|
FENTANYL 100 MCG/HR TRANSDERMAL PATCH [27908]
|
Facility
|
IP
|
$33.07
|
|
|
Service Code
|
NDC 0406-9100-76
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.61 |
| Max. Negotiated Rate |
$28.11 |
| Rate for Payer: EPIC Health Plan Commercial |
$13.23
|
| Rate for Payer: EPIC Health Plan Senior |
$13.23
|
| Rate for Payer: Galaxy Health WC |
$28.11
|
| Rate for Payer: Cigna of CA HMO |
$23.15
|
| Rate for Payer: Cigna of CA PPO |
$23.15
|
| Rate for Payer: Adventist Health Commercial |
$6.61
|
| Rate for Payer: Blue Shield of California Commercial |
$24.41
|
| Rate for Payer: Blue Shield of California EPN |
$16.07
|
| Rate for Payer: Cash Price |
$18.19
|
| Rate for Payer: Global Benefits Group Commercial |
$19.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.94
|
| Rate for Payer: Multiplan Commercial |
$26.46
|
| Rate for Payer: Networks By Design Commercial |
$21.50
|
| Rate for Payer: Prime Health Services Commercial |
$28.11
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH [41382]
|
Facility
|
IP
|
$5.28
|
|
|
Service Code
|
NDC 50742-549-05
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$4.49 |
| Rate for Payer: Adventist Health Commercial |
$1.06
|
| Rate for Payer: Blue Shield of California Commercial |
$3.90
|
| Rate for Payer: Blue Shield of California EPN |
$2.57
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: Cigna of CA HMO |
$3.70
|
| Rate for Payer: Cigna of CA PPO |
$3.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.11
|
| Rate for Payer: EPIC Health Plan Senior |
$2.11
|
| Rate for Payer: Galaxy Health WC |
$4.49
|
| Rate for Payer: Global Benefits Group Commercial |
$3.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: Multiplan Commercial |
$4.22
|
| Rate for Payer: Networks By Design Commercial |
$3.43
|
| Rate for Payer: Prime Health Services Commercial |
$4.49
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH [41382]
|
Facility
|
OP
|
$19.49
|
|
|
Service Code
|
NDC 47781-423-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$16.57 |
| Rate for Payer: Adventist Health Commercial |
$3.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.97
|
| Rate for Payer: Cash Price |
$10.72
|
| Rate for Payer: Cigna of CA HMO |
$13.64
|
| Rate for Payer: Cigna of CA PPO |
$13.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7.80
|
| Rate for Payer: Galaxy Health WC |
$16.57
|
| Rate for Payer: Global Benefits Group Commercial |
$11.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.64
|
| Rate for Payer: Multiplan Commercial |
$15.59
|
| Rate for Payer: Networks By Design Commercial |
$12.67
|
| Rate for Payer: Prime Health Services Commercial |
$16.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.74
|
| Rate for Payer: United Healthcare All Other HMO |
$9.74
|
| Rate for Payer: United Healthcare HMO Rider |
$9.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.57
|
| Rate for Payer: Vantage Medical Group Senior |
$16.57
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH [41382]
|
Facility
|
OP
|
$19.49
|
|
|
Service Code
|
NDC 47781-423-47
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$16.57 |
| Rate for Payer: Adventist Health Commercial |
$3.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.97
|
| Rate for Payer: Cash Price |
$10.72
|
| Rate for Payer: Cigna of CA HMO |
$13.64
|
| Rate for Payer: Cigna of CA PPO |
$13.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7.80
|
| Rate for Payer: Galaxy Health WC |
$16.57
|
| Rate for Payer: Global Benefits Group Commercial |
$11.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.64
|
| Rate for Payer: Multiplan Commercial |
$15.59
|
| Rate for Payer: Networks By Design Commercial |
$12.67
|
| Rate for Payer: Prime Health Services Commercial |
$16.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.74
|
| Rate for Payer: United Healthcare All Other HMO |
$9.74
|
| Rate for Payer: United Healthcare HMO Rider |
$9.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.57
|
| Rate for Payer: Vantage Medical Group Senior |
$16.57
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH [41382]
|
Facility
|
IP
|
$19.49
|
|
|
Service Code
|
NDC 47781-423-47
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$16.57 |
| Rate for Payer: Adventist Health Commercial |
$3.90
|
| Rate for Payer: Blue Shield of California Commercial |
$14.38
|
| Rate for Payer: Blue Shield of California EPN |
$9.47
|
| Rate for Payer: Cash Price |
$10.72
|
| Rate for Payer: Cigna of CA HMO |
$13.64
|
| Rate for Payer: Cigna of CA PPO |
$13.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7.80
|
| Rate for Payer: Galaxy Health WC |
$16.57
|
| Rate for Payer: Global Benefits Group Commercial |
$11.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.68
|
| Rate for Payer: Multiplan Commercial |
$15.59
|
| Rate for Payer: Networks By Design Commercial |
$12.67
|
| Rate for Payer: Prime Health Services Commercial |
$16.57
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH [41382]
|
Facility
|
OP
|
$5.28
|
|
|
Service Code
|
NDC 50742-549-05
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$4.49 |
| Rate for Payer: Adventist Health Commercial |
$1.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.24
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: Cigna of CA HMO |
$3.70
|
| Rate for Payer: Cigna of CA PPO |
$3.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.11
|
| Rate for Payer: EPIC Health Plan Senior |
$2.11
|
| Rate for Payer: Galaxy Health WC |
$4.49
|
| Rate for Payer: Global Benefits Group Commercial |
$3.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.70
|
| Rate for Payer: Multiplan Commercial |
$4.22
|
| Rate for Payer: Networks By Design Commercial |
$3.43
|
| Rate for Payer: Prime Health Services Commercial |
$4.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.64
|
| Rate for Payer: United Healthcare All Other HMO |
$2.64
|
| Rate for Payer: United Healthcare HMO Rider |
$2.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4.49
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH [41382]
|
Facility
|
OP
|
$19.49
|
|
|
Service Code
|
NDC 0406-9112-76
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$16.57 |
| Rate for Payer: Adventist Health Commercial |
$3.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.97
|
| Rate for Payer: Cash Price |
$10.72
|
| Rate for Payer: Cigna of CA HMO |
$13.64
|
| Rate for Payer: Cigna of CA PPO |
$13.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7.80
|
| Rate for Payer: Galaxy Health WC |
$16.57
|
| Rate for Payer: Global Benefits Group Commercial |
$11.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.64
|
| Rate for Payer: Multiplan Commercial |
$15.59
|
| Rate for Payer: Networks By Design Commercial |
$12.67
|
| Rate for Payer: Prime Health Services Commercial |
$16.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.74
|
| Rate for Payer: United Healthcare All Other HMO |
$9.74
|
| Rate for Payer: United Healthcare HMO Rider |
$9.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.57
|
| Rate for Payer: Vantage Medical Group Senior |
$16.57
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH [41382]
|
Facility
|
IP
|
$19.49
|
|
|
Service Code
|
NDC 47781-423-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$16.57 |
| Rate for Payer: Adventist Health Commercial |
$3.90
|
| Rate for Payer: Blue Shield of California Commercial |
$14.38
|
| Rate for Payer: Blue Shield of California EPN |
$9.47
|
| Rate for Payer: Cash Price |
$10.72
|
| Rate for Payer: Cigna of CA HMO |
$13.64
|
| Rate for Payer: Cigna of CA PPO |
$13.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7.80
|
| Rate for Payer: Galaxy Health WC |
$16.57
|
| Rate for Payer: Global Benefits Group Commercial |
$11.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.68
|
| Rate for Payer: Multiplan Commercial |
$15.59
|
| Rate for Payer: Networks By Design Commercial |
$12.67
|
| Rate for Payer: Prime Health Services Commercial |
$16.57
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH [41382]
|
Facility
|
IP
|
$5.28
|
|
|
Service Code
|
NDC 50742-549-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$4.49 |
| Rate for Payer: Adventist Health Commercial |
$1.06
|
| Rate for Payer: Blue Shield of California Commercial |
$3.90
|
| Rate for Payer: Blue Shield of California EPN |
$2.57
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: Cigna of CA HMO |
$3.70
|
| Rate for Payer: Cigna of CA PPO |
$3.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.11
|
| Rate for Payer: EPIC Health Plan Senior |
$2.11
|
| Rate for Payer: Galaxy Health WC |
$4.49
|
| Rate for Payer: Global Benefits Group Commercial |
$3.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: Multiplan Commercial |
$4.22
|
| Rate for Payer: Networks By Design Commercial |
$3.43
|
| Rate for Payer: Prime Health Services Commercial |
$4.49
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH [41382]
|
Facility
|
IP
|
$19.49
|
|
|
Service Code
|
NDC 0406-9112-76
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$16.57 |
| Rate for Payer: Adventist Health Commercial |
$3.90
|
| Rate for Payer: Blue Shield of California Commercial |
$14.38
|
| Rate for Payer: Blue Shield of California EPN |
$9.47
|
| Rate for Payer: Cash Price |
$10.72
|
| Rate for Payer: Cigna of CA HMO |
$13.64
|
| Rate for Payer: Cigna of CA PPO |
$13.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7.80
|
| Rate for Payer: Galaxy Health WC |
$16.57
|
| Rate for Payer: Global Benefits Group Commercial |
$11.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.68
|
| Rate for Payer: Multiplan Commercial |
$15.59
|
| Rate for Payer: Networks By Design Commercial |
$12.67
|
| Rate for Payer: Prime Health Services Commercial |
$16.57
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH [41382]
|
Facility
|
OP
|
$5.28
|
|
|
Service Code
|
NDC 50742-549-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$4.49 |
| Rate for Payer: Multiplan Commercial |
$4.22
|
| Rate for Payer: Networks By Design Commercial |
$3.43
|
| Rate for Payer: Adventist Health Commercial |
$1.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.24
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: Cigna of CA HMO |
$3.70
|
| Rate for Payer: Cigna of CA PPO |
$3.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.11
|
| Rate for Payer: EPIC Health Plan Senior |
$2.11
|
| Rate for Payer: Galaxy Health WC |
$4.49
|
| Rate for Payer: Global Benefits Group Commercial |
$3.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.70
|
| Rate for Payer: Prime Health Services Commercial |
$4.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.64
|
| Rate for Payer: United Healthcare All Other HMO |
$2.64
|
| Rate for Payer: United Healthcare HMO Rider |
$2.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4.49
|
|
|
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 |
$1.20 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.68
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.20
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$5.10
|
|
|
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 |
$1.71 |
| Max. Negotiated Rate |
$7.28 |
| Rate for Payer: Adventist Health Commercial |
$1.71
|
| Rate for Payer: Blue Shield of California Commercial |
$6.32
|
| Rate for Payer: Blue Shield of California EPN |
$4.16
|
| Rate for Payer: Cash Price |
$4.71
|
| Rate for Payer: Cigna of CA HMO |
$5.99
|
| Rate for Payer: Cigna of CA PPO |
$5.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.42
|
| Rate for Payer: EPIC Health Plan Senior |
$3.42
|
| Rate for Payer: Galaxy Health WC |
$7.28
|
| Rate for Payer: Global Benefits Group Commercial |
$5.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.05
|
| Rate for Payer: Multiplan Commercial |
$6.85
|
| Rate for Payer: Networks By Design Commercial |
$5.56
|
| Rate for Payer: Prime Health Services Commercial |
$7.28
|
|
|
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 |
$1.71 |
| Max. Negotiated Rate |
$7.28 |
| Rate for Payer: Adventist Health Commercial |
$1.71
|
| Rate for Payer: Blue Shield of California Commercial |
$6.32
|
| Rate for Payer: Blue Shield of California EPN |
$4.16
|
| Rate for Payer: Cash Price |
$4.71
|
| Rate for Payer: Cigna of CA HMO |
$5.99
|
| Rate for Payer: Cigna of CA PPO |
$5.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.42
|
| Rate for Payer: EPIC Health Plan Senior |
$3.42
|
| Rate for Payer: Galaxy Health WC |
$7.28
|
| Rate for Payer: Global Benefits Group Commercial |
$5.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.05
|
| Rate for Payer: Multiplan Commercial |
$6.85
|
| Rate for Payer: Networks By Design Commercial |
$5.56
|
| Rate for Payer: Prime Health Services Commercial |
$7.28
|
|
|
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 |
$1.20 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4.43
|
| Rate for Payer: Blue Shield of California EPN |
$2.92
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
|
|
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 |
$1.71 |
| Max. Negotiated Rate |
$7.28 |
| Rate for Payer: Adventist Health Commercial |
$1.71
|
| Rate for Payer: Blue Shield of California Commercial |
$6.32
|
| Rate for Payer: Blue Shield of California EPN |
$4.16
|
| Rate for Payer: Cash Price |
$4.71
|
| Rate for Payer: Cigna of CA HMO |
$5.99
|
| Rate for Payer: Cigna of CA PPO |
$5.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.42
|
| Rate for Payer: EPIC Health Plan Senior |
$3.42
|
| Rate for Payer: Galaxy Health WC |
$7.28
|
| Rate for Payer: Global Benefits Group Commercial |
$5.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.05
|
| Rate for Payer: Multiplan Commercial |
$6.85
|
| Rate for Payer: Networks By Design Commercial |
$5.56
|
| Rate for Payer: Prime Health Services Commercial |
$7.28
|
|
|
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 |
$1.71 |
| Max. Negotiated Rate |
$7.28 |
| Rate for Payer: Adventist Health Commercial |
$1.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.26
|
| Rate for Payer: Cash Price |
$4.71
|
| Rate for Payer: Cigna of CA HMO |
$5.99
|
| Rate for Payer: Cigna of CA PPO |
$5.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.42
|
| Rate for Payer: EPIC Health Plan Senior |
$3.42
|
| Rate for Payer: Galaxy Health WC |
$7.28
|
| Rate for Payer: Global Benefits Group Commercial |
$5.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.99
|
| Rate for Payer: Multiplan Commercial |
$6.85
|
| Rate for Payer: Networks By Design Commercial |
$5.56
|
| Rate for Payer: Prime Health Services Commercial |
$7.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.28
|
| Rate for Payer: United Healthcare All Other HMO |
$4.28
|
| Rate for Payer: United Healthcare HMO Rider |
$4.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.28
|
| Rate for Payer: Vantage Medical Group Senior |
$7.28
|
|
|
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 |
$1.20 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4.43
|
| Rate for Payer: Blue Shield of California EPN |
$2.92
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
|
|
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 |
$1.71 |
| Max. Negotiated Rate |
$7.28 |
| Rate for Payer: Adventist Health Commercial |
$1.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.26
|
| Rate for Payer: Cash Price |
$4.71
|
| Rate for Payer: Cigna of CA HMO |
$5.99
|
| Rate for Payer: Cigna of CA PPO |
$5.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.42
|
| Rate for Payer: EPIC Health Plan Senior |
$3.42
|
| Rate for Payer: Galaxy Health WC |
$7.28
|
| Rate for Payer: Global Benefits Group Commercial |
$5.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.99
|
| Rate for Payer: Multiplan Commercial |
$6.85
|
| Rate for Payer: Networks By Design Commercial |
$5.56
|
| Rate for Payer: Prime Health Services Commercial |
$7.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.28
|
| Rate for Payer: United Healthcare All Other HMO |
$4.28
|
| Rate for Payer: United Healthcare HMO Rider |
$4.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.28
|
| Rate for Payer: Vantage Medical Group Senior |
$7.28
|
|
|
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 |
$1.71 |
| Max. Negotiated Rate |
$7.28 |
| Rate for Payer: Adventist Health Commercial |
$1.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.26
|
| Rate for Payer: Cash Price |
$4.71
|
| Rate for Payer: Cigna of CA HMO |
$5.99
|
| Rate for Payer: Cigna of CA PPO |
$5.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.42
|
| Rate for Payer: EPIC Health Plan Senior |
$3.42
|
| Rate for Payer: Galaxy Health WC |
$7.28
|
| Rate for Payer: Global Benefits Group Commercial |
$5.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.99
|
| Rate for Payer: Multiplan Commercial |
$6.85
|
| Rate for Payer: Networks By Design Commercial |
$5.56
|
| Rate for Payer: Prime Health Services Commercial |
$7.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.28
|
| Rate for Payer: United Healthcare All Other HMO |
$4.28
|
| Rate for Payer: United Healthcare HMO Rider |
$4.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.28
|
| Rate for Payer: Vantage Medical Group Senior |
$7.28
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH [27905]
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 50742-550-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.68
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.20
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$5.10
|
|
|
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 |
$3.04 |
| Max. Negotiated Rate |
$12.92 |
| Rate for Payer: Adventist Health Commercial |
$3.04
|
| Rate for Payer: Blue Shield of California Commercial |
$11.22
|
| Rate for Payer: Blue Shield of California EPN |
$7.39
|
| Rate for Payer: Cash Price |
$8.36
|
| Rate for Payer: Cigna of CA HMO |
$10.64
|
| Rate for Payer: Cigna of CA PPO |
$10.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.08
|
| Rate for Payer: EPIC Health Plan Senior |
$6.08
|
| Rate for Payer: Galaxy Health WC |
$12.92
|
| Rate for Payer: Global Benefits Group Commercial |
$9.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.65
|
| Rate for Payer: Multiplan Commercial |
$12.16
|
| Rate for Payer: Networks By Design Commercial |
$9.88
|
| Rate for Payer: Prime Health Services Commercial |
$12.92
|
|
|
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 |
$1.68 |
| Max. Negotiated Rate |
$7.14 |
| Rate for Payer: Adventist Health Commercial |
$1.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.16
|
| Rate for Payer: Cash Price |
$4.62
|
| Rate for Payer: Cigna of CA HMO |
$5.88
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: EPIC Health Plan Senior |
$3.36
|
| Rate for Payer: Galaxy Health WC |
$7.14
|
| Rate for Payer: Global Benefits Group Commercial |
$5.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.88
|
| Rate for Payer: Multiplan Commercial |
$6.72
|
| Rate for Payer: Networks By Design Commercial |
$5.46
|
| Rate for Payer: Prime Health Services Commercial |
$7.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Other HMO |
$4.20
|
| Rate for Payer: United Healthcare HMO Rider |
$4.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.14
|
| Rate for Payer: Vantage Medical Group Senior |
$7.14
|
|
|
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 |
$3.04 |
| Max. Negotiated Rate |
$12.92 |
| Rate for Payer: Adventist Health Commercial |
$3.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.33
|
| Rate for Payer: Cash Price |
$8.36
|
| Rate for Payer: Cigna of CA HMO |
$10.64
|
| Rate for Payer: Cigna of CA PPO |
$10.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.08
|
| Rate for Payer: EPIC Health Plan Senior |
$6.08
|
| Rate for Payer: Galaxy Health WC |
$12.92
|
| Rate for Payer: Global Benefits Group Commercial |
$9.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.64
|
| Rate for Payer: Multiplan Commercial |
$12.16
|
| Rate for Payer: Networks By Design Commercial |
$9.88
|
| Rate for Payer: Prime Health Services Commercial |
$12.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.60
|
| Rate for Payer: United Healthcare All Other HMO |
$7.60
|
| Rate for Payer: United Healthcare HMO Rider |
$7.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.92
|
| Rate for Payer: Vantage Medical Group Senior |
$12.92
|
|
|
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 |
$1.68 |
| Max. Negotiated Rate |
$7.14 |
| Rate for Payer: Adventist Health Commercial |
$1.68
|
| Rate for Payer: Blue Shield of California Commercial |
$6.20
|
| Rate for Payer: Blue Shield of California EPN |
$4.08
|
| Rate for Payer: Cash Price |
$4.62
|
| Rate for Payer: Cigna of CA HMO |
$5.88
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: EPIC Health Plan Senior |
$3.36
|
| Rate for Payer: Galaxy Health WC |
$7.14
|
| Rate for Payer: Global Benefits Group Commercial |
$5.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.02
|
| Rate for Payer: Multiplan Commercial |
$6.72
|
| Rate for Payer: Networks By Design Commercial |
$5.46
|
| Rate for Payer: Prime Health Services Commercial |
$7.14
|
|
