Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

FENTANYL 25 MCG/HR TRANSDERMAL PATCH [27905]

Facility

OP

$8.56

Service Code	NDC 0378-9121-16
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$4.71
Max. Negotiated Rate	$6.85
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.14
Rate for Payer: Aetna of CA Government/Medicare	$5.14
Rate for Payer: Cash Price	$4.71
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$6.85
Rate for Payer: Health Smart Auto/Commercial	$5.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.14
Rate for Payer: LLUH Dept of Risk Management WC	$4.71
Rate for Payer: Multiplan Commercial	$6.42

FENTANYL 25 MCG/HR TRANSDERMAL PATCH [27905]

Facility

IP

$6.00

Service Code	NDC 50742-550-05
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$4.80
Rate for Payer: Cash Price	$3.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.80
Rate for Payer: Health Smart Auto/Commercial	$3.60
Rate for Payer: LLUH Dept of Risk Management WC	$3.30
Rate for Payer: Multiplan Commercial	$4.50

FENTANYL 25 MCG/HR TRANSDERMAL PATCH [27905]

Facility

OP

$6.00

Service Code	NDC 50742-550-05
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$4.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.60
Rate for Payer: Aetna of CA Government/Medicare	$3.60
Rate for Payer: Cash Price	$3.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.80
Rate for Payer: Health Smart Auto/Commercial	$3.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.60
Rate for Payer: LLUH Dept of Risk Management WC	$3.30
Rate for Payer: Multiplan Commercial	$4.50

FENTANYL 25 MCG/HR TRANSDERMAL PATCH [27905]

Facility

OP

$8.56

Service Code	NDC 0406-9125-76
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$4.71
Max. Negotiated Rate	$6.85
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.14
Rate for Payer: Aetna of CA Government/Medicare	$5.14
Rate for Payer: Cash Price	$4.71
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$6.85
Rate for Payer: Health Smart Auto/Commercial	$5.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.14
Rate for Payer: LLUH Dept of Risk Management WC	$4.71
Rate for Payer: Multiplan Commercial	$6.42

FENTANYL 25 MCG/HR TRANSDERMAL PATCH [27905]

Facility

IP

$8.56

Service Code	NDC 0406-9125-76
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$4.71
Max. Negotiated Rate	$6.85
Rate for Payer: Cash Price	$4.71
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$6.85
Rate for Payer: Health Smart Auto/Commercial	$5.14
Rate for Payer: LLUH Dept of Risk Management WC	$4.71
Rate for Payer: Multiplan Commercial	$6.42

FENTANYL 25 MCG/HR TRANSDERMAL PATCH [27905]

Facility

IP

$8.56

Service Code	NDC 0378-9121-16
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$4.71
Max. Negotiated Rate	$6.85
Rate for Payer: Cash Price	$4.71
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$6.85
Rate for Payer: Health Smart Auto/Commercial	$5.14
Rate for Payer: LLUH Dept of Risk Management WC	$4.71
Rate for Payer: Multiplan Commercial	$6.42

FENTANYL 25 MCG/HR TRANSDERMAL PATCH [27905]

Facility

IP

$8.56

Service Code	NDC 0378-9121-98
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$4.71
Max. Negotiated Rate	$6.85
Rate for Payer: Cash Price	$4.71
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$6.85
Rate for Payer: Health Smart Auto/Commercial	$5.14
Rate for Payer: LLUH Dept of Risk Management WC	$4.71
Rate for Payer: Multiplan Commercial	$6.42

FENTANYL 25 MCG/HR TRANSDERMAL PATCH [27905]

Facility

IP

$6.00

Service Code	NDC 50742-550-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$4.80
Rate for Payer: Cash Price	$3.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.80
Rate for Payer: Health Smart Auto/Commercial	$3.60
Rate for Payer: LLUH Dept of Risk Management WC	$3.30
Rate for Payer: Multiplan Commercial	$4.50

FENTANYL 25 MCG/HR TRANSDERMAL PATCH [27905]

Facility

OP

$8.56

Service Code	NDC 0378-9121-98
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$4.71
Max. Negotiated Rate	$6.85
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.14
Rate for Payer: Aetna of CA Government/Medicare	$5.14
Rate for Payer: Cash Price	$4.71
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$6.85
Rate for Payer: Health Smart Auto/Commercial	$5.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.14
Rate for Payer: LLUH Dept of Risk Management WC	$4.71
Rate for Payer: Multiplan Commercial	$6.42

FENTANYL 50 MCG/HR TRANSDERMAL PATCH [27906]

Facility

IP

$8.40

Service Code	NDC 50742-552-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$6.72
Rate for Payer: Cash Price	$4.62
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$6.72
Rate for Payer: Health Smart Auto/Commercial	$5.04
Rate for Payer: LLUH Dept of Risk Management WC	$4.62
Rate for Payer: Multiplan Commercial	$6.30

FENTANYL 50 MCG/HR TRANSDERMAL PATCH [27906]

Facility

IP

$15.20

Service Code	NDC 0406-9150-76
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$8.36
Max. Negotiated Rate	$12.16
Rate for Payer: Cash Price	$8.36
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$12.16
Rate for Payer: Health Smart Auto/Commercial	$9.12
Rate for Payer: LLUH Dept of Risk Management WC	$8.36
Rate for Payer: Multiplan Commercial	$11.40

FENTANYL 50 MCG/HR TRANSDERMAL PATCH [27906]

Facility

IP

$8.40

Service Code	NDC 50742-552-05
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$6.72
Rate for Payer: Cash Price	$4.62
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$6.72
Rate for Payer: Health Smart Auto/Commercial	$5.04
Rate for Payer: LLUH Dept of Risk Management WC	$4.62
Rate for Payer: Multiplan Commercial	$6.30

FENTANYL 50 MCG/HR TRANSDERMAL PATCH [27906]

Facility

OP

$15.20

Service Code	NDC 0406-9150-76
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$8.36
Max. Negotiated Rate	$12.16
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.12
Rate for Payer: Aetna of CA Government/Medicare	$9.12
Rate for Payer: Cash Price	$8.36
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$12.16
Rate for Payer: Health Smart Auto/Commercial	$9.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.12
Rate for Payer: LLUH Dept of Risk Management WC	$8.36
Rate for Payer: Multiplan Commercial	$11.40

FENTANYL 50 MCG/HR TRANSDERMAL PATCH [27906]

Facility

OP

$8.40

Service Code	NDC 50742-552-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$6.72
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.04
Rate for Payer: Aetna of CA Government/Medicare	$5.04
Rate for Payer: Cash Price	$4.62
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$6.72
Rate for Payer: Health Smart Auto/Commercial	$5.04
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.04
Rate for Payer: LLUH Dept of Risk Management WC	$4.62
Rate for Payer: Multiplan Commercial	$6.30

FENTANYL 50 MCG/HR TRANSDERMAL PATCH [27906]

Facility

OP

$8.40

Service Code	NDC 50742-552-05
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$6.72
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.04
Rate for Payer: Aetna of CA Government/Medicare	$5.04
Rate for Payer: Cash Price	$4.62
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$6.72
Rate for Payer: Health Smart Auto/Commercial	$5.04
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.04
Rate for Payer: LLUH Dept of Risk Management WC	$4.62
Rate for Payer: Multiplan Commercial	$6.30

FENTANYL 75 MCG/HR TRANSDERMAL PATCH [27907]

Facility

OP

$24.02

Service Code	NDC 0378-9123-16
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$13.21
Max. Negotiated Rate	$19.22
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$14.41
Rate for Payer: Aetna of CA Government/Medicare	$14.41
Rate for Payer: Cash Price	$13.21
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$19.22
Rate for Payer: Health Smart Auto/Commercial	$14.41
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$14.41
Rate for Payer: LLUH Dept of Risk Management WC	$13.21
Rate for Payer: Multiplan Commercial	$18.02

FENTANYL 75 MCG/HR TRANSDERMAL PATCH [27907]

Facility

IP

$24.02

Service Code	NDC 0406-9175-76
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$13.21
Max. Negotiated Rate	$19.22
Rate for Payer: Cash Price	$13.21
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$19.22
Rate for Payer: Health Smart Auto/Commercial	$14.41
Rate for Payer: LLUH Dept of Risk Management WC	$13.21
Rate for Payer: Multiplan Commercial	$18.02

FENTANYL 75 MCG/HR TRANSDERMAL PATCH [27907]

Facility

IP

$24.02

Service Code	NDC 0378-9123-98
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$13.21
Max. Negotiated Rate	$19.22
Rate for Payer: Cash Price	$13.21
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$19.22
Rate for Payer: Health Smart Auto/Commercial	$14.41
Rate for Payer: LLUH Dept of Risk Management WC	$13.21
Rate for Payer: Multiplan Commercial	$18.02

FENTANYL 75 MCG/HR TRANSDERMAL PATCH [27907]

Facility

IP

$24.02

Service Code	NDC 0378-9123-16
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$13.21
Max. Negotiated Rate	$19.22
Rate for Payer: Cash Price	$13.21
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$19.22
Rate for Payer: Health Smart Auto/Commercial	$14.41
Rate for Payer: LLUH Dept of Risk Management WC	$13.21
Rate for Payer: Multiplan Commercial	$18.02

FENTANYL 75 MCG/HR TRANSDERMAL PATCH [27907]

Facility

OP

$24.02

Service Code	NDC 0406-9175-76
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$13.21
Max. Negotiated Rate	$19.22
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$14.41
Rate for Payer: Aetna of CA Government/Medicare	$14.41
Rate for Payer: Cash Price	$13.21
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$19.22
Rate for Payer: Health Smart Auto/Commercial	$14.41
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$14.41
Rate for Payer: LLUH Dept of Risk Management WC	$13.21
Rate for Payer: Multiplan Commercial	$18.02

FENTANYL 75 MCG/HR TRANSDERMAL PATCH [27907]

Facility

OP

$24.02

Service Code	NDC 0378-9123-98
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$13.21
Max. Negotiated Rate	$19.22
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$14.41
Rate for Payer: Aetna of CA Government/Medicare	$14.41
Rate for Payer: Cash Price	$13.21
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$19.22
Rate for Payer: Health Smart Auto/Commercial	$14.41
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$14.41
Rate for Payer: LLUH Dept of Risk Management WC	$13.21
Rate for Payer: Multiplan Commercial	$18.02

FENTANYL-BUPIVACAINE 2 MCG/ML-0.0625% EPIDURAL PREMIX ADULT [4081452]

Facility

OP

$0.18

Service Code	NDC 71286-2081-1
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.11
Rate for Payer: Aetna of CA Government/Medicare	$0.11
Rate for Payer: Cash Price	$0.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.11
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.11
Rate for Payer: LLUH Dept of Risk Management WC	$0.10
Rate for Payer: Multiplan Commercial	$0.14

FENTANYL-BUPIVACAINE 2 MCG/ML-0.0625% EPIDURAL PREMIX ADULT [4081452]

Facility

IP

$0.18

Service Code	NDC 71286-2081-1
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.14
Rate for Payer: Cash Price	$0.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.11
Rate for Payer: LLUH Dept of Risk Management WC	$0.10
Rate for Payer: Multiplan Commercial	$0.14

FENTANYL-BUPIVACAINE 2 MCG/ML-0.0625% EPIDURAL PREMIX PEDS [117212]

Facility

IP

$0.18

Service Code	NDC 70004-244-40
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.14
Rate for Payer: Cash Price	$0.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.11
Rate for Payer: LLUH Dept of Risk Management WC	$0.10
Rate for Payer: Multiplan Commercial	$0.14

FENTANYL-BUPIVACAINE 2 MCG/ML-0.0625% EPIDURAL PREMIX PEDS [117212]

Facility

IP

$0.18

Service Code	NDC 71286-2081-1
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.14
Rate for Payer: Cash Price	$0.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.11
Rate for Payer: LLUH Dept of Risk Management WC	$0.10
Rate for Payer: Multiplan Commercial	$0.14

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