|
FENOFIBRATE 160 MG TABLET [28252]
|
Facility
|
OP
|
$3.51
|
|
|
Service Code
|
NDC 68084-328-21
|
| Hospital Charge Code |
1712496
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$2.98 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.09
|
| Rate for Payer: Blue Distinction Transplant |
$2.11
|
| Rate for Payer: Blue Shield of California Commercial |
$2.59
|
| Rate for Payer: Blue Shield of California EPN |
$2.05
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Cigna of CA HMO |
$2.46
|
| Rate for Payer: Cigna of CA PPO |
$2.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.98
|
| Rate for Payer: Dignity Health Media |
$2.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.40
|
| Rate for Payer: Galaxy Health WC |
$2.98
|
| Rate for Payer: Global Benefits Group Commercial |
$2.11
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| Rate for Payer: Multiplan Commercial |
$2.81
|
| Rate for Payer: Networks By Design Commercial |
$2.28
|
| Rate for Payer: Prime Health Services Commercial |
$2.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.76
|
| Rate for Payer: United Healthcare All Other HMO |
$1.76
|
| Rate for Payer: United Healthcare HMO Rider |
$1.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.98
|
| Rate for Payer: Vantage Medical Group Senior |
$2.98
|
|
|
FENOFIBRATE 160 MG TABLET [28252]
|
Facility
|
OP
|
$3.51
|
|
|
Service Code
|
NDC 68084-328-11
|
| Hospital Charge Code |
1712496
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$2.98 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.09
|
| Rate for Payer: Blue Distinction Transplant |
$2.11
|
| Rate for Payer: Blue Shield of California Commercial |
$2.59
|
| Rate for Payer: Blue Shield of California EPN |
$2.05
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Cigna of CA HMO |
$2.46
|
| Rate for Payer: Cigna of CA PPO |
$2.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.98
|
| Rate for Payer: Dignity Health Media |
$2.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.40
|
| Rate for Payer: Galaxy Health WC |
$2.98
|
| Rate for Payer: Global Benefits Group Commercial |
$2.11
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| Rate for Payer: Multiplan Commercial |
$2.81
|
| Rate for Payer: Networks By Design Commercial |
$2.28
|
| Rate for Payer: Prime Health Services Commercial |
$2.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.76
|
| Rate for Payer: United Healthcare All Other HMO |
$1.76
|
| Rate for Payer: United Healthcare HMO Rider |
$1.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.98
|
| Rate for Payer: Vantage Medical Group Senior |
$2.98
|
|
|
FENOFIBRATE 54 MG TABLET [31336]
|
Facility
|
IP
|
$1.30
|
|
|
Service Code
|
NDC 68084-827-95
|
| Hospital Charge Code |
1712510
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Blue Shield of California Commercial |
$0.93
|
| Rate for Payer: Blue Shield of California EPN |
$0.67
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cigna of CA HMO |
$0.91
|
| Rate for Payer: Cigna of CA PPO |
$0.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$1.04
|
| Rate for Payer: Networks By Design Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.10
|
|
|
FENOFIBRATE 54 MG TABLET [31336]
|
Facility
|
OP
|
$1.30
|
|
|
Service Code
|
NDC 68084-827-25
|
| Hospital Charge Code |
1712510
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.77
|
| Rate for Payer: Blue Distinction Transplant |
$0.78
|
| Rate for Payer: Blue Shield of California Commercial |
$0.96
|
| Rate for Payer: Blue Shield of California EPN |
$0.76
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cigna of CA HMO |
$0.91
|
| Rate for Payer: Cigna of CA PPO |
$0.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.10
|
| Rate for Payer: Dignity Health Media |
$1.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.78
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$1.04
|
| Rate for Payer: Networks By Design Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.65
|
| Rate for Payer: United Healthcare All Other HMO |
$0.65
|
| Rate for Payer: United Healthcare HMO Rider |
$0.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1.10
|
|
|
FENOFIBRATE 54 MG TABLET [31336]
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
NDC 27241-116-03
|
| Hospital Charge Code |
1712510
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
|
|
FENOFIBRATE 54 MG TABLET [31336]
|
Facility
|
OP
|
$0.82
|
|
|
Service Code
|
NDC 42858-454-45
|
| Hospital Charge Code |
1712510
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.49
|
| Rate for Payer: Blue Distinction Transplant |
$0.49
|
| Rate for Payer: Blue Shield of California Commercial |
$0.60
|
| Rate for Payer: Blue Shield of California EPN |
$0.48
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: Cigna of CA HMO |
$0.57
|
| Rate for Payer: Cigna of CA PPO |
$0.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.70
|
| Rate for Payer: Dignity Health Media |
$0.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.33
|
| Rate for Payer: Galaxy Health WC |
$0.70
|
| Rate for Payer: Global Benefits Group Commercial |
$0.49
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.66
|
| Rate for Payer: Networks By Design Commercial |
$0.53
|
| Rate for Payer: Prime Health Services Commercial |
$0.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.41
|
| Rate for Payer: United Healthcare All Other HMO |
$0.41
|
| Rate for Payer: United Healthcare HMO Rider |
$0.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.70
|
| Rate for Payer: Vantage Medical Group Senior |
$0.70
|
|
|
FENOFIBRATE 54 MG TABLET [31336]
|
Facility
|
IP
|
$0.26
|
|
|
Service Code
|
NDC 63304-900-90
|
| Hospital Charge Code |
1712510
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| 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: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| 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
|
|
|
FENOFIBRATE 54 MG TABLET [31336]
|
Facility
|
IP
|
$1.30
|
|
|
Service Code
|
NDC 68084-827-25
|
| Hospital Charge Code |
1712510
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Blue Shield of California Commercial |
$0.93
|
| Rate for Payer: Blue Shield of California EPN |
$0.67
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cigna of CA HMO |
$0.91
|
| Rate for Payer: Cigna of CA PPO |
$0.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$1.04
|
| Rate for Payer: Networks By Design Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.10
|
|
|
FENOFIBRATE 54 MG TABLET [31336]
|
Facility
|
OP
|
$1.30
|
|
|
Service Code
|
NDC 68084-827-95
|
| Hospital Charge Code |
1712510
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.77
|
| Rate for Payer: Blue Distinction Transplant |
$0.78
|
| Rate for Payer: Blue Shield of California Commercial |
$0.96
|
| Rate for Payer: Blue Shield of California EPN |
$0.76
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cigna of CA HMO |
$0.91
|
| Rate for Payer: Cigna of CA PPO |
$0.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.10
|
| Rate for Payer: Dignity Health Media |
$1.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.78
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$1.04
|
| Rate for Payer: Networks By Design Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.65
|
| Rate for Payer: United Healthcare All Other HMO |
$0.65
|
| Rate for Payer: United Healthcare HMO Rider |
$0.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1.10
|
|
|
FENOFIBRATE 54 MG TABLET [31336]
|
Facility
|
OP
|
$0.27
|
|
|
Service Code
|
NDC 27241-116-03
|
| Hospital Charge Code |
1712510
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: Blue Distinction Transplant |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.23
|
| Rate for Payer: Dignity Health Media |
$0.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
| 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 |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO |
$0.14
|
| Rate for Payer: United Healthcare HMO Rider |
$0.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Vantage Medical Group Senior |
$0.23
|
|
|
FENOFIBRATE 54 MG TABLET [31336]
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
NDC 63304-900-90
|
| Hospital Charge Code |
1712510
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.22 |
| 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 |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Blue Distinction Transplant |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| 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 Media |
$0.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| 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
|
|
|
FENOFIBRATE 54 MG TABLET [31336]
|
Facility
|
IP
|
$0.82
|
|
|
Service Code
|
NDC 42858-454-45
|
| Hospital Charge Code |
1712510
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.70 |
| Rate for Payer: Blue Shield of California Commercial |
$0.58
|
| Rate for Payer: Blue Shield of California EPN |
$0.42
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: Cigna of CA HMO |
$0.57
|
| Rate for Payer: Cigna of CA PPO |
$0.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.33
|
| Rate for Payer: Galaxy Health WC |
$0.70
|
| Rate for Payer: Global Benefits Group Commercial |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.66
|
| Rate for Payer: Networks By Design Commercial |
$0.53
|
| Rate for Payer: Prime Health Services Commercial |
$0.70
|
|
|
FENOLDOPAM 10 MG/ML INTRAVENOUS SOLUTION [22133]
|
Facility
|
IP
|
$597.48
|
|
|
Service Code
|
NDC 0409-3373-01
|
| Hospital Charge Code |
1759555
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$143.40 |
| Max. Negotiated Rate |
$507.86 |
| Rate for Payer: Blue Shield of California Commercial |
$425.41
|
| Rate for Payer: Blue Shield of California EPN |
$305.91
|
| Rate for Payer: Cash Price |
$268.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$238.99
|
| Rate for Payer: Galaxy Health WC |
$507.86
|
| Rate for Payer: Global Benefits Group Commercial |
$358.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$398.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.40
|
| Rate for Payer: Multiplan Commercial |
$477.98
|
| Rate for Payer: Networks By Design Commercial |
$388.36
|
| Rate for Payer: Prime Health Services Commercial |
$507.86
|
|
|
FENOLDOPAM 10 MG/ML INTRAVENOUS SOLUTION [22133]
|
Facility
|
OP
|
$597.48
|
|
|
Service Code
|
NDC 0409-3373-01
|
| Hospital Charge Code |
1759555
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$143.40 |
| Max. Negotiated Rate |
$507.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$391.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$507.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$328.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$328.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$355.98
|
| Rate for Payer: Blue Distinction Transplant |
$358.49
|
| Rate for Payer: Blue Shield of California Commercial |
$440.34
|
| Rate for Payer: Blue Shield of California EPN |
$348.93
|
| Rate for Payer: Cash Price |
$268.87
|
| Rate for Payer: Cigna of CA HMO |
$382.39
|
| Rate for Payer: Cigna of CA PPO |
$442.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$507.86
|
| Rate for Payer: Dignity Health Media |
$507.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$507.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$238.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$238.99
|
| Rate for Payer: Galaxy Health WC |
$507.86
|
| Rate for Payer: Global Benefits Group Commercial |
$358.49
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$448.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$398.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.40
|
| Rate for Payer: Multiplan Commercial |
$477.98
|
| Rate for Payer: Networks By Design Commercial |
$388.36
|
| Rate for Payer: Prime Health Services Commercial |
$507.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$358.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$358.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$298.74
|
| Rate for Payer: United Healthcare All Other HMO |
$298.74
|
| Rate for Payer: United Healthcare HMO Rider |
$298.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$298.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$507.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.86
|
| Rate for Payer: Vantage Medical Group Senior |
$507.86
|
|
|
FENTANYL 100 MCG/HR TRANSDERMAL PATCH [27908]
|
Facility
|
IP
|
$33.07
|
|
|
Service Code
|
NDC 0406-9100-76
|
| Hospital Charge Code |
1737055
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.94 |
| Max. Negotiated Rate |
$28.11 |
| Rate for Payer: Blue Shield of California Commercial |
$23.55
|
| Rate for Payer: Blue Shield of California EPN |
$16.93
|
| 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: EPIC Health Plan Commercial |
$13.23
|
| Rate for Payer: Galaxy Health WC |
$28.11
|
| 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: 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 0406-9100-76
|
| Hospital Charge Code |
1737055
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.94 |
| Max. Negotiated Rate |
$28.11 |
| 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 |
$18.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.70
|
| Rate for Payer: Blue Distinction Transplant |
$19.84
|
| Rate for Payer: Blue Shield of California Commercial |
$24.37
|
| Rate for Payer: Blue Shield of California EPN |
$19.31
|
| 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 Media |
$28.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.23
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.23
|
| Rate for Payer: Galaxy Health WC |
$28.11
|
| Rate for Payer: Global Benefits Group Commercial |
$19.84
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$24.80
|
| 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: 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
|
| 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
|
$19.49
|
|
|
Service Code
|
NDC 0406-9112-76
|
| Hospital Charge Code |
1730786
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$16.57 |
| Rate for Payer: Blue Shield of California Commercial |
$13.88
|
| Rate for Payer: Blue Shield of California EPN |
$9.98
|
| 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: EPIC Health Plan Commercial |
$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: 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 0406-9112-76
|
| Hospital Charge Code |
1730786
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$16.57 |
| 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 |
$10.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.61
|
| Rate for Payer: Blue Distinction Transplant |
$11.69
|
| Rate for Payer: Blue Shield of California Commercial |
$14.36
|
| Rate for Payer: Blue Shield of California EPN |
$11.38
|
| 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 Media |
$16.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.80
|
| Rate for Payer: Galaxy Health WC |
$16.57
|
| Rate for Payer: Global Benefits Group Commercial |
$11.69
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$14.62
|
| 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: 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
|
| 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 1,600 MCG LOZENGE ON A HANDLE [27918]
|
Facility
|
IP
|
$43.11
|
|
|
Service Code
|
NDC 0406-9216-30
|
| Hospital Charge Code |
1730151
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.35 |
| Max. Negotiated Rate |
$36.64 |
| Rate for Payer: Blue Shield of California Commercial |
$30.69
|
| Rate for Payer: Blue Shield of California EPN |
$22.07
|
| Rate for Payer: Cash Price |
$19.40
|
| Rate for Payer: Cigna of CA HMO |
$30.18
|
| Rate for Payer: Cigna of CA PPO |
$30.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.24
|
| Rate for Payer: Galaxy Health WC |
$36.64
|
| Rate for Payer: Global Benefits Group Commercial |
$25.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.35
|
| Rate for Payer: Multiplan Commercial |
$34.49
|
| Rate for Payer: Networks By Design Commercial |
$28.02
|
| Rate for Payer: Prime Health Services Commercial |
$36.64
|
|
|
FENTANYL 1,600 MCG LOZENGE ON A HANDLE [27918]
|
Facility
|
OP
|
$43.11
|
|
|
Service Code
|
NDC 0406-9216-30
|
| Hospital Charge Code |
1730151
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.35 |
| Max. Negotiated Rate |
$36.64 |
| Rate for Payer: Aetna of CA HMO/PPO |
$28.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.68
|
| Rate for Payer: Blue Distinction Transplant |
$25.87
|
| Rate for Payer: Blue Shield of California Commercial |
$31.77
|
| Rate for Payer: Blue Shield of California EPN |
$25.18
|
| Rate for Payer: Cash Price |
$19.40
|
| Rate for Payer: Cigna of CA HMO |
$30.18
|
| Rate for Payer: Cigna of CA PPO |
$30.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.64
|
| Rate for Payer: Dignity Health Media |
$36.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.24
|
| Rate for Payer: Galaxy Health WC |
$36.64
|
| Rate for Payer: Global Benefits Group Commercial |
$25.87
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$32.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.35
|
| Rate for Payer: Multiplan Commercial |
$34.49
|
| Rate for Payer: Networks By Design Commercial |
$28.02
|
| Rate for Payer: Prime Health Services Commercial |
$36.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.56
|
| Rate for Payer: United Healthcare All Other HMO |
$21.56
|
| Rate for Payer: United Healthcare HMO Rider |
$21.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.64
|
| Rate for Payer: Vantage Medical Group Senior |
$36.64
|
|
|
FENTANYL 200 MCG LOZENGE ON A HANDLE [27913]
|
Facility
|
OP
|
$14.62
|
|
|
Service Code
|
NDC 0406-9202-30
|
| Hospital Charge Code |
1730148
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$12.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.71
|
| Rate for Payer: Blue Distinction Transplant |
$8.77
|
| Rate for Payer: Blue Shield of California Commercial |
$10.77
|
| Rate for Payer: Blue Shield of California EPN |
$8.54
|
| Rate for Payer: Cash Price |
$6.58
|
| Rate for Payer: Cigna of CA HMO |
$10.23
|
| Rate for Payer: Cigna of CA PPO |
$10.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.43
|
| Rate for Payer: Dignity Health Media |
$12.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.85
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.85
|
| Rate for Payer: Galaxy Health WC |
$12.43
|
| Rate for Payer: Global Benefits Group Commercial |
$8.77
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.51
|
| Rate for Payer: Multiplan Commercial |
$11.70
|
| Rate for Payer: Networks By Design Commercial |
$9.50
|
| Rate for Payer: Prime Health Services Commercial |
$12.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.31
|
| Rate for Payer: United Healthcare All Other HMO |
$7.31
|
| Rate for Payer: United Healthcare HMO Rider |
$7.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.43
|
| Rate for Payer: Vantage Medical Group Senior |
$12.43
|
|
|
FENTANYL 200 MCG LOZENGE ON A HANDLE [27913]
|
Facility
|
IP
|
$14.62
|
|
|
Service Code
|
NDC 0406-9202-30
|
| Hospital Charge Code |
1730148
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$12.43 |
| Rate for Payer: Blue Shield of California Commercial |
$10.41
|
| Rate for Payer: Blue Shield of California EPN |
$7.49
|
| Rate for Payer: Cash Price |
$6.58
|
| Rate for Payer: Cigna of CA HMO |
$10.23
|
| Rate for Payer: Cigna of CA PPO |
$10.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.85
|
| Rate for Payer: Galaxy Health WC |
$12.43
|
| Rate for Payer: Global Benefits Group Commercial |
$8.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.51
|
| Rate for Payer: Multiplan Commercial |
$11.70
|
| Rate for Payer: Networks By Design Commercial |
$9.50
|
| Rate for Payer: Prime Health Services Commercial |
$12.43
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH [27905]
|
Facility
|
IP
|
$8.56
|
|
|
Service Code
|
NDC 0406-9125-76
|
| Hospital Charge Code |
1737052
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.05 |
| Max. Negotiated Rate |
$7.28 |
| Rate for Payer: Blue Shield of California Commercial |
$6.09
|
| Rate for Payer: Blue Shield of California EPN |
$4.38
|
| 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: EPIC Health Plan Commercial |
$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: 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 0406-9125-76
|
| Hospital Charge Code |
1737052
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.05 |
| Max. Negotiated Rate |
$7.28 |
| 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 |
$4.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.10
|
| Rate for Payer: Blue Distinction Transplant |
$5.14
|
| Rate for Payer: Blue Shield of California Commercial |
$6.31
|
| Rate for Payer: Blue Shield of California EPN |
$5.00
|
| 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 Media |
$7.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.42
|
| Rate for Payer: Galaxy Health WC |
$7.28
|
| Rate for Payer: Global Benefits Group Commercial |
$5.14
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.42
|
| 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: 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
|
| 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 400 MCG LOZENGE ON A HANDLE [27914]
|
Facility
|
IP
|
$18.53
|
|
|
Service Code
|
NDC 0406-9204-30
|
| Hospital Charge Code |
1730147
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.45 |
| Max. Negotiated Rate |
$15.75 |
| Rate for Payer: Blue Shield of California Commercial |
$13.19
|
| Rate for Payer: Blue Shield of California EPN |
$9.49
|
| Rate for Payer: Cash Price |
$8.34
|
| Rate for Payer: Cigna of CA HMO |
$12.97
|
| Rate for Payer: Cigna of CA PPO |
$12.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.41
|
| Rate for Payer: Galaxy Health WC |
$15.75
|
| Rate for Payer: Global Benefits Group Commercial |
$11.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.45
|
| Rate for Payer: Multiplan Commercial |
$14.82
|
| Rate for Payer: Networks By Design Commercial |
$12.04
|
| Rate for Payer: Prime Health Services Commercial |
$15.75
|
|
