FLECAINIDE 100 MG TABLET [10041]
|
Facility
OP
|
$1.13
|
|
Service Code
|
NDC 0054-0011-20
|
Hospital Charge Code |
1711440
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.20 |
Max. Negotiated Rate |
$0.96 |
Rate for Payer: Adventist Health Commercial |
$0.23
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.60
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.78
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.96
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.62
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.85
|
Rate for Payer: Blue Shield of California Commercial |
$0.70
|
Rate for Payer: Blue Shield of California EPN |
$0.66
|
Rate for Payer: Cash Price |
$0.51
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.73
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.96
|
Rate for Payer: Dignity Health Medi-Cal |
$0.96
|
Rate for Payer: Dignity Health Senior |
$0.96
|
Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
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 Commercial |
$0.54
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
Rate for Payer: Multiplan Commercial |
$0.85
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.96
|
Rate for Payer: Vantage Medical Group Senior |
$0.96
|
|
FLECAINIDE 100 MG TABLET [10041]
|
Facility
OP
|
$0.84
|
|
Service Code
|
NDC 65862-622-01
|
Hospital Charge Code |
1711440
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.15 |
Max. Negotiated Rate |
$0.71 |
Rate for Payer: Adventist Health Commercial |
$0.17
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.45
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.58
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.71
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.46
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.63
|
Rate for Payer: Blue Shield of California Commercial |
$0.52
|
Rate for Payer: Blue Shield of California EPN |
$0.49
|
Rate for Payer: Cash Price |
$0.38
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.55
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.71
|
Rate for Payer: Dignity Health Medi-Cal |
$0.71
|
Rate for Payer: Dignity Health Senior |
$0.71
|
Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
Rate for Payer: Heritage Provider Network Commercial |
$0.52
|
Rate for Payer: Heritage Provider Network Senior |
$0.52
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.40
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
Rate for Payer: Multiplan Commercial |
$0.63
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.71
|
Rate for Payer: Vantage Medical Group Senior |
$0.71
|
|
FLECAINIDE 100 MG TABLET [10041]
|
Facility
IP
|
$0.84
|
|
Service Code
|
NDC 65862-622-01
|
Hospital Charge Code |
1711440
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.15 |
Max. Negotiated Rate |
$0.63 |
Rate for Payer: Adventist Health Commercial |
$0.17
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.58
|
Rate for Payer: Cash Price |
$0.38
|
Rate for Payer: EPIC Health Plan Commercial |
$0.45
|
Rate for Payer: Heritage Provider Network Commercial |
$0.57
|
Rate for Payer: Heritage Provider Network Senior |
$0.57
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
Rate for Payer: Multiplan Commercial |
$0.63
|
|
FLECAINIDE 100 MG TABLET [10041]
|
Facility
OP
|
$0.24
|
|
Service Code
|
NDC 62559-381-01
|
Hospital Charge Code |
1711440
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.04 |
Max. Negotiated Rate |
$0.20 |
Rate for Payer: Adventist Health Commercial |
$0.05
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.13
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.16
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.20
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.13
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.18
|
Rate for Payer: Blue Shield of California Commercial |
$0.15
|
Rate for Payer: Blue Shield of California EPN |
$0.14
|
Rate for Payer: Cash Price |
$0.11
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.16
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
Rate for Payer: Dignity Health Senior |
$0.20
|
Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
Rate for Payer: Heritage Provider Network Commercial |
$0.15
|
Rate for Payer: Heritage Provider Network Senior |
$0.15
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.12
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
Rate for Payer: Multiplan Commercial |
$0.18
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
FLECAINIDE 100 MG TABLET [10041]
|
Facility
OP
|
$1.13
|
|
Service Code
|
NDC 0054-0011-21
|
Hospital Charge Code |
1711440
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.20 |
Max. Negotiated Rate |
$0.96 |
Rate for Payer: Adventist Health Commercial |
$0.23
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.60
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.78
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.96
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.62
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.85
|
Rate for Payer: Blue Shield of California Commercial |
$0.70
|
Rate for Payer: Blue Shield of California EPN |
$0.66
|
Rate for Payer: Cash Price |
$0.51
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.73
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.96
|
Rate for Payer: Dignity Health Medi-Cal |
$0.96
|
Rate for Payer: Dignity Health Senior |
$0.96
|
Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
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 Commercial |
$0.54
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
Rate for Payer: Multiplan Commercial |
$0.85
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.96
|
Rate for Payer: Vantage Medical Group Senior |
$0.96
|
|
FLECAINIDE 100 MG TABLET [10041]
|
Facility
IP
|
$1.13
|
|
Service Code
|
NDC 0054-0011-21
|
Hospital Charge Code |
1711440
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.20 |
Max. Negotiated Rate |
$0.85 |
Rate for Payer: Adventist Health Commercial |
$0.23
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.78
|
Rate for Payer: Cash Price |
$0.51
|
Rate for Payer: EPIC Health Plan Commercial |
$0.61
|
Rate for Payer: Heritage Provider Network Commercial |
$0.77
|
Rate for Payer: Heritage Provider Network Senior |
$0.77
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
Rate for Payer: Multiplan Commercial |
$0.85
|
|
FLECAINIDE 100 MG TABLET [10041]
|
Facility
OP
|
$1.07
|
|
Service Code
|
NDC 50268-321-11
|
Hospital Charge Code |
1711440
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.19 |
Max. Negotiated Rate |
$0.91 |
Rate for Payer: Adventist Health Commercial |
$0.21
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.57
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.74
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.91
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.59
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.80
|
Rate for Payer: Blue Shield of California Commercial |
$0.66
|
Rate for Payer: Blue Shield of California EPN |
$0.63
|
Rate for Payer: Cash Price |
$0.48
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.70
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.91
|
Rate for Payer: Dignity Health Medi-Cal |
$0.91
|
Rate for Payer: Dignity Health Senior |
$0.91
|
Rate for Payer: EPIC Health Plan Commercial |
$0.68
|
Rate for Payer: Heritage Provider Network Commercial |
$0.66
|
Rate for Payer: Heritage Provider Network Senior |
$0.66
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.52
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
Rate for Payer: Multiplan Commercial |
$0.80
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.91
|
Rate for Payer: Vantage Medical Group Senior |
$0.91
|
|
FLECAINIDE 100 MG TABLET [10041]
|
Facility
OP
|
$1.13
|
|
Service Code
|
NDC 0054-0011-25
|
Hospital Charge Code |
1711440
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.20 |
Max. Negotiated Rate |
$0.96 |
Rate for Payer: Adventist Health Commercial |
$0.23
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.60
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.78
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.96
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.62
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.85
|
Rate for Payer: Blue Shield of California Commercial |
$0.70
|
Rate for Payer: Blue Shield of California EPN |
$0.66
|
Rate for Payer: Cash Price |
$0.51
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.73
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.96
|
Rate for Payer: Dignity Health Medi-Cal |
$0.96
|
Rate for Payer: Dignity Health Senior |
$0.96
|
Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
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 Commercial |
$0.54
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
Rate for Payer: Multiplan Commercial |
$0.85
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.96
|
Rate for Payer: Vantage Medical Group Senior |
$0.96
|
|
FLECAINIDE 100 MG TABLET [10041]
|
Facility
IP
|
$1.13
|
|
Service Code
|
NDC 0054-0011-25
|
Hospital Charge Code |
1711440
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.20 |
Max. Negotiated Rate |
$0.85 |
Rate for Payer: Adventist Health Commercial |
$0.23
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.78
|
Rate for Payer: Cash Price |
$0.51
|
Rate for Payer: EPIC Health Plan Commercial |
$0.61
|
Rate for Payer: Heritage Provider Network Commercial |
$0.77
|
Rate for Payer: Heritage Provider Network Senior |
$0.77
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
Rate for Payer: Multiplan Commercial |
$0.85
|
|
FLECAINIDE 100 MG TABLET [10041]
|
Facility
IP
|
$1.07
|
|
Service Code
|
NDC 50268-321-11
|
Hospital Charge Code |
1711440
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.19 |
Max. Negotiated Rate |
$0.80 |
Rate for Payer: Adventist Health Commercial |
$0.21
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.74
|
Rate for Payer: Cash Price |
$0.48
|
Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
Rate for Payer: Heritage Provider Network Commercial |
$0.72
|
Rate for Payer: Heritage Provider Network Senior |
$0.72
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
Rate for Payer: Multiplan Commercial |
$0.80
|
|
FLECAINIDE 100 MG TABLET [10041]
|
Facility
OP
|
$1.07
|
|
Service Code
|
NDC 50268-321-15
|
Hospital Charge Code |
1711440
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.19 |
Max. Negotiated Rate |
$0.91 |
Rate for Payer: Adventist Health Commercial |
$0.21
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.57
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.74
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.91
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.59
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.80
|
Rate for Payer: Blue Shield of California Commercial |
$0.66
|
Rate for Payer: Blue Shield of California EPN |
$0.63
|
Rate for Payer: Cash Price |
$0.48
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.70
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.91
|
Rate for Payer: Dignity Health Medi-Cal |
$0.91
|
Rate for Payer: Dignity Health Senior |
$0.91
|
Rate for Payer: EPIC Health Plan Commercial |
$0.68
|
Rate for Payer: Heritage Provider Network Commercial |
$0.66
|
Rate for Payer: Heritage Provider Network Senior |
$0.66
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.52
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
Rate for Payer: Multiplan Commercial |
$0.80
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.91
|
Rate for Payer: Vantage Medical Group Senior |
$0.91
|
|
FLECAINIDE 100 MG TABLET [10041]
|
Facility
IP
|
$0.24
|
|
Service Code
|
NDC 62559-381-01
|
Hospital Charge Code |
1711440
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.04 |
Max. Negotiated Rate |
$0.18 |
Rate for Payer: Adventist Health Commercial |
$0.05
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.16
|
Rate for Payer: Cash Price |
$0.11
|
Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
Rate for Payer: Heritage Provider Network Commercial |
$0.16
|
Rate for Payer: Heritage Provider Network Senior |
$0.16
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
Rate for Payer: Multiplan Commercial |
$0.18
|
|
FLECAINIDE 100 MG TABLET [10041]
|
Facility
IP
|
$1.07
|
|
Service Code
|
NDC 50268-321-15
|
Hospital Charge Code |
1711440
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.19 |
Max. Negotiated Rate |
$0.80 |
Rate for Payer: Adventist Health Commercial |
$0.21
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.74
|
Rate for Payer: Cash Price |
$0.48
|
Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
Rate for Payer: Heritage Provider Network Commercial |
$0.72
|
Rate for Payer: Heritage Provider Network Senior |
$0.72
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
Rate for Payer: Multiplan Commercial |
$0.80
|
|
FLECAINIDE 100 MG TABLET [10041]
|
Facility
IP
|
$1.13
|
|
Service Code
|
NDC 0054-0011-20
|
Hospital Charge Code |
1711440
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.20 |
Max. Negotiated Rate |
$0.85 |
Rate for Payer: Adventist Health Commercial |
$0.23
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.78
|
Rate for Payer: Cash Price |
$0.51
|
Rate for Payer: EPIC Health Plan Commercial |
$0.61
|
Rate for Payer: Heritage Provider Network Commercial |
$0.77
|
Rate for Payer: Heritage Provider Network Senior |
$0.77
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
Rate for Payer: Multiplan Commercial |
$0.85
|
|
FLECAINIDE 50 MG TABLET [10043]
|
Facility
OP
|
$0.69
|
|
Service Code
|
NDC 0054-0010-21
|
Hospital Charge Code |
1711525
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.12 |
Max. Negotiated Rate |
$0.59 |
Rate for Payer: Adventist Health Commercial |
$0.14
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.37
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.47
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.59
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.38
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.52
|
Rate for Payer: Blue Shield of California Commercial |
$0.43
|
Rate for Payer: Blue Shield of California EPN |
$0.41
|
Rate for Payer: Cash Price |
$0.31
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.45
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.59
|
Rate for Payer: Dignity Health Medi-Cal |
$0.59
|
Rate for Payer: Dignity Health Senior |
$0.59
|
Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
Rate for Payer: Heritage Provider Network Commercial |
$0.43
|
Rate for Payer: Heritage Provider Network Senior |
$0.43
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.33
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
Rate for Payer: Multiplan Commercial |
$0.52
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.59
|
Rate for Payer: Vantage Medical Group Senior |
$0.59
|
|
FLECAINIDE 50 MG TABLET [10043]
|
Facility
OP
|
$0.69
|
|
Service Code
|
NDC 0054-0010-20
|
Hospital Charge Code |
1711525
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.12 |
Max. Negotiated Rate |
$0.59 |
Rate for Payer: Adventist Health Commercial |
$0.14
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.37
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.47
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.59
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.38
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.52
|
Rate for Payer: Blue Shield of California Commercial |
$0.43
|
Rate for Payer: Blue Shield of California EPN |
$0.41
|
Rate for Payer: Cash Price |
$0.31
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.45
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.59
|
Rate for Payer: Dignity Health Medi-Cal |
$0.59
|
Rate for Payer: Dignity Health Senior |
$0.59
|
Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
Rate for Payer: Heritage Provider Network Commercial |
$0.43
|
Rate for Payer: Heritage Provider Network Senior |
$0.43
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.33
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
Rate for Payer: Multiplan Commercial |
$0.52
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.59
|
Rate for Payer: Vantage Medical Group Senior |
$0.59
|
|
FLECAINIDE 50 MG TABLET [10043]
|
Facility
IP
|
$0.69
|
|
Service Code
|
NDC 0054-0010-21
|
Hospital Charge Code |
1711525
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.12 |
Max. Negotiated Rate |
$0.52 |
Rate for Payer: Adventist Health Commercial |
$0.14
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.47
|
Rate for Payer: Cash Price |
$0.31
|
Rate for Payer: EPIC Health Plan Commercial |
$0.37
|
Rate for Payer: Heritage Provider Network Commercial |
$0.47
|
Rate for Payer: Heritage Provider Network Senior |
$0.47
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
Rate for Payer: Multiplan Commercial |
$0.52
|
|
FLECAINIDE 50 MG TABLET [10043]
|
Facility
IP
|
$0.69
|
|
Service Code
|
NDC 0054-0010-20
|
Hospital Charge Code |
1711525
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.12 |
Max. Negotiated Rate |
$0.52 |
Rate for Payer: Adventist Health Commercial |
$0.14
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.47
|
Rate for Payer: Cash Price |
$0.31
|
Rate for Payer: EPIC Health Plan Commercial |
$0.37
|
Rate for Payer: Heritage Provider Network Commercial |
$0.47
|
Rate for Payer: Heritage Provider Network Senior |
$0.47
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
Rate for Payer: Multiplan Commercial |
$0.52
|
|
FLECAINIDE 50 MG TABLET [10043]
|
Facility
OP
|
$0.52
|
|
Service Code
|
NDC 65862-621-01
|
Hospital Charge Code |
1711525
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.09 |
Max. Negotiated Rate |
$0.44 |
Rate for Payer: Adventist Health Commercial |
$0.10
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.28
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.36
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.44
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.29
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.39
|
Rate for Payer: Blue Shield of California Commercial |
$0.32
|
Rate for Payer: Blue Shield of California EPN |
$0.31
|
Rate for Payer: Cash Price |
$0.23
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.34
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.44
|
Rate for Payer: Dignity Health Medi-Cal |
$0.44
|
Rate for Payer: Dignity Health Senior |
$0.44
|
Rate for Payer: EPIC Health Plan Commercial |
$0.33
|
Rate for Payer: Heritage Provider Network Commercial |
$0.32
|
Rate for Payer: Heritage Provider Network Senior |
$0.32
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.25
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
Rate for Payer: Multiplan Commercial |
$0.39
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.44
|
Rate for Payer: Vantage Medical Group Senior |
$0.44
|
|
FLECAINIDE 50 MG TABLET [10043]
|
Facility
OP
|
$0.69
|
|
Service Code
|
NDC 0054-0010-25
|
Hospital Charge Code |
1711525
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.12 |
Max. Negotiated Rate |
$0.59 |
Rate for Payer: Adventist Health Commercial |
$0.14
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.37
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.47
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.59
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.38
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.52
|
Rate for Payer: Blue Shield of California Commercial |
$0.43
|
Rate for Payer: Blue Shield of California EPN |
$0.41
|
Rate for Payer: Cash Price |
$0.31
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.45
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.59
|
Rate for Payer: Dignity Health Medi-Cal |
$0.59
|
Rate for Payer: Dignity Health Senior |
$0.59
|
Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
Rate for Payer: Heritage Provider Network Commercial |
$0.43
|
Rate for Payer: Heritage Provider Network Senior |
$0.43
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.33
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
Rate for Payer: Multiplan Commercial |
$0.52
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.59
|
Rate for Payer: Vantage Medical Group Senior |
$0.59
|
|
FLECAINIDE 50 MG TABLET [10043]
|
Facility
IP
|
$0.16
|
|
Service Code
|
NDC 62559-380-01
|
Hospital Charge Code |
1711525
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.03 |
Max. Negotiated Rate |
$0.12 |
Rate for Payer: Adventist Health Commercial |
$0.03
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.11
|
Rate for Payer: Cash Price |
$0.07
|
Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
Rate for Payer: Heritage Provider Network Commercial |
$0.11
|
Rate for Payer: Heritage Provider Network Senior |
$0.11
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
Rate for Payer: Multiplan Commercial |
$0.12
|
|
FLECAINIDE 50 MG TABLET [10043]
|
Facility
OP
|
$0.16
|
|
Service Code
|
NDC 62559-380-01
|
Hospital Charge Code |
1711525
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.03 |
Max. Negotiated Rate |
$0.14 |
Rate for Payer: Adventist Health Commercial |
$0.03
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.09
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.11
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.14
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.09
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.12
|
Rate for Payer: Blue Shield of California Commercial |
$0.10
|
Rate for Payer: Blue Shield of California EPN |
$0.09
|
Rate for Payer: Cash Price |
$0.07
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.10
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
Rate for Payer: Dignity Health Senior |
$0.14
|
Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
Rate for Payer: Heritage Provider Network Commercial |
$0.10
|
Rate for Payer: Heritage Provider Network Senior |
$0.10
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.08
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
Rate for Payer: Multiplan Commercial |
$0.12
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
FLECAINIDE 50 MG TABLET [10043]
|
Facility
IP
|
$0.52
|
|
Service Code
|
NDC 65862-621-01
|
Hospital Charge Code |
1711525
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.09 |
Max. Negotiated Rate |
$0.39 |
Rate for Payer: Adventist Health Commercial |
$0.10
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.36
|
Rate for Payer: Cash Price |
$0.23
|
Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
Rate for Payer: Heritage Provider Network Commercial |
$0.35
|
Rate for Payer: Heritage Provider Network Senior |
$0.35
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
Rate for Payer: Multiplan Commercial |
$0.39
|
|
FLECAINIDE 50 MG TABLET [10043]
|
Facility
IP
|
$0.69
|
|
Service Code
|
NDC 0054-0010-25
|
Hospital Charge Code |
1711525
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.12 |
Max. Negotiated Rate |
$0.52 |
Rate for Payer: Adventist Health Commercial |
$0.14
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.47
|
Rate for Payer: Cash Price |
$0.31
|
Rate for Payer: EPIC Health Plan Commercial |
$0.37
|
Rate for Payer: Heritage Provider Network Commercial |
$0.47
|
Rate for Payer: Heritage Provider Network Senior |
$0.47
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
Rate for Payer: Multiplan Commercial |
$0.52
|
|
FLECAINIDE ORAL SUSPENSION COMPOUND 20 MG/ML [4080273]
|
Facility
IP
|
$0.55
|
|
Service Code
|
NDC 9994-0802-73
|
Hospital Charge Code |
1715085
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.10 |
Max. Negotiated Rate |
$0.41 |
Rate for Payer: Adventist Health Commercial |
$0.11
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.38
|
Rate for Payer: Cash Price |
$0.25
|
Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
Rate for Payer: Heritage Provider Network Commercial |
$0.37
|
Rate for Payer: Heritage Provider Network Senior |
$0.37
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
Rate for Payer: Multiplan Commercial |
$0.41
|
|