of California EPN |
$1.80
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Cigna of CA HMO |
$2.46
|
| Rate for Payer: Cigna of CA PPO |
$2.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.40
|
| Rate for Payer: Galaxy Health WC |
$2.98
|
| Rate for Payer: Global Benefits Group Commercial |
$2.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| Rate for Payer: Multiplan Commercial |
$2.81
|
| Rate for Payer: Networks By Design Commercial |
$2.28
|
| Rate for Payer: Prime Health Services Commercial |
$2.98
|
|
|
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 |
$0.84 |
| Max. Negotiated Rate |
$2.98 |
| Rate for Payer: Blue Shield of California Commercial |
$2.50
|
| Rate for Payer: Blue Shield of California EPN |
$1.80
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Cigna of CA HMO |
$2.46
|
| Rate for Payer: Cigna of CA PPO |
$2.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.40
|
| Rate for Payer: Galaxy Health WC |
$2.98
|
| Rate for Payer: Global Benefits Group Commercial |
$2.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| Rate for Payer: Multiplan Commercial |
$2.81
|
| Rate for Payer: Networks By Design Commercial |
$2.28
|
| Rate for Payer: Prime Health Services Commercial |
$2.98
|
|
|
FENOFIBRATE 160 MG TABLET [28252]
|
Facility
|
IP
|
$2.88
|
|
|
Service Code
|
NDC 42858-660-45
|
| Hospital Charge Code |
1712496
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$2.45 |
| Rate for Payer: Blue Shield of California Commercial |
$2.05
|
| Rate for Payer: Blue Shield of California EPN |
$1.47
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Cigna of CA HMO |
$2.02
|
| Rate for Payer: Cigna of CA PPO |
$2.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.15
|
| Rate for Payer: Galaxy Health WC |
$2.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$2.30
|
| Rate for Payer: Networks By Design Commercial |
$1.87
|
| Rate for Payer: Prime Health Services Commercial |
$2.45
|
|
|
FENOFIBRATE 160 MG TABLET [28252]
|
Facility
|
OP
|
$2.88
|
|
|
Service Code
|
NDC 42858-660-45
|
| Hospital Charge Code |
1712496
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$2.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.72
|
| Rate for Payer: Blue Distinction Transplant |
$1.73
|
| Rate for Payer: Blue Shield of California Commercial |
$2.12
|
| Rate for Payer: Blue Shield of California EPN |
$1.68
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Cigna of CA HMO |
$2.02
|
| Rate for Payer: Cigna of CA PPO |
$2.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.45
|
| Rate for Payer: Dignity Health Media |
$2.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.15
|
| Rate for Payer: Galaxy Health WC |
$2.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1.73
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$2.30
|
| Rate for Payer: Networks By Design Commercial |
$1.87
|
| Rate for Payer: Prime Health Services Commercial |
$2.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.44
|
| Rate for Payer: United Healthcare All Other HMO |
$1.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2.45
|
|
