|
FENOFIBRATE 54 MG TABLET [31336]
|
Facility
|
IP
|
$0.18
|
|
|
Service Code
|
NDC 4285845445
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Senior |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
|
|
FENOFIBRATE 54 MG TABLET [31336]
|
Facility
|
OP
|
$0.18
|
|
|
Service Code
|
NDC 4285845445
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.12
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Senior |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Vantage Medical Group Senior |
$0.15
|
|
|
FENOFIBRATE 54 MG TABLET [31336]
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
NDC 6330490090
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.17
|
| 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 |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Cash Price |
$0.12
|
| 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 Medi-Cal |
$0.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: Networks By Design Commercial |
$0.17
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
| 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 Commercial/Exchange |
$0.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Vantage Medical Group Senior |
$0.22
|
|
|
FENTANYL 100 MCG/HR TRANSDERMAL PATCH [27908]
|
Facility
|
IP
|
$33.07
|
|
|
Service Code
|
NDC 0406910076
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.61 |
| Max. Negotiated Rate |
$28.11 |
| Rate for Payer: Adventist Health Commercial |
$6.61
|
| Rate for Payer: Blue Shield of California Commercial |
$16.77
|
| Rate for Payer: Blue Shield of California Commercial |
$25.43
|
| Rate for Payer: Cash Price |
$14.88
|
| Rate for Payer: Cigna of CA HMO |
$23.15
|
| Rate for Payer: Cigna of CA PPO |
$23.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.15
|
| 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: Global Benefits Group Commercial |
$19.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.51
|
| 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 100 MCG/HR TRANSDERMAL PATCH [27908]
|
Facility
|
OP
|
$33.07
|
|
|
Service Code
|
NDC 0406910076
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.61 |
| Max. Negotiated Rate |
$28.11 |
| Rate for Payer: Adventist Health Commercial |
$6.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.22
|
| Rate for Payer: Cash Price |
$14.88
|
| Rate for Payer: Cigna of CA HMO |
$23.15
|
| Rate for Payer: Cigna of CA PPO |
$23.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.15
|
| 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: Global Benefits Group Commercial |
$19.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.15
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.54
|
| Rate for Payer: United Healthcare All Other HMO |
$16.54
|
| Rate for Payer: United Healthcare HMO Rider |
$16.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.11
|
| Rate for Payer: Vantage Medical Group Senior |
$28.11
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH [41382]
|
Facility
|
IP
|
$5.28
|
|
|
Service Code
|
NDC 5074254901
|
| 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 |
$2.68
|
| Rate for Payer: Blue Shield of California Commercial |
$4.06
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cigna of CA HMO |
$3.70
|
| Rate for Payer: Cigna of CA PPO |
$3.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$3.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.12
|
| 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 4778142311
|
| 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 |
$14.99
|
| Rate for Payer: Blue Shield of California Commercial |
$9.88
|
| Rate for Payer: Cash Price |
$8.77
|
| Rate for Payer: Cigna of CA HMO |
$13.64
|
| Rate for Payer: Cigna of CA PPO |
$13.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$12.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.50
|
| 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
|
$19.49
|
|
|
Service Code
|
NDC 4778142311
|
| 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 |
$12.51
|
| Rate for Payer: Cash Price |
$8.77
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$12.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.50
|
| 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
|
$5.28
|
|
|
Service Code
|
NDC 5074254905
|
| 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 |
$2.68
|
| Rate for Payer: Blue Shield of California Commercial |
$4.06
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cigna of CA HMO |
$3.70
|
| Rate for Payer: Cigna of CA PPO |
$3.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$3.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.12
|
| 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
|
$5.28
|
|
|
Service Code
|
NDC 5074254905
|
| 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 |
$3.39
|
| Rate for Payer: Cash Price |
$2.38
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$3.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.12
|
| 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 0406911276
|
| 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 |
$12.51
|
| Rate for Payer: Cash Price |
$8.77
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$12.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.50
|
| 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 4778142347
|
| 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 |
$12.51
|
| Rate for Payer: Cash Price |
$8.77
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$12.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.50
|
| 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 0406911276
|
| 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 |
$14.99
|
| Rate for Payer: Blue Shield of California Commercial |
$9.88
|
| Rate for Payer: Cash Price |
$8.77
|
| Rate for Payer: Cigna of CA HMO |
$13.64
|
| Rate for Payer: Cigna of CA PPO |
$13.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$12.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.50
|
| 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
|
$19.49
|
|
|
Service Code
|
NDC 4778142347
|
| 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 |
$14.99
|
| Rate for Payer: Blue Shield of California Commercial |
$9.88
|
| Rate for Payer: Cash Price |
$8.77
|
| Rate for Payer: Cigna of CA HMO |
$13.64
|
| Rate for Payer: Cigna of CA PPO |
$13.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$12.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.50
|
| 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 5074254901
|
| 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 |
$3.39
|
| Rate for Payer: Cash Price |
$2.38
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$3.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.12
|
| 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 25 MCG/HR TRANSDERMAL PATCH [27905]
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 5074255001
|
| 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 |
$3.85
|
| Rate for Payer: Cash Price |
$2.70
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$3.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.54
|
| 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 0378912198
|
| 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 |
$4.34
|
| Rate for Payer: Blue Shield of California Commercial |
$6.58
|
| Rate for Payer: Cash Price |
$3.85
|
| Rate for Payer: Cigna of CA HMO |
$5.99
|
| Rate for Payer: Cigna of CA PPO |
$5.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$5.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.05
|
| 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 0406912576
|
| 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 |
$4.34
|
| Rate for Payer: Blue Shield of California Commercial |
$6.58
|
| Rate for Payer: Cash Price |
$3.85
|
| Rate for Payer: Cigna of CA HMO |
$5.99
|
| Rate for Payer: Cigna of CA PPO |
$5.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$5.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.05
|
| 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 5074255001
|
| 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 |
$3.04
|
| Rate for Payer: Blue Shield of California Commercial |
$4.61
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$3.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.54
|
| 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 0378912198
|
| 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 |
$5.49
|
| Rate for Payer: Cash Price |
$3.85
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$5.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.05
|
| 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
|
$8.56
|
|
|
Service Code
|
NDC 0378912116
|
| 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 |
$4.34
|
| Rate for Payer: Blue Shield of California Commercial |
$6.58
|
| Rate for Payer: Cash Price |
$3.85
|
| Rate for Payer: Cigna of CA HMO |
$5.99
|
| Rate for Payer: Cigna of CA PPO |
$5.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$5.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.05
|
| 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
|
$6.00
|
|
|
Service Code
|
NDC 5074255005
|
| 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 |
$3.85
|
| Rate for Payer: Cash Price |
$2.70
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$3.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.54
|
| 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
|
OP
|
$8.56
|
|
|
Service Code
|
NDC 0406912576
|
| 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 |
$5.49
|
| Rate for Payer: Cash Price |
$3.85
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$5.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.05
|
| 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 0378912116
|
| 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 |
$5.49
|
| Rate for Payer: Cash Price |
$3.85
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$5.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.05
|
| 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 5074255005
|
| 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 |
$3.04
|
| Rate for Payer: Blue Shield of California Commercial |
$4.61
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$3.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.54
|
| 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
|
|
