|
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 |
$0.09 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.28
|
| 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 Exchange |
$0.22
|
| 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 |
$0.29
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Central Health Plan Commercial |
$0.37
|
| 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 Management Network EPO/PPO |
$0.41
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.16
|
| 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 |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: Networks By Design Commercial |
$0.30
|
| Rate for Payer: Prime Health Services Commercial |
$0.39
|
| Rate for Payer: Riverside University Health System MISP |
$0.18
|
| 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 Medi-Cal |
$0.39
|
| Rate for Payer: Vantage Medical Group Senior |
$0.39
|
|
|
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 |
$0.09 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Blue Shield of California Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.25
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Central Health Plan Commercial |
$0.37
|
| 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: Health Management Network EPO/PPO |
$0.41
|
| 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 |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| 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
|
$0.65
|
|
|
Service Code
|
NDC 57237-108-01
|
| Hospital Charge Code |
1712195
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.39
|
| 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 Exchange |
$0.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.38
|
| Rate for Payer: Blue Distinction Transplant |
$0.39
|
| Rate for Payer: Blue Shield of California Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California EPN |
$0.32
|
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: Central Health Plan Commercial |
$0.52
|
| 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 Management Network EPO/PPO |
$0.59
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.23
|
| 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 |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.49
|
| Rate for Payer: Networks By Design Commercial |
$0.42
|
| Rate for Payer: Prime Health Services Commercial |
$0.55
|
| Rate for Payer: Riverside University Health System MISP |
$0.26
|
| 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 Medi-Cal |
$0.55
|
| Rate for Payer: Vantage Medical Group Senior |
$0.55
|
|
|
FEMALE REPRODUCTIVE SYSTEM INFECTIONS
|
Facility
|
IP
|
$25,330.32
|
|
|
Service Code
|
APR-DRG 5314
|
| Min. Negotiated Rate |
$15,998.10 |
| Max. Negotiated Rate |
$25,330.32 |
| Rate for Payer: Adventist Health Medi-Cal |
$15,998.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19,064.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25,330.32
|
|
|
FEMALE REPRODUCTIVE SYSTEM INFECTIONS
|
Facility
|
IP
|
$15,476.98
|
|
|
Service Code
|
APR-DRG 5313
|
| Min. Negotiated Rate |
$9,774.94 |
| Max. Negotiated Rate |
$15,476.98 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,774.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11,648.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15,476.98
|
|
|
FEMALE REPRODUCTIVE SYSTEM INFECTIONS
|
Facility
|
IP
|
$10,023.60
|
|
|
Service Code
|
APR-DRG 5312
|
| Min. Negotiated Rate |
$6,330.70 |
| Max. Negotiated Rate |
$10,023.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,330.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,544.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,023.60
|
|
|
FEMALE REPRODUCTIVE SYSTEM INFECTIONS
|
Facility
|
IP
|
$7,679.08
|
|
|
Service Code
|
APR-DRG 5311
|
| Min. Negotiated Rate |
$4,849.94 |
| Max. Negotiated Rate |
$7,679.08 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,849.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,779.52
|
| 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 |
$10,389.86 |
| Max. Negotiated Rate |
$16,450.62 |
| Rate for Payer: Adventist Health Medi-Cal |
$10,389.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12,381.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,450.62
|
|
|
FEMALE REPRODUCTIVE SYSTEM MALIGNANCY
|
Facility
|
IP
|
$26,417.47
|
|
|
Service Code
|
APR-DRG 5304
|
| Min. Negotiated Rate |
$16,684.72 |
| Max. Negotiated Rate |
$26,417.47 |
| Rate for Payer: Adventist Health Medi-Cal |
$16,684.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19,882.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26,417.47
|
|
|
FEMALE REPRODUCTIVE SYSTEM MALIGNANCY
|
Facility
|
IP
|
$8,402.66
|
|
|
Service Code
|
APR-DRG 5301
|
| Min. Negotiated Rate |
$5,306.94 |
| Max. Negotiated Rate |
$8,402.66 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,306.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,324.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,402.66
|
|
|
FEMALE REPRODUCTIVE SYSTEM MALIGNANCY
|
Facility
|
IP
|
$11,314.67
|
|
|
Service Code
|
APR-DRG 5302
|
| Min. Negotiated Rate |
$7,146.11 |
| Max. Negotiated Rate |
$11,314.67 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,146.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,515.78
|
| 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 |
$7,893.20 |
| Max. Negotiated Rate |
$12,497.57 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,893.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,406.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,497.57
|
|
|
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES
|
Facility
|
IP
|
$35,784.88
|
|
|
Service Code
|
APR-DRG 5143
|
| Min. Negotiated Rate |
$22,600.98 |
| Max. Negotiated Rate |
$35,784.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$22,600.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26,932.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35,784.88
|
|
|
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES
|
Facility
|
IP
|
$59,811.72
|
|
|
Service Code
|
APR-DRG 5144
|
| Min. Negotiated Rate |
$37,775.82 |
| Max. Negotiated Rate |
$59,811.72 |
| Rate for Payer: Adventist Health Medi-Cal |
$37,775.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$45,016.19
|
| 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 |
$11,709.31 |
| Max. Negotiated Rate |
$18,539.74 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,709.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13,953.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,539.74
|
|
|
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 |
$1.91 |
| Max. Negotiated Rate |
$8.59 |
| Rate for Payer: Blue Shield of California Commercial |
$7.16
|
| Rate for Payer: Blue Shield of California EPN |
$5.09
|
| Rate for Payer: Cash Price |
$4.29
|
| Rate for Payer: Central Health Plan Commercial |
$7.63
|
| 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: Health Management Network EPO/PPO |
$8.59
|
| 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 |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$7.16
|
| Rate for Payer: Networks By Design Commercial |
$6.20
|
| Rate for Payer: Prime Health Services Commercial |
$8.11
|
|
|
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 |
$1.91 |
| Max. Negotiated Rate |
$8.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.79
|
| 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 Exchange |
$4.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.64
|
| Rate for Payer: Blue Distinction Transplant |
$5.72
|
| Rate for Payer: Blue Shield of California Commercial |
$6.00
|
| Rate for Payer: Blue Shield of California EPN |
$4.67
|
| Rate for Payer: Cash Price |
$4.29
|
| Rate for Payer: Central Health Plan Commercial |
$7.63
|
| 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 Management Network EPO/PPO |
$8.59
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.34
|
| 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 |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$7.16
|
| Rate for Payer: Networks By Design Commercial |
$6.20
|
| Rate for Payer: Prime Health Services Commercial |
$8.11
|
| Rate for Payer: Riverside University Health System MISP |
$3.82
|
| 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 Medi-Cal |
$8.11
|
| Rate for Payer: Vantage Medical Group Senior |
$8.11
|
|
|
FENOFIBRATE 160 MG TABLET [28252]
|
Facility
|
OP
|
$3.51
|
|
|
Service Code
|
NDC 68084-328-11
|
| Hospital Charge Code |
1712496
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$3.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.07
|
| Rate for Payer: Blue Distinction Transplant |
$2.11
|
| Rate for Payer: Blue Shield of California Commercial |
$2.21
|
| Rate for Payer: Blue Shield of California EPN |
$1.72
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Central Health Plan Commercial |
$2.81
|
| Rate for Payer: Cigna of CA HMO |
$2.46
|
| Rate for Payer: Cigna of CA PPO |
$2.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.98
|
| Rate for Payer: Dignity Health Media |
$2.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.40
|
| Rate for Payer: Galaxy Health WC |
$2.98
|
| Rate for Payer: Global Benefits Group Commercial |
$2.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.16
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.23
|
| 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 |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$2.63
|
| Rate for Payer: Networks By Design Commercial |
$2.28
|
| Rate for Payer: Prime Health Services Commercial |
$2.98
|
| Rate for Payer: Riverside University Health System MISP |
$1.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.76
|
| Rate for Payer: United Healthcare All Other HMO |
$1.76
|
| Rate for Payer: United Healthcare HMO Rider |
$1.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.98
|
| Rate for Payer: Vantage Medical Group Senior |
$2.98
|
|
|
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 |
$0.70 |
| Max. Negotiated Rate |
$3.16 |
| Rate for Payer: Blue Shield of California Commercial |
$2.63
|
| Rate for Payer: Blue Shield of California EPN |
$1.87
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Central Health Plan Commercial |
$2.81
|
| 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: Health Management Network EPO/PPO |
$3.16
|
| 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 |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$2.63
|
| Rate for Payer: Networks By Design Commercial |
$2.28
|
| Rate for Payer: Prime Health Services Commercial |
$2.98
|
|
|
FENOFIBRATE 160 MG TABLET [28252]
|
Facility
|
OP
|
$3.51
|
|
|
Service Code
|
NDC 68084-328-21
|
| Hospital Charge Code |
1712496
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$3.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.07
|
| Rate for Payer: Blue Distinction Transplant |
$2.11
|
| Rate for Payer: Blue Shield of California Commercial |
$2.21
|
| Rate for Payer: Blue Shield of California EPN |
$1.72
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Central Health Plan Commercial |
$2.81
|
| Rate for Payer: Cigna of CA HMO |
$2.46
|
| Rate for Payer: Cigna of CA PPO |
$2.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.98
|
| Rate for Payer: Dignity Health Media |
$2.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.40
|
| Rate for Payer: Galaxy Health WC |
$2.98
|
| Rate for Payer: Global Benefits Group Commercial |
$2.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.16
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.23
|
| 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 |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$2.63
|
| Rate for Payer: Networks By Design Commercial |
$2.28
|
| Rate for Payer: Prime Health Services Commercial |
$2.98
|
| Rate for Payer: Riverside University Health System MISP |
$1.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.76
|
| Rate for Payer: United Healthcare All Other HMO |
$1.76
|
| Rate for Payer: United Healthcare HMO Rider |
$1.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.98
|
| Rate for Payer: Vantage Medical Group Senior |
$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 |
$0.70 |
| Max. Negotiated Rate |
$3.16 |
| Rate for Payer: Blue Shield of California Commercial |
$2.63
|
| Rate for Payer: Blue Shield of California EPN |
$1.87
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Central Health Plan Commercial |
$2.81
|
| 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: Health Management Network EPO/PPO |
$3.16
|
| 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 |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$2.63
|
| Rate for Payer: Networks By Design Commercial |
$2.28
|
| Rate for Payer: Prime Health Services Commercial |
$2.98
|
|
|
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 |
$0.58 |
| Max. Negotiated Rate |
$2.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.75
|
| 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 Exchange |
$1.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.70
|
| Rate for Payer: Blue Distinction Transplant |
$1.73
|
| Rate for Payer: Blue Shield of California Commercial |
$1.81
|
| Rate for Payer: Blue Shield of California EPN |
$1.41
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Central Health Plan Commercial |
$2.30
|
| 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 Management Network EPO/PPO |
$2.59
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.01
|
| 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 |
$0.58
|
| Rate for Payer: Multiplan Commercial |
$2.16
|
| Rate for Payer: Networks By Design Commercial |
$1.87
|
| Rate for Payer: Prime Health Services Commercial |
$2.45
|
| Rate for Payer: Riverside University Health System MISP |
$1.15
|
| 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 Medi-Cal |
$2.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2.45
|
|
|
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 |
$0.58 |
| Max. Negotiated Rate |
$2.59 |
| Rate for Payer: Blue Shield of California Commercial |
$2.16
|
| Rate for Payer: Blue Shield of California EPN |
$1.54
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Central Health Plan Commercial |
$2.30
|
| 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: Health Management Network EPO/PPO |
$2.59
|
| 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 |
$0.58
|
| Rate for Payer: Multiplan Commercial |
$2.16
|
| Rate for Payer: Networks By Design Commercial |
$1.87
|
| Rate for Payer: Prime Health Services Commercial |
$2.45
|
|
|
FENOFIBRATE 54 MG TABLET [31336]
|
Facility
|
IP
|
$0.82
|
|
|
Service Code
|
NDC 42858-454-45
|
| Hospital Charge Code |
1712510
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.74 |
| Rate for Payer: Blue Shield of California Commercial |
$0.62
|
| Rate for Payer: Blue Shield of California EPN |
$0.44
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: Central Health Plan Commercial |
$0.66
|
| Rate for Payer: Cigna of CA HMO |
$0.57
|
| Rate for Payer: Cigna of CA PPO |
$0.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.33
|
| Rate for Payer: Galaxy Health WC |
$0.70
|
| Rate for Payer: Global Benefits Group Commercial |
$0.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
| Rate for Payer: Networks By Design Commercial |
$0.53
|
| Rate for Payer: Prime Health Services Commercial |
$0.70
|
|
|
FENOFIBRATE 54 MG TABLET [31336]
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
NDC 63304-900-90
|
| Hospital Charge Code |
1712510
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Blue Distinction Transplant |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Central Health Plan Commercial |
$0.21
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.22
|
| Rate for Payer: Dignity Health Media |
$0.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.23
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.17
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
| Rate for Payer: Riverside University Health System MISP |
$0.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Vantage Medical Group Senior |
$0.22
|
|
